Neurology Practice Questions

Q: Which of the following drugs is NOT used in the condition shown?

Intravenous immunoglobulin. ***Intravenous immunoglobulin*** - The image shows a brain MRI with **multiple, hyperintense white matter lesions**, characteristic of **multiple sclerosis (MS)**. IVIG is generally **not a primary treatment** for relapsing-remitting MS (RRMS) or progressive forms of MS, although it might be considered in rare, specific circumstances like highly active disease refractory to standard therapies or in pregnant women where other agents are contraindicated. - While IVIG is used in other autoimmune neurological conditions, its role in MS is **limited and controversial**, and it is not considered a standard disease-modifying therapy. *Methylprednisolone* - **High-dose intravenous methylprednisolone** is the **standard acute treatment for MS relapses**, rapidly reducing inflammation. - It works by suppressing the immune system and reducing the severity and duration of exacerbations in MS. *Fingolimod* - **Fingolimod** is an **oral disease-modifying therapy** approved for relapsing forms of MS, which acts by sequestering lymphocytes in lymph nodes, thus preventing them from entering the CNS. - It is effective in reducing relapse rates and slowing disease progression in MS. *Mitoxantrone* - **Mitoxantrone** is an **immunosuppressant chemotherapy drug** used for worsening relapsing-remitting MS, secondary progressive MS, and progressive relapsing MS. - It is a potent agent reserved for more aggressive forms of MS due to its potential for **cardiotoxicity**.

Q: A middle-aged patient presents with history of left sided weakness for 2 days. Currently the patient is extremely drowsy and underwent a NCCT brain. Which of the following is the best treatment for this patient? (AIIMS Nov 2017)

Decompressive surgery. ***Decompressive surgery*** - The NCCT image shows a **large, well-demarcated hypodensity in the right cerebral hemisphere**, characteristic of a **subacute to chronic ischemic infarct with significant edema and mass effect**. This is evidenced by the effaced sulci, compressed ventricles on the right, and likely midline shift, causing the patient's **drowsiness** and **left-sided weakness**. - Given the patient's **drowsiness** (indicating rising intracranial pressure) and significant mass effect from the large infarct, **decompressive craniectomy** is often a life-saving measure to reduce intractable intracranial pressure and prevent further herniation in cases of malignant middle cerebral artery (MCA) infarction. *Aspirin/Clopidogrel* - These are **antiplatelet medications used for secondary stroke prevention** after an acute ischemic event. - They are not the primary treatment for an **existing large infarct with mass effect and neurological deterioration** (drowsiness), as they do not address the acute intracranial pressure. *Mechanical thrombectomy* - This procedure is indicated for **acute ischemic stroke due to large vessel occlusion**, typically performed within a very narrow time window (usually up to 6-24 hours) from symptom onset. - The patient presents two days after symptom onset, and the CT findings suggest a **subacute to chronic infarct that has completed evolution**, making thrombectomy ineffective and potentially harmful. *Mannitol* - Mannitol is an **osmotic diuretic used to acutely reduce intracranial pressure (ICP)** in situations like cerebral edema. - While it can provide temporary relief, it is often insufficient for profound edema and mass effect from a **large, evolving infarct** that is causing significant neurological decline (drowsiness), and it does not treat the underlying structural issue.

Q: All are true about the mid brain stroke syndrome shown except:

Anterior cerebral peduncle is involved. ***Anterior cerebral peduncle is involved*** - The **anterior cerebral peduncle (crus cerebri)** is located in the **ventral midbrain** and contains descending motor tracts, but the lesion shown affects the **dorsal midbrain structures**. - This statement is **false** because the lesion does not extend to involve the anterior cerebral peduncle, making this the correct answer for the "except" question. *Dorsal midbrain lesion* - The image clearly shows a lesion in the **dorsal aspect of the midbrain**, affecting structures such as the **red nucleus** and surrounding areas. - This statement is **true** as it accurately describes the anatomical location of the stroke shown in the image. *Ipsilateral 3rd nerve palsy* - **Weber's syndrome** (ventral midbrain stroke) commonly presents with ipsilateral 3rd nerve palsy, and some dorsal midbrain lesions can extend to affect **oculomotor nerve fascicles**. - This statement is **true** as 3rd nerve palsy can occur with midbrain strokes, particularly when the lesion affects nerve pathways in the midbrain. *Contralateral hemiplegia* - Midbrain strokes can cause **contralateral weakness** through involvement of **corticospinal tract fibers** that pass through or near the affected area. - This statement is **true** as motor deficits are commonly seen in midbrain stroke syndromes, even with dorsal lesions that may affect descending motor connections.

Q: The CSF electrophoresis of patient shows oligoclonal bands. Which of the following is associated.

Multiple sclerosis. ***Multiple sclerosis*** - The presence of **oligoclonal bands** in the CSF, but not in the plasma, indicates intrathecal IgG production, which is a hallmark of **multiple sclerosis**. - These bands represent a restricted number of **B cell clones** producing immunoglobulins within the central nervous system, consistent with the immune-mediated demyelination seen in MS. *CNS leukemia* - While CNS leukemia can involve the CSF, it typically presents with **malignant cells** in the CSF and not specifically with oligoclonal bands. - The primary diagnostic finding would be abnormal cell morphology or flow cytometry detecting leukemic cells. *Monoclonal gammopathy of unknown significance* - This condition involves the presence of a **monoclonal protein (M-protein)** in the blood (plasma), but it does not typically involve intrathecal synthesis of oligoclonal bands in the CSF. - The M-protein is usually detected in serum protein electrophoresis, not CSF. *Multiple myeloma* - Multiple myeloma is a plasma cell malignancy characterized by a **monoclonal protein** in the serum and/or urine, and sometimes in the CSF if there is CNS involvement. - However, the CSF findings in multiple myeloma would typically show the presence of the same monoclonal protein found in the serum, rather than distinct oligoclonal bands specific to the CNS.

Q: SAH leads to which of the following ECG changes?

T-wave inversion. ***T-wave inversion*** - Subarachnoid hemorrhage (SAH) can cause **cerebral stunning** and lead to characteristic ECG changes, including widespread deep **T-wave inversions** often resembling cardiac ischemia. - These T-wave inversions are thought to be due to an autonomic surge, particularly **sympathetic activation**, which can induce myocardial stunning or injury without direct coronary artery disease. *Deep Q waves* - **Deep Q waves** typically signify a previous **myocardial infarction** due to myocardial necrosis. - While SAH can cause cardiac issues, the primary and most common ECG change observed is not deep Q waves. *Premature ventricular complexes* - Although SAH can trigger **arrhythmias** due to autonomic instability, **premature ventricular complexes (PVCs)** are a non-specific finding and less characteristic of SAH-induced ECG changes than T-wave inversions. - PVCs can be seen in various cardiac conditions and are not uniquely indicative of SAH. *Sine wave pattern* - A **sine wave pattern** on ECG is a classic sign of **severe hyperkalemia**, indicating impending ventricular fibrillation or asystole. - This pattern is not typically associated with subarachnoid hemorrhage.

Q: A 50 -year-old man develops an excruciating headache. On examination he has nuchal rigidity. NCCT performed after 4 hours shows blood in the Sylvain fissure. What does the ECG show?

T-wave inversion. ***T-wave inversion*** - The ECG image prominently displays **deep, diffuse T-wave inversions** in multiple leads (e.g., II, aVL, V2, V5). These T-wave changes, particularly deep and widespread, are often referred to as "cerebral T waves" or "neurogenic T waves" and are characteristic findings in patients with **subarachnoid hemorrhage**. - Subarachnoid hemorrhage can cause various ECG abnormalities due to heightened **sympathetic nervous system activity** and direct myocardial injury (neurogenic stunning), leading to repolarization abnormalities. *Artifact* - **Artifacts on an ECG** typically manifest as irregular, erratic deflections or baseline wander that do not conform to physiological cardiac activity. - The T-wave inversions observed in the ECG are consistent, well-defined, and fit a pattern of cardiac repolarization disturbance, rather than random noise or movement. *Premature ventricular complexes* - **Premature ventricular complexes (PVCs)** are early, wide QRS complexes that are not preceded by a P wave. - While PVCs can occur in patients with subarachnoid hemorrhage, they are not the predominant or most striking abnormality seen in this specific ECG, which is dominated by T-wave changes. *Prominent U wave* - A **prominent U wave** is a small, positive deflection following the T wave, usually best seen in precordial leads. It is often associated with bradycardia or hypokalemia. - The ECG shows significant T-wave abnormalities, but not distinctly prominent U waves as the primary or most characteristic finding for subarachnoid hemorrhage.

Q: In the ECG tracing shown below, which of the following is correct?

Second degree AV block type 1, intranodal. ***Second degree AV block type 1, intranodal*** - The ECG shows **progressive lengthening of the PR interval** with each successive beat, followed by a **dropped QRS complex**, a classic pattern for Mobitz I (Wenckebach) AV block. - Mobitz I block is almost always due to a physiological delay within the **AV node (intranodal)**. *First degree AV block, intranodal* - First-degree AV block is characterized by a **constant, prolonged PR interval** (>0.20 seconds) without any dropped QRS complexes. - While it can be intranodal, the key feature of a dropped beat after progressive PR lengthening is absent here. *Second degree AV block type 2, infranodal* - Second degree AV block type 2 (Mobitz II) involves a **constant PR interval** for conducted beats, but with intermittent, **unheralded dropped QRS complexes**. - Mobitz II is typically due to disease in the **His-Purkinje system (infranodal)** and carries a higher risk of progression to complete heart block. *Second degree AV block type 2, intranodal* - Second-degree AV block type 2 is characterized by a **constant PR interval** with intermittently dropped beats. - While Mobitz II is usually infranodal, the hallmark of progressive PR lengthening seen in the tracing rules out Mobitz II entirely.

Q: A 65-year-old man loses consciousness at a Newyear party. On admission heart rate is 50 / min and BP is 170 / 110 mm Hg. JVP is normal. S2 is normal split and chest is bilaterally clear. The medic shows you his ECG. Troponin I value is <0.04 ng / dL. GCS is 7. Comment on the diagnosis.

Stroke. ***Stroke*** - The combination of **altered consciousness (GCS 7)**, **hypertension (BP 170/110 mmHg)**, and **bradycardia (HR 50/min)** in an elderly patient losing consciousness abruptly is highly suggestive of **Cushing's triad**, which is a sign of increased intracranial pressure often due to a stroke. - The **normal JVP and clear chest** rule out acute heart failure or pulmonary edema, and the **normal troponin I** rules out an acute myocardial infarction as the primary event. The provided ECG is essentially normal, lacking signs of acute ischemia or severe electrolyte disturbances. *STEMI* - An **ST-elevation myocardial infarction (STEMI)** would typically present with chest pain (though silent MIs can occur), and the ECG would show significant **ST-segment elevation** in at least two contiguous leads. - The patient's **troponin I is normal (<0.04 ng/dL)**, making STEMI very unlikely. *Hyperkalemia* - **Hyperkalemia** on ECG typically manifests as **tall, peaked T waves**, prolonged PR interval, wide QRS, and eventually sine wave patterns or asystole. - The provided ECG does not show these characteristic findings, rendering hyperkalemia an improbable primary diagnosis. *Stokes-Adams syndrome* - **Stokes-Adams syndrome** is characterized by recurrent syncopal attacks caused by transient **bradyarrhythmias or asystole** due to advanced AV block or sick sinus syndrome. - While the patient has bradycardia, there is no evidence of advanced AV block or asystole on the provided ECG, and the primary presentation points more strongly towards a neurological event.

Q: Which of the following statements are correct regarding a brain abscess? I. Abscesses arise when the brain is exposed directly as a result of fracture or infection of air sinus. II. Presenting features include low grade fever, confusion, seizures and focal deficits. III. MRI with contrast is the initial imaging modality of choice. IV. The aetological agents include bacteria, fungi, protozoa and viruses. Select the answer using the code given below :

I, II and III. I, II and III - This option correctly identifies that brain abscesses can result from direct exposure due to fractures or sinus infections [1], present with symptoms like fever, confusion, seizures, and focal deficits, and are best initially imaged with MRI with contrast. - While bacteria, fungi, and protozoa are common causes of brain abscesses, viruses are generally not a primary cause of brain abscess formation [1], making statement IV incorrect in its broad inclusion of viruses. I, III and IV - This option incorrectly includes statement IV, which claims viruses are etiological agents for brain abscesses. While viruses cause CNS infections, they typically lead to meningitis or encephalitis [1], not abscesses. - It also omits statement II, which accurately describes the common clinical presentation of brain abscesses, including symptoms like confusion and focal deficits. I, II and IV - This option incorrectly includes statement IV, which states that viruses are common etiologic agents for brain abscesses. Brain abscesses are primarily caused by bacteria, fungi, and parasites [1]. - It omits statement III, which correctly identifies MRI with contrast as the initial imaging modality of choice, crucial for diagnosis due to its superior soft tissue resolution. II, III and IV - This option incorrectly includes statement IV, which suggests viruses are among the etiologic agents. Viral infections of the brain typically manifest as encephalitis or meningitis [1], not abscesses. - It omits statement I, which correctly describes common routes of infection, including direct extension from adjacent structures like infected sinuses or trauma [1].

Q: Which of the following statements are correct regarding the use of benzodiazepines in the initial management of status epilepticus? I. Upto two doses may be used 5 minutes apart, if seizures are not controlled II. For Lorazepam, only a single dose should be used, even if seizures are not controlled III. Dose of midazolam at this stage is 1-15 mcg / kg / min infusion IV. Dose of both lorazepam and midazolam is 0.1 mg / kg Select the answer using the code given below :

I and IV. ***I and IV*** - According to current guidelines, **up to two doses** of a benzodiazepine may be administered 5 minutes apart if the **seizures are not controlled** after the initial dose. - The recommended dose for both **lorazepam and midazolam** in the initial management of status epilepticus is **0.1 mg/kg**. *II and IV* - This option is incorrect because statement II is false, as **multiple doses of lorazepam** can be administered if seizures are not controlled. - While statement IV is correct regarding the dosage of lorazepam and midazolam. *I and III* - This option is incorrect because statement III is false, as **1-15 mcg/kg/min infusion** is the dose for **continuous infusion** of midazolam in refractory status epilepticus, not the initial bolus dose. - Statement I is correct but paired with an incorrect statement. *II and III* - This option is incorrect because both statements II and III are false regarding the initial management of status epilepticus. - As previously stated, **multiple doses of lorazepam** can be used, and the given midazolam dose is for **continuous infusion**, not the initial bolus.

Question 1

Which of the following drugs is NOT used in the condition shown?

Accepted Answer

Intravenous immunoglobulin

Answer

Methylprednisolone

Answer

Fingolimod

Answer

Mitoxantrone

Question 2

A middle-aged patient presents with history of left sided weakness for 2 days. Currently the patient is extremely drowsy and underwent a NCCT brain. Which of the following is the best treatment for this patient? (AIIMS Nov 2017)

Accepted Answer

Decompressive surgery

Answer

Aspirin/Clopidogrel

Answer

Mechanical thrombectomy

Answer

Mannitol

Question 3

All are true about the mid brain stroke syndrome shown except:

Accepted Answer

Anterior cerebral peduncle is involved

Answer

Dorsal midbrain lesion

Answer

Contralateral tremor and ataxia

Answer

Red nucleus involvement causes movement disorders

Question 4

The CSF electrophoresis of patient shows oligoclonal bands. Which of the following is associated.

Accepted Answer

Multiple sclerosis

Answer

CNS leukemia

Answer

Monoclonal gammopathy of unknown significance

Answer

Multiple myeloma

Question 5

SAH leads to which of the following ECG changes?

Accepted Answer

T-wave inversion

Answer

Deep Q waves

Answer

Premature ventricular complexes

Answer

Sine wave pattern

Question 6

A 50 -year-old man develops an excruciating headache. On examination he has nuchal rigidity. NCCT performed after 4 hours shows blood in the Sylvain fissure. What does the ECG show?

Accepted Answer

T-wave inversion

Answer

Artifact

Answer

Premature ventricular complexes

Answer

Prominent U wave

Question 7

In the ECG tracing shown below, which of the following is correct?

Accepted Answer

Second degree AV block type 1, intranodal

Answer

First degree AV block, intranodal

Answer

Second degree AV block type 2, infranodal

Answer

Second degree AV block type 2, intranodal

Question 8

A 65-year-old man loses consciousness at a Newyear party. On admission heart rate is 50 / min and BP is 170 / 110 mm Hg. JVP is normal. S2 is normal split and chest is bilaterally clear. The medic shows you his ECG. Troponin I value is <0.04 ng / dL. GCS is 7. Comment on the diagnosis.

Accepted Answer

Stroke

Answer

STEMI

Answer

Hyperkalemia

Answer

Stokes-Adams syndrome

Question 9

Which of the following statements are correct regarding a brain abscess?
I. Abscesses arise when the brain is exposed directly as a result of fracture or infection of air sinus.
II. Presenting features include low grade fever, confusion, seizures and focal deficits.
III. MRI with contrast is the initial imaging modality of choice.
IV. The aetological agents include bacteria, fungi, protozoa and viruses.

Select the answer using the code given below :

Accepted Answer

I, II and III

Answer

I, III and IV

Answer

I, II and IV

Answer

II, III and IV

Question 10

Which of the following statements are correct regarding the use of benzodiazepines in the initial management of status epilepticus?
I. Upto two doses may be used 5 minutes apart, if seizures are not controlled
II. For Lorazepam, only a single dose should be used, even if seizures are not controlled
III. Dose of midazolam at this stage is 1-15 mcg / kg / min infusion
IV. Dose of both lorazepam and midazolam is 0.1 mg / kg

Select the answer using the code given below :

Accepted Answer

I and IV

Answer

II and IV

Answer

I and III

Answer

II and III

Neurology — MCQs

Neurology — MCQs

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