Neurology Practice Questions

Q: Tumefactive lesions are seen most commonly in which disease?

Multiple sclerosis. ### Explanation **Correct Answer: B. Multiple Sclerosis** **Tumefactive Demyelinating Lesions (TDLs)** are a rare variant of demyelinating disease characterized by large, tumor-like brain lesions. These lesions are typically defined as being **>2 cm in diameter**, often associated with perilesional edema and mass effect. While they can mimic high-grade gliomas or brain abscesses on imaging, they are most commonly associated with **Multiple Sclerosis (MS)** [1]. On MRI, TDLs often show a characteristic **"open-ring" enhancement**, where the incomplete portion of the ring faces the gray matter of the cortex [1]. This is a high-yield diagnostic sign for demyelination over malignancy. **Why other options are incorrect:** * **A. Reiter’s Disease (Reactive Arthritis):** This is a seronegative spondyloarthropathy characterized by the triad of urethritis, conjunctivitis, and arthritis. It does not involve the central nervous system (CNS) white matter. * **C. Paget Disease:** This is a localized disorder of bone remodeling resulting in thickened, structurally weak bone. While it can cause neurological complications via nerve compression (e.g., deafness or spinal stenosis), it does not produce intraparenchymal brain lesions. * **D. Marfan Syndrome:** This is a connective tissue disorder caused by *FBN1* gene mutations. It primarily affects the skeletal, ocular, and cardiovascular systems (e.g., aortic dissection), not the CNS parenchyma. **NEET-PG High-Yield Pearls:** * **Imaging Hallmark:** Open-ring enhancement (suggests an active inflammatory front) [1]. * **Histology:** Creutzfeldt cells (astrocytes with fragmented nuclear material) are often seen in TDLs. * **Management:** Unlike tumors, TDLs usually show a dramatic response to high-dose intravenous corticosteroids. * **Differential:** Marburg variant of MS is a fulminant, monophasic form of demyelination that can also present with large, aggressive lesions.

Q: Which of the following causes distal myopathy?

Myotonic dystrophy. In clinical neurology, most primary muscle diseases (myopathies) present with **proximal** muscle weakness (e.g., difficulty climbing stairs or combing hair). However, a specific subset of conditions presents with **distal** weakness (difficulty with hand grip or foot drop). **Why Myotonic Dystrophy is Correct:** **Myotonic Dystrophy (Type 1)** is the most common adult-onset muscular dystrophy. Unlike Duchenne or Becker, it characteristically involves the **distal muscles** (hands and feet), along with the face, neck (sternocleidomastoids), and ptosis. The underlying pathology involves a CTG repeat expansion in the DMPK gene, leading to "myotonia" (delayed muscle relaxation). **Analysis of Incorrect Options:** * **Duchenne (DMD) and Becker (BMD) Muscular Dystrophy:** These are X-linked recessive disorders caused by dystrophin mutations [1]. They classically present with **proximal** weakness, starting in the pelvic girdle (Gower’s sign) and progressing to the shoulder girdle. * **Polymyositis:** This is an inflammatory myopathy. The hallmark clinical feature is subacute, symmetrical **proximal** muscle weakness. Distal involvement is rare and usually occurs only in very advanced stages. **NEET-PG High-Yield Pearls:** * **Distal Myopathy Differential:** Myotonic Dystrophy, Inclusion Body Myositis (IBM - involves finger flexors), Miyoshi Myopathy, and Welander Myopathy. * **Myotonic Dystrophy Clinical Triad:** Distal weakness + Myotonia (grip/percussion) + Multi-system involvement (Frontal balding, Cataracts, Heart block, and Gonadal atrophy). * **Genetic Pattern:** Myotonic Dystrophy Type 1 shows **Anticipation** (worsening severity in successive generations due to triplet repeat expansion).

Q: The site of lesion in unilateral past pointing nystagmus is?

Cerebellar hemisphere. ### Explanation The correct answer is **D. Cerebellar hemisphere.** **1. Understanding the Mechanism** Past pointing (dysmetria) and nystagmus are classic signs of cerebellar dysfunction. When a lesion occurs in the **cerebellar hemisphere**, it disrupts the coordination of voluntary movements on the **ipsilateral** (same) side. * **Past pointing:** In cerebellar lesions, the patient overshoots the target because the cerebellum fails to provide the necessary "braking" signal to the muscles. * **Nystagmus:** Cerebellar nystagmus is typically coarse, gaze-evoked, and increases in intensity when looking toward the side of the lesion. The combination of unilateral past pointing and nystagmus strongly localizes the pathology to the cerebellar hemisphere rather than the vestibular apparatus. **2. Analysis of Incorrect Options** * **Options A & B (Posterior/Superior Semicircular Canals):** Lesions in the semicircular canals (like BPPV) cause positional vertigo and specific patterns of nystagmus (e.g., geotropic or torsional). While vestibular lesions cause past pointing, it is usually compensatory and occurs in the direction of the slow component of nystagmus, unlike the primary motor incoordination seen in cerebellar lesions. * **Option C (Flocculonodular Lobe):** This is the "vestibulocerebellum." Lesions here primarily cause **truncal ataxia** and equilibrium imbalances (drunken gait) rather than unilateral limb signs like past pointing. **3. Clinical Pearls for NEET-PG** * **Rule of Sides:** Cerebellar lesions produce **ipsilateral** symptoms (Ataxia, Hypotonia, Past pointing, Intention tremor). * **Vestibular vs. Cerebellar Nystagmus:** Vestibular nystagmus is suppressed by visual fixation; cerebellar nystagmus is **not** suppressed and may even be enhanced. * **Finger-Nose Test:** This is the standard clinical bedside test to elicit past pointing in suspected cerebellar hemisphere lesions.

Q: Raised intracranial pressure should be suspected when there is?

Sixth cranial nerve palsy. **Explanation:** **Sixth cranial nerve (Abducens nerve) palsy** is a classic sign of raised intracranial pressure (ICP) and is often referred to as a **"false localizing sign."** This occurs because the abducens nerve has the longest intracranial course of all cranial nerves. When ICP increases, the brainstem can be displaced downward, stretching the nerve against the sharp border of the petrous temporal bone or compressing it within Dorello’s canal [1]. This results in weakness of the lateral rectus muscle, leading to horizontal diplopia and an inability to abduct the eye. **Analysis of Incorrect Options:** * **A. Neck stiffness:** This is a hallmark of **meningeal irritation**, typically seen in meningitis or subarachnoid hemorrhage. While it can coexist with raised ICP, it is not a specific indicator of the pressure itself. * **C. Episodic unilateral headache:** This is the classic presentation of **Migraine**. Headaches associated with raised ICP are typically generalized, worse in the morning, and aggravated by coughing or straining (Valsalva maneuver). * **D. Unilateral ptosis:** This suggests a **Third cranial nerve (Oculomotor) palsy** or Horner’s syndrome. While a 3rd nerve palsy can occur in late-stage raised ICP (due to uncal herniation), it is usually accompanied by a fixed, dilated pupil rather than isolated ptosis [1], [2]. **High-Yield Clinical Pearls for NEET-PG:** * **Cushing’s Triad:** A late sign of raised ICP consisting of Hypertension (with widened pulse pressure), Bradycardia, and Irregular respirations [1]. * **Papilledema:** The most reliable physical sign of chronic raised ICP, though it may be absent in acute settings. * **False Localizing Signs:** Besides the 6th nerve, the 3rd nerve can also occasionally act as a false localizing sign [1].

Q: Inability to perform rapid alternating repeated movements is characteristic of which neurological sign?

Dysdiadochokinesia. **Explanation:** The inability to perform rapid alternating movements (such as pronation and supination of the hands or tapping the feet) is known as **Dysdiadochokinesia** [1]. This is a classic sign of **cerebellar dysfunction**, specifically involving the cerebellar hemispheres [1]. It occurs because the cerebellum fails to coordinate the precise timing of agonist-antagonist muscle switching required for rhythmic, repetitive tasks. **Analysis of Options:** * **Dysdiadochokinesia (Correct):** Derived from Greek (*dys* - difficult, *diadocho* - successive, *kinesia* - movement). It is tested clinically by asking the patient to "pat" the palm of one hand with the front and back of the other hand in rapid succession [1]. * **Past pointing:** Also known as hypermetria, this occurs when a patient overshoots a target during a finger-to-nose test [4]. It is a component of ataxia but specifically refers to spatial inaccuracy rather than rhythm. * **Dysmetria:** A broader term for the lack of coordination of movement typified by the underestimation (hypometria) or overestimation (hypermetria) of distance [4]. While related to cerebellar lesions, it refers to the *trajectory* and *range* of movement. * **Dyskinesia:** A general term for involuntary, abnormal movements (like chorea or tremors) typically associated with **Basal Ganglia** disorders (e.g., Parkinson’s or Levodopa-induced dyskinesia), not cerebellar rhythm [2], [3]. **NEET-PG High-Yield Pearls:** * **VANISSH** Mnemonic for Cerebellar signs: **V**ertigo, **A**taxia, **N**ystagmus (coarse), **I**ntention tremor, **S**lurred speech (Scanning speech), **S**ign of rebound, **H**ypotonia/Dysmetria/**H**eart rate (rarely used). * **Midline/Vermis lesions** result in truncal ataxia and gait instability. * **Lateral/Hemisphere lesions** result in ipsilateral limb ataxia and dysdiadochokinesia [4].

Q: Identify the type of convulsion shown below?

Myoclonic. ***Myoclonic*** - Characterized by **brief, shock-like muscle jerks** that are sudden and involuntary, typically lasting less than 100 milliseconds. - **EEG shows spike-and-wave complexes** with preserved consciousness during the brief jerking movements. *Tonic* - Involves **sustained muscle contraction** causing rigid posturing and stiffening of limbs for several seconds. - **Loss of consciousness** occurs with continuous muscle tension, not brief jerky movements. *Generalized Tonic-Clonic Seizure (GTCS)* - Begins with **tonic phase** (stiffening) followed by **clonic phase** (rhythmic jerking), lasting 1-3 minutes. - Associated with **complete loss of consciousness**, **tongue biting**, and **post-ictal confusion**, which are more severe than myoclonic jerks. *Atonic* - Characterized by **sudden loss of muscle tone** causing the patient to drop or fall ("drop attacks"). - Results in **collapse or head drop** due to muscle weakness, opposite to the jerky movements seen in myoclonic seizures.

Q: A simple partial seizure is diagnosed by which of the following investigations?

Electroencephalogram (EEG). **Explanation:** **1. Why EEG is the Correct Answer:** A seizure is defined as a transient occurrence of signs and symptoms due to abnormal excessive or synchronous neuronal activity in the brain. The diagnosis of any seizure type—including **simple partial seizures** [2] (now referred to as focal aware seizures)—is primarily clinical, but the definitive investigation to confirm and categorize the electrical nature of the event is the **Electroencephalogram (EEG)** [1]. EEG records the electrical activity of the cerebral cortex and can identify focal spikes or sharp waves in the specific brain region corresponding to the clinical symptoms [1]. **2. Why Other Options are Incorrect:** * **BAER (Brainstem Auditory Evoked Response):** This test evaluates the integrity of the auditory pathway from the ear to the brainstem. It is used for diagnosing hearing loss or brainstem lesions (like acoustic neuroma), not cortical electrical discharges. * **CT Scan & MRI:** These are **neuroimaging** modalities. While they are crucial for identifying the *structural cause* of a seizure (e.g., a tumor, stroke, or cortical dysplasia), they cannot diagnose the seizure activity itself, as a patient with epilepsy can have a perfectly normal-looking brain on imaging. **3. Clinical Pearls for NEET-PG:** * **Gold Standard:** While a routine EEG is often used, **Video-EEG monitoring** is the gold standard for diagnosing and localizing seizure foci. * **Sensitivity:** A single interictal (between seizures) EEG may be normal in up to 50% of patients with epilepsy. * **Terminology Update:** Per the latest ILAE classification, "Simple Partial Seizure" [2] is now termed a **Focal Aware Seizure**. * **MRI vs. CT:** MRI is the preferred imaging modality for epilepsy due to its superior sensitivity in detecting subtle lesions like Mesial Temporal Sclerosis (MTS).

Q: An obese 43-year-old female complains of transient visual obscuration, headache, and diplopia. All the following are associated findings EXCEPT?

Cerebral venous thrombosis. The clinical presentation of an **obese female** with **headache**, **transient visual obscurations (TVO)**, and **diplopia** (likely due to 6th nerve palsy) is a classic description of **Idiopathic Intracranial Hypertension (IIH)**, also known as Pseudotumor Cerebri. ### Why "Cerebral Venous Thrombosis" is the Correct Answer The diagnosis of IIH is based on the **Modified Dandy Criteria**, which requires the absence of any structural or systemic cause for increased intracranial pressure. **Cerebral Venous Thrombosis (CVT)** is a secondary cause of raised ICP. If CVT is present, the condition is no longer "idiopathic." Therefore, while CVT can mimic the symptoms of IIH, it is not a finding *associated* with the diagnosis of IIH itself; rather, it is a differential diagnosis that must be ruled out via MRV (Magnetic Resonance Venography). ### Explanation of Incorrect Options * **A. Papilledema:** This is the hallmark ophthalmic finding of IIH due to transmission of high CSF pressure to the optic nerve sheath. * **B. Increased intracranial pressure:** By definition, IIH involves elevated opening pressure on lumbar puncture (typically >25 cm H₂O) with normal CSF composition. * **C. 6th nerve palsy:** This occurs as a "false localizing sign." The increased ICP causes the abducens nerve to be stretched against the petrous temporal bone, leading to diplopia. ### High-Yield Clinical Pearls for NEET-PG * **Demographics:** Most common in "Fat, Fertile, Females of Forty" (though "Fertile" refers to childbearing age). * **Drugs associated with IIH:** Oral contraceptives, Tetracyclines, Vitamin A toxicity, and Steroid withdrawal. * **Visual Field Defect:** The most common field defect is an **enlarged blind spot**. * **Management:** Weight loss is primary; **Acetazolamide** is the first-line medical treatment. Surgical options include Optic Nerve Sheath Fenestration (for vision loss) or CSF shunting (for headache).

Q: Guillain-Barré syndrome can be seen following which type of immunization?

Killed Influenza vaccine. ### Explanation **Correct Option: D. Killed Influenza vaccine** Guillain-Barré Syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy. The association between GBS and the influenza vaccine was first significantly noted during the 1976 Swine Flu (H1N1) vaccination campaign. While the absolute risk is extremely low (approximately 1–2 additional cases per million doses), it remains a classic association in medical literature and exams. The underlying mechanism is believed to be **molecular mimicry**, where the immune response against vaccine antigens cross-reacts with gangliosides in the peripheral nerves. **Analysis of Incorrect Options:** * **A. Pertussis:** The Whole-cell Pertussis (wP) vaccine is more commonly associated with febrile seizures and, historically, a controversial link to encephalopathy, but not GBS. * **B. Measles:** Measles vaccination is associated with a rare risk of Subacute Sclerosing Panencephalitis (SSPE)-like symptoms in immunocompromised individuals or idiopathic thrombocytopenic purpura (ITP), but GBS is not a standard complication. * **C. Diphtheria:** Diphtheria toxoid is generally considered safe; while the diphtheria *infection* can cause neuropathy (via exotoxin), the vaccine is not a recognized trigger for GBS. **High-Yield Clinical Pearls for NEET-PG:** * **Most common antecedent infection for GBS:** *Campylobacter jejuni* (presents with bloody diarrhea). * **Other associated vaccines:** Oral Polio Vaccine (OPV) and Rabies vaccine (Neural tissue derived - Semple vaccine) have historical associations with neurological complications. * **Key CSF Finding in GBS:** **Albuminocytologic dissociation** (High protein with normal cell count). * **Treatment of choice:** Intravenous Immunoglobulin (IVIG) or Plasmapheresis. Steroids are generally not effective.

Question 1

Tumefactive lesions are seen most commonly in which disease?

Accepted Answer

Multiple sclerosis

Answer

Reiter's disease

Answer

Paget disease

Answer

Marfan syndrome

Question 2

Which of the following causes distal myopathy?

Accepted Answer

Myotonic dystrophy

Answer

Duchenne Muscular Dystrophy

Answer

Becker Muscular Dystrophy

Answer

Polymyositis

Question 3

The site of lesion in unilateral past pointing nystagmus is?

Accepted Answer

Cerebellar hemisphere

Answer

Posterior semicircular canal

Answer

Superior semicircular canal

Answer

Flocculonodular lobe

Question 4

A patient presents with the following neurological findings: loss of pain and temperature sensation over the left side of the face, loss of pain and temperature sensation in the right arm and leg, and normal tactile and vibratory sensations on the face, body, and extremities. Where is the lesion located?

Accepted Answer

Dorsolateral medulla

Answer

Mesencephalon at the level of the inferior colliculus

Answer

Spinal cord at the cervical enlargement

Answer

Posterior limb of the internal capsule

Question 5

Raised intracranial pressure should be suspected when there is?

Accepted Answer

Sixth cranial nerve palsy

Answer

Neck stiffness

Answer

Episodic unilateral headache

Answer

Unilateral ptosis

Question 6

Inability to perform rapid alternating repeated movements is characteristic of which neurological sign?

Accepted Answer

Dysdiadochokinesia

Answer

Past pointing

Answer

Dysmetria

Answer

Dyskinesia

Question 7

Identify the type of convulsion shown below?

Accepted Answer

Myoclonic

Answer

Tonic

Answer

Generalized Tonic-Clonic Seizure (GTCS)

Answer

Atonic

Question 8

A simple partial seizure is diagnosed by which of the following investigations?

Accepted Answer

Electroencephalogram (EEG)

Answer

Brainstem Auditory Evoked Response (BAER)

Answer

CT scan

Answer

MRI

Question 9

An obese 43-year-old female complains of transient visual obscuration, headache, and diplopia. All the following are associated findings EXCEPT?

Accepted Answer

Cerebral venous thrombosis

Answer

Papilledema

Answer

Increased intracranial pressure

Answer

6th nerve palsy

Question 10

Guillain-Barré syndrome can be seen following which type of immunization?

Accepted Answer

Killed Influenza vaccine

Answer

Pertussis

Answer

Measles

Answer

Diphtheria

Neurology — MCQs

Neurology — MCQs

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