MCCQE Neurological Disorders 1 — Questions and Answers
Question 1: A 68-year-old man presents with sudden onset of right-sided weakness and aphasia that began 45 minutes ago. CT head shows no hemorrhage. He has no contraindications to thrombolysis. What is the most appropriate next step?
- Administer IV alteplase (tPA) (Correct answer)
- Start aspirin 325 mg orally
- Arrange urgent carotid endarterectomy
- Begin heparin infusion
Correct answer: Administer IV alteplase (tPA)
IV alteplase is indicated within 4.5 hours of ischemic stroke onset in eligible patients with no contraindications, making it the most appropriate immediate intervention.
Question 2: A 35-year-old woman presents with recurrent episodes of unilateral throbbing headache, nausea, and photophobia lasting 6-12 hours. She reports seeing zigzag lines before each episode. What is the most likely diagnosis?
- Cluster headache
- Tension-type headache
- Migraine with aura (Correct answer)
- Trigeminal neuralgia
Correct answer: Migraine with aura
Migraine with aura is characterized by unilateral throbbing headache with associated nausea/photophobia preceded by visual disturbances (aura) such as zigzag lines.
Question 3: A 72-year-old woman is brought in by her family due to progressive memory loss over 3 years, difficulty with word finding, and getting lost in familiar places. Examination shows no focal deficits. Which diagnosis best fits this presentation?
- Vascular dementia
- Alzheimer's disease (Correct answer)
- Lewy body dementia
- Normal pressure hydrocephalus
Correct answer: Alzheimer's disease
Alzheimer's disease presents with insidious progressive memory loss, language difficulties, and spatial disorientation over years without focal neurological deficits.
Question 4: A 22-year-old student presents after a witnessed generalized tonic-clonic seizure lasting 3 minutes followed by postictal confusion. EEG shows generalized 3 Hz spike-and-wave discharges. What is the most appropriate first-line treatment?
- Carbamazepine
- Valproate (Correct answer)
- Phenytoin
- Levetiracetam
Correct answer: Valproate
Valproate is the preferred first-line agent for generalized epilepsy with 3 Hz spike-and-wave discharges (consistent with juvenile myoclonic or generalized epilepsy syndrome).
Question 5: A 55-year-old man presents with resting tremor, bradykinesia, and cogwheel rigidity more prominent on the right side. He has a shuffling gait. Which dopaminergic pathway is primarily affected in this condition?
- Mesolimbic pathway
- Mesocortical pathway
- Nigrostriatal pathway (Correct answer)
- Tuberoinfundibular pathway
Correct answer: Nigrostriatal pathway
Parkinson's disease results from degeneration of dopaminergic neurons in the substantia nigra pars compacta, affecting the nigrostriatal pathway and causing motor deficits.
Question 6: A 40-year-old woman presents with episodic diplopia, unilateral facial numbness, and limb weakness that have occurred on 3 separate occasions over 2 years, each resolving completely. MRI brain shows periventricular white matter lesions. What is the most likely diagnosis?
- Transient ischemic attacks
- Multiple sclerosis (Correct answer)
- Myasthenia gravis
- Cerebral vasculitis
Correct answer: Multiple sclerosis
Multiple sclerosis is characterized by relapsing-remitting neurological deficits disseminated in time and space, with periventricular demyelinating plaques on MRI.
Question 7: A 60-year-old man presents with progressive asymmetric weakness of his hands and legs over 18 months. Examination reveals both upper and lower motor neuron signs. Sensation is intact. What is the most likely diagnosis?
- Cervical spondylotic myelopathy
- Amyotrophic lateral sclerosis (Correct answer)
- Syringomyelia
- Guillain-Barré syndrome
Correct answer: Amyotrophic lateral sclerosis
ALS is characterized by progressive combined upper and lower motor neuron degeneration without sensory involvement, distinguishing it from other motor neuron disorders.
MCCQE Neurological Disorders 1
A 68-year-old man presents with sudden onset of right-sided weakness and aphasia that began 45 minutes ago.
CT head shows no hemorrhage.
He has no contraindications to thrombolysis.
What is the most appropriate next step?