MCCQE Neurological Disorders 2

Question 1

A 25-year-old woman presents with ascending weakness that began in her feet 2 weeks after a gastrointestinal illness. Deep tendon reflexes are absent bilaterally. CSF shows elevated protein with normal cell count. What is the most likely diagnosis?

Accepted Answer

Guillain-Barré syndrome

Answer

Guillain-Barré syndrome presents with ascending flaccid paralysis, areflexia, and albuminocytologic dissociation (high CSF protein, normal cells) often following infection.

Question 2

A 70-year-old man develops sudden-onset severe headache described as 'the worst headache of my life,' followed by neck stiffness. CT head is normal. What is the next most important diagnostic step?

Accepted Answer

Lumbar puncture for CSF analysis

Answer

A negative CT does not exclude subarachnoid hemorrhage; lumbar puncture should be performed to look for xanthochromia and red blood cells in the CSF.

Question 3

A 45-year-old woman with known HIV presents with headache, fever, and confusion over 5 days. CSF India ink preparation shows encapsulated yeast. What is the most appropriate treatment?

Accepted Answer

Amphotericin B plus flucytosine

Answer

Cryptococcal meningitis (seen on India ink as encapsulated yeast) is treated with induction therapy using amphotericin B plus flucytosine for at least 2 weeks.

Question 4

A 30-year-old man presents with acute-onset severe eye pain, diplopia, and proptosis. MRI reveals a lesion in the cavernous sinus. Which cranial nerve is NOT typically affected by cavernous sinus pathology?

Accepted Answer

CN VII (facial)

Answer

The facial nerve (CN VII) does not pass through the cavernous sinus; the structures within it include CN III, IV, V1, V2, and VI, as well as the internal carotid artery.

Question 5

A 65-year-old woman with hypertension presents with sudden-onset right-sided hemiplegia and hemisensory loss. CT shows a hyperdense lesion in the left internal capsule. What type of stroke is most likely?

Accepted Answer

Hypertensive intracerebral hemorrhage

Answer

A hyperdense lesion on CT indicates hemorrhage; hypertensive ICH most commonly affects the basal ganglia and internal capsule, causing contralateral hemiplegia.

(MCCQE) Medical Council of Canada Qualifying Examination Practice Test

(MCCQE) Medical Council of Canada Qualifying Examination Practice Test

MCCQE Neurological Disorders 2