Cerebrovascular Disease USMLE Step 1 Practice Question
A 52-year-old woman with a history of migraine with aura presents to the emergency department with acute onset of right-sided weakness and numbness. Her symptoms completely resolved within 25 minutes of onset. Vital signs are: BP 156/94 mmHg, HR 82/min, RR 14/min, temperature 37.2°C, SpO2 99% on room air. Neurologic examination is now normal. Brain MRI including diffusion-weighted imaging shows no acute infarction. The patient denies recent cocaine or amphetamine use, has no recent surgical procedures, and is not pregnant. CT angiography of the head demonstrates segmental narrowing of the anterior and middle cerebral arteries bilaterally. Which of the following findings would most strongly support a diagnosis of reversible cerebral vasoconstriction syndrome (RCVS) rather than a transient ischemic attack (TIA)?
Answer choices
- ARecurrent thunderclap headaches occurring over the next 1-2 weeks with repeated episodes of focal neurologic symptoms
- BElevated serum homocysteine level and positive anticardiolipin antibodies on repeat testing
- CDetection of atrial fibrillation on continuous cardiac monitoring
- DPositive human immunodeficiency virus serology with CD4 count of 45 cells/μL
- ECerebral angiography demonstrating segmental vasoconstriction involving multiple major cerebral arteries with normal vessel caliber interspersed between narrowed segmentsCorrect answer
- FHigh-intensity transient signals on transcranial Doppler ultrasound and elevated mean flow velocity
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