USAHS NEURO UPDATED EXAMS SCRIPT
QUESTIONS AND ANSWERS SURE A+
✔✔Lateropulsion - ✔✔Involuntary lateral lean toward one side; often associated with
stroke.
✔✔Saccule & utricle function - ✔✔Detect linear acceleration and head position relative
to gravity (otolith organs).
✔✔DCML modality list - ✔✔Vibration, fine touch, pressure, proprioception; tested with
tuning fork, joint position testing, 2-point discrimination.
✔✔Spinothalamic modalities - ✔✔Pain, temperature, crude/coarse touch; tested with
sharp/dull and hot/cold.
✔✔ALS clinical features - ✔✔Mixed UMN + LMN signs, progressive weakness,
fasciculations, hyperreflexia, spasticity, dysarthria, eventual respiratory failure.
✔✔UMN screening signs - ✔✔Hyperreflexia, spasticity, Babinski sign, clonus, slow
disuse atrophy.
✔✔LMN screening signs - ✔✔Hyporeflexia, flaccidity, fasciculations, profound muscle
atrophy.
✔✔Intention tremor - ✔✔Tremor that worsens as the limb approaches a target; hallmark
of cerebellar (especially cerebrocerebellar) lesion.
✔✔Dysdiadochokinesia - ✔✔Inability to perform rapid alternating movements; sign of
cerebellar dysfunction.
✔✔Dysmetria - ✔✔Inaccurate movement distances (overshoot/undershoot); cerebellar
sign.
, ✔✔Cerebellar lesion hallmark - ✔✔Ipsilateral ataxia due to double decussation of
pathways entering/exiting the cerebellum.
✔✔Three systems for balance - ✔✔Vision, vestibular, somatosensory (proprioception)
all integrate for postural control.
✔✔Somatosensory contribution to balance - ✔✔Provides joint position, stepping
strategies, and ground reaction feedback.
✔✔Vestibular contribution to balance - ✔✔Detects head movement + acceleration;
stabilizes gaze and posture.
✔✔VOR (vestibulo-ocular reflex) - ✔✔Stabilizes vision during head movement; eyes
move opposite the head to maintain gaze.
✔✔Positive Dix-Hallpike test - ✔✔Reproduces vertigo + nystagmus; indicates BPPV
(posterior canal most common).
✔✔Central nystagmus features - ✔✔Vertical or direction-changing, non-fatigable,
persists with fixation — suggests brainstem/cerebellar lesion.
✔✔Peripheral nystagmus features - ✔✔Horizontal, fatigable, suppressed by visual
fixation — suggests inner ear cause.
✔✔Direct pathway (Go) - ✔✔Facilitates movement; dopamine via D1 receptors excites
this pathway.
✔✔Indirect pathway (No-Go) - ✔✔Inhibits unwanted movement; dopamine via D2
receptors reduces inhibition.
✔✔Hyper-direct pathway - ✔✔STN-driven emergency stop of movement; fastest
inhibitory motor mechanism.
✔✔Parkinson's disease hallmark - ✔✔Loss of dopamine from substantia nigra →
underactive Go pathway + overactive No-Go → bradykinesia.
✔✔Parkinsonisms definition - ✔✔Group of disorders that resemble PD but are typically
bilateral at onset and poorly responsive to levodopa.
✔✔Superior peduncle lesion - ✔✔Affects cerebellar output → dysmetria, tremor.
✔✔Middle peduncle lesion - ✔✔Affects pontocerebellar input → limb ataxia.
QUESTIONS AND ANSWERS SURE A+
✔✔Lateropulsion - ✔✔Involuntary lateral lean toward one side; often associated with
stroke.
✔✔Saccule & utricle function - ✔✔Detect linear acceleration and head position relative
to gravity (otolith organs).
✔✔DCML modality list - ✔✔Vibration, fine touch, pressure, proprioception; tested with
tuning fork, joint position testing, 2-point discrimination.
✔✔Spinothalamic modalities - ✔✔Pain, temperature, crude/coarse touch; tested with
sharp/dull and hot/cold.
✔✔ALS clinical features - ✔✔Mixed UMN + LMN signs, progressive weakness,
fasciculations, hyperreflexia, spasticity, dysarthria, eventual respiratory failure.
✔✔UMN screening signs - ✔✔Hyperreflexia, spasticity, Babinski sign, clonus, slow
disuse atrophy.
✔✔LMN screening signs - ✔✔Hyporeflexia, flaccidity, fasciculations, profound muscle
atrophy.
✔✔Intention tremor - ✔✔Tremor that worsens as the limb approaches a target; hallmark
of cerebellar (especially cerebrocerebellar) lesion.
✔✔Dysdiadochokinesia - ✔✔Inability to perform rapid alternating movements; sign of
cerebellar dysfunction.
✔✔Dysmetria - ✔✔Inaccurate movement distances (overshoot/undershoot); cerebellar
sign.
, ✔✔Cerebellar lesion hallmark - ✔✔Ipsilateral ataxia due to double decussation of
pathways entering/exiting the cerebellum.
✔✔Three systems for balance - ✔✔Vision, vestibular, somatosensory (proprioception)
all integrate for postural control.
✔✔Somatosensory contribution to balance - ✔✔Provides joint position, stepping
strategies, and ground reaction feedback.
✔✔Vestibular contribution to balance - ✔✔Detects head movement + acceleration;
stabilizes gaze and posture.
✔✔VOR (vestibulo-ocular reflex) - ✔✔Stabilizes vision during head movement; eyes
move opposite the head to maintain gaze.
✔✔Positive Dix-Hallpike test - ✔✔Reproduces vertigo + nystagmus; indicates BPPV
(posterior canal most common).
✔✔Central nystagmus features - ✔✔Vertical or direction-changing, non-fatigable,
persists with fixation — suggests brainstem/cerebellar lesion.
✔✔Peripheral nystagmus features - ✔✔Horizontal, fatigable, suppressed by visual
fixation — suggests inner ear cause.
✔✔Direct pathway (Go) - ✔✔Facilitates movement; dopamine via D1 receptors excites
this pathway.
✔✔Indirect pathway (No-Go) - ✔✔Inhibits unwanted movement; dopamine via D2
receptors reduces inhibition.
✔✔Hyper-direct pathway - ✔✔STN-driven emergency stop of movement; fastest
inhibitory motor mechanism.
✔✔Parkinson's disease hallmark - ✔✔Loss of dopamine from substantia nigra →
underactive Go pathway + overactive No-Go → bradykinesia.
✔✔Parkinsonisms definition - ✔✔Group of disorders that resemble PD but are typically
bilateral at onset and poorly responsive to levodopa.
✔✔Superior peduncle lesion - ✔✔Affects cerebellar output → dysmetria, tremor.
✔✔Middle peduncle lesion - ✔✔Affects pontocerebellar input → limb ataxia.
