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Clinical Neurology Flashcards

7 cards from real NBME practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A 68-year-old man develops sudden right-sided weakness and aphasia. CT head is negative for hemorrhage. Which artery territory is most likely affected?

    Answer: Left middle cerebral artery

    Left MCA territory ischemia classically presents with contralateral (right) hemiplegia plus aphasia when the dominant hemisphere is involved.

  2. A 24-year-old woman has stereotyped episodes of lip smacking, hand automatisms, and postictal confusion lasting ~2 minutes. EEG shows left temporal spikes. What seizure type is this?

    Answer: Focal impaired awareness seizure

    Automatisms with impaired awareness and postictal confusion from a temporal focus define focal impaired awareness (complex partial) seizures.

  3. A 72-year-old man with Parkinson's disease on levodopa develops end-of-dose wearing off. What pharmacologic strategy best addresses this?

    Answer: Add a COMT inhibitor

    COMT inhibitors (entacapone, tolcapone) extend levodopa half-life by blocking peripheral dopamine metabolism, reducing wearing-off fluctuations.

  4. A 34-year-old woman presents with ptosis and diplopia that worsen throughout the day. Ice pack test is positive. Which antibody is most likely elevated?

    Answer: Anti-acetylcholine receptor (AChR)

    Fatigable ptosis and diplopia with a positive ice pack test are classic for myasthenia gravis, caused by anti-AChR antibodies in ~85% of generalized cases.

  5. A 38-year-old man presents with progressive chorea, personality changes, and cognitive decline. His father died of a similar illness at 45. CAG repeat expansion is confirmed. What is the inheritance pattern?

    Answer: Autosomal dominant with anticipation

    Huntington's disease is autosomal dominant with CAG trinucleotide repeat expansion in HTT; anticipation occurs with paternal transmission.

  6. A 55-year-old woman with chronic subdural hematoma is found to have midline shift on CT. She is increasingly drowsy. What is the most appropriate acute intervention?

    Answer: Urgent surgical evacuation

    Symptomatic chronic subdural hematoma with midline shift and deteriorating consciousness requires urgent surgical drainage (burr hole or craniotomy).

  7. A 19-year-old has brief myoclonic jerks on awakening and a generalized tonic-clonic seizure while sleep-deprived. EEG shows 4-6 Hz generalized spike-and-wave. What syndrome is most likely?

    Answer: Juvenile myoclonic epilepsy

    Juvenile myoclonic epilepsy presents in adolescents with morning myoclonus, GTC seizures triggered by sleep deprivation, and 4-6 Hz generalized spike-wave on EEG.