Neurology Practice Questions

Q: A 12-year-old boy presents with difficulty in reading from the blackboard in school. Initially refraction error was considered but visual acuity was normal. He has started complaining of diplopia on watching TV or after studying for long. He takes very long time to finish his meals and his speech becomes very difficult to understand after speaking continuously for few minutes. Anti-Acetylcholine receptor blocking antibody is detected in high titers. All are done in management except? (Recent NEET Pattern 2016-17)

Atropine. ***Atropine*** - The patient's symptoms (diplopia, dysphagia, dysarthria, and improvement with rest, along with high titers of **anti-acetylcholine receptor blocking antibody**) are classic for **myasthenia gravis (MG)** [1], [2]. - **Atropine** is an anticholinergic agent that may occasionally be used to manage muscarinic side effects of cholinesterase inhibitors (like pyridostigmine), such as bradycardia, hypersalivation, or diarrhea [3]. - However, **atropine is NOT a primary treatment modality for MG** and is not part of routine management protocols [3]. It does not address the underlying pathophysiology or improve muscle strength. - In contrast, the other options represent core components of MG management. *Pyridostigmine* - **Pyridostigmine** is an **acetylcholinesterase inhibitor** and is the **first-line symptomatic treatment** for myasthenia gravis [1]. - It increases the amount of acetylcholine available at the neuromuscular junction, improving muscle strength and function. *Steroids* - **Corticosteroids** (like prednisone) are a mainstay of **immunosuppressive therapy** for myasthenia gravis, used to reduce the autoimmune attack on acetylcholine receptors [1]. - They are typically used when symptoms are not adequately controlled by pyridostigmine alone or in moderate to severe cases. *CT chest* - A **CT scan of the chest** is crucial in the initial workup of myasthenia gravis to screen for a **thymoma**, a tumor of the thymus gland. - Thymomas are associated with MG in 10-15% of patients, and their presence often dictates the need for thymectomy. - Even in the absence of thymoma, thymic hyperplasia is common in MG patients.

Q: Which of the following is incorrect about the condition shown below?

Most common CT finding is intraventricular calcification. ***Most common CT finding is intraventricular calcification*** - This statement is **incorrect**. In neurocysticercosis, the most common CT finding is **parenchymal calcifications**, which represent the remnants of dead cysts, rather than intraventricular calcifications. - **Intraventricular calcifications** are possible but less frequent than parenchymal lesions and often arise from degenerating intraventricular cysts leading to obstructive hydrocephalus. *Most common presentation is partial seizures* - This statement is **correct**. **Partial seizures** (also known as focal seizures) are indeed the most common clinical presentation of neurocysticercosis, especially when **parenchymal cysts** are involved. - This is due to the cysts acting as a **focal irritant** within the cerebral cortex, leading to abnormal electrical activity. *Albendazole is given for 8 days* - This statement is **correct**. For neurocysticercosis, **Albendazole** is typically administered for a duration ranging from **8 days to 30 days**, depending on the number, location, and stage of the cysts. - The precise duration can vary based on clinical response and cyst resolution observed on follow-up imaging. *Steroids help in alleviating vasogenic oedema of ring enhancing lesion* - This statement is **correct**. **Corticosteroids**, such as dexamethasone, are frequently co-administered with anti-parasitic drugs like albendazole to manage the **inflammatory response** (vasogenic edema) caused by the dying parasites. - This edema often surrounds the **ring-enhancing lesions** seen on imaging and can exacerbate symptoms like seizures and headaches.

Q: A 25-year-old lady presents with reduced color vision and paresthesias. Her symptoms increase with rise of body temperature. Examine the appearance of her eyes and comment on diagnosis.

Internuclear ophthalmoplegia. ***Internuclear ophthalmoplegia*** - The clinical presentation of **reduced color vision**, **paresthesias**, and symptoms worsening with increased body temperature (**Uhthoff's phenomenon**) is highly suggestive of **multiple sclerosis**. - **Internuclear ophthalmoplegia (INO)** is a common and characteristic ocular manifestation of multiple sclerosis, causing impaired adduction of one eye during conjugate gaze with nystagmus of the abducting eye. Examination of the image would likely show such a gaze abnormality. *Horner syndrome* - **Horner syndrome** is characterized by **miosis**, **ptosis**, and **anhidrosis** on one side of the face. - These specific ocular findings and systemic symptoms (reduced color vision, paresthesias, Uhthoff's phenomenon) do not align with a classic Horner syndrome presentation. *Duane retraction syndrome* - **Duane retraction syndrome** is a congenital disorder characterized by **limited abduction** (most common) or adduction, globe retraction, and narrowing of the palpebral fissure on attempted adduction. - This is a developmental anomaly of ocular motility and does not explain the widespread neurological symptoms or the heat sensitivity described. *Hutchinson pupil* - A **Hutchinson pupil** is a fixed, dilated pupil seen in cases of **uncal herniation** due to compression of the oculomotor nerve (CN III). - This is an acute, unilateral neurological emergency and does not present with the chronic, relapsing-remitting symptoms like reduced color vision and paresthesias or Uhthoff's phenomenon.

Q: A patient has the following presentation. After administration of an intravenous drug to the patient, in 6 minutes his symptoms have resolved. The diagnosis of the patient is:

Myasthenia gravis. The question refers to an accompanying image (not provided in the text, but essential for context) showing a patient with **ptosis** (drooping eyelid) and possibly other ocular muscle weakness. The key information is that symptoms resolve within 6 minutes after administration of an intravenous drug. This rapid and complete resolution of symptoms following drug administration is highly characteristic of a specific condition and a specific diagnostic test. ***Myasthenia gravis*** - The rapid resolution of symptoms (ptosis and possibly other ocular muscle weakness) within 6 minutes after intravenous drug administration is the hallmark of a positive **Tensilon test**. - The **Tensilon test** involves injecting **edrophonium**, a short-acting acetylcholinesterase inhibitor, which temporarily increases acetylcholine at the neuromuscular junction, improving muscle strength in patients with **myasthenia gravis**. *Sixth nerve palsy* - Sixth nerve palsy (abducens nerve palsy) causes **diplopia** (double vision) and an inability to abduct the affected eye. - While symptoms may fluctuate or improve with treatment, they would not resolve completely in 6 minutes with a diagnostic agent like edrophonium. *Third nerve palsy* - Third nerve palsy (oculomotor nerve palsy) can cause **ptosis**, **diplopia**, and impairment of eye movements (inability to adduct, elevate, or depress the eye). - Nerve palsies are structural or neurological deficits that do not rapidly reverse with a cholinergic agonist like edrophonium. *Tolosa-Hunt syndrome* - Tolosa-Hunt syndrome is a rare inflammatory disorder characterized by **painful ophthalmoplegia** (paralysis of eye muscles), often affecting the third, fourth, and/or sixth cranial nerves. - It typically responds to corticosteroids, but symptoms would not resolve in 6 minutes with an intravenous drug, and the diagnostic approach is different.

Q: A 15-year-old boy presented with day dreaming and decline in school performance. EEG shows.

Typical absence seizure. ***Typical absence seizure*** - The clinical presentation of **daydreaming** and decline in school performance in a 15-year-old is classic for absence seizures. - The EEG shows a characteristic **generalized 3 Hz spike-and-wave discharge**, which is pathognomonic for typical absence seizures. *Atonic seizure* - Characterized by a **sudden loss of muscle tone**, leading to falls, often referred to as "drop attacks." - EEG in atonic seizures often shows **polyspike-and-wave discharges** or generalized slow waves, but not the 3 Hz spike-and-wave pattern. *Myoclonic seizure* - Involves **brief, shock-like jerks** of a muscle or group of muscles, without loss of consciousness. - EEG typically shows **generalized polyspike-and-wave discharges** or fast spike-and-wave activity, which differs from the 3 Hz pattern. *Atypical absence seizure* - Clinical features include a **less abrupt onset and termination** of altered consciousness, often accompanied by changes in muscle tone. - EEG shows **slower spike-and-wave complexes (typically 1.5-2.5 Hz)** and more heterogeneous patterns than typical absence seizures.

Q: Which of the following is true regarding type of seizures shown in EEG?

Hyperventilation often precipitates an attack. ***Hyperventilation often precipitates an attack*** - The EEG shows a classic **3-Hz spike-and-wave pattern**, which is characteristic of **absence seizures**. - **Hyperventilation** is a common and effective activation procedure used during EEG recordings to **induce or exacerbate absence seizures**, making them more apparent. *Attack lasts for 60 to 90 seconds* - **Absence seizures** are typically brief, usually lasting only **5 to 30 seconds**, much shorter than the 60-90 seconds stated. - Longer seizures, especially those with postictal confusion, are more characteristic of **complex partial seizures** or **tonic-clonic seizures**. *Onset of disease in the first year of life* - **Childhood absence epilepsy** typically has an onset between **4 and 8 years of age**, with a peak around 5-6 years. - Seizures appearing in the first year of life would suggest other epilepsy syndromes, such as ** infantile spasms** or severe myoclonic epilepsy in infancy (Dravet syndrome). *Attack followed by postictal confusion* - Absence seizures are classic for **lacking a postictal period**; the individual typically resumes activity immediately after the seizure ends without confusion or disorientation. - **Postictal confusion** is a hallmark feature of **tonic-clonic seizures** and often complex partial seizures, indicating a more widespread and prolonged disruption of brain activity.

Q: A patient presents with facial deviation to the right, inability to close the left eye with Bell's sign, and unclear ability to produce wrinkles on the forehead based on the image. What is the most likely diagnosis?

Left lower motor neuron (LMN/peripheral) lesion. ***Left lower motor neuron (LMN/peripheral) lesion*** - Facial deviation to the **right** indicates weakness of the **left facial muscles**, as the unaffected right side pulls the face toward it. - Complete involvement of **forehead muscles** (inability to wrinkle forehead) along with **Bell's sign** indicates a **peripheral/LMN lesion** affecting the entire facial nerve. *Left upper motor neuron (UMN/central) lesion* - **Central lesions** typically **spare forehead muscles** due to bilateral cortical innervation of the upper facial muscles. - Would not cause complete facial paralysis including forehead involvement as seen in this case. *Right lower motor neuron lesion* - A **right-sided lesion** would cause facial deviation to the **left**, not to the right as described. - The clinical presentation clearly indicates **left-sided facial weakness**, not right-sided. *Right upper motor neuron lesion* - Would cause facial deviation to the **left side**, opposite to what is observed in this patient. - **Central lesions** spare the forehead due to **bilateral cortical representation**, which contradicts the forehead involvement seen here.

Q: The following diagram and its branches should be remembered. The blood vessel involved in medial medullary syndrome is anterior spinal artery.

Choice B: Anterior spinal artery. ***Choice B: Anterior spinal artery*** - The **anterior spinal artery** supplies the medial medulla, and its occlusion leads to **medial medullary syndrome**. - This syndrome is characterized by contralateral hemiparesis (due to involvement of the pyramidal tract), contralateral loss of proprioception and vibratory sensation (due to medial lemniscus involvement), and ipsilateral tongue deviation (due to hypoglossal nerve nucleus involvement).

Q: Which of the following is characteristic of Parinaud's syndrome?

Dorsal midbrain lesion. ***Dorsal midbrain lesion*** - Parinaud's syndrome, also known as the **dorsal midbrain syndrome**, is characterized by a constellation of symptoms resulting from damage to the **tectal plate** and **pretectal area** of the midbrain. - This damage often affects the **superior colliculi** and adjacent structures, impairing **vertical gaze** and **pupillary reflexes**. *Ventral midbrain lesion* - Lesions in the **ventral midbrain** typically affect the **substantia nigra** and **cerebral peduncles**, causing different symptoms. - This location would result in **parkinsonian features** or **hemiparesis**, not the characteristic eye movement abnormalities of Parinaud's syndrome. *Pontine lesion* - Pontine lesions commonly cause **horizontal gaze palsy** and **internuclear ophthalmoplegia**, not vertical gaze dysfunction. - The **paramedian pontine reticular formation (PPRF)** controls horizontal eye movements, distinct from the vertical gaze control in the midbrain. *Thalamic lesion* - Thalamic lesions typically cause **altered consciousness**, **memory deficits**, or **sensory disturbances**. - While some thalamic lesions can affect eye movements, they don't produce the specific **upward gaze paralysis** and **light-near dissociation** seen in Parinaud's syndrome.

Q: The EEG of a 16-year-old boy with early morning involuntary movements of hands in his sleep noticed by parents, was performed. Immunization is complete. What does EEG show? (Recent NEET Pattern 2016-17)

Juvenile myoclonic epilepsy. ***Juvenile myoclonic epilepsy*** - The EEG shows generalized **polyspike-and-slow-wave discharges**, which are characteristic of juvenile myoclonic epilepsy (JME), especially when associated with early morning myoclonus. - The clinical presentation of a **16-year-old boy** with **involuntary movements of hands in his sleep** (suggesting myoclonic jerks), particularly in the morning, is highly consistent with JME. *SSPE* - Subacute sclerosing panencephalitis (SSPE) typically presents with characteristic EEG patterns like **Radermacker complexes** or **periodic complexes**, which are not seen here. - Clinical features of SSPE include progressive cognitive decline, myoclonus, and other neurological deficits, usually following a measles infection, which are not described. *Benign rolandic epilepsy* - Benign rolandic epilepsy (BRE) is characterized by **centrotemporal spikes** on EEG, often exacerbated by sleep, and presents with focal seizures affecting the face and mouth. - The generalized polyspike-and-slow-wave pattern and the clinical description of hand myoclonus do not fit the profile of BRE. *Huntington chorea* - Huntington's chorea is a **neurodegenerative genetic disorder** characterized by involuntary movements (chorea), cognitive decline, and psychiatric problems. - EEG findings in Huntington's chorea are often non-specific or show generalized slowing, and it is not an epilepsy syndrome with specific high-amplitude epileptiform discharges like those seen.

Question 1

A 12-year-old boy presents with difficulty in reading from the blackboard in school. Initially refraction error was considered but visual acuity was normal. He has started complaining of diplopia on watching TV or after studying for long. He takes very long time to finish his meals and his speech becomes very difficult to understand after speaking continuously for few minutes. Anti-Acetylcholine receptor blocking antibody is detected in high titers. All are done in management except? (Recent NEET Pattern 2016-17)

Accepted Answer

Atropine

Answer

Pyridostigmine

Answer

Steroids

Answer

CT chest

Question 2

Which of the following is incorrect about the condition shown below?

Accepted Answer

Most common CT finding is intraventricular calcification

Answer

Most common presentation is partial seizures

Answer

Albendazole is given for 8 days

Answer

Steroids help in alleviating vasogenic oedema of ring enhancing lesion

Question 3

A 25-year-old lady presents with reduced color vision and paresthesias. Her symptoms increase with rise of body temperature. Examine the appearance of her eyes and comment on diagnosis.

Accepted Answer

Internuclear ophthalmoplegia

Answer

Horner syndrome

Answer

Duane retraction syndrome

Answer

Hutchinson pupil

Question 4

A patient has the following presentation. After administration of an intravenous drug to the patient, in 6 minutes his symptoms have resolved. The diagnosis of the patient is:

Accepted Answer

Myasthenia gravis

Answer

Sixth nerve palsy

Answer

Third nerve palsy

Answer

Tolosa-Hunt syndrome

Question 5

A 15-year-old boy presented with day dreaming and decline in school performance. EEG shows.

Accepted Answer

Typical absence seizure

Answer

Atonic seizure

Answer

Myoclonic seizure

Answer

Atypical absence seizure

Question 6

Which of the following is true regarding type of seizures shown in EEG?

Accepted Answer

Hyperventilation often precipitates an attack

Answer

Attack lasts for 60 to 90 seconds

Answer

Onset of disease in the first year of life

Answer

Attack followed by postictal confusion

Question 7

A patient presents with facial deviation to the right, inability to close the left eye with Bell's sign, and unclear ability to produce wrinkles on the forehead based on the image. What is the most likely diagnosis?

Accepted Answer

Left lower motor neuron (LMN/peripheral) lesion

Answer

Right upper motor neuron lesion

Answer

Left upper motor neuron (UMN/central) lesion

Answer

Right lower motor neuron lesion

Question 8

The following diagram and its branches should be remembered. The blood vessel involved in medial medullary syndrome is anterior spinal artery.

Accepted Answer

Choice B: Anterior spinal artery

Answer

Choice A

Answer

Choice C

Answer

Choice D

Question 9

Which of the following is characteristic of Parinaud's syndrome?

Accepted Answer

Dorsal midbrain lesion

Answer

Ventral midbrain lesion

Answer

Thalamic lesion

Answer

Pontine lesion

Question 10

The EEG of a 16-year-old boy with early morning involuntary movements of hands in his sleep noticed by parents, was performed. Immunization is complete. What does EEG show? (Recent NEET Pattern 2016-17)

Accepted Answer

Juvenile myoclonic epilepsy

Answer

SSPE

Answer

Benign rolandic epilepsy

Answer

Huntington chorea

Neurology — MCQs

Neurology — MCQs

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