Neurology: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Neurology

Sample item

A 62-year-old heavy smoker has proximal leg weakness, dry mouth and erectile dysfunction. Strength improves briefly after sustained contraction, and reflexes are reduced. Repetitive nerve stimulation shows an incremental response at high frequency. Which is the most appropriate next investigation?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. CT chest to look for small cell lung cancer

Lambert-Eaton myasthenic syndrome is caused by antibodies against presynaptic voltage-gated calcium channels, impairing acetylcholine release. Weakness improves transiently with exertion, with autonomic features and an incremental response on high-frequency stimulation. About half of cases are paraneoplastic, mostly with small cell lung cancer.

Option by option

  • A. Muscle biopsy for dermatomyositis

    Dermatomyositis shows rash, raised creatine kinase and no autonomic features or incremental response.

  • B. Edrophonium test only

    Edrophonium testing is for myasthenia gravis, which shows decremental response and worsens with use.

  • C. MRI brain with contrast

    MRI brain does not address a neuromuscular junction disorder.

  • D. CT chest to look for small cell lung cancer (correct)

    Correct. Occult small cell lung cancer must be sought in LEMS.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, CT chest to look for small cell lung cancer. Lambert-Eaton myasthenic syndrome is caused by antibodies against presynaptic voltage-gated calcium channels, impairing acetylcholine release.

Why is "Muscle biopsy for dermatomyositis" not the answer?

Dermatomyositis shows rash, raised creatine kinase and no autonomic features or incremental response.

Why is "Edrophonium test only" not the answer?

Edrophonium testing is for myasthenia gravis, which shows decremental response and worsens with use.

Why is "MRI brain with contrast" not the answer?

MRI brain does not address a neuromuscular junction disorder.

What concept does this question test?

It tests Neurology in General Medicine. Weakness improves transiently with exertion, with autonomic features and an incremental response on high-frequency stimulation. About half of cases are paraneoplastic, mostly with small cell lung cancer.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neurology?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.