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

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

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

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

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

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

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

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.

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

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

NBME Practice Test

NBME Practice Test

NBME Clinical Neurology 2