PANRE Neurology 5 — Questions and Answers
Question 1: A 55-year-old with a history of small cell lung cancer presents with proximal muscle weakness, reduced reflexes that improve with repeated stimulation, and autonomic dysfunction. Diagnosis?
- Myasthenia gravis
- Lambert-Eaton myasthenic syndrome (Correct answer)
- Polymyositis
- Eaton-Lambert syndrome due to ALS
Correct answer: Lambert-Eaton myasthenic syndrome
Lambert-Eaton myasthenic syndrome is a paraneoplastic disorder most associated with small cell lung cancer; reflexes and strength paradoxically improve with repetitive activity.
Question 2: A 40-year-old woman presents with severe unilateral periorbital pain, lacrimation, rhinorrhea, and ptosis occurring in clusters over weeks. Best acute treatment?
- Oral sumatriptan
- High-flow 100% oxygen (Correct answer)
- IV ketorolac
- Prednisone taper
Correct answer: High-flow 100% oxygen
High-flow 100% oxygen via non-rebreather mask is the most effective abortive treatment for acute cluster headache attacks, providing relief within 15–20 minutes.
Question 3: A patient with a right MCA stroke has difficulty speaking but understands language perfectly. Which type of aphasia is this?
- Wernicke aphasia
- Global aphasia
- Broca aphasia (Correct answer)
- Conduction aphasia
Correct answer: Broca aphasia
Broca aphasia (expressive/non-fluent aphasia) involves damage to Broca's area in the left frontal lobe, producing halting speech with preserved comprehension.
Question 4: Which of the following is an absolute contraindication to thrombolytic therapy in acute ischemic stroke?
- Age over 80 years
- Blood glucose of 60 mg/dL
- Recent intracranial surgery within 3 months (Correct answer)
- Mild stroke with NIHSS score of 4
Correct answer: Recent intracranial surgery within 3 months
Recent intracranial surgery, head trauma, or prior stroke within 3 months is an absolute contraindication to IV tPA because of the risk of catastrophic hemorrhage.
Question 5: A 35-year-old presents with episodic severe headache, diaphoresis, palpitations, and hypertension. Which test confirms the diagnosis?
- 24-hour urine catecholamines and metanephrines (Correct answer)
- Serum cortisol
- MRI pituitary
- Thyroid function tests
Correct answer: 24-hour urine catecholamines and metanephrines
Pheochromocytoma presents with paroxysmal hypertension, diaphoresis, and headache; diagnosis is confirmed by elevated 24-hour urine metanephrines and catecholamines.
Question 6: A neonate presents with seizures, lethargy, and bulging fontanelle within 24 hours of birth. CSF shows gram-positive cocci in pairs. Causative organism?
- Listeria monocytogenes
- Group B Streptococcus (Correct answer)
- Escherichia coli
- Neisseria meningitidis
Correct answer: Group B Streptococcus
Group B Streptococcus (Streptococcus agalactiae) is the most common cause of early-onset neonatal meningitis and appears as gram-positive cocci in pairs or chains.
Question 7: Which clinical finding best differentiates upper motor neuron (UMN) lesion from lower motor neuron (LMN) lesion?
- Muscle atrophy
- Fasciculations
- Hyperreflexia with spasticity (Correct answer)
- Decreased tone
Correct answer: Hyperreflexia with spasticity
UMN lesions produce hyperreflexia, spasticity, and Babinski sign due to loss of descending inhibition; LMN lesions cause hyporeflexia, flaccidity, and atrophy.
PANRE Neurology 5
A 55-year-old with a history of small cell lung cancer presents with proximal muscle weakness, reduced reflexes that improve with repeated stimulation, and autonomic dysfunction.
Diagnosis?