Neurology Practice Questions

Q: Which of the following is a characteristic feature of frontotemporal dementia?

Alzheimer's disease. **Explanation:** Frontotemporal Dementia (FTD) is a heterogeneous group of non-Alzheimer’s dementias characterized by the selective atrophy of the frontal and temporal lobes. **Why the Correct Answer is Right:** Wait, there appears to be a discrepancy in the provided key. **Alzheimer’s Disease (Option D)** is typically the primary differential diagnosis for FTD, but it is **not** a characteristic feature of FTD. In fact, FTD is distinguished from Alzheimer’s by an earlier age of onset (typically 45–65 years) and the preservation of visuospatial skills, which are lost early in Alzheimer’s [1], [2]. If the question asks for a "characteristic feature," Options A, B, and C are all subtypes or pathological variants of FTD, whereas Alzheimer's is a distinct clinical entity [1]. **Analysis of Options:** * **A. Pick’s Disease:** A pathological subtype of FTD characterized by "Pick bodies" (silver-staining tau inclusions). It is a classic feature of behavioral-variant FTD. * **B. Nonfluent Aphasia:** A clinical variant of FTD (Progressive Nonfluent Aphasia) where patients struggle with speech production and grammar but retain word comprehension. * **C. Semantic Dementia:** A clinical variant of FTD where patients lose the meaning of words and objects but maintain fluent speech. * **D. Alzheimer’s Disease:** This is a separate neurodegenerative disorder characterized by amyloid plaques and neurofibrillary tangles, primarily affecting memory and posterior cortical functions first [1]. **NEET-PG High-Yield Pearls:** 1. **Clinical Triad of FTD:** Behavioral changes (disinhibition), personality shifts, and language impairment [2]. 2. **Imaging:** "Knife-edge" atrophy of frontal and temporal lobes on MRI. 3. **Genetics:** Often associated with mutations in the **MAPT** (tau) or **GRN** (progranulin) genes. 4. **Key Distinction:** Unlike Alzheimer’s, memory is often relatively preserved in the early stages of FTD [1].

Q: Which of the following is NOT a feature of Medial medullary syndrome?

Horner's syndrome. **Medial Medullary Syndrome (Dejerine Syndrome)** occurs due to occlusion of the **anterior spinal artery** or the paramedian branches of the vertebral artery. To master this topic for NEET-PG, remember the "Rule of 4" for brainstem strokes: Medial syndromes involve the "M" structures (Motor pathway, Medial lemniscus, and Motor cranial nerve nuclei). ### Why Horner’s Syndrome is the Correct Answer: **Horner’s syndrome** (ptosis, miosis, anhidrosis) is caused by damage to the **descending sympathetic fibers** [1]. These fibers travel in the **lateral** aspect of the medulla. Therefore, Horner’s syndrome is a hallmark of **Lateral Medullary Syndrome (Wallenberg Syndrome)**, not medial. ### Explanation of Incorrect Options: * **Contralateral hemiparesis:** Caused by involvement of the **Corticospinal tract** (Pyramids) in the medial medulla. Since the fibers decussate lower down, the weakness occurs on the opposite side of the lesion [4]. * **Ipsilateral paralysis of the tongue:** The **Hypoglossal nerve (CN XII) nucleus** and its exiting fibers are located medially. Damage leads to lower motor neuron paralysis of the tongue, causing it to deviate *toward* the side of the lesion. * **Contralateral loss of proprioception:** The **Medial Lemniscus** carries fine touch, vibration, and conscious proprioception [2]. Damage here results in loss of these sensations on the opposite side of the body. ### High-Yield Clinical Pearls for NEET-PG: * **The Medial Medulla Triad:** 1. Contralateral Hemiparesis, 2. Contralateral loss of vibration/proprioception, 3. Ipsilateral CN XII palsy. * **Lateral Medullary Syndrome (Wallenberg):** Look for PICA occlusion, dysphagia (CN IX, X), and ipsilateral Horner’s [1][3]. * **Key Distinction:** Medial syndromes affect **Motor** functions; Lateral syndromes affect **Sensory** (pain/temp) and **Autonomic** functions.

Q: What is the least common symptom in Friedrich's ataxia?

Moderate mental retardation. **Explanation:** Friedreich’s Ataxia (FRDA) is an autosomal recessive trinucleotide repeat (GAA) disorder characterized by the degeneration of the spinocerebellar tracts, posterior columns, and pyramidal tracts. **Why "Moderate Mental Retardation" is the correct answer:** Cognitive function is typically **preserved** in Friedreich’s Ataxia. While some patients may exhibit mild executive dysfunction or slowed processing speed late in the disease course due to cerebellar-cerebral pathways, significant or moderate mental retardation is **not** a feature of the disease. This distinguishes it from many other neurodegenerative storage disorders. **Analysis of Incorrect Options:** * **Scoliosis:** This is a very common skeletal manifestation, occurring in approximately 75–80% of patients. it often precedes the onset of significant ataxia. * **Cardiac Abnormality:** Hypertrophic cardiomyopathy (specifically symmetric or asymmetric septal hypertrophy) is present in about 90% of patients and is the **most common cause of death**. * **Diabetes Mellitus:** Impaired glucose tolerance or frank Diabetes Mellitus occurs in about 10–20% of cases due to insulin resistance and pancreatic beta-cell dysfunction. **High-Yield Clinical Pearls for NEET-PG:** * **Genetics:** GAA repeat on Chromosome 9 (Frataxin gene), leading to mitochondrial iron overload. * **Clinical Triad:** Progressive limb and gait ataxia, absent lower limb reflexes (areflexia), and extensor plantar responses (Babinski sign). * **Other Features:** Pes cavus (high-arched feet), optic atrophy, and sensorineural hearing loss. * **Differential:** Unlike Vitamin E deficiency (which mimics FRDA), FRDA involves cardiomyopathy and skeletal deformities.

Q: A 50-year-old man presents with ataxia and abnormal eye movements. Examination reveals gaze palsy. MRI was performed. What is the most likely diagnosis?

Progressive supranuclear palsy. ***Progressive supranuclear palsy*** - **Gaze palsy** (especially vertical gaze) combined with **ataxia** is pathognomonic for PSP, distinguishing it from other movement disorders. - MRI typically shows the **"hummingbird sign"** due to **midbrain atrophy**, which is characteristic of PSP. *Multiple system atrophy-cerebellar type* - Primarily presents with **cerebellar dysfunction** and **autonomic failure** (orthostatic hypotension, bladder dysfunction). - **Gaze palsy** is not a typical feature of MSA-C, which helps differentiate it from PSP. *Parkinsonism* - Classic **bradykinesia**, **rigidity**, and **resting tremor** are the hallmark features of Parkinsonism. - **Gaze palsy** and prominent **ataxia** are not characteristic of typical Parkinson's disease. *Cerebellar ataxia* - Presents with **coordination problems**, **dysmetria**, and **intention tremor** without gaze abnormalities. - **Gaze palsy** is not a feature of pure cerebellar disorders, making PSP more likely in this case.

Q: A 45-year-old hypertensive male presented with sudden onset severe headache, vomiting, and neck stiffness. On examination, he did not have any focal neurological deficit. His CT scan showed blood in the Sylvian fissure. What is the probable diagnosis?

Ruptured aneurysm. ### Explanation **Correct Answer: B. Ruptured aneurysm** The clinical presentation of "sudden onset severe headache" (often described as a **thunderclap headache**), vomiting, and signs of meningeal irritation (neck stiffness) without focal deficits is the classic triad of a **Subarachnoid Hemorrhage (SAH)** [1]. The most common cause of non-traumatic SAH is a **ruptured berry aneurysm**. The CT finding of blood in the **Sylvian fissure** is highly characteristic of a ruptured aneurysm, specifically of the **Middle Cerebral Artery (MCA)**. Unlike intraparenchymal bleeds, SAH follows the CSF spaces (fissures, sulci, and cisterns) [1]. **Why other options are incorrect:** * **A. Meningitis:** While it presents with headache, fever, and neck stiffness, it does not cause acute blood in the Sylvian fissure on a CT scan [1]. * **C. Hypertensive bleed:** These typically occur within the brain parenchyma (intracerebral hemorrhage). The most common sites are the **Putamen**, Thalamus, or Pons. They usually present with significant focal neurological deficits (e.g., hemiplegia). * **D. Stroke:** Ischemic stroke usually presents with painless, focal neurological deficits and would show an area of infarct (hypodensity) rather than acute blood (hyperdensity) on a CT scan. **Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Digital Subtraction Angiography (DSA) is the gold standard to identify the site of the aneurysm [2]. * **Initial Investigation:** Non-contrast CT (NCCT) Head is the first-line investigation (95% sensitivity in the first 24 hours) [1]. * **Complications:** Vasospasm (prevented by **Nimodipine** [2]) and Re-bleeding (most common in the first 24 hours). * **Commonest Site:** Anterior Communicating Artery (overall); however, Sylvian fissure blood specifically points to the MCA.

Question 1

Which of the following is a characteristic feature of frontotemporal dementia?

Accepted Answer

Alzheimer's disease

Answer

Pick's disease

Answer

Nonfluent aphasia

Answer

Semantic dementia

Question 2

A typical child presents with an epigastric aura, followed by a quiet period of unresponsiveness with staring, lip-smacking, picking at sheets or clothes, contralateral dystonic posturing, and postictal confusion and lethargy. What is the probable diagnosis?

Accepted Answer

Temporal lobe epilepsy

Answer

Psychogenic seizures

Answer

Panic disorder

Answer

Occipital lobe epilepsy

Question 3

Which of the following is NOT a feature of Medial medullary syndrome?

Accepted Answer

Horner's syndrome

Answer

Contralateral hemiparesis

Answer

Ipsilateral paralysis of the tongue

Answer

Contralateral loss of proprioception

Question 4

What is the least common symptom in Friedrich's ataxia?

Accepted Answer

Moderate mental retardation

Answer

Scoliosis

Answer

Cardiac abnormality

Answer

Diabetes mellitus

Question 5

A 50-year-old man presents with ataxia and abnormal eye movements. Examination reveals gaze palsy. MRI was performed. What is the most likely diagnosis?

Accepted Answer

Progressive supranuclear palsy

Answer

Multiple system atrophy-cerebellar type

Answer

Parkinsonism

Answer

Cerebellar ataxia

Question 6

A lady in her first trimester with hyperemesis gravidarum presents with diplopia, mental confusion, and nystagmus. What is the probable diagnosis?

Accepted Answer

Wernicke's syndrome

Answer

Pregnancy-induced hypertension

Answer

Occipital infarction

Answer

Pituitary apoplexy

Question 7

A patient presents with acute onset headache, fever, and seizure. What is the most likely diagnosis?

Accepted Answer

Encephalitis

Answer

Meningitis

Answer

Migraine

Answer

Subarachnoid haemorrhage

Question 8

All of the following are features of cerebellar disease except?

Accepted Answer

Hypotonia

Answer

Intention tremors

Answer

Past pointing

Answer

Ataxia

Question 9

A 45-year-old hypertensive male presented with sudden onset severe headache, vomiting, and neck stiffness. On examination, he did not have any focal neurological deficit. His CT scan showed blood in the Sylvian fissure. What is the probable diagnosis?

Accepted Answer

Ruptured aneurysm

Answer

Meningitis

Answer

Hypertensive bleed

Answer

Stroke

Question 10

A 48-year-old woman presents with a 6-month history of intermittent cranial nerve palsy that has become progressively worse in the past 2 weeks. On examination, ptosis and diplopia are evident. Her condition shows a favorable response to the anticholinesterase inhibitory drug neostigmine. What is the most likely diagnosis?

Accepted Answer

Myasthenia gravis

Answer

Cerebral palsy

Answer

Pineal gland tumor

Answer

Adenoma of the pituitary

Neurology — MCQs

Neurology — MCQs

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