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Behavioral & Nervous Anatomy — Step 1 practice questions
30 questions in this area, with an explanation for every answer choice.
Three samples below, free and without an account.
How this shows up on Step 1
Anatomy questions in this section combine two things the exam tests separately elsewhere. Anatomy on Step 1 is clinical rather than descriptive: nerve injuries, vascular territories, and the embryological origins of malformations. Neuroanatomy questions are localisation problems: a deficit is described and you name the lesion site.
Sample questions
Sample question 1
A patient has sudden unilateral hearing loss. Weber test lateralizes to the AFFECTED ear, and Rinne test shows bone conduction greater than air conduction on that side. Which of the following types of hearing loss is most likely?
Explanations
A. Normal hearing
These findings indicate abnormal, not normal, hearing function.
B. Sensorineural hearing loss
Sensorineural hearing loss would show Weber lateralizing to the UNAFFECTED (better-hearing) ear and Rinne showing air conduction still greater than bone conduction (though both reduced), the opposite pattern.
C. Presbycusis exclusively
Presbycusis is a form of SENSORINEURAL hearing loss (age-related), which would show the opposite Weber/Rinne pattern from what is described.
D. Central auditory processing disorder
Central auditory processing disorder does not classically produce this specific lateralization pattern on Weber/Rinne testing.
E. Conductive hearing loss · correct
Weber lateralizing TO the affected ear, combined with bone conduction greater than air conduction (abnormal Rinne) on that side, is classic for conductive hearing loss, in which an outer/middle ear problem impairs air conduction more than bone conduction.
Sample question 2
A 30-year-old man reports painless burns on his fingers. Examination shows loss of pain and temperature sensation across both shoulders and arms in a "cape" distribution, with preserved vibration and position sense, and wasting of the intrinsic hand muscles. MRI shows a fluid-filled cavity in the central cervical cord. Which of the following explains the pattern of sensory loss?
Explanations
A. The lesion selectively destroys peripheral small-fiber nerves
Peripheral small-fiber neuropathy causes distal, stocking-glove loss, not a cape distribution.
B. The lateral corticospinal tracts are involved first
Corticospinal involvement produces weakness later, not the sensory dissociation.
C. The dorsal columns are compressed before the spinothalamic tracts
Dorsal columns are affected late, hence preserved vibration/position sense.
D. The lesion is in the thalamus, causing a hemisensory syndrome
A thalamic lesion causes contralateral hemisensory loss for all modalities.
E. The expanding central cavity first interrupts spinothalamic fibers decussating in the anterior white commissure · correct
A syrinx expands within the central canal region and first severs the crossing spinothalamic fibers in the anterior white commissure, producing bilateral loss of pain and temperature at the involved levels while dorsal-column modalities (which ascend ipsilaterally without crossing there) are preserved — a dissociated, "cape-like" sensory loss. Further expansion reaches anterior horns (hand wasting). Syringomyelia is associated with Chiari I malformation and prior trauma.
Sample question 3
Which of the following best describes the classic anatomic locations of Broca and Wernicke areas, respectively, in the dominant hemisphere?
Explanations
A. Broca: inferior frontal gyrus; Wernicke: posterior superior temporal gyrus · correct
Broca area is classically located in the inferior frontal gyrus (involved in speech production), while Wernicke area is classically located in the posterior superior temporal gyrus (involved in language comprehension), typically in the dominant (usually left) hemisphere.
B. Both areas are located in the cerebellum
Neither language area is located in the cerebellum.
C. Both areas are located in the same gyrus
These are two distinct areas in different lobes, not the same gyrus.
D. Broca: occipital lobe; Wernicke: parietal lobe
Neither area is classically located in the occipital or parietal lobe as their primary/classic location.
E. Broca: posterior superior temporal gyrus; Wernicke: inferior frontal gyrus
This reverses the correct locations.
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