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Neuro NBME Form 1 Exam Questions and Answers- Graded A
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Neuro NBME Form 1 Exam Questions and Answers
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Neuro NBME Form 1 Exam Questionsand Answers
Neuro ii1
An ii84-year-old iiman iiis iievaluated iifor iia ii5-year iihistory iiof iia iigradually iiworsening iigait
iiand iia ii2-year iihistory iiof iicognitive iiimpairment iiand iiurinary iiincontinence. iiTwelve
iiyears iiago, iihe iisustained iia iiclosed iihead iiinjury iithat iicaused iia iimild iitraumatic
iisubarachnoid iihemorrhage iiand iia ii5-hour iiloss iiof iiconsciousness. iiMedications
iiinclude iizolpidem ii(when iineeded iias iia iisleep iiaid) iiand iia iidaily iimultivitamin.
On iiphysical iiexamination, iitemperature iiis ii36.2 ii°C ii(97.2 ii°F), iiblood iipressure iiis
ii128/78 iimm iiHg, iipulse iirate iiis ii76/min, iirespiration iirate iiis ii14/min, iiand iiBMI iiis ii27.
iiThe iipatient's iigait iiis iislow iiand iiunsteady iiand iiis iimarked iiby iismall, iishuffling iisteps.
iiHis iilevel iiof iialertness, iispeech, iiposture, iiarm iiswing, iiand iimuscle iitone iiare iiall
iinormal, iiand iihe iihas iino iitremor. iiHe iiscores ii24/30 iion iithe iiFolstein iiMini-Mental iiState
iiExamination, iilosing iione iipoint iiin iithe iiorientation iiportion iifor iiincorrectly iistating
iitoday's iidate, iithree iipoints iiin iithe iiserial iicalculation iiportion, iiand iit ii- iiAnswers ii-B
The iitriad iiof iigait iiapraxia, iidementia, iiand iiurinary iiincontinence, iiespecially iiwhen
iiaccompanied iiby iienlarged iiventricles, iiis iisuggestive iiof iinormal iipressure
iihydrocephalus.
This iipatient iiexhibits iithe iiclassic iitriad iiof iigait iiimpairment ii(specifically, iigait iiapraxia),
iidementia, iiand iiurinary iiincontinence iithat iitypifies iithe iipotentially iireversible iisyndrome
iiof iinormal iipressure iihydrocephalus ii(NPH). iiThis iitriad iiof iisymptoms iieventually
iioccurs iiin iimost iipatients iiwith iidementia, iiand iithe iidiagnosis iiof iiNPH iiis iioften
iiconsidered iibut iimuch iiless iioften iiproved iito iibe iithe iicorrect iidiagnosis. iiIn iithis iipatient,
iihowever, iistrong iievidence iisupports iia iidiagnosis iiof iiNPH, iiincluding iithe iiMRI
iievidence iiof iiventriculomegaly. iiAlthough iiAlzheimer iidementia ii(AD) iiis iialso
iiassociated iiwith iicognitive iiimpairment iiand iiimpaired iigait, iigait iidoes iinot iiimprove
iiafter iiremoval iiof iicerebrospinal iifluid iiin iiAD iias iiit iidoes iiin iiNPH. iiAD iiis iiso iicommon
iiin iielderly iipatients iiwith iicognitive iiimpairment iithat iiexcluding iiit iias iia iicause iican
iidelay iithe iidiagnosis iiof iiNPH; iithis iidelay iimay iihelp iiexplain iisome iiof iithe iieventual
iishunt iifailures iithat iioccur iieven iiin iipatients iiwith iiwell-diagnosed iiNPH. iiTherefore,
iirecognizing iireversible iidementia iisyndromes iias iisoon iias iipossible iiis iiimperative
iibecause iiof iithe iitherapeutic iiopportunity iithese iisyndromes iirepresent.
The iionly iisymptom iithis iipatient iihas iithat iiis iishared iiby iipatients iiwith iiParkinson
iidisease iiis iia iishuffling iigait. iiOtherwise, iihis iipresentation—normal iiposture, iiarm
iiswing, iiand iimuscle iitone iiand iithe iiabsence iiof iia iitremor—is iiquite iidifferent.
,Likewise, iithis iipatient iihas iino iihistory iiof iior iisymptoms iisuggesting iistroke iior iivascular
iidisease, iisuch iias iisudden iionset iiof iineurologic iisigns iior iisymptoms, iiwhich iimakes
iivascular iidementia iiunlikely. iiAlthough iicoincident iivascular, iiAlzheimer-type, iiand
iiParkinson-type iipathology iiis iia iicommon iifinding iiin iiautopsy iistudies, iieven iiin
iineurologically iiunimpaired iihealthy iielderly iiadults, iithis iifact iishould
Neuro ii2
An ii18-year-old iimale iicollege iistudent iiis iievaluated iifor iia iisingle iigeneralized iitonic-
clonic iiseizure iithat iibegan iiwhen iihe iiwas iiasleep iiin iihis iidormitory iiand iiresolved
iiuneventfully. iiHe iihas iino iihistory iiof iihead iitrauma, iimeningitis, iior iiprior iiseizure iiand
iino iifamily iihistory iiof iiepilepsy. iiHe iitakes iino iimedications.
Results iiof iiphysical iiexamination, iiincluding iia iineurologic iiexamination, iiare iinormal.
Results iiof iilaboratory iistudies, iiincluding iia iicomplete iiblood iicount, iia iiserum iielectrolyte
iipanel, iiand iia iiurine iitoxicology iiscreen, iiare iialso iinormal.
An iiMRI iiof iithe iibrain iiand iian iielectroencephalogram iishow iino iiabnormalities.
Which iiof iithe iifollowing iiis iithe iimost iiappropriate iimanagement iiof iithis iipatient's
iiseizure?
A iiInitiate iino iidrug iitherapy iiat iithis iitime
B iiInitiate iitherapy iiwith iicarbamazepine
C iiInitiate iitherapy iiwith iilamotrigine
D iiInitiate iitherapy iiwith iivalproic iiacid
E iiRefer iifor iiepilepsy iisurgery iievaluation ii- iiAnswers ii-A
Unless iispecial iicircumstances iiexist, iidrug iitherapy iiis iigenerally iinot iistarted iiin
iipatients iiwith iia iisingle iiunprovoked iiseizure.
Drug iitherapy iishould iinot iibe iiinitiated iiin iithis iipatient iiat iithis iitime. iiAfter iia iisingle
iiunprovoked iiseizure, iithe iirisk iiof iirecurrence iiin iithe iisubsequent ii2 iiyears iihas iibeen
iireported iito iibe ii30% iito ii40%. iiThe iirisk iiof iirecurrence iiis iigreatest iiin iipatients iiwith
iistatus iiepilepticus iion iipresentation, iiwith iian iiidentifiable iiunderlying iineurologic iicause,
iior iiwith iiabnormal iiresults iion iian iielectroencephalogram ii(EEG). iiPatients iiwith iia
iipartial iiseizure iiwho iiare iiage ii65 iiyears iior iiolder iior iiwho iihave iia iifamily iihistory iiof
iiepilepsy iimay iialso iibe iiin iia iihigher-risk iicategory. iiThe iiappropriate iirecommendation
iifor iithis iiyoung iipatient, iiwho iihas iiexperienced iia iisingle iiidiopathic iiseizure iibut iihas iino
iipersonal iior iifamily iihistory iiof iiepilepsy, iino iiidentified iineurologic iicause iiof iihis
iiseizure, iiand iinormal iiresults iion iian iiEEG, iiis iithat iino iimedication iibe iistarted. iiAs iiwith
iiall iimedical iitreatment iirecommendations, iipatient iipreference iimust iibe iitaken iiinto
iiaccount, iiand iisome iipatients iiin iithe iilow-risk iigroup iimay iielect iito iistart iitherapy iiafter
iia iisingle iiseizure, iiparticularly iiif iithey iihave iia iihigh-risk iioccupation. iiIf iia iisecond
,iiseizure iioccurs iiin iithe iifuture, iithe iirecurrence iirisk iiis iigreater iithan ii60%, iiand
iiantiepileptic iimedical iitherapy iishould iibe iirecommended iiat iithat iitime.
Of iinote, iidriver's iilicense iiprivileges iiare iirestricted iiin iievery iistate iiin iithe iiUnited iiStates
iifor iipersons iiwho iihave iiexperienced iia iiseizure. iiSpecific iirestrictions iivary iiby iistate,
iiwith iitypical iirequirements iiof iia iiseizure-free iiperiod iiof ii3 iito ii12 iimonths iiin iiorder iito
iiagain iioperate iia iimotor iivehicle; iia iifew iistates iimake iiexceptions iifor iia iisingle iiseizure.
iiReinstatement iiof iidriving iiprivileges iidepends iion iidemonstrating iifreedom iifrom
iiseizures iifor iithe iispecified iiperiod iiand iithere iibeing iia iireasonable iiexpectation iiof
iifuture iiseizure iicontrol. iiInitiation iiof iiantiepileptic iimedication
Neuro ii3
A ii36-year-old iiwoman iiis iievaluated iiin iithe iioffice iifor iia iihistory iiof iimigraine, iiwith iiand
iiwithout iiaura, iisince iiage ii16 iiyears. iiShe iihas iian iiaverage iiof iithree iiattacks iieach
iimonth iiand iiconsistently iiexperiences iian iiattack ii2 iidays iiprior iito iimenstruation; iithis
iiheadache iiis iimore iidifficult iito iitreat iithan iithose iinot iiassociated iiwith iimenstruation.
iiAlthough iishe iitypically iiobtains iipain iirelief iiwithin ii2 iihours iiof iitaking iisumatriptan, iithe
iiheadache iirecurs iiwithin ii24 iihours iiafter iieach iidose iiduring iithe iiperiod iiof iimenstrual
iiflow. iiSumatriptan, iiorally iias iineeded, iiis iiher iionly iimedication.
Results iiof iiphysical iiexamination iiare iiunremarkable.
Which iiof iithe iifollowing iiis iithe iimost iiappropriate iiperimenstrual iitreatment iifor iithis
iipatient's iiheadaches?
A iiEstrogen-progestin iicontraceptive iipill
B iiMefenamic iiacid
C iiSumatriptan iiplus iinaproxen, iiorally
D iiSumatriptan, iisubcutaneously
E iiTopiramate ii- iiAnswers ii-B
Evidence iisupports iithe iiuse iiof iimefenamic iiacid iifor iiperimenstrual iiprophylaxis iiof
iimenstrually iirelated iimigraines, iiwith iitreatment iistarting ii2 iidays iiprior iito iithe iionset iiof
iiflow iior ii1 iiday iiprior iito iithe iiexpected iionset iiof iithe iiheadache iiand iicontinuing iifor iithe
iiduration iiof iimenstruation.
This iipatient iishould iibe iitreated iiwith iimefenamic iiacid. iiShe iihas iimigraine iiwith iiaura,
iimigraine iiwithout iiaura, iiand iimenstrually iirelated iimigraine. iiHer iimenstrually iirelated
iiheadaches iiare iiless iiresponsive iito iiacute iitherapy iithan iiare iithe iinon-menstrually
iirelated iiattacks, iiand iiheadache iirecurs iidaily iithroughout iimenses. iiThe iibest
iimanagement iifor iithis iipatient iiis, iitherefore, iithe iiperimenstrual iiuse iiof iia iiprophylactic
iiagent. iiThere iiis iievidence iithat iisupports iithe iiuse iiof iimefenamic iiacid iifor
iiperimenstrual iiprophylaxis, iiwith iitreatment iistarting ii2 iidays iiprior iito iithe iionset iiof iiflow
iior ii1 iiday iiprior iito iithe iiexpected iionset iiof iithe iiheadache iiand iicontinuing iifor iithe
iiduration iiof iimenstruation. iiIn iithis iipatient, iithat iiwould iimean iibeginning ii3 iidays iibefore
iithe iionset iiof iimenstrual iiflow iiand iicontinuing iithroughout iimenstruation.
, The iiuse iiof iicombined iioral iicontraceptive iitherapy ii(estrogen iiplus iiprogestin) iiis
iicontraindicated iiin iithis iiwoman iibecause iiof iiher iihistory iiof iimigraine iiwith iiaura.
iiWomen iiwith iimigraine iiwith iiaura iiare iiat iia iitwo-fold iiincreased iirisk iiof iiischemic
iistroke, iiischemic iimyocardial iiinfarction, iiand iivenous iithromboembolism. iiThe iirisk iiof
iistroke iiis iiincreased iifurther, iiup iito iieight-fold, iiin iiwomen iiwith iimigraine iiwith iiaura
iiwho iiuse iicombined iioral iicontraceptive iipills.
No iievidence iisupports iithe iioral iiuse iiof iieither iisumatriptan iiplus iinaproxen iisodium iior
iitopiramate iifor iithe iiperimenstrual iiprophylaxis iiof iimenstrually iirelated iimigraine.
iiSimilarly, iithere iiis iino iievidence iisupporting iithe iisubcutaneous iiuse iiof iisumatriptan iiin
iithis iisetting. iiIn iifact, iithe iihigher iirecurrence iirate iiwith iithe iisubcutaneous iiformulation
iimay iiprove iicounterproductive.
Neuro ii4
A ii52-year-old iiwoman iiis iievaluated iifor iia ii2-year iihistory iiof iiburning iifeet. iiSymptoms
iiare iiconstant iiand iiare iiworse iiat iinight. iiThe iipatient iiis iioverweight iiand iihas iia iihistory
iiof iihypertension iitreated iiwith iilisinopril. iiThere iiis iino iiknown iifamily iihistory iiof
iiperipheral iineuropathy.
On iiphysical iiexamination, iithe iipatient iiis iiafebrile; iiblood iipressure iiis ii134/88 iimm iiHg,
iipulse iirate iiis ii66/min, iirespiration iirate iiis ii12/min, iiand iiBMI iiis ii28. iiNeurologic
iiexamination iishows iidiminished iipinprick iiand iitemperature iisensation iion iithe iidorsal
iiand iiplantar iisurfaces iiof iiboth iifeet. iiCranial iinerve iiexamination iiand iitesting iiof
iimanual iimuscle iistrength, iideep iitendon iireflexes, iiproprioception, iiand iicoordination
iireveal iino iiabnormalities.
Laboratory iistudies iishow iia iifasting iiplasma iiglucose iilevel iiof ii102 iimg/dL ii(5.7
iimmol/L). iiResults iiof iia iicomplete iiblood iicount, iivitamin iiB12 iimeasurement, iiand
iiserum iiprotein iielectrophoresis iiare iiall iinormal.
Electromyographic iitesting iishows iia iimild iireduction ii- iiAnswers ii-C
A iihistory iiof iiburning iior iilancinating iidistal iiextremity iipain iiand iiexamination iifindings
iishowing iionly iisensory iiloss iisuggest iia iismall-fiber iiperipheral iineuropathy, iiwhich iiis
iimost iifrequently iiassociated iiwith iidiabetes iimellitus iiand iiimpaired iiglucose iitolerance.
A ii2-hour iiglucose iitolerance iitest iito iidetect iidiabetes iimellitus iior iiimpaired iiglucose
iitolerance iiis iithe iimost iiappropriate iinext iidiagnostic iistudy iifor iithis iipatient. iiThe
iipatient's iihistory iiof iiburning iifeet, iiin iiconjunction iiwith iineurologic iiexamination iifindings
iishowing iionly iidistal iisensory iiloss ii(with iinormal iireflexes iiand iimuscle iistrength),
iisuggests iia iismall-fiber iiperipheral iineuropathy. iiThe iimost iicommon iiidentifiable iicause
iiof iismall-fiber iiperipheral iineuropathy iiis iidiabetes iior iiimpaired iiglucose iitolerance. iiThis
iipatient's iifasting iiplasma iiglucose iilevel, iiwhich iiis iijust iiover iithe iiupper iilimit iiof iinormal,
iishould iiprompt iia ii2-hour iiglucose iitolerance iitest. iiThis iitest iiis iimore iisensitive iiand
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