Neurology Practice Questions

Q: A 35-year-old patient recalls episodes where he smells a pungent odor, becomes sweaty, and loses consciousness. His family member reports that while unconscious, he was having facial twitching with lip-smacking movements. What is the most probable diagnosis?

Focal seizures. **Explanation:** The clinical presentation is classic for **Focal Seizures with Impaired Awareness** (formerly known as Complex Partial Seizures), likely originating from the **Temporal Lobe**. **Why Focal Seizures is correct:** The patient experiences a sensory "aura" (olfactory hallucination/pungent odor), which is a hallmark of focal cortical involvement. The subsequent loss of consciousness accompanied by **automatisms** (lip-smacking) and autonomic symptoms (sweating) are characteristic of temporal lobe epilepsy. Facial twitching indicates motor involvement within the focal seizure. **Why the other options are incorrect:** * **Hysteria (Dissociative/Conversion Disorder):** While it can mimic seizures (pseudoseizures), the presence of specific olfactory auras and stereotyped motor patterns like lip-smacking strongly points toward an organic neurological etiology. * **Atonic Seizures:** These involve a sudden loss of muscle tone ("drop attacks") leading to collapse. They do not typically feature olfactory auras or complex automatisms. * **Myoclonic Seizures:** These are characterized by brief, shock-like jerks of a muscle or group of muscles, usually without a preceding aura or prolonged loss of consciousness with automatisms. **High-Yield Clinical Pearls for NEET-PG:** * **Temporal Lobe Epilepsy (TLE):** The most common site for focal seizures. Look for the "4 As": **A**ura (olfactory/gustatory), **A**utomatisms (lip-smacking, hand rubbing), **A**utonomic features, and **A**mnesia for the event. * **Olfactory Hallucinations:** When associated with seizures, these often suggest a lesion or focus in the **uncus** (uncinate fits). * **Todd’s Paralysis:** Post-ictal focal neurological deficit (like hemiparesis) following a focal seizure; a common distracter in exams.

Q: All of the following are characteristic features of cluster headache except:

Bilateral photophobia. Explanation: Cluster headache is a primary headache disorder classified under **Trigeminal Autonomic Cephalalgias (TACs)** [2]. The hallmark of this condition is its strictly **unilateral** nature and associated autonomic symptoms. **1. Why "Bilateral Photophobia" is the correct answer (the exception):** While photophobia can occur in cluster headaches, it is typically **ipsilateral** (on the same side as the pain). Bilateral photophobia and phonophobia are classic features of **Migraine**, not cluster headache. If a patient presents with bilateral symptoms, the diagnosis should be reconsidered. **2. Analysis of incorrect options:** * **Periodic pain:** Cluster headaches are named for their "circadian and circannual periodicity." Attacks often occur at the same time each day (often waking the patient from sleep) and occur in "clusters" lasting weeks to months, followed by long remission periods [1]. * **Conjunctival injection:** This is a cardinal autonomic symptom caused by parasympathetic overactivity. Other features include lacrimation, rhinorrhea, nasal congestion, and miosis/ptosis (Horner’s syndrome), all of which are strictly ipsilateral. * **No response to oral sumatriptan:** Oral triptans are generally **ineffective** because the peak plasma concentration is reached too slowly (30–60 minutes) to treat an attack that typically lasts only 15–180 minutes [1]. The gold standard for acute treatment is **100% Oxygen** or **Subcutaneous/Nasal Sumatriptan** [1]. **Clinical Pearls for NEET-PG:** * **Demographics:** More common in males (unlike Migraine). * **Patient Behavior:** Patients are typically **restless and agitated** (pacing), whereas migraineurs prefer to lie still in a dark room [1]. * **Prophylaxis:** **Verapamil** is the drug of choice for long-term prevention [1]. * **Trigger:** Alcohol is a potent trigger during an active cluster period.

Q: Which of the following conditions is associated with vestibular schwannoma, spinal cord astrocytoma, and meningioma?

Neurofibromatosis - 2. **Explanation** **Neurofibromatosis Type 2 (NF-2)**, also known as MISME syndrome (Multiple Inherited Schwannomas, Meningiomas, and Ependymomas), is the correct answer. It is an autosomal dominant neurocutaneous syndrome caused by a mutation in the **merlin gene** on **chromosome 22**. The hallmark of NF-2 is **bilateral vestibular schwannomas** (acoustic neuromas), which typically present with sensorineural hearing loss and tinnitus. Beyond the 8th cranial nerve, patients are highly predisposed to other CNS tumors, specifically **meningiomas** and intramedullary spinal tumors, most commonly **ependymomas** and **astrocytomas**. **Why other options are incorrect:** * **Tuberous Sclerosis (TSC):** Characterized by the triad of seizures, mental retardation, and adenoma sebaceum. Associated tumors include Subependymal Giant Cell Astrocytomas (SEGA), cortical tubers, and cardiac rhabdomyomas. * **Neurofibromatosis-1 (NF-1):** Linked to chromosome 17. It presents with Lisch nodules, Café-au-lait spots, and neurofibromas. The classic CNS tumor associated with NF-1 is **Optic Nerve Glioma**, not vestibular schwannoma. * **Von Hippel-Lindau (VHL):** Associated with chromosome 3. It is characterized by **hemangioblastomas** (cerebellum, retina, spinal cord), renal cell carcinoma, and pheochromocytoma. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for NF-2:** Remember **"22"**—Chromosome **22**, **2** ears (bilateral schwannomas), and **2** eyes (juvenile posterior subcapsular lenticular opacities/cataracts). * **Diagnostic Hallmark:** Bilateral vestibular schwannomas on MRI are pathognomonic for NF-2. * **NF-1 vs. NF-2:** NF-1 is more common and primarily involves peripheral nerves and skin; NF-2 is rarer and primarily involves central nervous system tumors.

Q: Which of the following is NOT true about conus medullaris syndrome?

Knee and ankle jerks are absent.. **Explanation:** **Conus Medullaris Syndrome (CMS)** occurs due to injury to the terminal end of the spinal cord (usually at the L1-L2 vertebral level). Understanding the distinction between CMS and Cauda Equina Syndrome (CES) is a high-yield topic for NEET-PG. **Why Option B is the correct answer (The False Statement):** In CMS, the lesion is located at the **sacral segments** of the spinal cord. The **Knee jerk (L2-L4)** is mediated by segments above the conus; therefore, it is typically **preserved/normal**. While the ankle jerk (S1-S2) may be affected, the statement that "both knee and ankle jerks are absent" is incorrect. In contrast, both are usually absent in Cauda Equina Syndrome because it involves multiple nerve roots. **Analysis of other options:** * **Option A:** CMS specifically involves the sacral (S3-S5) and coccygeal segments of the spinal cord. * **Option C:** Since CMS is technically a spinal cord (CNS) lesion, the plantar reflex remains **flexor** (normal) or is absent. An extensor response (Babinski sign) is rare but more likely here than in CES, which is a pure lower motor neuron (LMN) lesion. * **Option D:** **Saddle anesthesia** (sensory loss over S3-S5 dermatomes) is a hallmark of CMS and is typically **symmetrical** and bilateral. **High-Yield Clinical Pearls for NEET-PG:** 1. **Level of Lesion:** CMS occurs at **L1-L2**; CES occurs below **L2**. 2. **Onset:** CMS has a **sudden, bilateral** onset; CES is often gradual and asymmetrical. 3. **Autonomic Dysfunction:** Early and severe urinary/fecal incontinence and impotence are characteristic of **Conus Medullaris Syndrome**. 4. **Pain:** Radicular pain is severe in CES but mild/absent in CMS.

Q: Which medication can be administered to reduce the frequency of future headache episodes in a 26-year-old female patient who experiences one-sided pulsating headaches accompanied by nausea, vomiting, and sensitivity to light and finds relief in a dimly lit environment?

Propranolol. ***Propranolol***- This is a non-selective **beta-blocker** and is considered a first-line prophylactic agent for the reduction of frequency and severity in patients with **episodic migraine** [1].- The patient's symptoms (unilateral, pulsating headache, **nausea, vomiting, and photophobia**) [2] are classic features of migraine, making **Propranolol** an appropriate choice for maintenance therapy [3].*Alprazolam*- This medication is a **short-acting benzodiazepine** primarily indicated for the acute management of anxiety and panic disorders [3].- It has **no established role** in the long-term prophylactic management of migraine and carries risks of sedation and dependence.*Diazepam*- This is a **long-acting benzodiazepine** commonly used as a muscle relaxant, anxiolytic, and for acute seizure management.- Similar to Alprazolam, it is **not recommended** for headache prophylaxis due to lack of efficacy and significant abuse potential [3].*Fluoxetine*- This drug is a selective serotonin reuptake inhibitor (**SSRI**) primarily used to treat **major depressive disorder** and anxiety [3].- While some antidepressants (like TCAs) are used for migraine prophylaxis, **Fluoxetine** is generally not considered a standard or preferred first-line agent for preventing migraine attacks.

Q: A patient presents with contralateral face, arm, and leg weakness. NCCT shows intracerebral hemorrhage (ICH). What is the most likely location of the CNS bleed?

Basal ganglia. ***Basal ganglia*** - The **basal ganglia**, particularly the **putamen**, is the most common site for hypertensive intracerebral hemorrhage, which aligns perfectly with the deep parenchymal bleed seen on the provided NCCT scan. - A lesion in this location classically damages the adjacent **internal capsule**, where motor fibers for the face, arm, and leg are tightly packed, resulting in **contralateral hemiparesis**. *Midbrain* - A midbrain hemorrhage would present with distinct cranial nerve deficits, most notably **oculomotor nerve (CN III) palsy**, causing a "down and out" eye position, ptosis, and a dilated pupil. - Other characteristic signs include altered consciousness and **vertical gaze palsy** (Parinaud syndrome), which are absent in this patient's pure motor presentation. *Pons* - Pontine hemorrhages have a catastrophic presentation, typically causing a rapid descent into **coma**, **quadriplegia**, and classic **pinpoint pupils** due to disruption of descending sympathetic pathways. - The patient's presentation of contralateral hemiparesis without coma or pupillary changes is inconsistent with a pontine bleed. *Medulla* - Medullary hemorrhages are rare and cause specific brainstem syndromes like **Wallenberg syndrome**, characterized by vertigo, nystagmus, dysphagia, and ipsilateral facial numbness. - These syndromes involve complex crossed sensory and motor deficits, not the uniform contralateral motor weakness described in the question.

Q: A 30-year-old male presents with deep-seated retro-orbital pain from cluster headache. What is the best management?

Oxygen. ***Oxygen*** - **High-flow oxygen** (100% at 7-15 L/min) is the safest and most effective **first-line abortive treatment** for an acute cluster headache attack [1] - It works rapidly to cause **vasoconstriction** and often terminates the severe retro-orbital pain within **15 to 20 minutes** - This is the preferred treatment for acute attacks due to its rapid onset and excellent safety profile *Verapamil* - Verapamil is a calcium channel blocker and is considered the **first-line prophylactic agent** for both episodic and chronic cluster headache, not acute treatment [1] - Its mechanism of action requires time, rendering it ineffective for terminating an ongoing acute pain episode - Used to prevent future attacks, not to abort current ones *Lithium* - Lithium is a prophylactic treatment reserved mainly for patients with **chronic cluster headache** or those who do not respond to Verapamil [1] - It has a slow onset of action and is not used to manage the acute pain of a cluster attack - Requires therapeutic monitoring due to narrow therapeutic window [1] *Topiramate* - Topiramate is an established prophylactic treatment primarily for **migraine**, and occasionally used as a second-line prophylactic agent for cluster headache - As a prophylactic medication, it plays **no role** in the acute termination or abortive management of a cluster headache episode

Question 1

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

Accepted Answer

Nifedipine

Answer

Subcutaneous LMWH

Answer

Steroids

Answer

Normal saline / Dextrose

Question 2

A 35-year-old patient recalls episodes where he smells a pungent odor, becomes sweaty, and loses consciousness. His family member reports that while unconscious, he was having facial twitching with lip-smacking movements. What is the most probable diagnosis?

Accepted Answer

Focal seizures

Answer

Hysteria

Answer

Atonic seizures

Answer

Myoclonic seizures

Question 3

A 48-year-old woman with chronic renal failure has bilaterally enlarged kidneys with multiple cysts on renal scan. She experienced a sudden onset of severe headache. A cerebral angiogram showed marked narrowing of cerebral artery branches near the base of the brain, consistent with vasospasm, and no intraparenchymal hemorrhage. Which of the following conditions MOST likely produced these findings?

Accepted Answer

Subarachnoid hemorrhage

Answer

Bacterial meningitis

Answer

Severe atherosclerosis

Answer

Malignant hypertension

Question 4

All of the following are characteristic features of cluster headache except:

Accepted Answer

Bilateral photophobia

Answer

Periodic pain

Answer

Conjunctival injection

Answer

No response to oral sumatriptan

Question 5

Which of the following conditions is associated with vestibular schwannoma, spinal cord astrocytoma, and meningioma?

Accepted Answer

Neurofibromatosis - 2

Answer

Tuberous sclerosis

Answer

Neurofibromatosis - 1

Answer

Von Hippel-Lindau syndrome

Question 6

Brain dead individuals have all of the following features EXCEPT?

Accepted Answer

Only pain is preserved

Answer

Dolls eye movement is absent

Answer

Oculo-vestibular reflex is absent

Answer

Corneal reflex is absent

Question 7

Which of the following is NOT true about conus medullaris syndrome?

Accepted Answer

Knee and ankle jerks are absent.

Answer

It involves segments from the lower 3 sacral and coccygeal segments.

Answer

Plantar reflex is flexor.

Answer

Saddle anesthesia is present.

Question 8

Which medication can be administered to reduce the frequency of future headache episodes in a 26-year-old female patient who experiences one-sided pulsating headaches accompanied by nausea, vomiting, and sensitivity to light and finds relief in a dimly lit environment?

Accepted Answer

Propranolol

Answer

Diazepam

Answer

Fluoxetine

Answer

Alprazolam

Question 9

A patient presents with contralateral face, arm, and leg weakness. NCCT shows intracerebral hemorrhage (ICH). What is the most likely location of the CNS bleed?

Accepted Answer

Basal ganglia

Answer

Pons

Answer

Midbrain

Answer

Medulla

Question 10

A 30-year-old male presents with deep-seated retro-orbital pain from cluster headache. What is the best management?

Accepted Answer

Oxygen

Answer

Verapamil

Answer

Lithium

Answer

Topiramate

Neurology — MCQs

Neurology — MCQs

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