Neurology Practice Questions

Q: A patient presents with unilateral painful ophthalmoplegia. Imaging revealed an enlargement of the cavernous sinus on the affected side. What is the likely diagnosis?

Tolosa-Hunt syndrome. **Explanation:** **Tolosa-Hunt Syndrome (THS)** is the correct diagnosis. It is characterized by idiopathic, non-specific granulomatous inflammation of the cavernous sinus, superior orbital fissure, or orbital apex. * **Clinical Presentation:** Patients typically present with **unilateral, boring orbital pain** and **ophthalmoplegia** (palsy of CN III, IV, and VI). * **Imaging:** MRI often shows enlargement or "fullness" of the cavernous sinus due to inflammatory tissue. * **Pathognomonic Feature:** A dramatic clinical response to systemic **corticosteroids** (usually within 48–72 hours) is a diagnostic hallmark. **Why the other options are incorrect:** * **Gradenigo Syndrome:** Characterized by the triad of abducens nerve palsy (CN VI), deep ear pain (trigeminal neuralgia), and suppurative otitis media (petrous apicitis). It does not involve the cavernous sinus. * **Cavernous Sinus Thrombosis (CST):** While it presents with painful ophthalmoplegia, it is typically an acute, life-threatening infectious process (often from a "danger area" facial infection) presenting with high fever, proptosis, and chemosis. * **Orbital Pseudotumor:** This is also an idiopathic inflammatory condition, but it primarily involves the **orbit** (extraocular muscles or lacrimal gland), leading to proptosis and chemosis rather than primary cavernous sinus enlargement. **High-Yield Pearls for NEET-PG:** * **THS is a diagnosis of exclusion:** Always rule out tumors or CST first. * **Nerves involved:** CN III, IV, VI, and the ophthalmic (V1) and maxillary (V2) branches of the trigeminal nerve. * **Steroid Response:** If the pain does not resolve rapidly with steroids, reconsider the diagnosis (likely a malignancy).

Q: The conus medullaris syndrome differs from the cauda equina syndrome in that the former shows which of the following?

Symmetric weakness of lower limbs. ### Explanation The differentiation between **Conus Medullaris Syndrome (CMS)** and **Cauda Equina Syndrome (CES)** is a high-yield neuroanatomy topic. **Why Option C is Correct:** The **Conus Medullaris** is the terminal, tapered end of the spinal cord (ending at L1-L2). Because it is a compact part of the central nervous system, a lesion here typically affects the spinal segments (S3-Co) bilaterally and simultaneously. This results in **symmetric** motor weakness and sensory loss. In contrast, the Cauda Equina consists of individual nerve roots; a lesion here is often eccentric, leading to asymmetric involvement. **Analysis of Incorrect Options:** * **A. Radicular Pain:** This is a hallmark of **Cauda Equina Syndrome**. Since CES involves compression of nerve roots, severe, asymmetric radicular pain is prominent. In CMS, pain is usually less severe and localized to the lower back (perianal/saddle area). * **B. Lower Motor Neuron (LMN) Injury:** While both can show LMN signs, CMS often presents with a **mix of UMN and LMN signs** (e.g., increased Achilles reflex but absent anal wink) because it involves the cord itself. CES is purely a peripheral nerve root (LMN) injury. * **D. Urinary Retention:** Both syndromes present with bladder and bowel dysfunction. However, in CMS, autonomic involvement occurs **early and suddenly**, whereas in CES, it is often a late-stage finding. **NEET-PG High-Yield Pearls:** 1. **Level of Lesion:** CMS occurs at **L1-L2**; CES occurs below L2. 2. **Saddle Anesthesia:** In CMS, it is **symmetric** and perianal; in CES, it is **asymmetric** and involves the saddle area. 3. **Reflexes:** In CMS, the Knee jerk (L2-L4) is preserved, but the Ankle jerk (S1) may be affected. In CES, both may be absent depending on the roots involved. 4. **Onset:** CMS has a sudden, bilateral onset; CES is typically gradual and unilateral/asymmetric.

Q: What is the characteristic EEG pattern observed in?

Creutzfeldt-Jakob Disease. ### Explanation **Correct Option: B. Creutzfeldt-Jakob Disease (CJD)** The characteristic EEG finding in CJD is **Periodic Sharp Wave Complexes (PSWCs)**, typically occurring at a frequency of 0.5 to 2.0 Hz [3]. These are seen in about 60-80% of patients, usually in the later stages of the disease. The underlying pathophysiology involves the rapid, widespread neuronal loss and spongiform changes caused by prion proteins, leading to synchronized, repetitive electrical discharges [3]. **Analysis of Incorrect Options:** * **A. Hepatic Encephalopathy:** The hallmark EEG finding is **Triphasic waves** (high-voltage, symmetrical, slow waves). While characteristic, they are not pathognomonic and can be seen in other metabolic encephalopathies (e.g., uremia). * **C. Generalized Tonic-Clonic Seizure (GTCS):** The EEG typically shows **generalized 10-12 Hz spikes** during the tonic phase, followed by **spike-and-slow-wave** discharges during the clonic phase [1], [2]. * **D. Herpes Simplex Encephalitis:** The classic finding is **Periodic Lateralized Epileptiform Discharges (PLEDs)**, usually localized to the temporal lobes, reflecting the focal necrotizing nature of the virus. **High-Yield Clinical Pearls for NEET-PG:** * **CJD Triad:** Rapidly progressive dementia, myoclonus (often startle-induced), and the characteristic PSWC on EEG [3]. * **Other CJD Markers:** Elevated **14-3-3 protein** in CSF and the **"Pulvinar sign"** (hyperintensity of the posterior thalamus) or **"Hockey stick sign"** on MRI (DWI/FLAIR sequences). * **Subacute Sclerosing Panencephalitis (SSPE):** Often confused with CJD; it shows **Radermecker complexes** (periodic high-voltage slow-wave complexes with longer intervals of 4-15 seconds).

Q: Right internal carotid artery stenosis leads to all except?

Drop attacks. **Explanation:** Internal Carotid Artery (ICA) stenosis typically presents with symptoms involving the **Anterior Circulation** (Middle Cerebral Artery and Anterior Cerebral Artery territories) [1]. **Why "Drop Attacks" is the correct answer:** Drop attacks (sudden loss of muscle tone causing a fall without loss of consciousness) are a classic hallmark of **Vertebrobasilar Insufficiency (Posterior Circulation)**. They occur due to transient ischemia of the brainstem (specifically the reticular formation or pyramidal tracts). Since the ICA supplies the anterior circulation, drop attacks are not a feature of ICA stenosis. **Analysis of Incorrect Options:** * **Contralateral hemiparesis & hemi-sensory loss:** These are classic signs of ICA territory ischemia [1]. The ICA gives rise to the **Middle Cerebral Artery (MCA)**; occlusion leads to motor and sensory deficits on the opposite side of the body (face and arm > leg) [1]. * **Abulia:** This refers to a lack of willpower or initiative. It occurs due to ischemia in the **Anterior Cerebral Artery (ACA)** territory (also a branch of the ICA), affecting the frontal lobes or the basal ganglia. **Clinical Pearls for NEET-PG:** * **Amaurosis Fugax:** Transient monocular blindness ("curtain coming down") is a highly specific sign of **ipsilateral** ICA stenosis due to emboli reaching the ophthalmic artery [1]. * **Horner’s Syndrome:** Can occur in ICA dissection due to involvement of sympathetic fibers surrounding the artery. * **Posterior Circulation (Vertebrobasilar) Triad:** Vertigo, Visual field defects (Diplopia/Hemianopia), and Vestibular dysfunction (Ataxia). Drop attacks belong here.

Q: Which of the following statements is FALSE regarding Parkinsonism developing in individuals over 70 years of age?

The prognosis is worse.. **Explanation** In Parkinson’s Disease (PD), the age of onset significantly influences the clinical phenotype, progression, and treatment complications. **Why Option D is the False Statement:** Contrary to what might be assumed, the prognosis regarding **motor complications** is often considered "better" or more stable in older-onset patients compared to young-onset PD. While older patients have a higher risk of cognitive decline, they are significantly **less likely to develop motor fluctuations and levodopa-induced dyskinesias**. In young-onset PD, the disease course is longer, and the risk of severe, disabling dyskinesias is much higher, often leading to a worse long-term functional prognosis regarding motor control [1]. **Analysis of Other Options:** * **Option A:** True. Older patients have a lower risk of developing levodopa-induced dyskinesias compared to younger patients, likely due to age-related changes in dopamine receptor plasticity. * **Option B:** True. Autonomic dysfunction (orthostatic hypotension, urinary urgency) is more prevalent and severe in late-onset Parkinsonism due to the cumulative effect of aging on the autonomic nervous system [1]. * **Option C:** True. There is a strong correlation between advanced age at onset and the early development of cognitive impairment and dementia (PDD) [1]. **High-Yield NEET-PG Pearls:** * **Young-Onset PD ( 70 years):** Faster progression of **non-motor symptoms** (dementia, gait instability, falls) but lower risk of motor fluctuations [1]. * **Drug of Choice:** In patients >65-70 years, Levodopa is the first-line treatment. Dopamine agonists are often avoided due to the high risk of hallucinations and confusion in this age group [1].

Q: A 45-year-old chronic alcoholic presents with confusion, ataxia, ophthalmoplegia, and peripheral neuropathy. What is the most likely diagnosis?

Wernicke's encephalopathy. **Explanation:** The patient presents with the classic **clinical triad** of **Wernicke’s Encephalopathy (WE)**: 1. **Ophthalmoplegia** (specifically nystagmus or abducens nerve palsy) 2. **Ataxia** (gait instability) 3. **Confusion** (Global encephalopathy) **Underlying Concept:** WE is an acute, reversible biochemical lesion caused by a deficiency of **Thiamine (Vitamin B1)**. In chronic alcoholics, this deficiency arises due to poor dietary intake, impaired gastrointestinal absorption, and reduced hepatic storage. Thiamine is a co-factor for key enzymes in glucose metabolism; its absence leads to neuronal cell death, particularly in the **mammillary bodies** and the periaqueductal gray matter. **Why other options are incorrect:** * **Korsakoff’s Psychosis:** This is the chronic, often irreversible stage following WE. It is characterized by **anterograde amnesia** and **confabulation** (filling memory gaps with fabrications). While often occurring together (Wernicke-Korsakoff Syndrome), the acute triad points to WE. * **Delirium Tremens:** A severe form of alcohol withdrawal occurring 48–96 hours after the last drink. It features autonomic hyperactivity (tachycardia, hypertension), tremors, and clouded consciousness, but not ophthalmoplegia. * **Alcoholic Hallucinosis:** Occurs within 12–24 hours of abstinence. It is characterized by vivid auditory hallucinations in a state of **clear sensorium** (the patient is alert and oriented), unlike the confusion seen here. **High-Yield NEET-PG Pearls:** * **MRI Finding:** Increased T2/FLAIR signal intensity in the **mammillary bodies** (most specific) and dorsomedial thalamus. * **Management:** Immediate administration of **IV Thiamine**. * **Crucial Rule:** Always give Thiamine **before** Glucose. Administering glucose first in a thiamine-deficient patient can precipitate or worsen WE by consuming the remaining thiamine stores during glycolysis.

Question 1

A patient presents with unilateral painful ophthalmoplegia. Imaging revealed an enlargement of the cavernous sinus on the affected side. What is the likely diagnosis?

Accepted Answer

Tolosa-Hunt syndrome

Answer

Gradenigo syndrome

Answer

Cavernous sinus thrombosis

Answer

Orbital pseudotumor

Question 2

The conus medullaris syndrome differs from the cauda equina syndrome in that the former shows which of the following?

Accepted Answer

Symmetric weakness of lower limbs

Answer

Radicular pain

Answer

Lower motor neuron injury

Answer

Urinary retention

Question 3

A 50-year-old right-handed female presented with right-sided hemiparesis, sensory loss, and right homonymous hemianopia. Neurological examination revealed dysarthria, global aphasia, alexia, agraphia, acalculia, and apraxia. Which artery is most likely involved in this condition?

Accepted Answer

Sylvian cistern

Answer

Cerebellomedullary cistern

Answer

Cisterna pontis

Answer

Quadrigeminal cistern

Question 4

What is the characteristic EEG pattern observed in?

Accepted Answer

Creutzfeldt-Jakob Disease

Answer

Hepatic encephalopathy

Answer

Generalized tonic-clonic seizure (GTCS)

Answer

Herpes simplex encephalitis

Question 5

A 30-year-old female presents with headache and transient obscurations of her vision. On examination, no focal neurological deficit was seen. Which one of the following would you start her on?

Accepted Answer

Acetazolamide

Answer

Bromocriptine

Answer

Corticosteroids

Answer

Furosemide

Question 6

Right internal carotid artery stenosis leads to all except?

Accepted Answer

Drop attacks

Answer

Abulia

Answer

Contralateral hemiparesis

Answer

Contralateral hemi-sensory loss

Question 7

Which of the following statements is FALSE regarding Parkinsonism developing in individuals over 70 years of age?

Accepted Answer

The prognosis is worse.

Answer

Long-term side effects of levodopa, such as dyskinesia, are less frequent.

Answer

Autonomic disturbances are more likely to develop.

Answer

Cognitive changes and dementia are more common.

Question 8

Which one of the following is not a useful drug for the initial management of status epilepticus?

Accepted Answer

IV clobazam

Answer

IV phenytoin

Answer

IV thiopental

Answer

IV sodium valproate

Question 9

A 32-year-old patient presents with decreased pain and temperature sensation in the upper extremities, atrophy of the intrinsic muscles of the hand, and brisk deep tendon reflexes in the upper extremities. What is your diagnosis?

Accepted Answer

Syringomyelia

Answer

Amyotrophic lateral sclerosis

Answer

Multiple sclerosis

Answer

Subacute combined degeneration

Question 10

A 45-year-old chronic alcoholic presents with confusion, ataxia, ophthalmoplegia, and peripheral neuropathy. What is the most likely diagnosis?

Accepted Answer

Wernicke's encephalopathy

Answer

Korsakoff's psychosis

Answer

Delirium tremens

Answer

Alcoholic hallucinosis

Neurology — MCQs

Neurology — MCQs

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