Neurology Practice Questions

Q: The EEG of the patient shows which of the following? (Recent NEET Pattern 2016-17)

Burst suppression pattern. ***Burst suppression pattern*** - The EEG shows periods of high amplitude, mixed-frequency **bursts of activity** alternating with periods of **relative electrical silence** (suppression). - This pattern is often seen in conditions like severe **hypoxic-ischemic encephalopathy**, deep **anesthesia**, or severe brain injury. *Rademecker complex* - This refers to periodic trifasic complexes, often associated with subacute sclerosing panencephalitis (SSPE), which is a **slow viral infection** of the brain. - The complexes are typically **bilateral, synchronous, and repetitive**, not characterized by alternating bursts and suppression. *3/sec spike and slow wave pattern* - This pattern is characteristic of **absence seizures (petit mal epilepsy)**, where there are generalized, synchronous 3 Hz spike-and-wave discharges. - The image does not show continuous, rhythmic 3 Hz activity but rather alternating periods of activity and flat-lining. *4-6 Hz Polyspike* - Polyspikes are a series of two or more spikes or sharp waves clustered together, often associated with **myoclonic seizures** or other generalized epilepsies. - While there are some sharp waves in the burst phases, the overall pattern is dominated by the distinct periods of suppression, not continuous polyspike activity.

Q: A 65-year-old man with dementia and poor hygiene due to urinary incontinence was evaluated. On examination: Deep tendon reflexes are brisk and gait apraxia with start hesitation is noted. CT scan was performed. What is the diagnosis?

Normal pressure hydrocephalus. ***Normal pressure hydrocephalus*** - The classic triad of **dementia**, **gait apraxia**, and **urinary incontinence** strongly points to normal pressure hydrocephalus (NPH). The CT scan shows **ventriculomegaly out of proportion to sulcal atrophy**, a key finding in NPH. - The symptoms are often reversible with **ventriculoperitoneal shunting**, making early diagnosis crucial. *Alzheimer's disease* - While it causes **dementia**, it does not typically present with gait apraxia or urinary incontinence as prominent initial features. - CT scans in Alzheimer's usually show **diffuse cerebral atrophy**, not significant ventriculomegaly disproportionate to sulcal changes. *Multi-infarct dementia* - Characterized by a **stepwise decline** in cognitive function and focal neurological deficits related to cerebrovascular events. - CT scans would typically show evidence of **multiple infarcts** or vascular lesions, which are not explicitly described as the primary finding. *Frontal lobe tumor* - Could cause dementia and gait issues, but it would typically present with other focal neurological signs depending on the tumor's location and size, as well as **mass effect or edema** on neuroimaging. - The presented symptoms align more specifically with NPH than a generalized tumor effect without additional details.

Q: A patient presents with GCS of 7 with nuchal rigidity and bloody CSF. Which is incorrect regarding this condition? (Recent NEET Pattern 2016-17)

IV ceftriaxone. **IV ceftriaxone** - The clinical presentation of **GCS of 7**, **nuchal rigidity**, and **bloody CSF** is highly suggestive of a **subarachnoid hemorrhage (SAH)**, not a bacterial infection like meningitis. - **Ceftriaxone** is an antibiotic commonly used to treat bacterial meningitis, which is not indicated here as the primary issue is hemorrhage, not infection. *Blood in sylvian fissure* - **Blood in the sylvian fissure** is a common finding in **subarachnoid hemorrhage**, as this area contains major cerebral arteries susceptible to aneurysm rupture. - CT scans often show hyperdense (bright) blood within the sulci and cisterns, including the sylvian fissure. *Seizures* - **Seizures** are a relatively common complication of **subarachnoid hemorrhage**, especially in the acute phase due to blood irritating the cerebral cortex. - They can occur in up to 10-20% of SAH patients and are a significant predictor of poorer outcomes. *Intraventricular extension* - **Intraventricular extension** of blood indicates a more severe hemorrhage and is often associated with a worse prognosis in **subarachnoid hemorrhage**. - The presence of blood within the ventricles can lead to **hydrocephalus** and increased intracranial pressure.

Q: A 50-year-old hypertensive patient develops sudden onset drooping of right face and hemiplegia. What is the diagnosis?

MCA area hemorrhage. ***MCA area hemorrhage*** - The **hyperdense lesion** on CT scan indicates **acute hemorrhage** in the MCA territory, which correlates with the sudden onset right facial droop and hemiplegia. - **Hypertension** is the most common risk factor for primary **intracerebral hemorrhage**, and MCA territory involvement typically causes contralateral face and arm weakness. *MCA area infarction* - **Infarctions** appear as **hypodense (dark) areas** on CT scan, not hyperdense lesions as described in this case. - While MCA infarction can cause similar clinical symptoms, the imaging findings clearly show hemorrhage rather than ischemic changes. *ACA area infarction* - **ACA infarction** typically presents with **leg weakness** more prominent than face/arm weakness, as the ACA supplies the medial motor cortex for lower limbs. - The imaging shows a **hyperdense hemorrhage**, not the **hypodense appearance** characteristic of infarction. *ACA area hemorrhage* - **ACA territory hemorrhage** would affect the **frontal lobe**, causing symptoms like leg weakness, **abulia** (lack of motivation), and urinary incontinence. - The clinical presentation of **facial droop and hemiplegia** involving face and arm is more characteristic of **MCA involvement** rather than ACA territory.

Q: Identify the abnormality shown in the image.

Festinating gait. ***Festinating gait*** - The image depicts a classic **flexed posture**, with the trunk bent forward and arms adducted, consistent with the characteristic stooped stance seen in Parkinson's disease. - While not visible in a static image, this posture often accompanies a shuffling, quickening gait pattern ("festination") as the patient tries to catch up with their center of gravity. *Magnetic gait* - This gait is characterized by the feeling that the feet are stuck to the floor, often seen in **frontal lobe dysfunction** or **normal pressure hydrocephalus**. - The image does not show features such as shuffling or difficulty lifting the feet from the ground typically associated with magnetic gait. *Titubation due to senility* - **Titubation** refers to an involuntary, rhythmic tremor of the head or trunk, often associated with cerebellar disease or severe weakness. - While senility can contribute to gait instability, titubation is a distinct symptom not primarily illustrated by this overall flexed posture. *Astasia abasia* - **Astasia abasia** is a functional (psychogenic) gait disorder where the patient is unable to stand (astasia) or walk (abasia) despite normal motor power and coordination in the supine position. - The image shows a person attempting to stand/walk with a specific posture, not an inability to perform these actions altogether.

Q: A 35-year-old male experiences bilateral asymmetrical ptosis and diplopia on watching TV or working on a laptop. Which test will be useful for diagnosis?

Ice pack test. ***Ice pack test*** - The patient's symptoms of **bilateral asymmetrical ptosis** and **diplopia** that worsen with activity (watching TV, working on a laptop) and improve with rest are highly suggestive of **Myasthenia Gravis**. - The **ice pack test** is a simple, non-invasive diagnostic tool for Myasthenia Gravis, where applying an ice pack to the eyelid improves ptosis by inhibiting acetylcholinesterase activity, thus making more acetylcholine available at the neuromuscular junction. *Nerve conduction velocity* - **Nerve conduction velocity (NCV)** studies are primarily used to evaluate peripheral nerve function and diagnose neuropathies, not typically for neuromuscular junction disorders like Myasthenia Gravis. - While electrodiagnostic studies like **repetitive nerve stimulation** can be used for Myasthenia Gravis, NCV alone is not the most direct or specific test for typical presentation. *Muscle biopsy* - **Muscle biopsy** is generally performed to diagnose myopathies (muscle diseases) characterized by muscle fiber abnormalities, inflammatory infiltrates, or specific dystrophies. - It is **not routinely used** for the diagnosis of Myasthenia Gravis, which is a disorder of the neuromuscular junction, not the muscle itself. *CPK-MM levels* - **Creatine phosphokinase (CPK-MM)** levels are elevated in conditions involving muscle damage or inflammation (e.g., rhabdomyolysis, myositis, muscular dystrophies). - In Myasthenia Gravis, the muscle itself is not primarily damaged, so **CPK-MM levels are typically normal**, making this test unhelpful for diagnosis.

Q: Which is correct for the image shown below?

Jendrassik maneuver. ***Jendrassik maneuver*** - The image shows a patient interlocking their fingers and pulling them apart while a patellar reflex is being tested, which is characteristic of the **Jendrassik maneuver**. - This maneuver is used to **distract the patient** and enhance the amplitude of muscle stretch reflexes, making them more perceptible. *Wartenberg sign* - The Wartenberg sign is observed when the **little finger spontaneously abducts** due to weakness of the adductor pollicis muscle, often indicating ulnar nerve neuropathy. - This sign involves observation of a specific hand posture, not an active maneuver by the patient to improve reflex testing. *Hoffman sign* - The Hoffman sign is elicited by flicking the distal phalanx of the patient's middle finger, and a positive response involves **involuntary flexion of other fingers and the thumb**. - It is an indicator of **upper motor neuron dysfunction** and is not depicted in this image. *Gordon sign* - The Gordon sign is a plantar reflex elicited by **squeezing the calf muscle**, resulting in an extensor plantar response (dorsiflexion of the great toe and fanning of other toes). - This sign is a variant of the Babinski reflex and is used to detect **pyramidal tract lesions**, which is not what is shown.

Q: Which reflex is being elicited in the patient?

Hoffmann reflex. ***Hoffmann reflex*** - The image shows the examiner **flicking the middle finger of the patient upward**, which is the technique used to elicit the Hoffmann reflex. - A positive Hoffmann reflex involves **involuntary flexion of the thumb and index finger** in response to this flick, indicating upper motor neuron dysfunction. *Wartenberg reflex* - This reflex is elicited by rapid abduction and adduction of the patient's fingers, which is not depicted in the image. - A positive Wartenberg reflex involves the patient being unable to relax from the abducted position, indicating ulnar nerve entrapment. *Finger flexion reflex* - While the Hoffmann reflex does involve finger flexion, "finger flexion reflex" is not a specific, recognized neurological reflex test with the exact technique shown. - This term is too general and does not precisely describe the specific maneuver being performed. *Supinator jerk* - The supinator jerk (also known as the brachioradialis reflex) is elicited by **tapping the brachioradialis tendon** near the wrist with a reflex hammer. - This technique is distinctly different from the flicking of the middle finger shown in the image.

Q: Which reflex is being elicited in the patient?

Hoffman reflex. ***Hoffman reflex*** - The image shows the examiner flicking or snapping the patient's **middle finger**. - A positive Hoffman sign is indicated by involuntary flexion of the thumb and/or index finger in response to this maneuver, suggesting an **upper motor neuron lesion**. *Wartenberg reflex* - This reflex involves testing for an abnormal flexion and adduction of the thumb when attempting to extend the fingers, often seen in **ulnar nerve lesions**. - The maneuver in the image does not correspond to the elicitation of the Wartenberg reflex. *Finger flexion reflex* - This is a broad term that can refer to various reflexes involving finger flexion, but it is not a specific named reflex elicited by the maneuver shown. - The specific technique of flicking the middle finger metacarpophalangeal joint is characteristic of the Hoffman reflex. *Supinator jerk* - The supinator jerk (also known as the brachioradialis reflex) is elicited by tapping the **brachioradialis tendon** near the wrist. - This test assesses the C5-C6 spinal cord segments and involves forearm supination and elbow flexion, not finger flexion as depicted.

Question 1

The EEG of the patient shows which of the following? (Recent NEET Pattern 2016-17)

Accepted Answer

Burst suppression pattern

Answer

Rademecker complex

Answer

3/sec spike and slow wave pattern

Answer

4-6 Hz Polyspike

Question 2

A 65-year-old man with dementia and poor hygiene due to urinary incontinence was evaluated. On examination: Deep tendon reflexes are brisk and gait apraxia with start hesitation is noted. CT scan was performed. What is the diagnosis?

Accepted Answer

Normal pressure hydrocephalus

Answer

Alzheimer's disease

Answer

Multi-infarct dementia

Answer

Frontal lobe tumor

Question 3

A patient presents with GCS of 7 with nuchal rigidity and bloody CSF. Which is incorrect regarding this condition? (Recent NEET Pattern 2016-17)

Accepted Answer

IV ceftriaxone

Answer

Blood in sylvian fissure

Answer

Seizures

Answer

Intraventricular extension

Question 4

A 50-year-old hypertensive patient develops sudden onset drooping of right face and hemiplegia. What is the diagnosis?

Accepted Answer

MCA area hemorrhage

Answer

ACA area infarction

Answer

ACA area hemorrhage

Answer

MCA area infarction

Question 5

Identify the lesion. (Recent NEET Pattern 2016-17)

Accepted Answer

Right supranuclear lesion

Answer

Left supranuclear lesion

Answer

Right infranuclear lesion

Answer

Left infranuclear lesion

Question 6

Identify the abnormality shown in the image.

Accepted Answer

Festinating gait

Answer

Magnetic gait

Answer

Titubation due to senility

Answer

Astasia abasia

Question 7

A 35-year-old male experiences bilateral asymmetrical ptosis and diplopia on watching TV or working on a laptop. Which test will be useful for diagnosis?

Accepted Answer

Ice pack test

Answer

Nerve conduction velocity

Answer

Muscle biopsy

Answer

CPK-MM levels

Question 8

Which is correct for the image shown below?

Accepted Answer

Jendrassik maneuver

Answer

Wartenberg sign

Answer

Hoffman sign

Answer

Gordon sign

Question 9

Which reflex is being elicited in the patient?

Accepted Answer

Hoffmann reflex

Answer

Wartenberg reflex

Answer

Finger flexion reflex

Answer

Supinator jerk

Question 10

Which reflex is being elicited in the patient?

Accepted Answer

Hoffman reflex

Answer

Wartenberg reflex

Answer

Finger flexion reflex

Answer

Supinator jerk

Neurology — MCQs

Neurology — MCQs

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