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 28-year-old woman has drooping eyelids and double vision that worsen by evening and improve after rest. Fatigable weakness is seen on sustained upgaze. Which antibody test is the most appropriate first confirmatory test?

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

The answer and the reasoning

B. Anti-acetylcholine receptor antibodies

Fatigable ocular weakness points to myasthenia gravis, an autoimmune disorder of the postsynaptic neuromuscular junction. Anti-acetylcholine receptor antibodies are present in most generalised cases and are the first serological test. Imaging of the thymus follows once the diagnosis is made.

Option by option

  • A. Anti-neutrophil cytoplasmic antibodies

    ANCA is associated with small-vessel vasculitis and has no link to neuromuscular transmission.

  • B. Anti-acetylcholine receptor antibodies (correct)

    Correct. These antibodies attack postsynaptic receptors and are the hallmark serological finding.

  • C. Anti-voltage-gated calcium channel antibodies

    These antibodies are found in the Lambert-Eaton myasthenic syndrome, where strength improves with repeated effort.

  • D. Anti-double-stranded DNA antibodies

    Anti-dsDNA is a marker of systemic lupus erythematosus and does not explain fatigable ptosis.

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 B, Anti-acetylcholine receptor antibodies. Fatigable ocular weakness points to myasthenia gravis, an autoimmune disorder of the postsynaptic neuromuscular junction.

Why is "Anti-neutrophil cytoplasmic antibodies" not the answer?

ANCA is associated with small-vessel vasculitis and has no link to neuromuscular transmission.

Why is "Anti-voltage-gated calcium channel antibodies" not the answer?

These antibodies are found in the Lambert-Eaton myasthenic syndrome, where strength improves with repeated effort.

Why is "Anti-double-stranded DNA antibodies" not the answer?

Anti-dsDNA is a marker of systemic lupus erythematosus and does not explain fatigable ptosis.

What concept does this question test?

It tests Neurology in General Medicine. Anti-acetylcholine receptor antibodies are present in most generalised cases and are the first serological test. Imaging of the thymus follows once the diagnosis is made.

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.