Neurology Practice Questions

Q: Chorea is NOT seen in

Tourette syndrome. ***Tourette syndrome*** - **Tourette syndrome** is primarily characterized by **motor and vocal tics**, which are sudden, repetitive, nonrhythmic movements or vocalizations. - While it involves involuntary movements, these are distinct from the continuous, flowing, dance-like movements of **chorea**. *Rheumatic fever* - **Sydenham's chorea** (St. Vitus' dance) is a major manifestation of **acute rheumatic fever**, particularly in children. - It is characterized by **involuntary, purposeless, jerky movements** affecting the face, trunk, and extremities. *Creutzfeldt-Jakob disease* - This rapidly progressive, fatal neurodegenerative disease often presents with various neurological symptoms including **chorea**, **myoclonus**, and ataxia. - The abnormal movements are due to widespread neuronal loss, particularly in the **basal ganglia**. *Huntington's disease* - **Huntington's disease** is a classic cause of **chorea**, characterized by progressive degeneration of neurons in the **caudate and putamen** [1]. - The chorea is typically generalized and worsens over time, accompanied by cognitive decline and psychiatric symptoms.

Q: Tic Douloureux is facial pain traveling through which of the following nerves?

Trigeminal. ***Trigeminal*** - **Tic douloureux**, also known as **trigeminal neuralgia**, is a chronic pain condition affecting the **trigeminal nerve (cranial nerve V)** [1]. - This nerve is responsible for sensory innervation of the face, and the condition presents as sudden, severe, electric shock-like pains [1]. *Hypoglossal* - The **hypoglossal nerve (cranial nerve XII)** primarily controls the **movement of the tongue**. - Dysfunction of this nerve typically manifests as speech and swallowing difficulties, not facial pain. *Vestibulocochlear* - The **vestibulocochlear nerve (cranial nerve VIII)** is responsible for **hearing and balance**. - Problems with this nerve cause symptoms like vertigo, dizziness, and hearing loss. *Facial* - The **facial nerve (cranial nerve VII)** controls **facial expressions**, taste sensation from the anterior two-thirds of the tongue, and functions of several glands. - Disorders of the facial nerve, such as Bell's palsy, cause facial weakness or paralysis, not the characteristic lancinating pain of tic douloureux.

Q: A 48-year-old man complains of muscle weakness in his right hand (dominant hand). On examination, the hand muscles are smaller than on the left, and the reflexes are decreased out of proportion to weakness. For the above patient with muscle weakness, select the most likely anatomic site for the disorder.

Peripheral nerve. ***Peripheral nerve*** - **Unilateral muscle weakness** (right hand), **atrophy** (smaller muscles), and **decreased reflexes** are classic signs of a peripheral nerve lesion, indicating damage to the nerve supply to those muscles [1]. - The combination of these findings points to a disruption of the motor unit distal to the anterior horn cell, consistent with **denervation** from a peripheral nerve injury [2]. *Neuromuscular junction* - Disorders of the neuromuscular junction, such as **myasthenia gravis**, typically cause **fatigable weakness** that worsens with activity and improves with rest. - While reflexes can be normal or mildly depressed, **muscle atrophy** is not a prominent feature, and the weakness often fluctuates rather than being a consistent, focal deficit. *Anterior horn cell* - **Anterior horn cell diseases** (e.g., **amyotrophic lateral sclerosis**) cause widespread **muscle weakness, atrophy**, and **fasciculations**, but generally also include a mixture of upper and lower motor neuron signs (e.g., spasticity with hyperreflexia, or prominent fasciculations) [2]. - The isolated, unilateral nature of the weakness and disproportionately decreased reflexes favor a peripheral nerve lesion over a more diffuse anterior horn cell process [1]. *Muscle* - Primary **muscle disorders** (**myopathies**) present with **proximal muscle weakness**, normal or mildly reduced reflexes, but often without significant atrophy until later stages. - **Sensory findings** are typically absent, and the distribution of weakness (e.g., only in one hand) is less common in generalized myopathies.

Q: A 22-year-old street vendor was found in the park having a seizure. Cops brought him to ER, unaware of any background medical history. He is continuously having seizures for 13 minutes and paramedics are not able to gain intravenous access. You ensure the airway is secure and administer oxygen, however, you are unable to gain intravenous access after two attempts. Blood glucose levels are 80mg%. Which medication would be most suitable to administer at this stage to treat patient's seizure?

Midazolam. .***Midazolam*** - **Midazolam** is a benzodiazepine that can be given via **intramuscular (IM)**, buccal, or intranasal routes, making it ideal when IV access is difficult or impossible. - Its rapid onset of action and efficacy in acute seizure management, particularly in **status epilepticus**, make it the most appropriate choice in this scenario. *Sodium Valproate* - While an effective anticonvulsant, **sodium valproate** is primarily administered **intravenously** in acute settings, which is not feasible here due to lack of IV access. - It also has a slower onset of action compared to benzodiazepines for immediate seizure cessation. *Lorazepam* - **Lorazepam** is a first-line benzodiazepine for status epilepticus but is typically given **intravenously (IV)**. - Although it can be given IM, its absorption is slower and less predictable than IM midazolam, and the question specifies difficulty in gaining IV access after two attempts. *Levetiracetam* - **Levetiracetam** is an effective anticonvulsant for status epilepticus but is generally administered **intravenously**, requiring reliable IV access. - It works more slowly than benzodiazepines and is often used as a second-line agent or adjunct once immediate seizure control is achieved.

Q: A 20-year-old girl complains of headache while studying. Her vision is found to be normal. In the initial medical evaluation of her headache, which of the following would be the LEAST essential to assess?

Her interest in studies. ***Her interest in studies*** - While **stress** and **academic pressure** can contribute to headaches, this represents a **psychosocial assessment** rather than a standard medical evaluation. - Among the listed options, this would be the **least essential** in the initial medical workup compared to the other clinical assessments. *Family history of headache* - Essential evaluation as many headache disorders, particularly **migraine** and **tension-type headache**, have strong **genetic predisposition**. - Family history helps establish diagnosis and guides appropriate management strategies for the patient's headaches. *Menstrual history* - Crucial in young women as **hormonal fluctuations** during the menstrual cycle are major triggers for headaches, especially **menstrual migraine**. - Understanding menstrual patterns can identify cyclical headache triggers and inform treatment approaches. *Fundoscopy examination* - Important to rule out **papilledema** (optic disc swelling) and signs of **increased intracranial pressure**, even with normal visual acuity. - Normal vision does not exclude underlying pathology that could be detected through **ophthalmoscopic examination** of the retina and optic nerve.

Q: Which of the following tests is not required for the diagnosis of multiple sclerosis?

Electronystagmogram. ***Electronystagmogram*** - An **electronystagmogram (ENG)** measures eye movements and nystagmus, which can be affected by MS but is not a **diagnostic criterion** for the disease. - While vestibulo-ocular dysfunction can occur in MS, an ENG is not required to establish the diagnosis. *Gadolinium-enhanced MRI* - **Gadolinium-enhanced MRI** of the brain and spinal cord is crucial for diagnosing MS as it identifies active lesions (enhancing lesions) and disseminated lesions in space and time [1]. - The presence of both **active and inactive lesions** on MRI helps fulfill the McDonald criteria for MS diagnosis [1]. *Visual evoked potential* - **Visual evoked potentials (VEPs)** measure electrical activity in the brain in response to visual stimuli, detecting subtle damage to the **optic nerve** even in the absence of clinical symptoms [1]. - Abnormal VEPs indicate demyelination and can contribute to fulfilling the **dissemination in space** criterion when lesions are not clearly visible on MRI in specific locations [1]. *Lumbar puncture* - A **lumbar puncture** to analyze **cerebrospinal fluid (CSF)** is often performed to look for **oligoclonal bands** and an **elevated IgG index**, which are characteristic findings in MS. - Although not always mandatory, CSF analysis can support the diagnosis, especially in cases where MRI findings are equivocal or incomplete.

Q: In Wernicke's aphasia all are seen except:

Spontaneous speech is reduced. ***Spontaneous speech is reduced*** - In **Wernicke's aphasia**, spontaneous speech is typically **fluent, copious, and often excessively verbose** (logorrhea), rather than reduced [1]. - The patient can produce many words, but the content is often meaningless due to **paraphasias** and **neologisms** [1]. *Neologism is present* - **Neologisms**, or made-up words, are characteristic of Wernicke's aphasia, contributing to the **incoherence** of speech [1]. - This reflects the severe impairment in **language comprehension** and word retrieval. *Paraphasia present* - **Paraphasias** (substitution of words or syllables) are a hallmark of Wernicke's aphasia, leading to **jumbled and nonsensical phrases** [1]. - Both semantic (e.g., "chair" for "table") and phonemic (e.g., "pipe" for "pike") paraphasias are common. *Speech is effortless* - The speech production in Wernicke's aphasia is typically **effortless and fluent**, often at a normal or even accelerated rate [1]. - This contrasts with non-fluent aphasias where speech is slow, labored, and requires significant effort.

Q: In a status epilepticus patient, first-line drug is

Benzodiazepine. ***Benzodiazepine*** - **Benzodiazepines** are the first-line treatment for status epilepticus due to their rapid onset of action in enhancing **GABAergic inhibition** [1]. - They effectively terminate seizures by binding to **GABA-A receptors**, leading to increased chloride influx and neuronal hyperpolarization. *Phenytoin* - **Phenytoin** is a second-line antiepileptic drug that can be used if benzodiazepines are unsuccessful, but it is not the initial treatment [1]. - Its mechanism involves blocking **voltage-gated sodium channels** to stabilize neuronal membranes and prevent seizure propagation [2]. *Magnesium* - **Magnesium sulfate** is primarily used in status epilepticus caused by **eclampsia** or severe **hypomagnesemia**, not as a general first-line agent. - It acts by stabilizing neuronal excitability and reducing acetylcholine release at the neuromuscular junction. *Barbiturates* - **Barbiturates** (e.g., phenobarbital) are typically considered third-line agents for refractory status epilepticus due to their significant side effects, including **respiratory depression** and hypotension. - They potentiate **GABA-A receptor** activity, similar to benzodiazepines, but with a higher risk profile.

Q: Burst suppression on EEG is seen in

SSPE. ***SSPE*** - **Subacute sclerosing panencephalitis (SSPE)** is a rare, fatal, and chronic progressive encephalitis caused by persistent measles virus infection, often presenting with **burst suppression** on EEG. - **Burst suppression** EEG patterns are characterized by periods of high-amplitude electrical activity alternating with periods of profound suppression or inactivity, reflecting severe global brain dysfunction. *Epilepsy* - **Epilepsy** typically presents with various EEG patterns such as **spikes, sharp waves, or spike-and-wave complexes**, reflecting hyperexcitable neuronal networks [2]. - While prolonged seizures (status epilepticus) can lead to a suppressed EEG, classic burst suppression is not a hallmark of typical epileptic seizures [1]. *Prions disease* - **Prion diseases**, such as Creutzfeldt-Jakob disease (CJD), often show characteristic EEG abnormalities like **periodic sharp wave complexes** or generalized slowing. - **Burst suppression** is not a typical or specific finding in prion diseases, although non-specific slowing or background disruption can occur in advanced stages. *Herpes* - **Herpes simplex encephalitis (HSE)** typically causes **focal abnormalities** like periodic lateralizing epileptiform discharges (PLEDs) or slowing over the temporal lobes on EEG. - While HSE can lead to severe brain damage and generalized slowing, **burst suppression** is not a characteristic EEG finding.

Q: In Millard-Gubler syndrome, all are involved except:

Oculomotor nerve. ***Oculomotor nerve*** - Millard-Gubler syndrome is a **ventral pontine syndrome** usually caused by a brainstem lesion in the **pons**. - This syndrome affects the **abducens (VI) and facial (VII) cranial nerves** and the **corticospinal tract**, but not the oculomotor (III) nerve. *Abducens nerve* - Involvement of the **abducens nerve nucleus** or fibers leads to **ipsilateral lateral rectus palsy**, resulting in **exotropia** (eye turned outward) and impairment of ipsilateral eye abduction. - This is a hallmark feature of Millard-Gubler syndrome. *Facial nerve* - Damage to the **facial nerve nucleus** or fascicles causes **ipsilateral facial paralysis** of the lower motor neuron type [2], affecting all facial muscles. - This is another characteristic component of the syndrome. *Corticospinal tract* - Involvement of the **descending corticospinal tract** results in **contralateral hemiparesis or hemiplegia** [1], impacting motor control on the opposite side of the body. - This long tract deficit is crucial for localizing the lesion to the pontine base.

Question 1

Chorea is NOT seen in

Accepted Answer

Tourette syndrome

Answer

Rheumatic fever

Answer

Creutzfeldt-Jakob disease

Answer

Huntington's disease

Question 2

Tic Douloureux is facial pain traveling through which of the following nerves?

Accepted Answer

Trigeminal

Answer

Hypoglossal

Answer

Vestibulocochlear

Answer

Facial

Question 3

A 48-year-old man complains of muscle weakness in his right hand (dominant hand). On examination, the hand muscles are smaller than on the left, and the reflexes are decreased out of proportion to weakness. For the above patient with muscle weakness, select the most likely anatomic site for the disorder.

Accepted Answer

Peripheral nerve

Answer

Neuromuscular junction

Answer

Anterior horn cell

Answer

Muscle

Question 4

A 22-year-old street vendor was found in the park having a seizure. Cops brought him to ER, unaware of any background medical history. He is continuously having seizures for 13 minutes and paramedics are not able to gain intravenous access. You ensure the airway is secure and administer oxygen, however, you are unable to gain intravenous access after two attempts. Blood glucose levels are 80mg%. Which medication would be most suitable to administer at this stage to treat patient's seizure?

Accepted Answer

Midazolam

Answer

Sodium Valproate

Answer

Lorazepam

Answer

Levetiracetam

Question 5

A 20-year-old girl complains of headache while studying. Her vision is found to be normal. In the initial medical evaluation of her headache, which of the following would be the LEAST essential to assess?

Accepted Answer

Her interest in studies

Answer

Family history of headache

Answer

Menstrual history

Answer

Fundoscopy examination

Question 6

Which of the following tests is not required for the diagnosis of multiple sclerosis?

Accepted Answer

Electronystagmogram

Answer

Gadolinium-enhanced MRI

Answer

Visual evoked potential

Answer

Lumbar puncture

Question 7

In Wernicke's aphasia all are seen except:

Accepted Answer

Spontaneous speech is reduced

Answer

Neologism is present

Answer

Paraphasia present

Answer

Speech is effortless

Question 8

In a status epilepticus patient, first-line drug is

Accepted Answer

Benzodiazepine

Answer

Phenytoin

Answer

Magnesium

Answer

Barbiturates

Question 9

Burst suppression on EEG is seen in

Accepted Answer

SSPE

Answer

Epilepsy

Answer

Prions disease

Answer

Herpes

Question 10

In Millard-Gubler syndrome, all are involved except:

Accepted Answer

Oculomotor nerve

Answer

Abducens nerve

Answer

Facial nerve

Answer

Corticospinal tract

Neurology — MCQs

Neurology — MCQs

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