NBME Clinical Neurology 2

Question 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?

Accepted Answer

Left middle cerebral artery

Answer

Posterior cerebral artery

Answer

Right middle cerebral artery

Answer

Anterior communicating artery

Question 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?

Accepted Answer

Focal impaired awareness seizure

Answer

Absence seizure

Answer

Focal aware seizure

Answer

Generalized tonic-clonic seizure

Question 3

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

Accepted Answer

Add a COMT inhibitor

Answer

Add an anticholinergic agent

Answer

Switch to immediate-release levodopa only

Answer

Initiate amantadine

Question 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?

Accepted Answer

Anti-acetylcholine receptor (AChR)

Answer

Anti-voltage-gated calcium channel (VGCC)

Answer

Anti-Jo-1

Answer

Anti-MOG

Question 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?

Accepted Answer

Autosomal dominant with anticipation

Answer

X-linked recessive

Answer

Autosomal recessive

Answer

Mitochondrial

Question 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?

Accepted Answer

Urgent surgical evacuation

Answer

IV mannitol alone

Answer

Oral dexamethasone and observation

Answer

Lumbar puncture to reduce ICP

Question 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?

Accepted Answer

Juvenile myoclonic epilepsy

Answer

Lennox-Gastaut syndrome

Answer

Childhood absence epilepsy

Answer

West syndrome