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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.

Read the first 7 Clinical Neurology flashcards as text

  1. A 62-year-old man presents with a 6-week history of headaches, cognitive decline, and a ring-enhancing lesion on MRI with surrounding edema. Biopsy shows pseudopalisading necrosis. What is the diagnosis?

    Answer: Glioblastoma multiforme (GBM)

    GBM (WHO grade IV astrocytoma) characteristically shows ring enhancement with central necrosis and pseudopalisading necrosis on histology.

  2. A 52-year-old woman has acute right facial droop involving the forehead. She cannot wrinkle her brow or close her eye. There is no limb weakness. Where is the lesion?

    Answer: Right facial nerve (LMN)

    Forehead involvement (loss of brow wrinkling) indicates a lower motor neuron lesion of CN VII (Bell's palsy) since UMN lesions spare the forehead due to bilateral cortical representation.

  3. A malnourished 45-year-old alcoholic presents with confusion, ophthalmoplegia, and ataxia. What is the most urgent intervention?

    Answer: IV thiamine before glucose

    Wernicke's encephalopathy (thiamine deficiency) requires IV thiamine before glucose; giving glucose first can precipitate or worsen the encephalopathy by depleting remaining thiamine.

  4. A 65-year-old woman has lancinating electric shock-like pain in her cheek triggered by chewing and light touch. Neurological exam is normal. MRI shows vascular compression of a cranial nerve root. What is the diagnosis?

    Answer: Trigeminal neuralgia

    Trigeminal neuralgia presents with brief, severe, unilateral facial pain in V2/V3 distribution triggered by light touch or chewing, often caused by vascular loop compression of CN V.

  5. A T4 paraplegic patient develops sudden severe hypertension, bradycardia, profuse sweating, and headache after bladder distension. What is the pathophysiology?

    Answer: Autonomic dysreflexia

    Autonomic dysreflexia occurs in spinal cord injuries at T6 or above; a noxious stimulus below the lesion triggers massive sympathetic discharge unchecked by supraspinal inhibition.

  6. A 30-year-old woman develops acute paraplegia, bilateral Babinski signs, and a sensory level at T6, with bladder dysfunction, 2 weeks after a viral illness. MRI shows T2 signal change spanning 3+ vertebral segments. What is the most likely diagnosis?

    Answer: Transverse myelitis

    Acute transverse myelitis presents with bilateral motor, sensory, and autonomic dysfunction with a sensory level, often post-infectious, with longitudinally extensive T2 MRI changes.

  7. A 55-year-old man develops acute low back pain, perianal saddle anesthesia, bilateral leg weakness, and urinary retention after lifting. What is the most urgent next step?

    Answer: Emergent MRI lumbar spine and surgical consultation

    Cauda equina syndrome (saddle anesthesia, bowel/bladder dysfunction, bilateral leg weakness) is a surgical emergency requiring emergent MRI and decompression within hours to preserve function.