LATEST NEUROLOGY – NEUROMUSCULAR
MEDICINE CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PSYCHIATRY &
NEUROLOGY (ABPN) | COMPLETE EXAM Q&A
WITH RATIONALES
1. A 55-year-old male presents with a 3-month history
of progressive proximal muscle weakness (hip
flexion, shoulder abduction) and dysphagia. CK is
2500 U/L. EMG shows short-duration, small-amplitude
motor unit potentials with fibrillations. What is the
most likely diagnosis?
A) Polymyositis
B) Inclusion body myositis (IBM)
C) Muscular dystrophy
D) ALS
Correct answer: A
Rationale: Polymyositis: subacute proximal
weakness, elevated CK, myopathic EMG with
irritative changes. IBM has asymmetric, distal
involvement, and specific EMG features.
2. A 45-year-old male presents with a 2-year history
of progressive weakness of the right hand. He has
,thenar atrophy and weakness of thumb abduction.
Median sensory response is absent. EMG shows
prolonged median distal motor latency (6.5 ms). What
is the most likely diagnosis?
A) Carpal tunnel syndrome (severe)
B) Cervical radiculopathy C8-T1
C) Ulnar neuropathy
D) Brachial plexopathy
Correct answer: A
Rationale: CTS: prolonged median distal motor
latency, absent sensory response, thenar atrophy in
advanced cases.
3. A 35-year-old female presents with a 3-month
history of episodic diplopia and ptosis that worsens
with fatigue. Repetitive nerve stimulation (3 Hz)
shows a 15% decrement. What is the most likely
diagnosis?
A) Myasthenia gravis
B) Lambert-Eaton myasthenic syndrome (LEMS)
C) Botulism
D) Miller Fisher syndrome
Correct answer: A
,Rationale: Myasthenia gravis: fatigable weakness,
decrement on low-rate RNS (2-5 Hz). LEMS has
increment on high-rate RNS.
4. A 62-year-old male presents with a 2-year history
of progressive asymmetric hand weakness (finger
flexors, wrist extensors). He has a history of
dysphagia and quadriceps weakness. CK is 400 U/L.
EMG shows myopathic changes with long-duration
MUPs and early recruitment. What is the most likely
diagnosis?
A) Inclusion body myositis (IBM)
B) Polymyositis
C) ALS
D) Myotonic dystrophy
Correct answer: A
Rationale: IBM: insidious onset, asymmetric
weakness (finger flexors, quadriceps), dysphagia, CK
normal to mildly elevated, EMG shows mixed
myopathic and neurogenic features.
5. A 28-year-old female presents with a 2-week
history of acute ascending weakness, areflexia, and
facial diplegia. She had a diarrheal illness 2 weeks
ago. CSF shows elevated protein (120 mg/dL) with
, normal WBC. What is the most appropriate
treatment?
A) IV immunoglobulin (IVIG) or plasmapheresis
B) High-dose corticosteroids
C) Interferon beta
D) Rituximab
Correct answer: A
Rationale: Guillain-Barré syndrome (acute
inflammatory demyelinating polyneuropathy): IVIG or
plasmapheresis equally effective.
6. A 55-year-old male with a 10-year history of type 2
diabetes presents with burning feet pain, worse at
night. Neurologic exam shows reduced pinprick
sensation to the ankles. What is first-line
pharmacotherapy?
A) Duloxetine
B) Gabapentin
C) Amitriptyline
D) Pregabalin
Correct answer: A
Rationale: Diabetic peripheral neuropathy: duloxetine
(SNRI) or gabapentin/pregabalin are first-line.
MEDICINE CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PSYCHIATRY &
NEUROLOGY (ABPN) | COMPLETE EXAM Q&A
WITH RATIONALES
1. A 55-year-old male presents with a 3-month history
of progressive proximal muscle weakness (hip
flexion, shoulder abduction) and dysphagia. CK is
2500 U/L. EMG shows short-duration, small-amplitude
motor unit potentials with fibrillations. What is the
most likely diagnosis?
A) Polymyositis
B) Inclusion body myositis (IBM)
C) Muscular dystrophy
D) ALS
Correct answer: A
Rationale: Polymyositis: subacute proximal
weakness, elevated CK, myopathic EMG with
irritative changes. IBM has asymmetric, distal
involvement, and specific EMG features.
2. A 45-year-old male presents with a 2-year history
of progressive weakness of the right hand. He has
,thenar atrophy and weakness of thumb abduction.
Median sensory response is absent. EMG shows
prolonged median distal motor latency (6.5 ms). What
is the most likely diagnosis?
A) Carpal tunnel syndrome (severe)
B) Cervical radiculopathy C8-T1
C) Ulnar neuropathy
D) Brachial plexopathy
Correct answer: A
Rationale: CTS: prolonged median distal motor
latency, absent sensory response, thenar atrophy in
advanced cases.
3. A 35-year-old female presents with a 3-month
history of episodic diplopia and ptosis that worsens
with fatigue. Repetitive nerve stimulation (3 Hz)
shows a 15% decrement. What is the most likely
diagnosis?
A) Myasthenia gravis
B) Lambert-Eaton myasthenic syndrome (LEMS)
C) Botulism
D) Miller Fisher syndrome
Correct answer: A
,Rationale: Myasthenia gravis: fatigable weakness,
decrement on low-rate RNS (2-5 Hz). LEMS has
increment on high-rate RNS.
4. A 62-year-old male presents with a 2-year history
of progressive asymmetric hand weakness (finger
flexors, wrist extensors). He has a history of
dysphagia and quadriceps weakness. CK is 400 U/L.
EMG shows myopathic changes with long-duration
MUPs and early recruitment. What is the most likely
diagnosis?
A) Inclusion body myositis (IBM)
B) Polymyositis
C) ALS
D) Myotonic dystrophy
Correct answer: A
Rationale: IBM: insidious onset, asymmetric
weakness (finger flexors, quadriceps), dysphagia, CK
normal to mildly elevated, EMG shows mixed
myopathic and neurogenic features.
5. A 28-year-old female presents with a 2-week
history of acute ascending weakness, areflexia, and
facial diplegia. She had a diarrheal illness 2 weeks
ago. CSF shows elevated protein (120 mg/dL) with
, normal WBC. What is the most appropriate
treatment?
A) IV immunoglobulin (IVIG) or plasmapheresis
B) High-dose corticosteroids
C) Interferon beta
D) Rituximab
Correct answer: A
Rationale: Guillain-Barré syndrome (acute
inflammatory demyelinating polyneuropathy): IVIG or
plasmapheresis equally effective.
6. A 55-year-old male with a 10-year history of type 2
diabetes presents with burning feet pain, worse at
night. Neurologic exam shows reduced pinprick
sensation to the ankles. What is first-line
pharmacotherapy?
A) Duloxetine
B) Gabapentin
C) Amitriptyline
D) Pregabalin
Correct answer: A
Rationale: Diabetic peripheral neuropathy: duloxetine
(SNRI) or gabapentin/pregabalin are first-line.
