Neurology Practice Questions

Q: Which of the following seizures has a clinical presentation of impaired consciousness with motor, sensory, or autonomic symptoms which are focal?

Complex partial. ### Explanation The correct answer is **Complex Partial Seizure** (now increasingly referred to as *Focal Impaired Awareness Seizure* in newer classifications). **1. Why Complex Partial is Correct:** The defining feature of a complex partial seizure is the **impairment of consciousness** (the patient is not aware of their surroundings and cannot respond appropriately) occurring alongside focal symptoms. These symptoms can be: * **Motor:** Automatisms like lip-smacking, hand-rubbing, or picking at clothes. * **Sensory/Autonomic:** Hallucinations, epigastric rising sensations, or tachycardia. Because the seizure discharge originates in a localized area of the brain (usually the temporal lobe), it is "partial" or "focal." **2. Why the Other Options are Incorrect:** * **Generalized Tonic-Clonic (GTC):** These involve the entire brain from the onset. While consciousness is lost, the motor activity is bilateral and symmetric (stiffening followed by jerking), not focal. * **Simple Partial:** In these seizures, **consciousness is fully preserved.** The patient remains aware and can describe the focal motor or sensory symptoms as they happen. * **Status Epilepticus:** This is a medical emergency defined by a seizure lasting >5 minutes or recurrent seizures without recovery of consciousness in between. It describes duration/frequency rather than a specific focal semiology. **3. NEET-PG Clinical Pearls:** * **Temporal Lobe Epilepsy (TLE):** The most common site for complex partial seizures. Look for "auras" (deja vu, jamis vu) or "gastric rising sensations." * **Post-ictal State:** Complex partial seizures are typically followed by a period of confusion or drowsiness, unlike absence seizures. * **Todd’s Paralysis:** A focal neurological deficit (like hemiparesis) following a focal seizure that resolves within 24 hours. * **Drug of Choice:** Carbamazepine or Levetiracetam are frequently used for focal seizures.

Q: All the following features are seen in Wernicke's encephalopathy except?

Confabulation. **Explanation:** Wernicke’s Encephalopathy (WE) is an acute, reversible neuropsychiatric emergency caused by **Thiamine (Vitamin B1) deficiency**, most commonly seen in chronic alcoholics. The diagnosis is clinical and is classically defined by a **triad** of symptoms: 1. **Ophthalmoplegia (Option A):** Most commonly manifests as **6th cranial nerve (Abducens) palsy**, leading to horizontal nystagmus or lateral rectus paralysis. 2. **Ataxia (Option B):** Primarily affecting gait and stance due to cerebellar involvement. 3. **Confusion (Option D):** An altered mental state or global cognitive impairment. **Why Confabulation is the correct answer:** **Confabulation** (the fabrication of memories to fill gaps) is a hallmark feature of **Korsakoff Psychosis**, not acute Wernicke’s Encephalopathy. While the two conditions are related (Wernicke-Korsakoff Syndrome), Korsakoff is the **chronic, irreversible** stage characterized by anterograde/retrograde amnesia and confabulation. Confabulation occurs when the acute confusion of WE clears, leaving behind a profound memory deficit. **High-Yield Clinical Pearls for NEET-PG:** * **The Triad:** Remember the mnemonic **CAN** (Confusion, Ataxia, Nystagmus/Ophthalmoplegia). * **Pathology:** Characterized by petechial hemorrhages in the **mammillary bodies** (most common site) and periaqueductal gray matter. * **Treatment Rule:** Always administer **Thiamine before Glucose**. Giving IV glucose first in a thiamine-deficient patient can precipitate or worsen WE by consuming the remaining B1 cofactors during glycolysis. * **Reversibility:** Ataxia and ophthalmoplegia usually respond rapidly to thiamine, but the memory deficits of Korsakoff are often permanent.

Q: A 45-year-old male hypertensive patient became unconscious while bathing. On examination, there was complete flaccid hemiplegia and the patient had difficulty in speaking, word ordering, and articulation, although could understand commands. The patient was diagnosed with a left Middle Cerebral Artery (MCA) territory infarct. What type of aphasia does the patient have?

Broca’s aphasia. **Explanation:** The patient presents with a classic **Left Middle Cerebral Artery (MCA) territory infarct**, specifically involving the **superior division**. The clinical hallmark here is the combination of right-sided hemiplegia and a **non-fluent aphasia**. 1. **Why Broca’s Aphasia is correct:** The patient has difficulty with speech production, word ordering, and articulation (non-fluent), but **comprehension is preserved** (can understand commands). This signifies damage to **Broca’s area (Brodmann areas 44, 45)** in the posterior inferior frontal gyrus [1]. Because the superior division of the MCA supplies both the motor cortex and Broca’s area, it typically presents with dense contralateral hemiplegia [1]. 2. **Why other options are incorrect:** * **Wernicke’s Aphasia:** Characterized by impaired comprehension ("word deafness") with fluent but nonsensical speech ("word salad"). It involves the inferior division of the MCA; motor deficits are usually absent. * **Global Aphasia:** Involves both Broca’s and Wernicke’s areas (total MCA stem occlusion). The patient would have both non-fluent speech and **impaired comprehension**. * **Anomic Aphasia:** The mildest form, characterized solely by difficulty in word-finding (naming objects), with intact fluency and comprehension. **Clinical Pearls for NEET-PG:** * **Broca’s = "Broken" speech:** Non-fluent, frustrated patient, comprehension intact [1]. * **Wernicke’s = "What?"/Wordy:** Fluent, unaware of deficit, comprehension lost [1]. * **Localization:** Broca’s is Frontal lobe (Superior MCA); Wernicke’s is Temporal lobe (Inferior MCA). * **Repeat after me:** Repetition is **impaired** in both Broca’s and Wernicke’s, but **preserved** in Transcortical aphasias.

Q: What is a contraindication for thrombolytic therapy (PA) in ischemic stroke?

Comatose patient. **Explanation:** Thrombolytic therapy with recombinant tissue plasminogen activator (rtPA) is the gold standard for acute ischemic stroke [1], but it carries a significant risk of hemorrhagic transformation. Therefore, strict adherence to inclusion and exclusion criteria is mandatory. **Why "Comatose patient" is the correct answer:** A comatose state (depressed level of consciousness) is considered a relative contraindication or a reason for extreme caution. In the context of a suspected stroke, coma often suggests a very large hemispheric infarction, a brainstem stroke, or a non-ischemic cause (such as metabolic encephalopathy or post-ictal state). Large-volume infarcts have a significantly higher risk of symptomatic intracranial hemorrhage (sICH) following thrombolysis, and the clinical benefit in a comatose patient is often negligible compared to the risks. **Analysis of Incorrect Options:** * **A. Clinical diagnosis of stroke:** This is a prerequisite (inclusion criterion). Thrombolysis is initiated based on a clinical diagnosis supported by a CT scan to rule out hemorrhage [1]. * **B. Systolic BP < 180 mm Hg:** This is actually a requirement for therapy. To safely administer rtPA, BP must be maintained below **185/110 mm Hg**. * **C. Onset 185/110, it must be lowered (e.g., using Labetalol or Nicardipine) before starting rtPA. * **Golden Hour:** The benefit of rtPA is time-dependent; "Time is Brain." * **Exclusion Lab Value:** Platelet count 1.7.

Q: All of the following cause subcortical dementia, EXCEPT?

Alzheimer's disease. ### Explanation Dementia is broadly classified into **Cortical** and **Subcortical** types based on the primary site of pathology and the clinical presentation. **1. Why Alzheimer’s Disease is the Correct Answer:** Alzheimer’s disease is the prototypical **Cortical Dementia**. The pathology primarily involves the cerebral cortex (specifically the hippocampus and temporoparietal lobes). Clinically, it is characterized by "The 4 A's": **Amnesia** (memory loss), **Aphasia** (language impairment), **Apraxia** (motor task failure), and **Agnosia** (failure to recognize objects). In cortical dementia, motor functions usually remain intact until the very late stages. **2. Analysis of Incorrect Options (Subcortical Dementias):** Subcortical dementias involve structures like the basal ganglia, thalamus, and brainstem. They are characterized by "psychomotor slowing," personality changes, and early motor symptoms. * **Parkinsonism:** Dementia occurs due to Lewy body deposition in subcortical nuclei; it features prominent bradyphrenia (slowed thinking) and motor tremors. * **HIV Encephalopathy (AIDS Dementia Complex):** Primarily affects the subcortical white matter and basal ganglia, leading to cognitive slowing and motor deficits. * **Progressive Supranuclear Palsy (PSP):** A "Parkinson-plus" syndrome involving subcortical degeneration; it presents with vertical gaze palsy and subcortical cognitive decline. **Clinical Pearls for NEET-PG:** * **Cortical Dementia:** Memory + Language + Perception (e.g., Alzheimer’s, Pick’s disease). * **Subcortical Dementia:** Memory + Movement + Mood (e.g., Huntington’s, Wilson’s, PSP, Parkinson’s). * **Key Distinguisher:** Aphasia and Agnosia are **absent** in subcortical dementia but **present** in cortical dementia. * **Multi-infarct dementia** can be both cortical and subcortical depending on the site of the stroke.

Q: What is the first-line treatment for generalized onset tonic-clonic seizures?

Lamotrigine. **Explanation:** The management of Generalized Tonic-Clonic Seizures (GTCS) has evolved, with a shift toward broad-spectrum Antiepileptic Drugs (AEDs) that offer better tolerability and fewer drug interactions. **Why Lamotrigine is Correct:** **Lamotrigine** is currently considered a first-line treatment for generalized onset tonic-clonic seizures. It acts by blocking voltage-gated sodium channels and inhibiting the release of glutamate. It is preferred due to its broad-spectrum efficacy and favorable side-effect profile compared to older agents. Notably, it is also a first-line choice in pregnancy (though doses may need adjustment). While **Valproate** was historically the "gold standard," Lamotrigine and Levetiracetam are now preferred first-line options, especially in females of childbearing age due to Valproate’s teratogenicity. **Analysis of Incorrect Options:** * **Phenytoin:** While effective for GTCS, it is no longer first-line due to its non-linear (zero-order) kinetics, narrow therapeutic index, and significant long-term side effects (gingival hyperplasia, hirsutism, osteomalacia). * **Levetiracetam:** This is also a first-line broad-spectrum AED. However, in many standardized clinical guidelines and recent NEET-PG patterns, Lamotrigine is frequently highlighted as the preferred initial monotherapy for generalized seizures. * **Ethosuximide:** This is the drug of choice for **Absence Seizures** only. It is ineffective against GTCS as it specifically targets T-type calcium channels in the thalamus. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC) for GTCS:** Valproate (Most effective, but avoid in pregnancy); Lamotrigine/Levetiracetam (Preferred alternatives). * **DOC for Absence Seizures:** Ethosuximide (Valproate if GTCS is also present). * **DOC for Myoclonic Seizures:** Valproate. * **Stevens-Johnson Syndrome (SJS):** A serious risk with Lamotrigine; always start with a low dose and titrate slowly.

Q: A patient is able to recognise a person by name but not by face. The lesion in this case is in which lobe of the brain?

Temporal lobe. ### Explanation The clinical scenario describes **Prosopagnosia** (face blindness), which is the inability to recognize familiar faces despite intact vision and the ability to recognize individuals by other cues, such as their voice or name [1]. **1. Why the Temporal Lobe is Correct:** Face recognition is a complex cognitive process localized to the **Fusiform Gyrus** (specifically the Fusiform Face Area), which is located on the basal surface of the **temporal and occipital lobes** [3]. In clinical neurology and standard medical examinations, prosopagnosia is most strongly associated with lesions in the **inferior temporal lobe** (often bilateral or right-sided) [1]. This area is part of the "ventral stream" (the "What" pathway) of visual processing, which identifies objects and faces. **2. Why Other Options are Incorrect:** * **Frontal Lobe:** Primarily involved in executive function, motor control (Broca’s area), and personality. Lesions here lead to motor aphasia or behavioral changes, not recognition deficits. * **Occipital Lobe:** While the primary visual cortex is here, a pure occipital lesion would cause visual field defects (like hemianopia) or cortical blindness, rather than a specific deficit in facial recognition [3]. * **Post Parietal Region:** This area is part of the "dorsal stream" (the "Where" pathway), involved in spatial awareness and motion. Lesions here lead to neglect syndromes, optic ataxia, or Balint’s syndrome. **3. High-Yield Clinical Pearls for NEET-PG:** * **Prosopagnosia:** Associated with the **Fusiform Gyrus** [1]. * **Agnosia:** Failure of recognition not due to sensory deficit [2]. * **Visual Agnosia:** Inability to name an object by sight (Temporal lobe) [2]. * **Astereognosis:** Inability to recognize objects by touch (Parietal lobe) [2]. * **Anosognosia:** Denial of illness (Right parietal lobe).

Q: A 60-year-old man presents to the emergency department with a generalized tonic-clonic seizure. He has no prior history of similar episodes or any other medical illnesses. Lorazepam 2 mg was administered, resulting in the cessation of seizure activity. Which of the following is the least likely cause of seizure in this patient?

Genetic disorder. ### Explanation The correct answer is **D. Genetic disorder**. **Why Genetic Disorder is the least likely:** Genetic (idiopathic) epilepsies typically manifest in childhood, adolescence, or early adulthood (usually before age 25). It is highly improbable for a primary genetic epilepsy to present for the first time at age 60 [1]. In an elderly patient with a "new-onset" seizure, the focus must always be on identifying **acquired** structural, metabolic, or toxic causes. **Analysis of Incorrect Options:** * **A. Alcohol withdrawal:** This is a common cause of new-onset seizures in adults. Withdrawal seizures typically occur 6–48 hours after the last drink and often present as generalized tonic-clonic seizures. * **B. Hyperglycemia:** Metabolic derangements (hypoglycemia, hyperglycemia, hyponatremia, or uremia) are frequent triggers for provoked seizures in the elderly. Non-ketotic hyperglycemia is a particularly well-known cause of focal or generalized seizures. * **C. Brain tumor:** In patients over the age of 50, structural brain lesions are a leading cause of new-onset seizures. Primary brain tumors (like glioblastoma) or metastatic disease (from lung or breast) must be ruled out via neuroimaging (MRI). **Clinical Pearls for NEET-PG:** * **Most common cause of seizures in elderly:** Stroke (Cerebrovascular disease) is the #1 cause, followed by neurodegenerative diseases (Alzheimer’s) and tumors. * **First-line management:** For status epilepticus or acute seizures, IV Lorazepam (0.1 mg/kg) is the benzodiazepine of choice. * **Work-up:** Any adult with a first-time seizure requires a CT/MRI to rule out structural lesions and blood work to rule out metabolic disturbances [1].

Q: A nurse is assessing the motor function of an unconscious male client. Which of the following would the nurse plan to use to test the client's peripheral response to pain?

Nail bed pressure. **Explanation:** In the assessment of an unconscious patient, distinguishing between **central** and **peripheral** painful stimuli is crucial for evaluating neurological integrity and the Glasgow Coma Scale (GCS) motor component. **1. Why Nail Bed Pressure is Correct:** To test a **peripheral response**, the stimulus must be applied to a limb. Applying pressure to the nail bed (using a pen or similar object) triggers a spinal reflex or a purposeful withdrawal/localization response. This helps determine if the patient can perceive pain in the extremities and whether the motor pathway from the brain to the peripheral nerves is intact. **2. Analysis of Incorrect Options:** * **A. Sternal Rub:** This is a **central stimulus**. It involves firm pressure on the sternum and is used to assess the brain's overall arousal level rather than peripheral nerve function. * **C. Pressure on the Orbital Rim:** This involves applying pressure to the supraorbital notch. It is a **central stimulus** used to elicit a response from the cranial nerves and the brainstem. * **D. Squeezing the Sternocleidomastoid (Trapezius Squeeze):** Squeezing the trapezius muscle or the sternocleidomastoid is considered a **central stimulus** because it targets the proximal midline structures. **NEET-PG High-Yield Pearls:** * **Central Stimulus:** Used to elicit the "Best Motor Response" in GCS (e.g., Trapezius squeeze, Supraorbital pressure, Sternal rub). * **Peripheral Stimulus:** Used specifically to check for localized nerve injury or spinal cord integrity (e.g., Nail bed pressure). * **Clinical Caution:** Avoid repeated sternal rubs as they can cause bruising and tissue damage. Supraorbital pressure is contraindicated in patients with suspected frontal skull fractures. * **GCS Motor Scoring:** Localization (M5) requires the patient to move a limb toward a central stimulus, whereas Withdrawal (M4) is a flexion response to a peripheral stimulus.

Question 1

What is the most common cause of inherited peripheral neuropathy?

Accepted Answer

Charcot-Marie-Tooth disease

Answer

Hereditary neuropathy with pressure palsy

Answer

Familial amyloid polyneuropathy

Answer

Hereditary sensory neuropathy

Question 2

Which of the following seizures has a clinical presentation of impaired consciousness with motor, sensory, or autonomic symptoms which are focal?

Accepted Answer

Complex partial

Answer

Generalized tonic clonic

Answer

Simple partial

Answer

Status epilepticus

Question 3

All the following features are seen in Wernicke's encephalopathy except?

Accepted Answer

Confabulation

Answer

6th cranial nerve palsy

Answer

Ataxia

Answer

Confusion

Question 4

A 45-year-old male hypertensive patient became unconscious while bathing. On examination, there was complete flaccid hemiplegia and the patient had difficulty in speaking, word ordering, and articulation, although could understand commands. The patient was diagnosed with a left Middle Cerebral Artery (MCA) territory infarct. What type of aphasia does the patient have?

Accepted Answer

Broca’s aphasia

Answer

Wernicke’s aphasia

Answer

Global aphasia

Answer

Anomic aphasia

Question 5

What is a contraindication for thrombolytic therapy (PA) in ischemic stroke?

Accepted Answer

Comatose patient

Answer

Clinical diagnosis of stroke

Answer

Systolic blood pressure < 180 mm of Hg

Answer

Onset of symptoms < 4.5 hours

Question 6

All of the following cause subcortical dementia, EXCEPT?

Accepted Answer

Alzheimer's disease

Answer

Parkinsonism

Answer

HIV encephalopathy

Answer

Progressive Supranuclear palsy

Question 7

What is the first-line treatment for generalized onset tonic-clonic seizures?

Accepted Answer

Lamotrigine

Answer

Phenytoin

Answer

Levetiracetam

Answer

Ethosuximide

Question 8

A patient is able to recognise a person by name but not by face. The lesion in this case is in which lobe of the brain?

Accepted Answer

Temporal lobe

Answer

Frontal lobe

Answer

Occipital lobe

Answer

Post parietal region

Question 9

A 60-year-old man presents to the emergency department with a generalized tonic-clonic seizure. He has no prior history of similar episodes or any other medical illnesses. Lorazepam 2 mg was administered, resulting in the cessation of seizure activity. Which of the following is the least likely cause of seizure in this patient?

Accepted Answer

Genetic disorder

Answer

Alcohol withdrawal

Answer

Hyperglycemia

Answer

Brain tumor

Question 10

A nurse is assessing the motor function of an unconscious male client. Which of the following would the nurse plan to use to test the client's peripheral response to pain?

Accepted Answer

Nail bed pressure

Answer

Sternal rub

Answer

Pressure on the orbital rim

Answer

Squeezing of the sternocleidomastoid muscle

Neurology — MCQs

Neurology — MCQs

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