Neurology Practice Questions

Q: Thrombolysis can be considered in all of these conditions, except:

Blood pressure of more than 185/110 mmHg. ***Blood pressure of more than 185/110 mmHg*** - A **blood pressure** greater than **185/110 mmHg** is an absolute contraindication for thrombolysis due to the significantly increased risk of developing **hemorrhagic transformation**. - **Aggressive blood pressure control** is necessary to reduce the risk of intracranial hemorrhage before considering thrombolytics. *Ischemic stroke within 2 hours* - This is within the **therapeutic window** for thrombolysis, which typically extends up to **4.5 hours** from symptom onset [1]. - Earlier administration of thrombolytics within this window generally leads to **better outcomes** and reduced disability [1]. *Onset of symptoms <4 hours* - An onset of symptoms less than **4.5 hours** is a primary **inclusion criterion** for intravenous thrombolysis in acute ischemic stroke [1]. - This timeframe allows for the maximum benefit from **clot dissolution** while minimizing the risk of adverse events. *MRI showing density in less than 1/3rd of the area supplied by MCA* - A **diffusion-weighted MRI** showing an infarct core of less than one-third of the **Middle Cerebral Artery (MCA)** territory is an indicator that the amount of **irreversibly damaged tissue** is small. - This suggests a larger volume of **salvageable penumbra**, making thrombolysis more likely to be beneficial.

Q: What is the possible cause of irreversible dementia?

Lewy body. ***Lewy body*** - **Lewy body dementia** is a progressive, irreversible neurodegenerative disorder characterized by the abnormal accumulation of **alpha-synuclein proteins** within neurons [1]. - It presents with fluctuating cognition, recurrent visual hallucinations, and spontaneous **parkinsonism**, eventually leading to severe and irreversible cognitive decline [1]. *Vitamin B12 deficiency* - **Vitamin B12 deficiency** can cause cognitive impairment and dementia-like symptoms, but these are often **reversible** with appropriate B12 supplementation [2]. - Symptoms include **anemia**, peripheral neuropathy, and psychiatric changes, which can improve with treatment. *NPH* - **Normal Pressure Hydrocephalus (NPH)** presents with a classic triad of gait disturbance, urinary incontinence, and dementia [2]. - While it causes dementia, it is often **reversible** with surgical placement of a **ventriculoperitoneal shunt** to drain excess CSF [2]. *Hypothyroid* - **Hypothyroidism** can lead to cognitive slowing, memory impairment, and confusion, resembling dementia. - These symptoms are typically **reversible** and improve significantly with **thyroid hormone replacement therapy**.

Q: A 45-year-old male patient presented with a history of bilateral lower limb weakness, which progressed to his upper limbs in a year. On examination, he had weakness in both lower limbs and wasting in the left upper limb. Babinski sign was positive and the deep tendon reflexes were hyperactive. He has no sensory loss or any autonomic dysfunction. What is the likely diagnosis?

ALS. ***ALS*** - This patient exhibits a classic combination of **upper motor neuron (UMN)** signs (hyperactive deep tendon reflexes, positive Babinski sign) and **lower motor neuron (LMN)** signs (weakness, wasting), along with progressive limb weakness [1], [2]. These findings are characteristic of **amyotrophic lateral sclerosis (ALS)**, especially with the sparing of sensory and autonomic function [1]. - ALS is fundamentally a **motor neuron disease** that affects both UMNs and LMNs, leading to progressive muscle weakness without significant sensory deficits [1]. *GBS* - **Guillain-Barré Syndrome (GBS)** typically presents with **acute, ascending paralysis** and **areflexia** or hyporeflexia, which contradicts the hyperactive reflexes and progressive, chronic nature observed in the patient. - While GBS causes motor weakness, it is primarily a demyelinating neuropathy affecting the peripheral nervous system and usually spares upper motor neuron signs. *MS* - **Multiple sclerosis (MS)** is characterized by **demyelinating lesions** in the central nervous system, leading to a wide variety of neurological deficits, often with sensory disturbances, visual problems, and bladder dysfunction. - While MS can cause motor weakness and hyperreflexia, it usually presents with a relapsing-remitting course and significant sensory symptoms, which are absent in this patient. *Tropical spastic paraparesis* - **Tropical spastic paraparesis** primarily causes **progressive spasticity and weakness** in the lower limbs, indicative of central nervous system involvement, often linked to **HTLV-1 infection**. - While it features upper motor neuron signs, it typically does not involve the prominent muscle wasting and lower motor neuron signs observed in this patient.

Q: Which of the following drugs is preferred in the management of primary progressive multiple sclerosis?

Ocrelizumab. ***Ocrelizumab*** - **Ocrelizumab** is the first and only FDA-approved disease-modifying therapy for **primary progressive multiple sclerosis (PPMS)**, demonstrating a reduction in disability progression. - It is a **monoclonal antibody** that selectively targets CD20-positive B cells, believed to play a critical role in the pathogenesis of MS. *Natalizumab* - **Natalizumab** is approved for **relapsing-remitting multiple sclerosis (RRMS)**, not primary progressive MS [1]. - It works by blocking the migration of immune cells into the **central nervous system**, but carries a risk of **progressive multifocal leukoencephalopathy (PML)**. *Alemtuzumab* - **Alemtuzumab** is used for **relapsing forms of MS**, particularly in patients who have had an inadequate response to other MS drugs [1]. - It is known for its durable efficacy but also its significant side effects, including **autoimmune conditions** and **infusion reactions**. *Fingolimod* - **Fingolimod** is an oral medication approved for **relapsing forms of MS**, but not for primary progressive MS [1]. - It acts by trapping lymphocytes in the **lymph nodes**, preventing them from entering the central nervous system.

Q: Reversible dementia is seen in?

Hypothyroidism. ***Hypothyroidism*** - **Hypothyroidism** can lead to cognitive impairment, including memory loss, slowed thinking, and executive dysfunction, which are reversible with appropriate **thyroid hormone replacement therapy**. - This condition is often characterized by other systemic symptoms like fatigue, weight gain, and cold intolerance, which also improve with treatment. *Pick's disease* - **Pick's disease** is a type of **frontotemporal dementia** caused by progressive degeneration of brain cells, primarily in the frontal and temporal lobes. - It is a **neurodegenerative** disorder, meaning it is progressive and irreversible. *Alzheimer's disease* - **Alzheimer's disease** is the most common cause of dementia, characterized by the accumulation of **amyloid plaques** and **neurofibrillary tangles** in the brain [1]. - It is a **progressive and irreversible neurodegenerative disease** with no cure [2]. *Subacute demyelination of spinal cord* - **Subacute demyelination of the spinal cord** typically refers to conditions like **subacute combined degeneration** due to **vitamin B12 deficiency** [1]. - While this can cause neurological symptoms, including cognitive changes, its primary impact is on the spinal cord and peripheral nerves, and "dementia" in the classic sense is not the primary or defining feature of spinal cord demyelination itself, although B12 deficiency can cause broader cognitive issues [1].

Q: Following statement are true about tremors except:

Essential tremor is an uncommon movement disorder affecting 5%of population. ***Essential tremor is an uncommon movement disorder affecting 5% of population*** - Essential tremor is, in fact, one of the most common movement disorders, affecting a significant portion of the population (often cited as 0.4% in the general population, with higher prevalence in older adults, ranging from 4-5%). - Therefore, stating it is "uncommon" contradicts its actual prevalence and epidemiological data. *Normal individuals can have physiologic tremor that manifest as mild high frequency, postural or action tremors.* - **Physiologic tremor** is a normal phenomenon present in healthy individuals, characterized by a low amplitude, high-frequency tremor. - It becomes more noticeable under conditions of **stress, fatigue, or stimulant use** and is typically seen as a **postural or action tremor**. *PD is characterised by resting tremor* - **Parkinson's disease (PD)** is classically associated with a **resting tremor**, meaning it occurs when the limb is at rest and supported, and often diminishes with voluntary movement [1], [2]. - This tremor usually presents as a **"pill-rolling"** movement of the fingers and thumb. *Tremor consist of alternate contraction of agonist and antagonist muscle in oscillating rhythmic manner* - Tremors are defined by their **oscillating, rhythmic, and involuntary movements** resulting from the alternating or synchronous contraction of **agonist and antagonist muscles** [1]. - This alternating muscle activity is what produces the characteristic shaking motion [2].

Q: Prosopagnosia is:

Inability to recognize face. ***Inability to recognize face*** - **Prosopagnosia**, or **face blindness**, is a cognitive disorder characterized by an impaired ability to recognize familiar faces, including one's own. - This condition is often associated with damage to the **fusiform face area** in the brain, typically in the right hemisphere. *Inability to read* - The inability to read is known as **alexia** or **dyslexia**, which is distinct from the visual recognition deficit seen in prosopagnosia. - Alexia primarily involves difficulties with processing written language, not the visual recognition of faces. *Anosmia* - **Anosmia** refers to the complete or partial loss of the sense of smell and is a disorder affecting the olfactory system. - It is unrelated to visual processing or face recognition. *Inability to write* - The inability to write is termed **agraphia** or **dysgraphia**, a neurological condition that impairs writing ability. - This condition affects motor skills and language processing related to writing, not visual face recognition.

Q: All the following are indications for brain imaging in epilepsy, except:

Epilepsy starts after the age of 5 years. Address the indications for brain imaging in epilepsy based on clinical guidelines. ***Epilepsy starts after the age of 5 years*** - The recommendation for **brain imaging** is typically suggested for epilepsy onset after the age of **16 years** to rule out structural causes, rather than age 5 [2]. An onset at age 5 does not exclude the possibility of idiopathic epilepsy, which often does not require imaging [1]. - While it's a good practice to image any new onset epilepsy, age 5 by itself is not a specific indication that *demands* imaging beyond standard workup if no other red flags are present. *EEG shows a focal seizure source* - A **focal seizure source identified on EEG** strongly indicates a structural lesion in the brain that could be responsible for the seizures [2]. - **Brain imaging** (e.g., MRI) is essential to identify the underlying **structural abnormality**, such as a tumor, malformation, or scar tissue [2]. *Control of seizures is difficult* - Poorly controlled or **refractory seizures** warrant further investigation with brain imaging to look for an **underlying structural cause** that might be amenable to surgical intervention or require alternative therapies [2]. - This suggests the possibility of a lesion that is not responding to standard anti-epileptic drugs, necessitating a search for the **etiology of intractability** [3]. *Seizures have focal features clinically* - **Focal clinical features** (e.g., twitching of one limb, sensory disturbances on one side) strongly point to a specific area of the brain where the seizures originate [4]. - **Brain imaging** is crucial to identify any **structural lesion** (e.g., tumor, malformation, stroke) corresponding to the clinically localized area of seizure onset [2].

Q: Todd's palsy can occur after episode of

Focal motor seizures. ***Focal motor seizures*** - **Todd's palsy** is a localized **postictal paresis** or paralysis that occurs after a focal seizure, especially **focal motor seizures** [1]. - It results from **neuronal exhaustion** in the seizure focus, leading to a temporary loss of function in the affected body part. *Generalised tonic clonic seizures* - While generalized tonic-clonic seizures can be followed by a postictal state, **Todd's palsy** is specifically associated with **focal onset seizures** [1]. - The diffuse nature of generalized seizures typically leads to global postictal confusion and fatigue rather than localized weakness [3]. *Myoclonic seizures* - Myoclonic seizures are characterized by **brief, shock-like jerks** and usually do not cause postictal weakness as they involve very short bursts of muscle activity [2]. - They are typically too brief and diffuse to induce the focal, prolonged neuronal exhaustion that leads to Todd's palsy. *Atonic seizures* - Atonic seizures cause a sudden loss of muscle tone, leading to falls, but they do not typically result in **postictal focal paralysis** like Todd's palsy [2]. - The brief, generalized loss of tone is not followed by a specific, localized neurological deficit.

Question 1

Thrombolysis can be considered in all of these conditions, except:

Accepted Answer

Blood pressure of more than 185/110 mmHg

Answer

Ischemic stroke within 2 hours

Answer

Onset of symptoms <4 hours

Answer

MRI showing density in less than 1/3rd of the area supplied by MCA

Question 2

What is the possible cause of irreversible dementia?

Accepted Answer

Lewy body

Answer

Vitamin B12 deficiency

Answer

NPH

Answer

Hypothyroid

Question 3

Patient presented with following features:

- ipsilateral loss of pain and temperature sensation in the face
- Contralateral loss of pain and temperature sensation in the body
- Horner's syndrome
- Dysphagia and hoarseness
- Ataxia and vertigo

Which artery is involved in syndrome based on above clinical features?

Accepted Answer

Posterior inferior cerebellar artery

Answer

Basilar artery.

Answer

Superior cerebellar artery

Answer

Anterior inferior cerebellar artery

Question 4

A 45-year-old male patient presented with a history of bilateral lower limb weakness, which progressed to his upper limbs in a year. On examination, he had weakness in both lower limbs and wasting in the left upper limb. Babinski sign was positive and the deep tendon reflexes were hyperactive. He has no sensory loss or any autonomic dysfunction. What is the likely diagnosis?

Accepted Answer

ALS

Answer

GBS

Answer

MS

Answer

Tropical spastic paraparesis

Question 5

Which of the following drugs is preferred in the management of primary progressive multiple sclerosis?

Accepted Answer

Ocrelizumab

Answer

Natalizumab

Answer

Alemtuzumab

Answer

Fingolimod

Question 6

Reversible dementia is seen in?

Accepted Answer

Hypothyroidism

Answer

Pick's disease

Answer

Alzheimer's disease

Answer

Subacute demyelination of spinal cord

Question 7

Following statement are true about tremors except:

Accepted Answer

Essential tremor is an uncommon movement disorder affecting 5%of population

Answer

Normal individuals can have physiologic tremor that manifest as mild high frequency, postural or action tremors.

Answer

PD is characterised by resting tremor

Answer

Tremor consist of alternate contraction of agonist and antagonist muscle in oscillating rhythmic manner

Question 8

Prosopagnosia is:

Accepted Answer

Inability to recognize face

Answer

Inability to read

Answer

Anosmia

Answer

Inability to write

Question 9

All the following are indications for brain imaging in epilepsy, except:

Accepted Answer

Epilepsy starts after the age of 5 years

Answer

EEG shows a focal seizure source

Answer

Control of seizures is difficult

Answer

Seizures have focal features clinically

Question 10

Todd's palsy can occur after episode of

Accepted Answer

Focal motor seizures

Answer

Generalised tonic clonic seizures

Answer

Myoclonic seizures

Answer

Atonic seizures

Neurology — MCQs

Neurology — MCQs

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