Neurology Practice Questions

Q: A female presented with a severe headache of sudden onset. On CT scan, a diagnosis of subarachnoid hemorrhage is made. What is the most common cause of subarachnoid hemorrhage?

Berry aneurysm rupture. **Explanation:** **Subarachnoid Hemorrhage (SAH)** is characterized by bleeding into the subarachnoid space, typically presenting as a "thunderclap headache" (the worst headache of one's life). 1. **Why Berry Aneurysm is Correct:** The most common cause of **spontaneous (non-traumatic)** SAH is the rupture of a **Berry (saccular) aneurysm**, accounting for approximately 80% of cases. These aneurysms typically occur at the bifurcations of arteries within the Circle of Willis, most commonly at the junction of the **Anterior Communicating Artery**. 2. **Why Other Options are Incorrect:** * **Middle Meningeal Artery:** Rupture of this artery (usually due to trauma at the pterion) leads to an **Epidural Hematoma (EDH)**, characterized by a biconvex/lens-shaped bleed on CT and a classic "lucid interval." * **Basilar Artery:** While aneurysms can occur here, they are far less common than those in the anterior circulation. * **Subdural Venous Sinuses:** Tearing of the bridging veins (which drain into these sinuses) results in a **Subdural Hematoma (SDH)**, typically seen as a crescent-shaped bleed on CT in elderly or alcoholic patients. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Digital Subtraction Angiography (DSA) is the gold standard for identifying the site of the aneurysm. * **Initial Investigation:** Non-contrast CT (NCCT) Head (shows hyperdensity in cisterns and sulci). * **Associated Conditions:** Berry aneurysms are associated with **ADPKD**, Ehlers-Danlos syndrome, and Coarctation of the Aorta. * **Complication:** Vasospasm is a major delayed complication (3–14 days); **Nimodipine** (a calcium channel blocker) is used to improve outcomes.

Q: Which type of headache typically affects young to middle-aged men, is unilateral, oculo-temporal, excruciating, and associated with lacrimation and rhinorrhoea?

Cluster headache. **Explanation:** **Cluster Headache** is the correct answer as it perfectly matches the clinical triad of **demographics** (young to middle-aged males), **location** (unilateral, oculo-temporal), and **autonomic symptoms**. It is a type of Trigeminal Autonomic Cephalalgia (TAC). The pain is described as "boring" or "suicide headache" due to its excruciating intensity. The hallmark is the association with ipsilateral parasympathetic hyperactivity (lacrimation, rhinorrhoea, nasal congestion) and sympathetic paralysis (partial Horner’s syndrome). **Why other options are incorrect:** * **Migraine:** More common in females. While unilateral, the pain is typically pulsatile/throbbing, lasts longer (4–72 hours), and is associated with nausea, vomiting, photophobia, and phonophobia rather than autonomic signs. * **Trigeminal Neuralgia:** Characterized by brief, "electric-shock-like" paroxysms of pain triggered by touching "trigger zones" (washing face, shaving). It usually affects the V2 or V3 distribution, not specifically the ocular region. * **Tension Headache:** The most common type of headache; it is typically bilateral, "band-like," and lacks autonomic symptoms or extreme intensity. **High-Yield Clinical Pearls for NEET-PG:** * **Prophylaxis:** Verapamil (Drug of Choice). * **Acute Treatment:** 100% Oxygen inhalation (7–10 L/min) or subcutaneous Sumatriptan. * **Periodicity:** Attacks occur in "clusters" (e.g., once or twice a year, lasting weeks), often occurring at the same time each day, frequently waking the patient from sleep (circadian rhythm involvement). * **Horner’s Syndrome:** Cluster headache is a classic cause of transient or permanent post-ganglionic Horner’s syndrome.

Q: Hemiplegia is commonly associated with infarction of the area of distribution of which artery?

Middle cerebral artery. **Explanation:** The **Middle Cerebral Artery (MCA)** is the most common site for cerebral infarction [1] and the primary artery associated with classic hemiplegia. This is because the MCA supplies the majority of the **primary motor cortex** (precentral gyrus) and the **internal capsule** (via lenticulostriate branches). Specifically, the MCA covers the motor areas for the face and upper limbs. Since the corticospinal tract fibers are densely packed in the internal capsule, an MCA stroke often results in contralateral hemiplegia (paralysis of the face, arm, and leg). **Analysis of Incorrect Options:** * **Anterior Cerebral Artery (ACA):** ACA infarction typically leads to motor and sensory deficits primarily affecting the **contralateral lower limb** (leg and foot), as it supplies the medial aspect of the cerebral hemisphere. It rarely causes total hemiplegia. * **Posterior Cerebral Artery (PCA):** PCA occlusion primarily affects the visual cortex (occipital lobe) and thalamus. The hallmark is **contralateral homonymous hemianopia** with macular sparing, rather than motor hemiplegia. * **Anterior Communicating Artery:** This is a common site for **berry aneurysms** (leading to subarachnoid hemorrhage) but is not a major supply vessel to the motor cortex; thus, its occlusion does not typically cause hemiplegia. **High-Yield Clinical Pearls for NEET-PG:** * **Lenticulostriate Arteries:** Branches of the MCA known as the "arteries of cerebral hemorrhage" (Charcot’s artery); they are the most common site for hypertensive bleeds. * **MCA Stroke Rule:** Contralateral hemiplegia + Hemianesthesia + Aphasia (if dominant hemisphere) or Hemispatial neglect (if non-dominant). * **ACA Stroke Rule:** Leg > Arm involvement.

Q: Deep brain stimulation is used in the treatment of which of the following conditions?

Parkinsonism. **Explanation:** **Deep Brain Stimulation (DBS)** is a neurosurgical procedure involving the implantation of electrodes into specific brain targets, which are connected to an implanted pulse generator (IPG). It acts as a "brain pacemaker" to modulate abnormal neural activity. **Why Parkinsonism is Correct:** DBS is a well-established, FDA-approved treatment for advanced **Parkinson’s disease**, particularly when motor fluctuations (like dyskinesia) become refractory to medical therapy (Levodopa). The most common targets are the **Subthalamic Nucleus (STN)** and the **Globus Pallidus interna (GPi)**. By delivering high-frequency electrical stimulation, DBS suppresses the overactive inhibitory output of these nuclei, thereby improving tremors, rigidity, and bradykinesia. **Why Other Options are Incorrect:** * **Depression:** While DBS is being researched for treatment-resistant depression (targeting the Subgenual Cingulate Cortex/Area 25), it is **not** a standard or first-line treatment. Electroconvulsive Therapy (ECT) remains the gold standard for refractory depression. * **Dementia & Delirium:** These are characterized by diffuse cortical dysfunction or acute metabolic/toxic insults. DBS is a focal neuromodulation technique and is not indicated for the global cognitive decline of dementia or the acute fluctuating sensorium of delirium. **High-Yield Clinical Pearls for NEET-PG:** * **Psychiatric Indications:** In psychiatry, the only FDA-approved use for DBS (under a Humanitarian Device Exemption) is for **Refractory Obsessive-Compulsive Disorder (OCD)**. The target is the **Ventral Striatum/Internal Capsule**. * **Other Targets:** * Essential Tremor: Ventral Intermediate Nucleus (Vim) of the Thalamus. * Dystonia: Globus Pallidus interna (GPi). * **Contraindication:** DBS is generally avoided in patients with significant cognitive impairment or active psychosis.

Q: A 25-year-old weightlifter experienced a severe headache during training. A CSF tap performed on the medical ward showed blood stains. What is the likely diagnosis?

Ruptured aneurysm. ### Explanation **Correct Answer: B. Ruptured aneurysm** The clinical presentation describes a classic case of **Subarachnoid Hemorrhage (SAH)** [1]. In a young adult, the most common cause of non-traumatic SAH is the rupture of a **Saccular (Berry) aneurysm** [1], [3]. 1. **Why it is correct:** The patient experienced a sudden, severe headache (often described as a "thunderclap headache" or the "worst headache of my life") triggered by physical exertion (weightlifting) [1]. Strenuous activity causes a transient spike in blood pressure, leading to the rupture of an underlying aneurysm. The presence of blood in the CSF (xanthochromia or gross blood) confirms the diagnosis of SAH, as blood leaks into the subarachnoid space [1], [2]. 2. **Why other options are incorrect:** * **Cluster Headache:** Presents as severe, unilateral periorbital pain with autonomic symptoms (tearing, rhinorrhea). It does not cause blood in the CSF. * **Embolism:** Typically causes focal neurological deficits (ischemic stroke) rather than a sudden global headache [3]. CSF is usually clear in ischemic events. * **Migraine:** While severe, migraines are usually gradual in onset, recurrent, and associated with photophobia/nausea. They do not present with hemorrhagic CSF. ### NEET-PG High-Yield Pearls * **Gold Standard Investigation:** Non-contrast CT (NCCT) Head is the initial investigation of choice (95% sensitivity in the first 24 hours) [1]. * **CSF Findings:** If CT is negative but suspicion is high, a lumbar puncture is performed [1]. Findings include high opening pressure and **Xanthochromia** (yellowish discoloration due to bilirubin, appearing 6–12 hours post-bleed). * **Common Site:** Most Berry aneurysms are located in the **Anterior Communicating Artery** (junction of the Circle of Willis). * **Associated Conditions:** Polycystic Kidney Disease (ADPKD), Ehlers-Danlos syndrome, and Coarctation of the Aorta.

Q: Which reflex is being tested?

Finger flexor Reflex. ***Finger flexor Reflex*** - This reflex is tested by **striking the examiner's finger** placed over the patient's flexed fingers, causing **flexion of the fingers and thumb**. - It tests the **C8-T1 nerve roots** and involves the **median** and **ulnar nerves** supplying the finger flexors. *Brachioradialis Reflex* - This reflex is elicited by **tapping the brachioradialis tendon** at the **radial styloid process**, causing **flexion and supination** of the forearm. - It tests the **C5-C6 nerve roots** and the **radial nerve**, not the finger flexors. *Waardenburg sign* - This refers to **Wartenberg's sign**, which is a **clinical sign** (not a reflex) indicating **ulnar nerve palsy**. - It involves **involuntary abduction** of the **little finger** due to weakness of the **palmar interossei muscles**. *Supinator reflex* - This reflex involves **tapping the dorsal aspect** of the **distal radius**, causing **supination** of the forearm. - It tests the **C6-C7 nerve roots** and **posterior interosseous nerve**, not finger flexion.

Q: Raised intracranial pressure will cause which of the following?

Papilloedema. ### Explanation **Correct Answer: C. Papilloedema** **Mechanism:** Raised Intracranial Pressure (ICP) is transmitted through the subarachnoid space to the optic nerve sheath. This pressure causes mechanical obstruction of axoplasmic flow and compression of the central retinal vein [3]. This leads to edema of the optic disc, known as **Papilloedema**. It is a hallmark sign of increased ICP, though its absence does not entirely rule out acute pressure rises [1]. **Analysis of Incorrect Options:** * **A & B (Tachycardia and Hypotension):** These are incorrect because raised ICP typically triggers the **Cushing’s Reflex** (a physiological response to maintain cerebral perfusion). The Cushing’s Triad consists of **Hypertension** (widened pulse pressure), **Bradycardia**, and **Irregular Respiration** [2]. Tachycardia and hypotension are more characteristic of hypovolemic shock. * **D (Normal looking anterior fontanelle):** In infants, the cranial sutures are not yet fused. Therefore, raised ICP characteristically causes a **Bulging (tense) anterior fontanelle**. A normal or depressed fontanelle usually indicates normal pressure or dehydration, respectively. **NEET-PG High-Yield Pearls:** * **Cushing’s Triad:** Hypertension + Bradycardia + Irregular breathing (Late sign of brain herniation) [2]. * **Early Sign of Raised ICP:** Headache (worse in the morning/stooping) and vomiting (often projectile) [1]. * **False Localizing Sign:** Sixth cranial nerve (Abducens) palsy is common in raised ICP due to its long intracranial course [1]. * **Contraindication:** Lumbar puncture is strictly contraindicated in patients with papilloedema/raised ICP due to the risk of **uncal herniation** [2].

Q: The above marked structures are seen in a condition where the most common cause of death is?

Aspiration pneumonia. ***Aspiration pneumonia*** - **Bulbar involvement** in ALS leads to **dysphagia** and impaired **swallowing reflexes**, increasing risk of aspiration of food and saliva. - Progressive **respiratory muscle weakness** reduces cough effectiveness and **respiratory reserve**, making pneumonia the leading cause of death. *Heart failure* - ALS primarily affects **motor neurons** and does not typically involve **cardiac muscle** or cause heart failure. - The **autonomic nervous system** remains largely intact in ALS, preserving cardiac function. *Renal failure* - **Kidney function** is not affected in ALS as it does not involve the **autonomic control** of renal systems. - ALS is a **motor neuron disease** that spares sensory, cognitive, and most autonomic functions including renal regulation. *Neuroparalytic coma* - While ALS causes progressive **paralysis**, patients typically remain **conscious** and cognitively intact throughout the disease course. - **Respiratory failure** from diaphragmatic weakness leads to death, but coma is not the usual terminal presentation.

Question 1

A female presented with a severe headache of sudden onset. On CT scan, a diagnosis of subarachnoid hemorrhage is made. What is the most common cause of subarachnoid hemorrhage?

Accepted Answer

Berry aneurysm rupture

Answer

Middle meningeal artery

Answer

Basilar artery

Answer

Subdural venous sinuses

Question 2

A 58-year-old male presents with a history of ipsilateral facial paralysis and contralateral hemiplegia. A plain CT scan of the head is provided. What is the most likely diagnosis?

Accepted Answer

Basilar artery stroke

Answer

Anterior Cerebral Artery (ACA) stroke

Answer

Posterior Cerebral Artery (PCA) stroke

Answer

Posterior Inferior Cerebellar Artery (PICA) stroke

Question 3

Which type of headache typically affects young to middle-aged men, is unilateral, oculo-temporal, excruciating, and associated with lacrimation and rhinorrhoea?

Accepted Answer

Cluster headache

Answer

Migraine

Answer

Trigeminal neuralgia

Answer

Tension headache

Question 4

Hemiplegia is commonly associated with infarction of the area of distribution of which artery?

Accepted Answer

Middle cerebral artery

Answer

Anterior cerebral artery

Answer

Posterior cerebral artery

Answer

Anterior communicating artery

Question 5

Deep brain stimulation is used in the treatment of which of the following conditions?

Accepted Answer

Parkinsonism

Answer

Depression

Answer

Dementia

Answer

Delirium

Question 6

A 25-year-old weightlifter experienced a severe headache during training. A CSF tap performed on the medical ward showed blood stains. What is the likely diagnosis?

Accepted Answer

Ruptured aneurysm

Answer

Cluster headache

Answer

Embolism

Answer

Migraine

Question 7

Which reflex is being tested?

Accepted Answer

Finger flexor Reflex

Answer

Brachioradialis Reflex

Answer

Waardenburg sign

Answer

Supinator reflex

Question 8

Raised intracranial pressure will cause which of the following?

Accepted Answer

Papilloedema

Answer

Tachycardia

Answer

Hypotension

Answer

Normal looking anterior fontanelle in infants

Question 9

A patient appears awake but is not talking and has no voluntary movements. The patient can signal with vertical eye movements. A CT scan shows infarction of the ventral pons. What is the most likely diagnosis?

Accepted Answer

Locked-in state

Answer

Coma

Answer

Abulia

Answer

Catatonia

Question 10

The above marked structures are seen in a condition where the most common cause of death is?

Accepted Answer

Aspiration pneumonia

Answer

Heart failure

Answer

Renal failure

Answer

Neuroparalytic coma

Neurology — MCQs

Neurology — MCQs

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