Neurology Practice Questions

Q: Which condition commonly involves the V1 distribution of the trigeminal nerve?

Post herpetic neuralgia. **Explanation:** **1. Why Post-herpetic Neuralgia (PHN) is correct:** Post-herpetic neuralgia is a complication of Herpes Zoster (shingles), caused by the reactivation of the Varicella-Zoster Virus (VZV) latent in sensory ganglia [1]. When VZV involves the Trigeminal (V) nerve, it most frequently affects the **Ophthalmic division (V1)**, a condition known as *Herpes Zoster Ophthalmicus*. This predilection for V1 is a classic clinical hallmark, often presenting with a vesicular rash in the supraorbital region and potential corneal involvement (Hutchinson’s sign). **2. Why the other options are incorrect:** * **Trigeminal Neuralgia (Tic Douloureux):** Characterized by paroxysmal, lancinating pain, it most commonly involves the **V2 (Maxillary)** and **V3 (Mandibular)** divisions. V1 involvement is rare (only ~5% of cases). * **Trotter’s Syndrome:** This is a triad associated with nasopharyngeal carcinoma. It involves the **V3 (Mandibular)** nerve (causing numbness in the lower jaw/tongue), ipsilateral palatal paralysis (CN X), and conductive deafness (Eustachian tube blockage). * **Hunt’s Syndrome (Ramsay Hunt Syndrome):** This involves VZV reactivation in the **Geniculate ganglion of the Facial nerve (CN VII)**. It presents with facial palsy and vesicles in the external auditory canal, not primary V1 distribution. **Clinical Pearls for NEET-PG:** * **Hutchinson’s Sign:** Vesicles on the tip of the nose indicate involvement of the nasociliary branch of V1, predicting a high risk of ocular complications. * **Drug of Choice (DOC):** For PHN, first-line treatments include **Gabapentin, Pregabalin**, or Amitriptyline. * **Trigeminal Neuralgia DOC:** **Carbamazepine** remains the gold standard medical treatment.

Q: A 24-year-old woman presents with progressively worsening foot and leg weakness over the past week. Initially, she experienced tingling in her feet and difficulty lifting them, which has now progressed to difficulty standing and walking due to leg weakness. Three weeks prior, she had a resolved upper respiratory infection. On examination, muscle bulk is normal, motor strength is 2/5 in the quadriceps and 1/5 in the feet. Deep tendon reflexes at the ankles and knees are absent, and sensory testing is normal. Upper limb examination is normal. Cerebrospinal fluid shows very high protein, normal glucose, and a slightly elevated cell count. What is the most likely diagnosis?

Guillain-Barre syndrome. **Explanation:** The clinical presentation is classic for **Guillain-Barré Syndrome (GBS)**, specifically the Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP) subtype. The hallmark of GBS is an **acute, symmetric, ascending paralysis** following a triggering event (usually a respiratory or gastrointestinal infection, often *Campylobacter jejuni*) [1]. **Why GBS is correct:** 1. **Clinical Progression:** Rapidly progressive weakness starting in the lower extremities (ascending) over one week [1]. 2. **Physical Findings:** Lower Motor Neuron (LMN) signs, specifically **areflexia** (absent DTRs) and flaccid weakness [1]. 3. **CSF Analysis:** The finding of **Albuminocytologic Dissociation** (elevated protein with a normal/near-normal cell count) is pathognomonic for GBS. **Why the other options are incorrect:** * **Diabetic/Alcoholic Neuropathy:** These are typically chronic, slowly progressive, and predominantly sensory-motor "stocking-glove" neuropathies. They do not present with acute, rapidly ascending motor paralysis. * **Cyanide Poisoning:** Presents acutely with altered mental status, seizures, metabolic acidosis, and cardiovascular collapse, rather than an isolated ascending motor paralysis. **NEET-PG High-Yield Pearls:** * **Most common trigger:** *Campylobacter jejuni* (associated with the AMAN variant). * **Earliest sign:** Loss of deep tendon reflexes (Areflexia) [1]. * **Treatment:** IV Immunoglobulin (IVIG) or Plasmapheresis. **Steroids are not effective.** * **Monitoring:** Frequent monitoring of **Forced Vital Capacity (FVC)** is crucial to detect impending respiratory failure [1]. * **Miller-Fisher Syndrome:** A GBS variant characterized by the triad of Ataxia, Areflexia, and Ophthalmoplegia (associated with anti-GQ1b antibodies) [1].

Q: A 52-year-old female complains of sudden visual abnormalities. Her history reveals a 30 pack-year history of smoking, hypertension, and hypercholesterolemia. A head CT shows a lesion in the right occipital lobe, and an angiogram reveals an embolic stroke of the right posterior cerebral artery. What type of visual deficit is she most likely experiencing?

Left homonymous hemianopia. ### Explanation **1. Why the Correct Answer is Right:** The patient has suffered an embolic stroke of the **right Posterior Cerebral Artery (PCA)**, leading to an infarct in the **right occipital lobe** (primary visual cortex). * **Neuroanatomy:** The visual pathway posterior to the optic chiasm (optic tract, lateral geniculate nucleus, optic radiations, and visual cortex) carries fibers from the **contralateral** visual field. * A lesion in the right occipital lobe results in a loss of vision in the left half of the visual field in both eyes, a condition known as **Left Homonymous Hemianopia**. * *Note:* While PCA strokes often present with "macular sparing" due to collateral supply from the Middle Cerebral Artery (MCA) to the occipital pole, the primary deficit remains a homonymous hemianopia. **2. Why the Incorrect Options are Wrong:** * **A. Bitemporal hemianopia:** This occurs due to a lesion at the **optic chiasm** (e.g., pituitary adenoma), affecting the decussating nasal retinal fibers. * **B. Central scotoma:** This is typically seen in **macular degeneration** or **optic neuritis** (lesion of the macula or optic nerve). * **D. Left superior quadrantanopia:** Also known as "pie in the sky," this results from a lesion in the **Right Meyer’s Loop** (temporal lobe), not the entire occipital cortex. **3. Clinical Pearls for NEET-PG:** * **PCA Stroke Triad:** Homonymous hemianopia (with macular sparing), hemisensory loss (thalamic involvement), and alexia without agraphia (if the dominant hemisphere/splenium is involved). * **Macular Sparing:** Occurs because the occipital pole (representing the macula) has a **dual blood supply** from both the PCA and MCA. * **Rule of Thumb:** Any lesion **behind the chiasm** produces a contralateral homonymous deficit.

Q: All of the following are true about Broca's aphasia except?

Repetition is preserved.. **Explanation:** Broca’s aphasia (Motor or Expressive aphasia) results from damage to **Broca’s area (Brodmann areas 44 and 45)**, located in the posterior part of the inferior frontal gyrus of the dominant hemisphere. **Why "Repetition is preserved" is the correct answer (the false statement):** In Broca’s aphasia, **repetition is significantly impaired**. Repetition requires an intact connection between the receptive (Wernicke’s) and expressive (Broca’s) areas via the arcuate fasciculus, as well as the functional integrity of both areas. Since the motor production of speech is damaged in Broca’s, the patient cannot repeat phrases spoken to them [1]. *Note: If repetition were preserved in a patient with non-fluent speech, the diagnosis would be Transcortical Motor Aphasia.* **Analysis of other options:** * **A. Lesion lies in the frontal lobe:** This is true. Broca’s area is situated in the **inferior frontal gyrus** [1]. * **B. Fluency is impaired:** This is true. It is a **non-fluent** aphasia characterized by "telegraphic speech," slow output, and great effort. * **C. Neologisms are absent:** This is true. Neologisms (creating new, meaningless words) are a hallmark of **Wernicke’s (fluent) aphasia**. Broca’s patients struggle to produce words but generally use existing ones (though often nouns/verbs only). **NEET-PG High-Yield Pearls:** * **Blood Supply:** Broca’s area is supplied by the **superior division of the Middle Cerebral Artery (MCA)**. * **Comprehension:** Remains **intact** (patients are often frustrated because they are aware of their deficit). * **Associated Deficit:** Often accompanied by **contralateral hemiparesis** (due to proximity to the motor cortex) [1]. * **Mnemonic:** **B**roca’s = **B**roken speech (non-fluent).

Q: A 63-year-old woman presents with weakness in her right hand, affecting her ability to write and button her clothes. Examination reveals marked atrophy of the forearm and hand muscles with fasciculations. Muscle tone is increased, reflexes are brisk, and sensory testing in the hand is normal. She also reports fasciculations in her thighs. Considering the patient's muscle weakness, what is the most likely anatomic site for the disorder?

anterior horn cell. The clinical presentation described is a classic manifestation of **Amyotrophic Lateral Sclerosis (ALS)**, a motor neuron disease characterized by the simultaneous involvement of both **Upper Motor Neurons (UMN)** and **Lower Motor Neurons (LMN)** [2]. ### Why Anterior Horn Cell is Correct: The **Anterior Horn Cell (AHC)** is the site of the lower motor neuron cell body [1]. Damage here results in LMN signs, while associated corticospinal tract involvement leads to UMN signs. * **LMN Signs in this patient:** Marked muscle atrophy and fasciculations (highly characteristic of AHC disease) [1]. * **UMN Signs in this patient:** Increased muscle tone (spasticity) and brisk reflexes. * **Sensory Sparing:** The absence of sensory deficits is a hallmark of AHC disorders, as the pathology is restricted to motor pathways [2]. ### Why Other Options are Incorrect: * **B. Peripheral Nerve:** While nerve lesions cause LMN signs (atrophy, weakness), they typically present with **sensory loss** (numbness/paresthesia) and **decreased/absent reflexes**, not brisk ones. * **C. Neuromuscular Junction (e.g., Myasthenia Gravis):** These disorders present with fatigable weakness and typically lack atrophy, fasciculations, or UMN signs. Reflexes remain normal. * **D. Muscle (Myopathy):** Primary muscle diseases usually cause proximal weakness (difficulty climbing stairs) rather than distal hand weakness. Fasciculations and UMN signs (brisk reflexes) are absent. ### NEET-PG High-Yield Pearls: * **The "Mixed" Picture:** Any question showing **atrophy + brisk reflexes** in the same limb points directly to ALS/Anterior Horn Cell disease [2]. * **Fasciculations:** These represent spontaneous firing of a motor unit and are the "signature" of AHC irritation [1]. * **Senses and Sphincters:** In ALS, sensory systems, ocular movements, and bowel/bladder sphincters are typically **spared** until very late stages [2].

Question 1

Which condition commonly involves the V1 distribution of the trigeminal nerve?

Accepted Answer

Post herpetic neuralgia

Answer

Trigeminal Neuralgia

Answer

Trotter’s syndrome

Answer

Hunt’s syndrome

Question 2

A 24-year-old woman presents with progressively worsening foot and leg weakness over the past week. Initially, she experienced tingling in her feet and difficulty lifting them, which has now progressed to difficulty standing and walking due to leg weakness. Three weeks prior, she had a resolved upper respiratory infection. On examination, muscle bulk is normal, motor strength is 2/5 in the quadriceps and 1/5 in the feet. Deep tendon reflexes at the ankles and knees are absent, and sensory testing is normal. Upper limb examination is normal. Cerebrospinal fluid shows very high protein, normal glucose, and a slightly elevated cell count. What is the most likely diagnosis?

Accepted Answer

Guillain-Barre syndrome

Answer

Diabetic neuropathy

Answer

Alcoholic neuropathy

Answer

Cyanide poisoning

Question 3

A patient with traumatic paraplegia due to injury of the T3 thoracic cord level presents with a blood pressure of 210/120. What should be the initial management?

Accepted Answer

Nifedipine

Answer

Subcutaneous low molecular weight heparin

Answer

Steroids

Answer

Normal saline / Dextrose

Question 4

A 52-year-old female complains of sudden visual abnormalities. Her history reveals a 30 pack-year history of smoking, hypertension, and hypercholesterolemia. A head CT shows a lesion in the right occipital lobe, and an angiogram reveals an embolic stroke of the right posterior cerebral artery. What type of visual deficit is she most likely experiencing?

Accepted Answer

Left homonymous hemianopia

Answer

Bitemporal hemianopia

Answer

Central scotoma

Answer

Left superior quadrantanopia

Question 5

Contralateral superior quadrantanopia and sensory aphasia occurs due to occlusion of which branch of the middle cerebral artery?

Accepted Answer

M2 segment, inferior division

Answer

M2 segment, superior division

Answer

MCA stem

Answer

M1 segment

Question 6

All of the following are true about Broca's aphasia except?

Accepted Answer

Repetition is preserved.

Answer

Lesion lies in the frontal lobe.

Answer

Fluency is impaired.

Answer

Neologisms are absent.

Question 7

A 70-year-old male presents with difficulty understanding written language, with no associated difficulty in understanding auditory information. He was in good health except for a recent head trauma after an accidental fall. What is the most probable diagnosis?

Accepted Answer

Anomic aphasia

Answer

Broca's aphasia

Answer

Wernicke's aphasia

Answer

Jargon aphasia

Question 8

A patient presents with sudden onset of unilateral or bilateral weakness, sensory loss, disorder of ocular motility, and loss of facial sensation, along with ataxia. Based on these symptoms, what is the most likely site of the cerebrovascular lesion?

Accepted Answer

Basilar artery

Answer

Internal carotid artery

Answer

Middle cerebral artery

Answer

Penetrating branch of the middle cerebral artery

Question 9

A 63-year-old woman presents with weakness in her right hand, affecting her ability to write and button her clothes. Examination reveals marked atrophy of the forearm and hand muscles with fasciculations. Muscle tone is increased, reflexes are brisk, and sensory testing in the hand is normal. She also reports fasciculations in her thighs. Considering the patient's muscle weakness, what is the most likely anatomic site for the disorder?

Accepted Answer

anterior horn cell

Answer

peripheral nerve

Answer

neuromuscular junction

Answer

muscle

Question 10

All of the following statements about Myasthenia Gravis are true, except?

Accepted Answer

Anti-MuSK antibodies are directed against muscarinic ACh receptors.

Answer

Anti-AChR antibodies are the most common antibodies in generalized myasthenia gravis.

Answer

The pathogenic Anti-AChR antibodies are IgG antibodies.

Answer

The major defect is a decrease in the number of available ACh receptors.

Neurology — MCQs

Neurology — MCQs

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