Neurology Practice Questions

Q: Neurogenic cause of dysphagia includes following except:

Tetany. ***Tetany*** - **Tetany** is characterized by **involuntary muscle contractions** due to electrolyte imbalances (e.g., hypocalcemia) or toxins, primarily affecting peripheral nerves and muscles, not typically considered a neurogenic cause of dysphagia in the context of central nervous system disorders. - While severe muscle spasms can impair swallowing, the underlying pathophysiology of tetany is distinct from the neurological deficits seen in conditions like MS or Parkinson's regarding direct innervation of swallowing muscles. *Multiple sclerosis* - **Multiple sclerosis** is a demyelinating disease of the central nervous system that can affect cranial nerves and brainstem pathways involved in swallowing, leading to **neurogenic dysphagia**. - Lesions in areas controlling **pharyngeal muscles** or **motor planning** for swallowing directly impair the neurological control of this process. *Tetanus* - **Tetanus** is caused by a neurotoxin (tetanospasmin) that blocks inhibitory neurotransmitters, leading to **severe muscle spasms** and rigidity, including those of the jaw (trismus) and pharynx. - The resulting **spastic paralysis** directly interferes with the coordinated muscle movements required for swallowing, making it a neurogenic cause of dysphagia. *Parkinson's disease* - **Parkinson's disease** is a progressive neurodegenerative disorder affecting the basal ganglia, leading to motor symptoms including **bradykinesia**, rigidity, and tremor [1]. - It commonly causes **neurogenic dysphagia** due to impaired coordination, reduced pharyngeal motility, and delayed swallow reflex, impacting all phases of swallowing [2].

Q: A 5-year-old boy presented with a history of focal seizures associated with episodes of impaired consciousness. The patient also has a history of episodic behavioral changes, including agitation and a dream-like state with thrashing movements of his limbs. The child doesn't recall these episodes, and there is no apparent precipitating factor. There is also a family history of seizures. The seizures are often intractable. Lab studies revealed unilateral or bilateral anterior temporal spikes on EEG, hypometabolism on interictal PET, hypoperfusion on interictal SPECT, and material-specific memory deficits on intracranial amobarbital (Wada) test. An MRI of the brain was also performed. Which of the following structures is commonly affected in the above condition?

Hippocampus. ### Hippocampus - The clinical presentation describes **temporal lobe epilepsy**, characterized by focal seizures, impaired consciousness, episodic behavioral changes (agitation, dream-like state, thrashing movements), and memory deficits [1]. - The hippocampus is a key structure within the **temporal lobe** and is commonly affected in temporal lobe epilepsy, often displaying **hippocampal sclerosis** on MRI [2]. *Parietal association cortex* - Dysfunction in the parietal association cortex typically leads to **spatial awareness deficits**, **neglect syndromes**, or **apraxia**, which are not indicated in this case. - Seizures originating here would likely manifest as **somatosensory symptoms** or difficulties with complex motor tasks. *Frontal association cortex* - Seizures originating from the frontal association cortex often present with **complex motor automatisms**, **speech arrest**, or **personality changes**. - While behavioral changes are present, the detailed description of "dream-like state" and memory deficits points more towards temporal lobe involvement. *Occipital association cortex* - Seizures involving the occipital association cortex typically result in **visual disturbances** such as **hallucinations** (e.g., flashing lights, geometric shapes) or **loss of vision**. - These visual symptoms are not mentioned in the patient's presentation.

Q: Bilateral inter nuclear ophthalmoplegia is pathognomonic of-

Multiple sclerosis. Bilateral internuclear ophthalmoplegia (INO) is highly suggestive of multiple sclerosis due to demyelination in the medial longitudinal fasciculus (MLF) on both sides. INO results from a lesion in the MLF, which coordinates conjugate eye movements, leading to impaired adduction on attempted lateral gaze and nystagmus of the abducting eye. *Pontine haemorrhage* - A pontine haemorrhage typically causes a more widespread neurological deficit, including coma, quadriplegia, and pinpoint pupils, rather than isolated INO. - While it can affect the brainstem, primary findings are usually related to mass effect and destruction of vital centers. *Lateral medullary syndrome* - Also known as Wallenberg syndrome, lateral medullary syndrome is caused by infarction of the posterior inferior cerebellar artery (PICA) and presents with vestibular symptoms, ataxia, dysphagia, and contralateral loss of pain and temperature sensation. - It does not directly cause bilateral internuclear ophthalmoplegia as its primary clinical feature. *Pontine glioma* - A pontine glioma is a brain tumor that can affect various cranial nerves and tracts within the pons. - While it can cause some ophthalmoplegia, bilateral internuclear ophthalmoplegia is not its specific or pathognomonic presentation; the clinical picture is usually more diverse and progressive.

Q: Reversible dementia causes are all except-

Lewy body dementia. ***Lewy body dementia*** - **Lewy body dementia** is a **progressive neurodegenerative disease**, characterized by the abnormal accumulation of alpha-synuclein proteins (Lewy bodies) in the brain. - It is an **irreversible form of dementia**, meaning its cognitive decline cannot be halted or reversed. *Subdural hematoma* - A **subdural hematoma**, especially chronic, can cause **cognitive impairment** due to pressure on the brain [1]. - If diagnosed and treated early (e.g., surgical evacuation), the associated cognitive deficits can often be **reversed or significantly improved**. *Myxedema* - **Myxedema**, or severe hypothyroidism, can lead to **reversible cognitive dysfunction**, including memory impairment and slowed thinking. - Treatment with **thyroid hormone replacement** can reverse the dementia-like symptoms. *Vitamin B12 deficiency* - **Vitamin B12 deficiency** can cause a range of neurological symptoms, including **cognitive decline** and dementia-like symptoms [1]. - With timely and adequate **vitamin B12 supplementation**, the associated cognitive impairment can often be **reversed** [1].

Q: Which one of the following statements truly represents Bell's paralysis?

Idiopathic ipsilateral paralysis of the facial nerve. ***Idiopathic ipsilateral paralysis of the facial nerve*** - **Bell's palsy** is defined as an **idiopathic acute peripheral facial nerve palsy**, meaning it has no identifiable cause and affects the facial nerve directly [1]. - The paralysis is **ipsilateral**, meaning it affects the same side of the face as the affected facial nerve. *Facial nerve paralysis and contralateral Hemiparesis* - This description suggests a central nervous system lesion, possibly a stroke, which would typically cause **contralateral hemiparesis** along with **facial weakness** (often sparing the forehead) [1]. - Bell's palsy is a peripheral nerve disorder and does not present with **hemiparesis** [1]. *Combined paralysis of the facial, trigeminal and abducens nerves* - Involvement of multiple cranial nerves, such as the **facial (VII)**, **trigeminal (V)**, and **abducens (VI)**, points towards a more extensive cranial neuropathy or a lesion in the brainstem. - **Bell's palsy** specifically affects only the **facial nerve (VII)**, not other cranial nerves. *Facial nerve paralysis with uveitis and parotid enlargement* - This combination of symptoms (facial nerve paralysis, uveitis, and parotid enlargement) is characteristic of **Heerfordt's syndrome**, a rare manifestation of **sarcoidosis**. - **Bell's palsy** is not associated with uveitis or parotid gland enlargement.

Q: True about lower motor neuron palsy of VIIth nerve:

All of the options. ***All of the options*** - All statements regarding **lower motor neuron (LMN) palsy of the VIIth cranial nerve** (facial nerve) are accurate. - This type of injury affects the entire ipsilateral side of the face, including the forehead and eye, which require specific protective measures [1]. *Melkersson's syndrome causes recurrent paralysis* - **Melkersson-Rosenthal syndrome** is characterized by the triad of **facial nerve palsy** (often recurrent), **orofacial swelling**, and **fissured tongue**. - The facial palsy in this syndrome is typically a **lower motor neuron lesion**. *Forehead muscles are affected unlike upper motor neuron lesions* - In a **lower motor neuron lesion**, all muscles of the ipsilateral face, including the **frontalis muscle** (which controls the forehead), are affected due to damage to the facial nerve nucleus or its peripheral branches. - In contrast, **upper motor neuron lesions** spare the forehead muscles because the upper face receives bilateral innervation from the cerebral cortex [1]. *Eye protection is done* - Due to paralysis of the **orbicularis oculi muscle**, patients cannot fully close their eye (lagophthalmos), leading to exposure keratitis and dryness. - **Eye protection** with artificial tears, lubricating ointments, and eyelid taping is crucial to prevent corneal damage [1].

Q: L'Hermitte's sign is a characteristic feature of

Multiple sclerosis. ***Multiple sclerosis*** [1] - **L'Hermitte's sign** is a classic symptom of **demyelination** in the cervical spinal cord, commonly seen in multiple sclerosis. - It presents as an **electric shock sensation** radiating down the spine and into the limbs upon neck flexion. *Parkinsonism* - Characterized by **bradykinesia**, **rigidity**, **tremor**, and **postural instability**, without the presence of L'Hermitte's sign. - It is primarily a **movement disorder** due to dopamine depletion in the basal ganglia. *Tabes dorsalis* - This is a late-stage manifestation of **syphilis** affecting the dorsal columns of the spinal cord and dorsal roots. - Symptoms include **ataxia**, **lightning pains**, **Argyll Robertson pupils**, and loss of proprioception, not L'Hermitte's sign. *Syringomyelia* [2] - A condition involving a **fluid-filled cyst (syrinx)** within the spinal cord, leading to loss of pain and temperature sensation. - It typically causes a **cape-like distribution sensory loss** over the shoulders and arms, distinct from L'Hermitte's sign. [2]

Q: A 60-year-old man has resting tremor, pill-rolling movements, rigidity, and bradykinesia. Which of the following is most likely to be decreased in this man?

Dopamine neurons in the substantia nigra. ***Dopamine neurons in the substantia nigra*** - The symptoms described—**resting tremor**, **pill-rolling movements**, **rigidity**, and **bradykinesia**—are classic signs of **Parkinson's disease** [5]. - Parkinson's disease is pathologically characterized by the degeneration of **dopamine-producing (dopaminergic) neurons** in the **substantia nigra pars compacta**, leading to decreased dopamine levels in the **striatum** [1]. *GABA neurons in the caudate nucleus and putamen* - **GABAergic neurons** in the **caudate nucleus and putamen** are primarily affected in conditions like **Huntington's disease**, where their degeneration leads to increased involuntary movements (chorea) [4]. - While there can be secondary changes in these neurons in Parkinson's, the primary deficit is not in GABA but in dopamine. *Serotonin neurons in the raphe nuclei* - **Serotonin neurons** in the **raphe nuclei** are involved in mood regulation, sleep, and appetite, and their dysfunction is primarily linked to conditions like **depression**, anxiety, and certain sleep disorders [3]. - While some serotonergic involvement can occur in Parkinson's, it is not the primary neurological deficit explaining the motor symptoms. *Acetylcholine neurons in the forebrain* - **Acetylcholine neurons** in the **nucleus basalis of Meynert** (part of the forebrain) are primarily implicated in **Alzheimer's disease**, where their degeneration contributes to cognitive decline [2]. - While some cholinergic deficits may be present in advanced Parkinson's, they are not the hallmark pathology or the initial cause of the characteristic motor symptoms.

Q: A 79-year-old woman is brought to the clinic for assessment of frequent falls. There is no loss of consciousness associated with the falls, and she reports no postural change or symptoms prior to the falls. She also describes difficulty in "getting going" when she starts walking and notices that her balance is "not right." Her gait is slow and shuffling on inspection. Which of the following is the most likely finding in a patient with Parkinson disease?

akinesia. ***Akinesia*** - The patient's symptoms of difficulty "getting going" and slow, shuffling gait are classic descriptions of **akinesia** or **bradykinesia**, a core motor symptom of Parkinson disease [1]. - **Akinesia** refers to the absence or loss of the power of voluntary movement, often manifesting as freezing of gait or difficulty initiating movements [1]. *Muscle atrophy* - This is not a typical feature of Parkinson disease; instead, patients may experience **rigidity** and **spasticity**, but not significant muscle wasting [1]. - Muscle atrophy is more characteristic of conditions like motor neuron disease or disuse. *Fine hand tremor with movement* - Parkinson disease typically presents with a **resting tremor** which improves with voluntary movement, rather than a tremor that occurs with movement (**action tremor**) [1]. - An action tremor is more typical of **essential tremor** [1]. *Pupillary constriction* - This is not a characteristic feature of Parkinson disease. - Pupillary changes are generally not a primary diagnostic criterion for Parkinson disease.

Q: A 24-year-old female with long standing history of sinusitis present with fevers, headache (recent origin) and personality changes; Fundus examination revealed papilledema. Most likely diagnosis is:

Frontal lobe abscess. ***Frontal lobe abscess*** - The combination of **chronic sinusitis** (a potential source of infection), **fevers, headache, personality changes**, and **papilledema** (indicating increased intracranial pressure) is highly suggestive of a frontal lobe abscess [1]. - An abscess in the frontal lobe can lead to **focal neurological deficits** and changes in higher cognitive functions and personality. *Frontal bone osteomyelitis* - While chronic sinusitis can lead to **frontal bone osteomyelitis** [2], this condition primarily involves bone infection and may not directly explain the rapid onset of **personality changes** and **papilledema** without direct intracranial extension. - Although it can cause headache and fever, it's less likely to cause such profound neurological and intracranial pressure signs as the primary diagnosis. *Meningitis* - **Meningitis** typically presents with fever, headache, and **neck stiffness**, but **papilledema** is an uncommon finding, especially at presentation, unless complicated by hydrocephalus or significant brain swelling. - While personality changes can occur in severe cases, the constellation of symptoms points more towards a **space-occupying lesion**. *Encephalitis* - **Encephalitis** involves inflammation of the brain parenchyma, leading to fever, headache, and **altered mental status**, which may include personality changes. - However, **papilledema** is less common in typical encephalitis and is more indicative of a localized mass effect or significant intracranial pressure, which an abscess would cause.

Question 1

Neurogenic cause of dysphagia includes following except:

Accepted Answer

Tetany

Answer

Multiple sclerosis

Answer

Tetanus

Answer

Parkinson's disease

Question 2

A 5-year-old boy presented with a history of focal seizures associated with episodes of impaired consciousness. The patient also has a history of episodic behavioral changes, including agitation and a dream-like state with thrashing movements of his limbs. The child doesn't recall these episodes, and there is no apparent precipitating factor. There is also a family history of seizures. The seizures are often intractable. Lab studies revealed unilateral or bilateral anterior temporal spikes on EEG, hypometabolism on interictal PET, hypoperfusion on interictal SPECT, and material-specific memory deficits on intracranial amobarbital (Wada) test. An MRI of the brain was also performed. Which of the following structures is commonly affected in the above condition?

Accepted Answer

Hippocampus

Answer

Parietal association cortex

Answer

Frontal association cortex

Answer

Occipital association cortex

Question 3

Bilateral inter nuclear ophthalmoplegia is pathognomonic of-

Accepted Answer

Multiple sclerosis

Answer

Pontine haemorrhage

Answer

Lateral medullary syndrome

Answer

Pontine glioma

Question 4

Reversible dementia causes are all except-

Accepted Answer

Lewy body dementia

Answer

Subdural hematoma

Answer

Myxedema

Answer

Vitamin B12 deficiency

Question 5

Which one of the following statements truly represents Bell's paralysis?

Accepted Answer

Idiopathic ipsilateral paralysis of the facial nerve

Answer

Facial nerve paralysis and contralateral Hemiparesis

Answer

Combined paralysis of the facial, trigeminal and abducens nerves

Answer

Facial nerve paralysis with uveitis and parotid enlargement

Question 6

True about lower motor neuron palsy of VIIth nerve:

Accepted Answer

All of the options

Answer

Forehead muscles are affected unlike upper motor neuron lesions

Answer

Melkersson's syndrome causes recurrent paralysis

Answer

Eye protection is done

Question 7

L'Hermitte's sign is a characteristic feature of

Accepted Answer

Multiple sclerosis

Answer

Parkinsonism

Answer

Tabes dorsalis

Answer

Syringomyelia

Question 8

A 60-year-old man has resting tremor, pill-rolling movements, rigidity, and bradykinesia. Which of the following is most likely to be decreased in this man?

Accepted Answer

Dopamine neurons in the substantia nigra

Answer

GABA neurons in the caudate nucleus and putamen

Answer

Serotonin neurons in the raphe nuclei

Answer

Acetylcholine neurons in the forebrain

Question 9

A 79-year-old woman is brought to the clinic for assessment of frequent falls. There is no loss of consciousness associated with the falls, and she reports no postural change or symptoms prior to the falls. She also describes difficulty in "getting going" when she starts walking and notices that her balance is "not right." Her gait is slow and shuffling on inspection. Which of the following is the most likely finding in a patient with Parkinson disease?

Accepted Answer

akinesia

Answer

muscle atrophy

Answer

fine hand tremor with movement

Answer

pupillary constriction

Question 10

A 24-year-old female with long standing history of sinusitis present with fevers, headache (recent origin) and personality changes; Fundus examination revealed papilledema. Most likely diagnosis is:

Accepted Answer

Frontal lobe abscess

Answer

Frontal bone osteomyelitis

Answer

Meningitis

Answer

Encephalitis

Neurology — MCQs

Neurology — MCQs

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