Neurology Practice Questions

Q: The image shows elicitation of:

Oppenheim sign. ***Oppenheim sign*** - The image demonstrates the elicitation of the **Oppenheim sign**, where a **Babinski-like reflex** (dorsiflexion of the great toe and fanning of other toes) is produced by firmly stroking down the medial aspect of the **tibia**. - This sign is used to detect **upper motor neuron lesions** and is considered a variant of the Babinski reflex. *Chaddock sign* - The Chaddock sign involves stroking the **lateral malleolus** down to the little toe to elicit dorsiflexion of the great toe, which is not what is shown in the image. - It is another variant of the Babinski reflex, indicating **pyramidal tract dysfunction**. *Babkin sign* - The Babkin sign is a **primitive reflex in infants** where pressure applied to the palms causes the infant to open its mouth and flex its head. - This reflex is not relevant to lower limb examination in adults for pyramidal tract lesions. *Gordon sign* - The Gordon sign is elicited by compressing the **calf muscles**, often by squeezing them firmly. - A positive response, dorsiflexion of the great toe, indicates **upper motor neuron pathology**, but the image shows stroking the tibia, not compressing the calf.

Q: Medial medullary syndrome occurs due to blockage of which of the following blood vessel?

A. ***A*** - Label A points to the **anterior spinal artery**, which supplies the medial medulla. Blockage of this artery leads to medial medullary syndrome. - Medial medullary syndrome is characterized by **contralateral hemiparesis**, **contralateral loss of proprioception**, and **ipsilateral hypoglossal nerve palsy**.

Q: Which reflex is being tested here?

Hoffman reflex. ***Hoffman reflex*** - The image shows the examiner flicking a patient's **distal phalanx of the middle finger**, which is the classic method for eliciting the Hoffman reflex. - A positive Hoffman sign involves **involuntary flexion of the thumb and index finger**, indicating a potential **upper motor neuron lesion** in the cervical spinal cord. *Brachioradialis reflex* - This reflex is elicited by striking the **distal radius**, about 2-3 inches above the wrist, with a reflex hammer. - The expected response is **flexion and supination** of the forearm, which is not what is shown in the image. *Finger flexor reflex* - The finger flexor reflex, or finger jerk reflex, is similar to the Hoffman but typically involves stimulating the palmar surface or the tips of all the fingers, leading to their flexion. - While related to finger flexion, the specific maneuver of flicking the middle finger's distal phalanx for involuntary thumb and index finger flexion is characteristic of the **Hoffman reflex**. *Supinator reflex* - The supinator reflex is another name for the **brachioradialis reflex**, as it involves the supinator muscle. - It is also elicited by striking the distal radius, leading to forearm flexion and supination, not the finger flick seen in the image.

Q: The EEG shows presence of:

Artifacts. ***Artifacts*** - The image displays inconsistent, **high-amplitude, irregular waveforms** across multiple channels without a clear, organized pattern suggestive of brain activity. - These patterns are typical of **muscle artifacts** or environmental interference, which are often observed in EEG recordings when there is movement, sweating, or electrical noise. *Normal EEG* - A normal EEG typically shows organized and rhythmic brainwave patterns, such as **alpha and beta rhythms**, with appropriate amplitude and frequency for the patient's state. - The chaotic and non-physiologic signals seen here do not resemble normal brain activity. *Absence seizures* - Absence seizures are characterized by **generalized 3 Hz spike-and-wave discharges** that are sudden in onset and offset and typically bilateral and synchronous. - The EEG image does not show this specific, highly characteristic epileptic pattern; instead, it shows widespread disorganized activity. *Myoclonic epilepsy* - Myoclonic epilepsy often presents with **generalized polyspike-and-wave discharges** or irregular spike-and-wave patterns, usually faster than 3 Hz, associated with sudden muscle jerks. - While there is some high-frequency activity, it lacks the clear, consistent morphology and rhythm of epileptic discharges and is more consistent with movement-related artifact.

Q: A 14-year-old boy presents with bilateral foot contractures. On examination, thickened peripheral nerves are noted. On biopsy of the nerve, a typical onion bulb appearance is noted. What is the probable diagnosis? (Recent NEET Pattern 2016-17)

Charcot-Marie-Tooth disease. ***Charcot-Marie-Tooth disease*** - The combination of **bilateral foot contractures** (often presenting as pes cavus or hammer toes, as hinted by the image), **thickened peripheral nerves**, and the pathological finding of an **onion bulb appearance** on nerve biopsy are classic diagnostic features of Charcot-Marie-Tooth (CMT) disease, particularly demyelinating forms. - CMT is a progressive **hereditary peripheral neuropathy** characterized by muscle weakness and sensory loss, primarily in the distal limbs, often leading to foot deformities. *Friedreich's ataxia* - This is a **spinocerebellar ataxia** primarily affecting the central nervous system, leading to gait ataxia, dysarthria, and scoliosis. - While it can cause foot deformities like pes cavus, it does not typically involve **thickened peripheral nerves** or the **onion bulb appearance** on nerve biopsy. *Ataxia telangiectasia* - This is a rare, **autosomal recessive disorder** characterized by progressive cerebellar ataxia, oculocutaneous telangiectasias, immunodeficiency, and an increased risk of malignancy. - It does not present with **thickened peripheral nerves** or the characteristic **onion bulb formation** on nerve biopsy. *Leprosy* - Leprosy, caused by *Mycobacterium leprae*, is an infectious disease that can affect peripheral nerves, leading to nerve thickening, sensory loss, and muscle weakness. - However, the characteristic finding on nerve biopsy in leprosy is **granulomatous inflammation** and **acid-fast bacilli**, not the **onion bulb formation** seen in hereditary demyelinating neuropathies.

Q: An 18-year-old patient presents with port wine stain, mental retardation and recurrent focal seizures. All are true about the condition except:

Confetti lesions. ***Confetti lesions*** - **Confetti lesions** (hypopigmented macules) are characteristic dermatological features of **tuberous sclerosis complex**, not Sturge-Weber syndrome. - The clinical presentation of a **port-wine stain**, mental retardation, and recurrent focal seizures is highly indicative of **Sturge-Weber syndrome**. *Optic nerve cupping* - **Glaucoma** is a common ocular complication of Sturge-Weber syndrome, often ipsilateral to the facial port-wine stain. - **Optic nerve cupping** is a finding associated with elevated intraocular pressure due to glaucoma. *Tram track appearance on X-ray skull* - The **tram track appearance** on skull X-ray or CT scan refers to **leptomeningeal angiomatosis** with underlying cortical calcifications, a hallmark of Sturge-Weber syndrome. - These calcifications follow the gyri of the brain, creating a curvilinear, double-lined pattern. *Vagal nerve stimulation* - **Vagal nerve stimulation (VNS)** is a recognized treatment option for **refractory seizures** in patients with Sturge-Weber syndrome when antiepileptic medications are insufficient. - It helps in reducing seizure frequency and severity in selected cases.

Q: A 60-year-old man presents with history of memory loss and fatigue. On examination, he has bradykinesia with axial rigidity. Resting tremor is absent and patient has broad-based gait with tendency to fall. MRI was done. All are true about the condition except:

Intracranial hypotension. ***Intracranial hypotension*** - Progressive Supranuclear Palsy (PSP) is characterized by **brain atrophy**, not intracranial hypotension, and specifically shows atrophy of the **midbrain** and superior cerebellar peduncle. - Intracranial hypotension typically presents with **postural headaches**, which were not mentioned in the patient's presentation. *Poor response to levodopa* - Patients with PSP often show a **poor or transient response to levodopa**, which distinguishes it from Parkinson's disease. - This is due to the widespread neurodegeneration affecting areas beyond the dopaminergic pathways. *Gaze palsy* - **Vertical supranuclear gaze palsy**, particularly affecting downward gaze, is a **hallmark symptom** of PSP. - This manifests as difficulty moving the eyes voluntarily, especially downwards, while reflex eye movements (e.g., vestibulo-ocular reflex) may be preserved initially. *Humming Bird appearance* - The **Hummingbird sign (or Penguin sign)** is a characteristic MRI finding in PSP, referring to the **midbrain atrophy** with relative preservation of the pons, resembling a hummingbird. - The image provided shows significant midbrain atrophy, consistent with this sign.

Q: MRI was performed on a 35-year-old man with progressive myoclonus and apathy. What is the diagnosis? (Recent NEET Pattern 2016-17)

Prion disease. ***Prion disease*** - The MRI shows **cortical ribboning** (hyperintensity in the cortex) and possible signal changes in the basal ganglia, which are characteristic findings in prion diseases such as **Creutzfeldt-Jakob disease (CJD)**. - The clinical presentation of **progressive myoclonus** (sudden, involuntary muscle jerks) and **apathy** (lack of emotion or motivation), especially in a relatively young individual (35 years old), is highly suggestive of CJD or another prion disease. *Herpes simplex encephalitis* - This typically presents with **fever, headache, and focal neurological deficits**, often affecting the **temporal lobes**. - While it can cause FLAIR hyperintensities, it usually begins acutely with more prominent edema and may have hemorrhagic components, and myoclonus is not a primary defining symptom. *SSPE* - **Subacute sclerosing panencephalitis (SSPE)** is a rare, fatal, progressive brain disorder caused by the **measles virus**, primarily affecting children and young adults. - While it can cause progressive neurological deterioration and cognitive decline, myoclonus is often a late feature, and MRI findings often show **white matter demyelination** in later stages, which is not the predominant finding here. *Mesial temporal sclerosis* - This condition is characterized by **atrophy and signal changes in the hippocampus and amygdala** on MRI, typically associated with **temporal lobe epilepsy**. - While it can cause cognitive issues, it usually does not account for widespread cortical ribboning or prominent myoclonus in this age group, and the image does not specifically highlight mesial temporal lobe changes.

Question 1

The image shows elicitation of:

Accepted Answer

Oppenheim sign

Answer

Chaddock sign

Answer

Babkin sign

Answer

Gordon sign

Question 2

All are correct about the reflex being elicited except:

Accepted Answer

Beevor sign is caudal movement of umbilicus on attempt to flex neck and upper trunk

Answer

Exaggerated abdominal reflexes can be seen in psychoneurosis

Answer

Repeated pregnancies may lead to absent abdominal reflex

Answer

Root value of upper abdomen is T7-T9

Question 3

Medial medullary syndrome occurs due to blockage of which of the following blood vessel?

Accepted Answer

A

Answer

B

Answer

C

Answer

D

Question 4

Which reflex is being tested here?

Accepted Answer

Hoffman reflex

Answer

Brachioradialis reflex

Answer

Finger flexor reflex

Answer

Supinator reflex

Question 5

The EEG shows presence of:

Accepted Answer

Artifacts

Answer

Normal EEG

Answer

Absence seizures

Answer

Myoclonic epilepsy

Question 6

A 14-year-old boy presents with bilateral foot contractures. On examination, thickened peripheral nerves are noted. On biopsy of the nerve, a typical onion bulb appearance is noted. What is the probable diagnosis? (Recent NEET Pattern 2016-17)

Accepted Answer

Charcot-Marie-Tooth disease

Answer

Friedreich's ataxia

Answer

Ataxia telangiectasia

Answer

Leprosy

Question 7

An 18-year-old patient presents with port wine stain, mental retardation and recurrent focal seizures. All are true about the condition except:

Accepted Answer

Confetti lesions

Answer

Optic nerve cupping

Answer

Tram track appearance on X-ray skull

Answer

Vagal nerve stimulation

Question 8

A 35-year-old woman presents with thunderclap headache. NCCT was done. All are true about the condition except:

Accepted Answer

Most common cause of death is rebleeding

Answer

Hyponatremia

Answer

Prolonged QT interval

Answer

Nimodipine is drug of choice

Question 9

A 60-year-old man presents with history of memory loss and fatigue. On examination, he has bradykinesia with axial rigidity. Resting tremor is absent and patient has broad-based gait with tendency to fall. MRI was done. All are true about the condition except:

Accepted Answer

Intracranial hypotension

Answer

Poor response to levodopa

Answer

Gaze palsy

Answer

Humming Bird appearance

Question 10

MRI was performed on a 35-year-old man with progressive myoclonus and apathy. What is the diagnosis? (Recent NEET Pattern 2016-17)

Accepted Answer

Prion disease

Answer

Herpes simplex encephalitis

Answer

SSPE

Answer

Mesial temporal sclerosis

Neurology — MCQs

Neurology — MCQs

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