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Behavioral & Nervous Pathology — Step 1 practice questions
40 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
Pathology questions in this section combine two things the exam tests separately elsewhere. Pathology is the largest discipline on Step 1. Neuroanatomy questions are localisation problems: a deficit is described and you name the lesion site.
Sample questions
Sample question 1
A 28-year-old woman taking combined oral contraceptives develops a progressively worsening headache over a week, papilledema, and a seizure. CT shows a hemorrhagic infarct that does not conform to an arterial territory. Which of the following is the most likely diagnosis?
Explanations
A. Hypertensive intracerebral hemorrhage
Hypertensive hemorrhage occurs in deep structures in older hypertensive patients.
B. Arterial ischemic stroke requiring thrombolysis
Arterial strokes respect vascular territories and present abruptly.
C. Migraine with aura
Migraine does not cause papilledema or hemorrhagic infarction.
D. Cerebral venous sinus thrombosis, treated with anticoagulation despite the hemorrhagic component · correct
Cerebral venous sinus thrombosis presents with subacute headache, papilledema from impaired CSF absorption, seizures, and infarcts that cross arterial boundaries and are frequently hemorrhagic because of venous congestion. Risk factors include estrogen-containing contraceptives, pregnancy and the puerperium, thrombophilias, dehydration, and local infection. Counterintuitively, ANTICOAGULATION is the treatment even with hemorrhage, since the underlying problem is venous outflow obstruction.
E. Subarachnoid hemorrhage from aneurysm rupture
Subarachnoid hemorrhage is a thunderclap event with blood in the cisterns.
Sample question 2
A patient with chronic alcohol use develops confusion, ataxia, and ophthalmoplegia. Despite treatment with thiamine, he is left with a persistent severe anterograde amnesia and confabulation. Which of the following brain structures are classically damaged in this chronic phase?
Explanations
A. Cerebellar vermis exclusively
While cerebellar involvement can contribute to the ataxia seen in the acute Wernicke phase, the memory deficits of Korsakoff syndrome relate to the mammillary body/thalamic damage.
B. Broca area
Broca area relates to speech production, not the memory deficits described here.
C. Primary visual cortex
Primary visual cortex is not the classic site of damage in this condition.
D. Mammillary bodies and medial thalamic nuclei · correct
Chronic thiamine deficiency in Wernicke-Korsakoff syndrome classically damages the mammillary bodies and medial thalamic nuclei, structures critical for memory consolidation, explaining the persistent anterograde amnesia and confabulation of Korsakoff syndrome.
E. Hippocampus exclusively
While memory involves the hippocampus broadly, the classic structures specifically implicated in Wernicke-Korsakoff syndrome are the mammillary bodies and medial thalamus.
Sample question 3
A 74-year-old man has progressive memory loss, visual hallucinations, and parkinsonian rigidity that fluctuate significantly from day to day. His wife notes he acts out his dreams during sleep. Which of the following medications should be avoided in this patient?
Explanations
A. Levodopa-carbidopa
Levodopa can be used cautiously for the parkinsonian features, though the response may be less robust than in Parkinson disease.
B. Donepezil
Cholinesterase inhibitors like donepezil are often used and may help in Lewy body dementia; they are not contraindicated.
C. Haloperidol · correct
This presentation (fluctuating cognition, visual hallucinations, parkinsonism, REM sleep behavior disorder) is classic Lewy body dementia; patients with this condition have severe, potentially life-threatening sensitivity to antipsychotics like haloperidol and they should be avoided.
D. Melatonin
Melatonin is often used to help manage REM sleep behavior disorder and is not contraindicated.
E. Memantine
Memantine is used in dementia management and is not specifically dangerous in this condition.
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