Neurology Practice Questions

Q: Which of the following is NOT a feature of corticospinal tract involvement?

Cog-wheel rigidity. The **Corticospinal tract (CST)** is the primary Upper Motor Neuron (UMN) pathway responsible for voluntary motor control. Lesions involving the CST result in a **UMN syndrome**, characterized by a loss of inhibitory control over spinal reflexes. ### Why Cog-wheel Rigidity is the Correct Answer **Cog-wheel rigidity** is a hallmark of **Extrapyramidal system** involvement (specifically the Basal Ganglia), not the Corticospinal tract. It is typically seen in Parkinson’s disease and results from a combination of lead-pipe rigidity and a resting tremor. Unlike UMN lesions, extrapyramidal lesions do not typically cause weakness or changes in deep tendon reflexes. ### Explanation of Incorrect Options (Features of CST Lesions) * **Spasticity:** This is a velocity-dependent increase in muscle tone (clasp-knife type) seen in UMN lesions due to the loss of descending inhibition on the gamma motor neurons. * **Plantar extensor response (Babinski sign):** This is the most reliable sign of a CST lesion. In adults, the normal response is flexor; an extensor response indicates damage to the pyramidal tract. * **Exaggerated deep tendon reflexes (Hyperreflexia):** Damage to the CST removes the inhibitory influence on the monosynaptic stretch reflex arc, leading to brisk reflexes and potentially clonus. ### High-Yield Clinical Pearls for NEET-PG * **Pyramidal vs. Extrapyramidal:** Pyramidal (CST) lesions cause **spasticity** (clasp-knife, velocity-dependent), while Extrapyramidal (Basal Ganglia) lesions cause **rigidity** (lead-pipe or cog-wheel, uniform throughout movement). * **UMN vs. LMN:** UMN lesions show hyperreflexia and hypertonia; Lower Motor Neuron (LMN) lesions show atrophy, fasciculations, and hyporeflexia. * **The "Rule of Thumb":** If the question mentions "Babinski sign" or "Clasp-knife," think Corticospinal Tract. If it mentions "Tremor" or "Cog-wheel," think Basal Ganglia.

Q: The only intact eye movement in one and a half syndrome is?

Abduction of the contralateral eye. **Explanation:** **One-and-a-half syndrome** is a clinical condition caused by a single lesion in the **dorsal pontine tegmentum**. This lesion involves two critical structures: 1. **The Ipsilateral Parapontine Reticular Formation (PPRF)** or Abducens nucleus: Leading to an ipsilateral horizontal gaze palsy (the "one"). 2. **The Ipsilateral Medial Longitudinal Fasciculus (MLF):** Leading to an Internuclear Ophthalmoplegia (INO) in the ipsilateral eye (the "half"). **Why the correct answer is right:** * **Option B (Abduction of the contralateral eye):** This is the only movement preserved because the contralateral PPRF and the contralateral Abducens nerve (VI) are intact. When the patient attempts to look towards the side opposite the lesion, the contralateral eye can still abduct. However, it often exhibits **dissociated nystagmus** due to the associated INO. **Why the incorrect options are wrong:** * **Option A & C (Ipsilateral eye):** The ipsilateral eye is completely "frozen" in the horizontal plane. It cannot abduct (due to the PPRF/VI nucleus lesion) and cannot adduct (due to the MLF lesion). * **Option D (Adduction of the contralateral eye):** Adduction of the contralateral eye requires the ipsilateral MLF to be intact. Since the ipsilateral MLF is damaged, the signal cannot reach the contralateral eye's medial rectus during horizontal gaze. **High-Yield Clinical Pearls for NEET-PG:** * **Lesion Site:** Dorsal pontine tegmentum. * **Common Causes:** Multiple Sclerosis (younger patients) or Pontine Stroke (older patients). * **Clinical Presentation:** The patient presents with a "frozen" ipsilateral eye and a contralateral eye that can only abduct (with nystagmus). * **Convergence:** Usually **preserved** because the pathway for convergence bypasses the MLF and PPRF.

Q: Examination of a patient shows abducens nerve paresis, ipsilateral facial nerve paresis, and contralateral hemiparesis. What is the most likely diagnosis in this patient?

Millard Gubler syndrome. ### Explanation **Millard-Gubler Syndrome** is a classic **ventral pontine syndrome** caused by a lesion (typically vascular or neoplastic) in the lower part of the pons. **1. Why the correct answer is right:** The syndrome is characterized by the involvement of three key structures: * **Abducens Nerve (CN VI) fibers:** Results in **ipsilateral** lateral rectus palsy (inability to abduct the eye). * **Facial Nerve (CN VII) fibers:** Results in **ipsilateral** lower motor neuron (LMN) type facial paralysis [1]. * **Corticospinal Tract:** Since the fibers have not yet decussated (they cross at the medulla), a lesion here results in **contralateral hemiparesis** of the limbs [1]. **2. Why the other options are incorrect:** * **Raymond’s Syndrome:** This is also a ventral pontine syndrome but is more restricted. It involves the **CN VI** and the **Corticospinal tract**, but **spares the Facial Nerve (CN VII)**. * **Foville’s Syndrome:** This involves the **dorsal** tegmentum of the lower pons. While it includes CN VII and hemiparesis, its hallmark is the involvement of the **PPRF (Parabedian Pontine Reticular Formation)**, leading to **ipsilateral conjugate gaze palsy** (the patient cannot look toward the side of the lesion). **3. Clinical Pearls for NEET-PG:** * **Rule of 4s:** Remember that CN 5, 6, 7, and 8 are located in the **Pons**. * **Crossed Hemiplegia:** Any syndrome presenting with an ipsilateral cranial nerve palsy and contralateral hemiparesis indicates a **Brainstem lesion**. * **Millard-Gubler vs. Foville:** If the question mentions "gaze palsy," think Foville; if it mentions "facial palsy + abducens palsy + hemiparesis," think Millard-Gubler.

Q: Symmetrical areflexic bladder, bowel, and lower limb dysfunction occurs in which of the following conditions?

Conus medullaris syndrome. The key to distinguishing between spinal cord syndromes lies in the **symmetry** and the **level of the lesion**. **1. Why Conus Medullaris Syndrome is Correct:** The conus medullaris is the tapered terminal end of the spinal cord (ending at L1-L2). Because it is a compact area containing the sacral and coccygeal segments, a lesion here typically results in **symmetrical** and **bilateral** involvement. It presents with sudden onset of bladder and bowel dysfunction (autonomic centers are located here) and "saddle anesthesia." Since it involves the terminal cord, it presents with **Lower Motor Neuron (LMN)** signs like areflexia. **2. Why the other options are incorrect:** * **Cauda Equina Syndrome:** This involves a bundle of nerve roots below the cord. It is characterized by **asymmetrical** motor weakness and sensory loss, with a more gradual onset of bladder/bowel symptoms compared to conus medullaris syndrome. * **Nerve Root Damage:** This typically presents with radiculopathy in a specific dermatomal or myotomal distribution, usually unilateral and rarely causing symmetrical total bladder/bowel dysfunction. * **Brown-Séquard Syndrome:** This is a hemisection of the spinal cord. It presents with **asymmetrical** findings: ipsilateral loss of motor function/proprioception and contralateral loss of pain/temperature. **Clinical Pearls for NEET-PG:** * **Level:** Conus Medullaris (L1-L2); Cauda Equina (L2-Sacrum). * **Symmetry:** Conus is **Symmetrical**; Cauda Equina is **Asymmetrical**. * **Reflexes:** Both show LMN signs (areflexia), but the **Ankle Jerk** is specifically lost in Conus Medullaris lesions. * **Onset:** Conus Medullaris symptoms are sudden/abrupt; Cauda Equina is gradual.

Question 1

Which of the following is NOT a feature of corticospinal tract involvement?

Accepted Answer

Cog-wheel rigidity

Answer

Spasticity

Answer

Plantar extensor response

Answer

Exaggerated deep tendon reflexes

Question 2

Which of the following is a cause of reversible dementia?

Accepted Answer

Subacute combined degeneration.

Answer

Picks disease.

Answer

Creutzfeldt-Jakob disease.

Answer

Alzheimer's disease.

Question 3

What distinguishes cervical transverse myelitis with spinal shock from Guillain-Barré syndrome?

Accepted Answer

A sharp level of demarcation of sensory and motor symptoms exists.

Answer

Hypotonia is present.

Answer

Decreased stretch and superficial reflexes are observed.

Answer

Absent neuropathic pain occurs.

Question 4

A 50-year-old male patient presents to the emergency department with right hemiparesis and loss of speech for 2.5 hours. His blood pressure is 180/100 mmHg. What is the next best step in the management of this patient?

Accepted Answer

Perform non-contrast computed tomography (NCCT) of the brain

Answer

Administer antihypertensives to control blood pressure

Answer

Administer aspirin and anticoagulants

Answer

Administer tissue plasminogen activator

Question 5

Alternating hemiplegia is best described as?

Accepted Answer

A neurological deficit involving limbs on one side and cranial nerves on the other side

Answer

A neurological deficit involving pairs of cranial nerves

Answer

A neurological deficit involving four limbs (quadriplegia)

Answer

Neurological deficits involving cranial nerves and limbs on the same side

Question 6

Alpha Coma is seen in which condition?

Accepted Answer

Diffuse cortical damage

Answer

Hyperthermia

Answer

Neurosarcoidosis

Answer

Critical illness polyneuropathy

Question 7

The only intact eye movement in one and a half syndrome is?

Accepted Answer

Abduction of the contralateral eye

Answer

Abduction of the ipsilateral eye

Answer

Adduction of the ipsilateral eye

Answer

Adduction of the contralateral eye

Question 8

Examination of a patient shows abducens nerve paresis, ipsilateral facial nerve paresis, and contralateral hemiparesis. What is the most likely diagnosis in this patient?

Accepted Answer

Millard Gubler syndrome

Answer

Foville's syndrome

Answer

Raymond's syndrome

Answer

None of the above

Question 9

Symmetrical areflexic bladder, bowel, and lower limb dysfunction occurs in which of the following conditions?

Accepted Answer

Conus medullaris syndrome

Answer

Cauda equina syndrome

Answer

Nerve root damage

Answer

Brown-Séquard syndrome

Question 10

An elderly man presents with ataxic hemiparesis. What is the most likely diagnosis?

Accepted Answer

Cerebellar hemorrhage

Answer

Acute ischemic stroke

Answer

Friedreich's ataxia

Answer

Spinal hemisection

Neurology — MCQs

Neurology — MCQs

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