SPEX Neurology 3 — Questions and Answers
Question 1: A 30-year-old woman presents with episodic unilateral headache, nausea, photophobia, and phonophobia lasting 6 hours. What is the diagnosis?
- Cluster headache
- Tension-type headache
- Migraine without aura (Correct answer)
- Trigeminal neuralgia
Correct answer: Migraine without aura
Migraine without aura is characterized by unilateral throbbing headache with nausea, photophobia, and phonophobia lasting 4–72 hours.
Question 2: Which test is used to evaluate the integrity of the corticospinal tract?
- Romberg test
- Babinski sign (Correct answer)
- Dix-Hallpike maneuver
- Finger-nose test
Correct answer: Babinski sign
An upgoing plantar reflex (Babinski sign) indicates an upper motor neuron lesion in the corticospinal tract.
Question 3: A 70-year-old man develops sudden inability to speak but can understand language perfectly. Which aphasia does he have?
- Wernicke aphasia
- Broca aphasia (Correct answer)
- Global aphasia
- Conduction aphasia
Correct answer: Broca aphasia
Broca aphasia is a non-fluent aphasia with intact comprehension, caused by lesions in the left inferior frontal gyrus.
Question 4: Which of the following is the most common cause of peripheral neuropathy in the United States?
- Alcohol abuse
- Diabetes mellitus (Correct answer)
- Vitamin B12 deficiency
- Hypothyroidism
Correct answer: Diabetes mellitus
Diabetic peripheral neuropathy is the most common cause of peripheral neuropathy in the US, affecting up to 50% of diabetic patients.
Question 5: A patient has weakness of finger abduction and adduction with wasting of the intrinsic hand muscles but intact wrist flexion. Which nerve is most likely injured?
- Median nerve
- Radial nerve
- Ulnar nerve (Correct answer)
- Musculocutaneous nerve
Correct answer: Ulnar nerve
The ulnar nerve innervates most intrinsic hand muscles including the interossei and hypothenar muscles responsible for finger abduction/adduction.
Question 6: Which imaging modality is preferred for evaluating suspected acute ischemic stroke?
- MRI with gadolinium
- Non-contrast CT of the head (Correct answer)
- CT with contrast
- PET scan
Correct answer: Non-contrast CT of the head
Non-contrast CT is the first-line study to rule out hemorrhage before thrombolytic therapy in acute stroke.
Question 7: A 25-year-old presents with ascending weakness beginning in the legs 2 weeks after a GI infection. CSF shows albuminocytologic dissociation. What is the diagnosis?
- Myasthenia gravis
- Multiple sclerosis
- Guillain-Barré syndrome (Correct answer)
- Botulism
Correct answer: Guillain-Barré syndrome
Guillain-Barré syndrome presents with post-infectious ascending flaccid paralysis and CSF showing high protein with normal cell count (albuminocytologic dissociation).
SPEX Neurology 3
A 30-year-old woman presents with episodic unilateral headache, nausea, photophobia, and phonophobia lasting 6 hours.
What is the diagnosis?