Medicine
Neurology
Which complication or major adverse outcome is particularly associated with Myasthenia gravis?
A. Completed ischemic stroke
B. Hypoxic brain injury and rhabdomyolysis
C. Myasthenic respiratory crisis
D. Medication-overuse headache
Correct Answer: C
Respiratory and bulbar muscle weakness can cause life-threatening ventilatory failure.
Medicine
Neurology
A patient is diagnosed with Myasthenia gravis. Which is the most appropriate management principle?
A. Activate a stroke pathway and assess urgently for intravenous thrombolysis and/or mechanical thrombectomy when eligible
B. Use symptomatic acetylcholinesterase inhibition and individualized immunotherapy; treat myasthenic crisis in a monitored setting
C. Start rapid secondary stroke prevention based on etiology and bleeding risk
D. Give a benzodiazepine promptly followed by an appropriate longer-acting antiseizure medicine if seizures continue
Correct Answer: B
Treatment depends on severity and includes symptomatic, immunologic and thymus-directed strategies.
Medicine
Neurology
In a patient with suspected Myasthenia gravis, which investigation or diagnostic approach is most appropriate at this stage?
A. Acetylcholine-receptor antibody testing with electrodiagnostic studies when needed
B. Neurologic assessment including respiratory function with CSF and nerve-conduction studies when appropriate
C. Immediate noncontrast CT brain with rapid vascular assessment as indicated
D. Urgent brain and vascular evaluation plus cardiac rhythm assessment
Correct Answer: A
Autoantibody testing and neuromuscular transmission studies support the diagnosis.
Medicine
Neurology
A patient has fluctuating ptosis, diplopia and fatigable bulbar or limb weakness that worsens with repeated activity. What is the most likely diagnosis?
A. Parkinson disease
B. Guillain-Barré syndrome
C. Acute ischemic stroke
D. Myasthenia gravis
Correct Answer: D
Fluctuating fatigable weakness, especially ocular or bulbar, strongly suggests myasthenia gravis.
Medicine
Neurology
Which reflex finding is typical of Guillain-Barré syndrome?
A. Diffuse sustained clonus
B. Markedly brisk reflexes as the rule
C. Reduced or absent deep tendon reflexes
D. Normal reflexes in all patients
Correct Answer: C
Areflexia or hyporeflexia is a hallmark of the typical GBS presentation.
Medicine
Neurology
Which complication or major adverse outcome is particularly associated with Guillain-Barré syndrome?
A. Medication-overuse headache
B. Respiratory failure
C. Cerebral vasospasm with delayed ischemia
D. Falls and aspiration risk in advanced disease
Correct Answer: B
Diaphragmatic and bulbar weakness can require mechanical ventilation.
Medicine
Neurology
A patient is diagnosed with Guillain-Barré syndrome. Which is the most appropriate management principle?
A. Use intravenous immunoglobulin or plasma exchange for significant disease and closely monitor respiratory and autonomic function
B. Give a benzodiazepine promptly followed by an appropriate longer-acting antiseizure medicine if seizures continue
C. Use acute migraine therapy and consider preventive treatment when attacks are frequent or disabling
D. Urgent neurosurgical or neurovascular management with stabilization and prevention of rebleeding and secondary injury
Correct Answer: A
IVIG and plasma exchange are effective disease-modifying therapies; corticosteroids alone are not effective treatment.
Medicine
Neurology
In a patient with suspected Guillain-Barré syndrome, which investigation or diagnostic approach is most appropriate at this stage?
A. Urgent brain and vascular evaluation plus cardiac rhythm assessment
B. Bedside glucose and urgent evaluation for metabolic, toxic, structural and infectious causes
C. Clinical diagnosis when the history is typical and neurologic examination is normal
D. Neurologic assessment including respiratory function with CSF and nerve-conduction studies when appropriate
Correct Answer: D
Respiratory monitoring is critical because weakness can progress rapidly; supportive tests confirm the diagnosis.
Medicine
Neurology
A patient develops progressive symmetric ascending weakness and areflexia after a recent infection. What is the most likely diagnosis?
A. Acute ischemic stroke
B. Transient ischemic attack (TIA)
C. Guillain-Barré syndrome
D. Convulsive status epilepticus
Correct Answer: C
Acute ascending flaccid weakness with reduced reflexes is characteristic of GBS.
Medicine
Neurology
Which motor feature is required for the clinical syndrome of parkinsonism?
A. Hyperreflexia alone
B. Bradykinesia
C. Isolated intention tremor
D. Chorea
Correct Answer: B
Bradykinesia is central to parkinsonism and is combined with tremor, rigidity or postural instability.
Medicine
Neurology
Which complication or major adverse outcome is particularly associated with Parkinson disease?
A. Falls and aspiration risk in advanced disease
B. Respiratory failure
C. Myasthenic respiratory crisis
D. Cerebral edema or hemorrhagic transformation
Correct Answer: A
Postural instability and bulbar dysfunction can cause major morbidity later in disease.
Medicine
Neurology
A patient is diagnosed with Parkinson disease. Which is the most appropriate management principle?
A. Urgent neurosurgical or neurovascular management with stabilization and prevention of rebleeding and secondary injury
B. Use intravenous immunoglobulin or plasma exchange for significant disease and closely monitor respiratory and autonomic function
C. Use symptomatic acetylcholinesterase inhibition and individualized immunotherapy; treat myasthenic crisis in a monitored setting
D. Use individualized dopaminergic therapy and multidisciplinary rehabilitation
Correct Answer: D
Treatment targets motor and nonmotor symptoms and is tailored to age, function and complications.
Medicine
Neurology
In a patient with suspected Parkinson disease, which investigation or diagnostic approach is most appropriate at this stage?
A. Clinical diagnosis when the history is typical and neurologic examination is normal
B. Urgent noncontrast CT brain followed by further evaluation if suspicion remains despite nondiagnostic initial imaging
C. Clinical neurologic diagnosis; imaging is used mainly when an alternative diagnosis is suspected
D. Neurologic assessment including respiratory function with CSF and nerve-conduction studies when appropriate
Correct Answer: C
Idiopathic Parkinson disease is primarily diagnosed clinically.
Medicine
Neurology
A patient has bradykinesia with resting tremor, rigidity and reduced arm swing. What is the most likely diagnosis?
A. Convulsive status epilepticus
B. Parkinson disease
C. Migraine with aura
D. Subarachnoid hemorrhage
Correct Answer: B
Bradykinesia plus rigidity and/or rest tremor is typical of parkinsonism.
Medicine
Neurology
Which description best fits the classic onset of aneurysmal subarachnoid hemorrhage?
A. Abrupt thunderclap headache
B. Slowly progressive mild headache over years
C. Headache only after missing meals
D. Brief scalp tenderness with chewing only
Correct Answer: A
SAH often presents with headache that reaches maximal intensity almost immediately.
Medicine
Neurology
Which complication or major adverse outcome is particularly associated with Subarachnoid hemorrhage?
A. Cerebral edema or hemorrhagic transformation
B. Completed ischemic stroke
C. Hypoxic brain injury and rhabdomyolysis
D. Cerebral vasospasm with delayed ischemia
Correct Answer: D
Delayed cerebral ischemia from vasospasm is a major complication after aneurysmal SAH.
Medicine
Neurology
A patient is diagnosed with Subarachnoid hemorrhage. Which is the most appropriate management principle?
A. Use symptomatic acetylcholinesterase inhibition and individualized immunotherapy; treat myasthenic crisis in a monitored setting
B. Activate a stroke pathway and assess urgently for intravenous thrombolysis and/or mechanical thrombectomy when eligible
C. Urgent neurosurgical or neurovascular management with stabilization and prevention of rebleeding and secondary injury
D. Start rapid secondary stroke prevention based on etiology and bleeding risk
Correct Answer: C
Aneurysmal SAH requires rapid specialist treatment and careful management of neurologic and systemic complications.
Medicine
Neurology
In a patient with suspected Subarachnoid hemorrhage, which investigation or diagnostic approach is most appropriate at this stage?
A. Neurologic assessment including respiratory function with CSF and nerve-conduction studies when appropriate
B. Urgent noncontrast CT brain followed by further evaluation if suspicion remains despite nondiagnostic initial imaging
C. Acetylcholine-receptor antibody testing with electrodiagnostic studies when needed
D. Immediate noncontrast CT brain with rapid vascular assessment as indicated
Correct Answer: B
Rapid CT is first-line; additional testing may be required depending on timing and clinical suspicion.
Medicine
Neurology
A patient develops the sudden worst headache of life during exertion with neck stiffness. What is the most likely diagnosis?
A. Subarachnoid hemorrhage
B. Parkinson disease
C. Guillain-Barré syndrome
D. Myasthenia gravis
Correct Answer: A
Thunderclap headache with meningism is classic for subarachnoid hemorrhage.
Medicine
Neurology
Which feature is a headache red flag that should prompt urgent evaluation for a secondary cause?
A. Similar attacks since adolescence
B. Headache relieved by sleep
C. Photophobia during a typical migraine
D. Sudden thunderclap onset reaching maximal intensity within seconds
Correct Answer: D
Thunderclap headache raises concern for subarachnoid hemorrhage and other vascular emergencies.