Neurology Practice Questions

Q: Which one of the following oral drugs may be used as adjunctive therapy in the management of super-refractory status epilepticus?

Topiramate. ***Topiramate*** - **Topiramate** is an antiepileptic drug with multiple mechanisms of action, including potentiation of **GABAergic** activity, blockade of **voltage-gated sodium channels**, and antagonism of **AMPA/kainate glutamate receptors**. - Its broad-spectrum action and ability to be administered orally make it a suitable **adjunctive therapy** in complex cases like **super-refractory status epilepticus (SRSE)**, where patients have failed other conventional treatments. *Clobazam* - **Clobazam** is a **benzodiazepine** primarily used as an **anxiolytic** and antiepileptic drug, particularly for Lennox-Gastaut syndrome. - While supportive in status epilepticus, its primary role is in acute seizure termination rather than as a long-term adjunctive therapy for **super-refractory status epilepticus** post-acute phase. *Clonazepam* - **Clonazepam** is another **benzodiazepine** with potent **antiepileptic** properties. - It is effective in terminating acute seizures but is not typically used as a primary oral adjunctive agent for **super-refractory status epilepticus** due to its sedative side effects and potential for tolerance. *Lamotrigine* - **Lamotrigine** is an **antiepileptic drug** that primarily works by inhibiting **voltage-sensitive sodium channels**, thereby stabilizing neuronal membranes and modulating the release of excitatory neurotransmitters. - While effective for various seizure types, including focal and generalized seizures, it is not a first-line or common choice as an **adjunctive oral therapy** in **super-refractory status epilepticus**, which often requires drugs with faster onset or broader mechanisms beyond sodium channel blockade.

Q: Which of the following are clinical features of Fronto-Temporal dementia ? I. Personality change II. Language disturbance III. Memory may be preserved in early stages IV. Anti-cholinesterases are the drug of choice for treatment Select the correct answer using the code given below :

I, II and III. ***Correct Answer: I, II and III*** - **Fronto-temporal dementia (FTD)** is characterized by prominent **personality and behavioral changes** (disinhibition, apathy, loss of empathy) and **language disturbances** (progressive non-fluent aphasia or semantic variant aphasia). - Unlike Alzheimer's disease, **memory is often relatively preserved in the early stages** of FTD, with executive function, behavior, and social cognition being more affected initially. - **Statement IV is incorrect**: Anti-cholinesterases (donepezil, rivastigmine, galantamine) are the treatment for Alzheimer's disease and are **generally ineffective or may even worsen behavioral symptoms in FTD**. There is no FDA-approved pharmacological treatment specifically for FTD; management focuses on behavioral interventions and symptomatic treatment. *Incorrect: II, III and IV* - This option incorrectly includes **Statement IV (anti-cholinesterases)** as a clinical feature or appropriate treatment. - Anti-cholinesterases are not the drug of choice for FTD and may exacerbate behavioral symptoms. *Incorrect: I, III and IV* - This option incorrectly includes **Statement IV (anti-cholinesterases)** while missing the important language disturbance feature. - Language disturbances are a core feature of FTD, particularly in the language-variant subtypes. *Incorrect: I, II and IV* - This option incorrectly includes **Statement IV (anti-cholinesterases)** while missing the fact that memory preservation in early stages is characteristic. - The preservation of memory early on is a key distinguishing feature between FTD and Alzheimer's disease.

Q: Which of the following are causes of reversible dementia? I. Hypothyroidism II. Vitamin B12 deficiency III. Dementia with lewy body IV. Thiamine deficiency Select the correct answer using the code given below :

I, II and IV. ***I, II and IV*** - **Hypothyroidism** can cause cognitive impairment, including memory loss and slowed thinking, which are often reversible with **thyroid hormone replacement**. - **Vitamin B12 deficiency** can lead to neurological symptoms such as memory problems and cognitive decline, which can improve significantly with **B12 supplementation** [1]. - **Thiamine deficiency**, particularly in the context of Wernicke-Korsakoff syndrome, can cause severe amnesia and cognitive deficits that may be partially or fully reversible with **thiamine repletion** [1], [2]. *II, III and IV* - This option incorrectly includes **Dementia with Lewy bodies (DLB)** as a reversible cause. DLB is a progressive and irreversible neurodegenerative disease. - While II and IV are correct, the inclusion of III makes this option incorrect. *I, III and IV* - This option incorrectly includes **Dementia with Lewy bodies (DLB)** as a reversible cause. DLB is a progressive neurodegenerative dementia. - Although I and IV are correct, the presence of III makes this an invalid choice. *I, II and III* - This option incorrectly includes **Dementia with Lewy bodies (DLB)** as a reversible cause. DLB is an **irreversible neurodegenerative disorder**. - While I and II are correct, the miscategorization of III leads to this option being incorrect.

Q: Which of the following are features of Alzheimer's disease? I. It is a disorder of cerebral cortical function II. Only short term memory is affected III. Patients deny that there is anything wrong IV. Depression is commonly present Select the correct answer using the code given below :

I, III and IV. ***I, III and IV*** - Alzheimer's disease is indeed a **disorder of cerebral cortical function** [1], primarily affecting areas responsible for memory, language, and executive functions. - Patients often exhibit **anosognosia** (denial of illness), failing to recognize their cognitive deficits, and **depression** is a common comorbidity [2] that can complicate diagnosis and management. *II, III and IV* - This option incorrectly states that **only short-term memory is affected** in Alzheimer's disease; both short-term and long-term memory are progressively impaired [2]. - While denial of illness and depression are common, the underlying memory impairment is more global than just short-term memory [2]. *I, II and III* - This option incorrectly includes the statement that **only short-term memory is affected**, which is not characteristic of Alzheimer's disease. - Alzheimer's patients experience a decline in various cognitive domains, including **long-term memory** [2], language, and executive functions. *I, II and IV* - This option incorrectly includes the statement that **only short-term memory is affected**; Alzheimer's disease impacts both short-term and long-term memory [2]. - While cerebral cortical dysfunction and depression are relevant features, the denial of illness (anosognosia) is also a significant clinical presentation not included here.

Q: Out of the following areas of brain, which area is most commonly affected on brain imaging in Wilson's disease?

Basal ganglia. ***Basal ganglia*** - The **basal ganglia**, particularly the **putamen** and **globus pallidus**, are the most commonly affected brain regions due to their high susceptibility to **copper deposition** in Wilson's disease. - Imaging findings like **hyperintense lesions** on T2-weighted MRI in these areas are characteristic of neurodegeneration and edema caused by copper accumulation. *Thalamus* - While the **thalamus** can be affected in later stages of Wilson's disease, it is not typically the primary or most common site of involvement compared to the basal ganglia. - Thalamic lesions are usually seen in more advanced cases and may contribute to cognitive deficits and motor symptoms. *Sub-cortex* - The term **sub-cortex** refers to a broad region beneath the cerebral cortex, encompassing many structures, including the basal ganglia, thalamus, and white matter. - While structures within the sub-cortex are affected, "basal ganglia" is a more specific and accurate answer for the most commonly affected area. *Cerebellum* - **Cerebellar involvement** is less common than basal ganglia involvement in Wilson's disease, though it can occur in some patients. - When affected, it can lead to **ataxia** and coordination problems, but it is not the most consistently or severely damaged area.

Q: Which of the following are trigger factors for seizures? I. Sleep deprivation II. Missed doses of antiepileptic drugs III. Recreational drug misuse IV. Physical exhaustion Select the correct answer using the code given below:

I, II, III and IV. ***I, II, III and IV*** - **Sleep deprivation** significantly lowers the **seizure threshold** by altering brain excitability and neurochemical balance. - **Missed doses of antiepileptic drugs** lead to subtherapeutic drug levels, increasing the likelihood of breakthrough seizures in individuals undergoing treatment. - **Recreational drug misuse** (e.g., cocaine, amphetamines, alcohol withdrawal) can directly cause seizures by neurotoxic effects or by unmasking an underlying seizure disorder. - **Physical exhaustion** can act as a stressor, disrupting brain homeostasis and making individuals more susceptible to seizures, similar to sleep deprivation. *II and III only* - This option is incomplete as **sleep deprivation** and **physical exhaustion** are also well-established seizure triggers. *I and IV only* - This option is incomplete because **missed doses of antiepileptic drugs** and **recreational drug misuse** are critical and common triggers for seizures. *I, II and III only* - This option overlooks **physical exhaustion**, which can, similar to sleep deprivation, significantly reduce the seizure threshold.

Q: Which of the following are seen in Normal pressure hydrocephalus ? 1. Hearing loss 2. Gait disturbance 3. Incontinence 4. Cognitive decline Select the correct answer using the code given below :

2, 3 and 4. ***2, 3 and 4*** - This option correctly identifies the **Hakim-Adams triad** of Normal pressure hydrocephalus: **gait disturbance**, **urinary incontinence**, and **cognitive decline**. - The classic mnemonic "**wet, wobbly, and wacky**" describes these three cardinal features - incontinence (wet), gait instability (wobbly), and cognitive impairment (wacky). *3 and 4 only* - This option only includes **incontinence** and **cognitive decline**, missing the crucial **gait disturbance** component of the triad. - **Gait apraxia** is often the earliest and most prominent feature of NPH, making this option incomplete. *1, 2 and 3* - **Hearing loss** is not a feature of Normal pressure hydrocephalus and is incorrectly included in this option. - While it correctly includes **gait disturbance** and **incontinence**, the presence of hearing loss makes this choice inaccurate. *1, 2 and 4* - **Hearing loss** is not associated with NPH and represents a major error in this option. - Though **gait disturbance** and **cognitive decline** are correct features, including hearing loss eliminates this as a valid choice.

Q: Which of the following represents the underlying pathophysiology of the classic triad of brain tumor presentation? 1. Raised ICP 2. Seizures 3. Hemianopia 4. Focal deficit

1. Raised ICP. ***Raised ICP*** - **Increased Intracranial Pressure (ICP)** is the fundamental underlying cause of the classic triad of brain tumor symptoms [1]. - As a tumor grows, it occupies space within the rigid skull, leading to an increase in pressure that manifests as headache, nausea/vomiting, and papilledema [1]. *Anopia* - **Anopia** (complete blindness in one eye) is a specific visual field defect, not a general underlying pathophysiological mechanism for the classic triad. - While brain tumors can cause visual field defects, these are typically considered focal neurological deficits rather than the primary cause of the general triad [1]. *Focal deficit* - **Focal neurological deficits** (like hemianopia, weakness, or sensory loss) are *symptoms* caused by brain tumors, but they represent localized damage, not the overarching pathophysiology of the classic triad [1]. - The classic triad (headache, nausea/vomiting, papilledema) is a manifestation of diffuse increased pressure, not specific focal damage [1]. *Seizures* - **Seizures** are a common symptom of brain tumors, often due to irritation of cortical tissue [1]. - However, seizures are a *symptom* that can occur due to focal irritation or diffuse pressure and do not represent the primary underlying pathophysiology (raised ICP) that causes the classic triad itself [1].

Q: Genetic disorder predisposing patients to develop Berry aneurysm includes all EXCEPT:

Neurofibromatosis Type II. ***Neurofibrofomatosis Type II*** - This condition is primarily associated with **central nervous system tumors** like **vestibular schwannomas** and **meningiomas**, not Berry aneurysms [2]. - While it affects the nervous system, its vascular manifestations are typically different from those predisposing to aneurysms. *Marfan’s syndrome* - Patients with Marfan's syndrome have **fragile connective tissue** due to a defect in **fibrillin-1**, which can weaken arterial walls. - This weakness increases the risk of **aortic aneurysms** and dissections, and can also predispose to intracranial aneurysms like Berry aneurysms. *Adult polycystic kidney* - This **autosomal dominant** disorder is characterized by the formation of **cysts in the kidneys**, but also has systemic manifestations [1]. - There is a well-established association between **autosomal dominant polycystic kidney disease (ADPKD)** and an increased incidence of **Berry aneurysms**. *Fibromuscular dysplasia* - This condition involves **abnormal cellular development** in the **arterial walls**, leading to areas of narrowing and enlargement. - It commonly affects the **renal arteries** and **carotid arteries**, and is also a known risk factor for the development of **intracranial aneurysms**, including Berry aneurysms.

Q: A patient presented with violent, flinging movements. Where is the lesion causing the hemiballismus seen?

Subthalamic nucleus. ***Subthalamic nucleus*** - **Hemiballismus** is characterized by **violent, flinging movements** of one side of the body, most commonly affecting the proximal limbs [1]. - This involuntary movement disorder is typically caused by a lesion, often an **infarct** or **hemorrhage**, in the **contralateral subthalamic nucleus (STN)** [1]. *Putamen* - Lesions in the **putamen** are more commonly associated with other movement disorders such as **dystonia** or **chorea**. - The putamen is part of the **striatum** and plays a key role in the direct and indirect pathways of the basal ganglia. *Globus pallidus* - Damage to the **globus pallidus (GP)**, particularly the external segment (GPe), can lead to conditions like **dystonia** or contribute to Parkinsonian symptoms depending on the specific region affected [2]. - The globus pallidus is a central component of the **basal ganglia output** to the thalamus. *Caudate nucleus* - Lesions in the **caudate nucleus** are closely linked to **Huntington's disease**, which primarily manifests as **chorea** and cognitive decline [1]. - The caudate nucleus is primarily involved in **cognitive functions** and motor control planning.

Question 1

Which one of the following oral drugs may be used as adjunctive therapy in the management of super-refractory status epilepticus?

Accepted Answer

Topiramate

Answer

Clobazam

Answer

Clonazepam

Answer

Lamotrigine

Question 2

Which of the following are clinical features of Fronto-Temporal dementia ?
I. Personality change
II. Language disturbance
III. Memory may be preserved in early stages
IV. Anti-cholinesterases are the drug of choice for treatment
Select the correct answer using the code given below :

Accepted Answer

I, II and III

Answer

II, III and IV

Answer

I, III and IV

Answer

I, II and IV

Question 3

Which of the following are causes of reversible dementia?
I. Hypothyroidism
II. Vitamin B12 deficiency
III. Dementia with lewy body
IV. Thiamine deficiency

Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

Answer

I, II and III

Question 4

Which of the following are features of Alzheimer's disease?
I. It is a disorder of cerebral cortical function
II. Only short term memory is affected
III. Patients deny that there is anything wrong
IV. Depression is commonly present

Select the correct answer using the code given below :

Accepted Answer

I, III and IV

Answer

II, III and IV

Answer

I, II and III

Answer

I, II and IV

Question 5

Out of the following areas of brain, which area is most commonly affected on brain imaging in Wilson's disease?

Accepted Answer

Basal ganglia

Answer

Thalamus

Answer

Sub-cortex

Answer

Cerebellum

Question 6

Which of the following are trigger factors for seizures?
I. Sleep deprivation
II. Missed doses of antiepileptic drugs
III. Recreational drug misuse
IV. Physical exhaustion

Select the correct answer using the code given below:

Accepted Answer

I, II, III and IV

Answer

II and III only

Answer

I and IV only

Answer

I, II and III only

Question 7

Which of the following are seen in Normal pressure hydrocephalus ?

1. Hearing loss
2. Gait disturbance
3. Incontinence
4. Cognitive decline

Select the correct answer using the code given below :

Accepted Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

3 and 4 only

Question 8

Which of the following represents the underlying pathophysiology of the classic triad of brain tumor presentation?

1. Raised ICP
2. Seizures
3. Hemianopia
4. Focal deficit

Accepted Answer

1. Raised ICP

Answer

3. Anopia

Answer

4. Focal deficit

Answer

2. Seizures

Question 9

Genetic disorder predisposing patients to develop Berry aneurysm includes all EXCEPT:

Accepted Answer

Neurofibromatosis Type II

Answer

Marfan’s syndrome

Answer

Adult polycystic kidney

Answer

Fibromuscular dysplasia

Question 10

A patient presented with violent, flinging movements. Where is the lesion causing the hemiballismus seen?

Accepted Answer

Subthalamic nucleus

Answer

Putamen

Answer

Globus pallidus

Answer

Caudate nucleus

Neurology — MCQs

Neurology — MCQs

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