NBME Clinical Neurology 3

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?

Accepted Answer

Sumatriptan

Answer

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?

Accepted Answer

Verapamil

Answer

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?

Accepted Answer

Hyperphosphorylated tau

Answer

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?

Accepted Answer

McDonald criteria (2017)

Answer

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?

Accepted Answer

Length-dependent axonal polyneuropathy

Answer

Diabetic peripheral neuropathy is typically a length-dependent axonal polyneuropathy with reduced amplitudes on NCS and preserved conduction velocity.

NBME Practice Test

NBME Practice Test

NBME Clinical Neurology 3