Stuttering — MCQs
Which of the following speech patterns is most indicative of Wernicke's aphasia?
Frontal gyrus lesion leads to?
Which of the following is a CORE diagnostic criterion of autistic spectrum disorder according to DSM-5?
What is Broca's aphasia?
A two year old girl child is brought to the out patient with features of hand wringing stereotype movements, impaired language and communication development, breath holding spells, poor social skills and deceleration of head growth after 6 months of age. The most likely diagnosis is –
Dysdiadochokinesia refers to:
Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
Brainstem Evoked Response Audiometry (BERA) can be most accurately performed from which gestational age?
Which test can be used to assess middle ear deafness?
Otoacoustic emissions arise from which cells?
Stuttering Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following speech patterns is most indicative of Wernicke's aphasia?
- A. Normal speech with comprehension
- B. Non-fluent speech with intact comprehension
- C. Fluent but nonsensical speech (Correct Answer)
- D. Speech with meaningful content
Explanation: ***Fluent but nonsensical speech*** - Wernicke's aphasia is characterized by **fluent**, often grammatically correct, speech that is **devoid of meaning** and often includes **paraphasias** (word substitutions) and **neologisms** (made-up words). - Patients have significant **comprehension deficits**, making meaningful conversation difficult despite preserved speech fluency. - This is also known as **receptive aphasia** or **sensory aphasia**, caused by damage to Wernicke's area in the superior temporal gyrus. *Normal speech with comprehension* - This describes **healthy speech patterns**, where both production and understanding of language are intact. - It directly contradicts the definition of **aphasia**, which involves impairment in language abilities. *Non-fluent speech with intact comprehension* - This describes **Broca's aphasia** (expressive aphasia), where speech production is effortful and halting. - Unlike Wernicke's aphasia, patients with Broca's aphasia have **preserved comprehension** but struggle with speech output. - The key differentiator is that Wernicke's has **fluent speech with poor comprehension**, while Broca's has **non-fluent speech with good comprehension**. *Speech with meaningful content* - This indicates that the speaker can convey understandable and relevant information, which is precisely what is lacking in **Wernicke's aphasia**. - In Wernicke's aphasia, the content is typically **empty** or **circumlocutory**, making it difficult to extract any coherent meaning.
Question 2: Frontal gyrus lesion leads to?
- A. Nominal aphasia
- B. Akinetic mutism
- C. Wernicke's aphasia
- D. Broca's aphasia (Correct Answer)
Explanation: ***Broca's aphasia*** - A lesion in the **frontal gyrus**, specifically **Broca's area** (Brodmann areas 44 and 45), leads to Broca's aphasia [1]. - This condition is characterized by **non-fluent speech**, difficulty with articulation, and telegraphic sentences, while comprehension remains relatively intact [1]. *Nominal aphasia* - This is also known as **anomic aphasia**, characterized primarily by difficulty with **word finding** (naming objects). - It results from lesions in various cortical areas, but typically not isolated to Broca's area in the frontal gyrus. *Akinetic mutism* - This condition involves a state of **unresponsiveness** where the patient is awake but does not move or speak. - It usually results from lesions in the **cingulate gyrus**, basal ganglia, or medial frontal lobes, often bilateral, not typically a solitary frontal gyrus lesion. *Wernicke's aphasia* - Wernicke's aphasia results from damage to **Wernicke's area**, located in the **posterior superior temporal gyrus** [1]. - It is characterized by **fluent but nonsensical speech** with impaired comprehension [1].
Question 3: Which of the following is a CORE diagnostic criterion of autistic spectrum disorder according to DSM-5?
- A. Impaired communication (Correct Answer)
- B. Impaired imagination
- C. Language developmental delay
- D. Vision problems
Explanation: ***Impaired communication*** - Deficits in **social communication and social interaction** are one of the two core diagnostic criteria for Autism Spectrum Disorder (ASD) in DSM-5. - This includes deficits in social-emotional reciprocity, nonverbal communicative behaviors, and developing/maintaining relationships. - Communication impairments are essential for diagnosis and must be present across multiple contexts. *Impaired imagination* - While restricted, repetitive patterns of behavior (which can include rigid thinking patterns) are the second core criterion, "impaired imagination" is not specifically listed as a core diagnostic criterion in DSM-5. - Imaginative play deficits may be present but fall under the broader category of restricted/repetitive behaviors, not as a standalone core criterion. *Language developmental delay* - Language delay is **not a core diagnostic criterion** in DSM-5 for ASD. - DSM-5 explicitly states that ASD can occur with or without accompanying language impairment. - When present, language delay is noted as a specifier, not a required criterion. *Vision problems* - Vision problems are not a characteristic feature of Autism Spectrum Disorder. - Any vision issues in individuals with ASD are co-occurring conditions unrelated to the core diagnostic features.
Question 4: What is Broca's aphasia?
- A. Fluent aphasia
- B. Sensory aphasia
- C. Conduction aphasia
- D. Non-fluent aphasia (Correct Answer)
Explanation: ***Non-fluent aphasia*** - Broca's aphasia is characterized by **non-fluent speech**, meaning speech is effortful, slow, and consists of short phrases with many pauses. [1] - Patients typically have **relatively preserved comprehension** but significant difficulty with speech production and repetition. [1] *Fluent aphasia* - This describes conditions like **Wernicke's aphasia**, where speech is fluent but often lacks meaning. [1] - Patients with fluent aphasia typically have **poor comprehension**, which is not the primary feature of Broca's aphasia. *Sensory aphasia* - This is another term for **Wernicke's aphasia**, primarily characterized by **impaired comprehension** of spoken and written language. - While it involves language deficits, the core issue is receptive, not expressive as in Broca's aphasia. *Conduction aphasia* - Conduction aphasia is characterized by **impaired repetition** despite relatively fluent speech and good comprehension. [1] - It results from damage to the **arcuate fasciculus**, connecting Broca's and Wernicke's areas. [1]
Question 5: A two year old girl child is brought to the out patient with features of hand wringing stereotype movements, impaired language and communication development, breath holding spells, poor social skills and deceleration of head growth after 6 months of age. The most likely diagnosis is –
- A. Rett's syndrome (Correct Answer)
- B. Asperger's syndrome
- C. Fragile x–syndrome
- D. Colorado syndrome
Explanation: ***Rett's syndrome*** - The constellation of **hand-wringing stereotype movements**, language impairment, poor social skills, and **deceleration of head growth** after 6 months of age in a female child is highly characteristic of Rett's syndrome. - This neurodevelopmental disorder is almost exclusively seen in girls and is caused by a mutation in the **MECP2 gene**. *Asperger's syndrome* - Asperger's syndrome (now part of **Autism Spectrum Disorder**) typically presents with difficulties in social interaction and nonverbal communication, alongside restricted and repetitive patterns of behavior and interests. - However, it does not usually involve **seizures, loss of purposeful hand use, or acquired microcephaly**, which are key features of Rett's syndrome. *Fragile x–syndrome* - Fragile X syndrome is a genetic condition causing intellectual disability, most commonly in males, characterized by a **long face, prominent jaw and ears**, and **macroorchidism** (large testicles) in post-pubertal males. - It does not specifically feature the unique hand stereotypes or decelerated head growth seen in Rett's syndrome. *Colorado syndrome* - **Colorado syndrome** is not a recognized medical diagnosis for such a clinical presentation. - The symptoms described do not align with any known neurological or developmental disorder named "Colorado syndrome."
Question 6: Dysdiadochokinesia refers to:
- A. Inability to Perform Rapid Alternating Movements (Correct Answer)
- B. Intention Tremor
- C. Tremor of the Eyeballs
- D. Failure of Progression in Talking
Explanation: ***Inability to Perform Rapid Alternating Movements*** - **Dysdiadochokinesia** is a neurological sign indicating an impaired ability to perform **rapid alternating movements**, such as pronation and supination of the forearms [1]. - It is a key indicator of **cerebellar dysfunction**, as the cerebellum is responsible for coordinating the rate, range, and force of movements [1]. *Intention Tremor* - An **intention tremor** is a tremor that worsens during purposeful movement towards a target, not a difficulty with alternating movements themselves. - While also a sign of **cerebellar damage**, it manifests as oscillations during voluntary action, distinct from dysdiadochokinesia. *Tremor of the Eyeballs* - This condition is known as **nystagmus**, which refers to involuntary rhythmic eye movements [2]. - While nystagmus can be associated with **cerebellar dysfunction**, it is a distinct sign separate from the ability to perform rapid alternating limb movements [2]. *Failure of Progression in Talking* - This symptom is characteristic of **dysarthria**, a motor speech disorder that impacts articulation, phonation, and prosody [2]. - While certain types of dysarthria can be linked to **cerebellar disease**, "failure of progression in talking" specifically describes speech difficulties, not the coordination of limb movements [2].
Question 7: Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
- A. Statements 1 & 2 are correct, 2 is not explaining 1 (Correct Answer)
- B. Statements 1 and 2 are correct and 2 is the correct explanation for 1
- C. Statements 1 and 2 are incorrect
- D. Statement 1 is incorrect
Explanation: ***Correct: Statements 1 & 2 are correct, 2 is not explaining 1*** **Analysis of Statement 1:** - A 59-year-old patient with **flaccid bullae** and **suprabasal acantholytic split** on histopathology is the classic presentation of **Pemphigus vulgaris** - The flaccid (easily ruptured) nature of bullae distinguishes it from tense bullae seen in bullous pemphigoid - The suprabasal location of the split (just above the basal layer) with acantholysis (loss of cell-to-cell adhesion) is pathognomonic - **Statement 1 is CORRECT** ✓ **Analysis of Statement 2:** - The **"row of tombstones" or "tombstone appearance"** is indeed a diagnostic histopathological feature of Pemphigus vulgaris - This appearance results from basal keratinocytes remaining attached to the basement membrane while suprabasal cells separate due to acantholysis - The intact basal cells standing upright resemble a row of tombstones - **Statement 2 is CORRECT** ✓ **Does Statement 2 explain Statement 1?** - Statement 2 describes a **histopathological appearance** (tombstone pattern) that is a **consequence** of the suprabasal split - However, it does NOT explain the **underlying cause** of the flaccid bullae or the suprabasal split - The true explanation involves **IgG autoantibodies against desmoglein 3 (and desmoglein 1)**, which attack intercellular adhesion structures (desmosomes), causing **acantholysis** - Therefore, **Statement 2 does NOT explain Statement 1** ✗ *Incorrect: Statement 2 is the correct explanation for Statement 1* - While both statements describe features of Pemphigus vulgaris, the tombstone appearance is a descriptive finding, not an explanatory mechanism *Incorrect: Statements 1 and 2 are incorrect* - Both statements are medically accurate descriptions of Pemphigus vulgaris features *Incorrect: Statement 1 is incorrect* - Statement 1 correctly describes the cardinal clinical and histopathological features of Pemphigus vulgaris
Question 8: Brainstem Evoked Response Audiometry (BERA) can be most accurately performed from which gestational age?
- A. 30 weeks
- B. 32 weeks
- C. 34 weeks (Correct Answer)
- D. 28 weeks
Explanation: **Explanation:** Brainstem Evoked Response Audiometry (BERA), also known as ABR, is an objective electrophysiological test used to assess the integrity of the auditory pathway from the cochlear nerve to the brainstem. **Why 34 weeks is correct:** The auditory system undergoes significant maturation during the third trimester. While the inner ear (cochlea) reaches adult size by 20 weeks of gestation, the **myelination** of the auditory nerve and the brainstem pathways—essential for conducting electrical impulses—is only sufficiently developed to produce a consistent, reproducible, and interpretable BERA waveform by **34 weeks of gestation**. Before this period, the waves are often absent, inconsistent, or have excessively prolonged latencies. **Analysis of Incorrect Options:** * **28 & 30 weeks:** At this stage, the fetus may show a startle response to loud sounds, but the neural pathways are too immature (lack of myelination) to yield a reliable BERA recording. * **32 weeks:** While some rudimentary waves may appear, they are often unstable. 34 weeks is the clinically accepted threshold for "accurate" and standardized testing. **High-Yield Clinical Pearls for NEET-PG:** * **Waveforms:** BERA consists of 7 waves, but **Waves I, III, and V** are the most clinically significant. * **Wave V:** This is the most robust wave and is used to determine the **hearing threshold** (the lowest intensity at which Wave V is visible). * **Site of Origin:** Wave I (Distal 8th Nerve), Wave II (Proximal 8th Nerve), Wave III (Cochlear Nucleus), Wave IV (Superior Olivary Complex), Wave V (Lateral Lemniscus/Inferior Colliculus). * **Indications:** Newborn hearing screening (gold standard), diagnosing acoustic neuroma (retrocochlear lesions), and determining hearing thresholds in uncooperative patients.
Question 9: Which test can be used to assess middle ear deafness?
- A. Babinski test
- B. Chvostek test
- C. Finger-nose test
- D. Weber's test (Correct Answer)
Explanation: **Explanation:** **Weber’s test** is a tuning fork test used to evaluate hearing loss by assessing bone conduction. In a patient with **middle ear deafness (conductive hearing loss)**, the sound lateralizes to the **affected (poorer) ear**. This occurs because the conductive defect masks ambient room noise, making the cochlea on that side more sensitive to the bone-conducted vibrations of the tuning fork. In contrast, in sensorineural hearing loss, the sound lateralizes to the better ear. **Analysis of Incorrect Options:** * **Babinski test:** A neurological reflex test where stroking the sole of the foot causes big toe extension. It indicates upper motor neuron (UMN) lesions. * **Chvostek test:** A clinical sign of hypocalcemia elicited by tapping the facial nerve at the angle of the jaw, resulting in twitching of facial muscles. * **Finger-nose test:** A test of cerebellar function used to assess dysmetria and coordination. **Clinical Pearls for NEET-PG:** * **Tuning Fork Frequency:** 512 Hz is the gold standard for clinical testing as it provides a balance between bone conduction and minimal tactile vibration. * **Rinne’s Test:** In conductive hearing loss, Rinne is **Negative** (Bone Conduction > Air Conduction). In sensorineural loss, Rinne is **Positive** (AC > BC). * **Gelle’s Test:** Specifically used to diagnose **Otosclerosis** (assesses ossicular chain mobility). * **ABC (Absolute Bone Conduction) Test:** Used to differentiate between normal hearing and sensorineural hearing loss by bypassing the external/middle ear.
Question 10: Otoacoustic emissions arise from which cells?
- A. Outer hair cells (Correct Answer)
- B. Inner hair cells
- C. Both
- D. Organ of Corti
Explanation: **Explanation:** **Otoacoustic Emissions (OAEs)** are low-intensity sounds generated within the cochlea that can be measured in the external auditory canal. 1. **Why Outer Hair Cells (OHCs) are correct:** OHCs possess a unique property called **electromotility**. Unlike Inner Hair Cells, which are primarily sensory, OHCs contain a motor protein called **prestin**. This allows them to physically contract and expand in response to sound, acting as a "cochlear amplifier." This mechanical movement creates a pressure wave that travels backward through the middle ear and vibrates the tympanic membrane, resulting in the sound we record as an OAE. 2. **Why other options are incorrect:** * **Inner Hair Cells (IHCs):** These are the primary sensory receptors that convert mechanical vibrations into electrical signals for the auditory nerve. They lack electromotility and do not generate OAEs. * **Organ of Corti:** While OHCs are *part* of the Organ of Corti, this option is too broad. The question specifically asks for the cellular origin. * **Both:** Incorrect because the physiological mechanism (electromotility) is exclusive to the OHCs. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Use:** OAEs are the gold standard for **Universal Newborn Hearing Screening (UNHS)** because they are non-invasive, objective, and rapid. * **Requirement:** For OAEs to be recorded, the **middle ear must be normal** (no effusion or ossicular pathology). * **Interpretation:** A "Pass" on OAE indicates hearing thresholds of **30 dB or better**. It does not rule out retrocochlear pathology (e.g., Auditory Neuropathy Spectrum Disorder), as OAEs will be present even if the auditory nerve is damaged. * **Types:** **Spontaneous OAEs** (occur in 50% of normal ears) and **Evoked OAEs** (Transient or Distortion Product), which are used clinically.
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