NBME Clinical Neurology 3 — Questions and Answers
Question 1: A 30-year-old woman has recurring unilateral pulsating headaches with nausea, photophobia, and preceding visual scotoma. Acute treatment with which agent is most appropriate?
- Acetaminophen alone
- Propranolol
- Sumatriptan (Correct answer)
- Verapamil
Correct answer: Sumatriptan
Triptans (serotonin 5-HT1B/1D agonists) are first-line acute therapy for moderate-to-severe migraine with or without aura.
Question 2: A 45-year-old man has severe unilateral periorbital pain lasting 45 minutes occurring nightly, with ipsilateral lacrimation and ptosis. What prophylactic medication is most effective?
- Amitriptyline
- Verapamil (Correct answer)
- Valproate
- Topiramate
Correct answer: Verapamil
Verapamil is the first-line prophylactic agent for cluster headache; high doses (240-960 mg/day) are often required.
Question 3: Autopsy of a 78-year-old with progressive memory loss shows neocortical neuritic plaques and neurofibrillary tangles. Which protein forms the tau tangles?
- Alpha-synuclein
- TDP-43
- Hyperphosphorylated tau (Correct answer)
- Amyloid precursor protein
Correct answer: Hyperphosphorylated tau
Neurofibrillary tangles in Alzheimer's disease are composed of hyperphosphorylated tau protein arranged in paired helical filaments.
Question 4: A 28-year-old woman has two episodes of optic neuritis and a spinal cord lesion separated by time and space on MRI. CSF shows oligoclonal bands. Which diagnostic criteria confirm MS?
- Poser criteria
- McDonald criteria (2017) (Correct answer)
- CHADS2 criteria
- Miller Fisher criteria
Correct answer: McDonald criteria (2017)
The 2017 McDonald criteria require dissemination in space (DIS) and time (DIT) demonstrated by MRI or clinical events to diagnose MS.
Question 5: A 60-year-old diabetic has symmetric stocking-glove sensory loss with reduced ankle reflexes and NCS showing reduced sensory amplitudes with normal conduction velocity. What type of neuropathy is this?
- Demyelinating polyneuropathy
- Mononeuritis multiplex
- Length-dependent axonal polyneuropathy (Correct answer)
- Radiculopathy
Correct answer: Length-dependent axonal polyneuropathy
Diabetic peripheral neuropathy is typically a length-dependent axonal polyneuropathy with reduced amplitudes on NCS and preserved conduction velocity.
Question 6: A 70-year-old man presents with the triad of gait ataxia, urinary incontinence, and dementia. MRI shows ventriculomegaly out of proportion to sulcal atrophy. Lumbar puncture reveals improvement in gait. What is the diagnosis?
- Alzheimer's disease
- Communicating hydrocephalus (NPH) (Correct answer)
- Frontotemporal dementia
- Multi-infarct dementia
Correct answer: Communicating hydrocephalus (NPH)
Normal pressure hydrocephalus presents with Hakim's triad (wet, wobbly, wacky) and ventriculomegaly; gait improvement after LP tap test supports VP shunt candidacy.
Question 7: A 22-year-old obese woman has daily bifrontal headaches, pulsatile tinnitus, and papilledema. Opening pressure on LP is 32 cmH2O with normal CSF. What is the first-line treatment?
- Sumatriptan
- Acetazolamide and weight loss (Correct answer)
- Ventriculoperitoneal shunt
- Methylprednisolone
Correct answer: Acetazolamide and weight loss
Idiopathic intracranial hypertension (pseudotumor cerebri) is treated first with acetazolamide (CSF production reduction) and weight loss in obese patients.
NBME Clinical Neurology 3
A 30-year-old woman has recurring unilateral pulsating headaches with nausea, photophobia, and preceding visual scotoma.
Acute treatment with which agent is most appropriate?