Neurology: neuromyelitis optica spectrum disorder: 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: neuromyelitis optica spectrum disorder

Sample item

A 30-year-old woman has severe bilateral visual loss over a week, followed by a transverse myelitis whose MRI lesion spans five vertebral segments, and intractable vomiting and hiccups. Which antibody is most likely to be found?

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

The answer and the reasoning

D. Anti-aquaporin-4 IgG

Neuromyelitis optica spectrum disorder is an autoimmune astrocytopathy directed against aquaporin-4 water channels, causing severe optic neuritis, longitudinally extensive transverse myelitis (three or more segments) and area postrema syndrome with vomiting and hiccups. Treatment of relapses is with high-dose steroids or plasma exchange, and long-term immunosuppression, which differs from multiple sclerosis therapy.

Option by option

  • A. Anti-acetylcholine receptor antibody

    Anti-acetylcholine receptor antibody causes myasthenia gravis, which does not cause myelitis.

  • B. Anti-NMDA receptor antibody

    Anti-NMDA receptor antibody causes encephalitis with psychiatric features, seizures and dyskinesias.

  • C. Anti-GAD65 antibody

    Anti-GAD65 antibody is linked to stiff person syndrome and cerebellar ataxia.

  • D. Anti-aquaporin-4 IgG (correct)

    Correct. Anti-aquaporin-4 antibody defines this disorder.

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.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Anti-aquaporin-4 IgG. Neuromyelitis optica spectrum disorder is an autoimmune astrocytopathy directed against aquaporin-4 water channels, causing severe optic neuritis, longitudinally extensive transverse myelitis (three or more segments) and area postrema syndrome with vomiting and hiccups.

Why is "Anti-acetylcholine receptor antibody" not the answer?

Anti-acetylcholine receptor antibody causes myasthenia gravis, which does not cause myelitis.

Why is "Anti-NMDA receptor antibody" not the answer?

Anti-NMDA receptor antibody causes encephalitis with psychiatric features, seizures and dyskinesias.

Why is "Anti-GAD65 antibody" not the answer?

Anti-GAD65 antibody is linked to stiff person syndrome and cerebellar ataxia.

What concept does this question test?

It tests Neurology: neuromyelitis optica spectrum disorder in General Medicine. Treatment of relapses is with high-dose steroids or plasma exchange, and long-term immunosuppression, which differs from multiple sclerosis therapy.

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: neuromyelitis optica spectrum disorder?

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.