MCCQE Neurological Disorders 1

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?

Accepted Answer

Administer IV alteplase (tPA)

Answer

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?

Accepted Answer

Migraine with aura

Answer

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?

Accepted Answer

Alzheimer's disease

Answer

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?

Accepted Answer

Valproate

Answer

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?

Accepted Answer

Nigrostriatal pathway

Answer

Parkinson's disease results from degeneration of dopaminergic neurons in the substantia nigra pars compacta, affecting the nigrostriatal pathway and causing motor deficits.

(MCCQE) Medical Council of Canada Qualifying Examination Practice Test

(MCCQE) Medical Council of Canada Qualifying Examination Practice Test

MCCQE Neurological Disorders 1