Neurology Practice Questions

Q: A patient presents with headache for one hour on awakening, associated with nasal stuffiness and reddening of eye. Suggestive of

Cluster headache. ***Cluster headache*** - This presentation describes a **cluster headache**, which is characterized by **severe, unilateral pain** affecting the area around the eye, often accompanied by **autonomic symptoms** like nasal stuffiness and conjunctival injection (reddening of the eye). [1] [2] - Cluster headaches typically occur in **clusters**, with attacks lasting from 15 minutes to 3 hours, and frequently occur at the same time each day, often awakening the patient from sleep. [1] *Migraine* - **Migraines** usually involve **throbbing, pulsating pain** and are often accompanied by **photophobia, phonophobia**, and nausea/vomiting, which are not mentioned here. [3] - While migraines can cause eye symptoms, the combination with pronounced nasal stuffiness and the specific pattern of awakening and duration are more characteristic of cluster headaches. [1] *Tension headache* - **Tension headaches** are typically described as a **tight band or pressure** around the head, involving the entire head, and are generally **mild to moderate** in intensity. [2] - They lack the severe pain and distinct autonomic symptoms (nasal stuffiness, eye reddening) seen in this patient. *All of the options* - This option is incorrect because the specific combination of symptoms points clearly to a **cluster headache** and excludes migraines and tension headaches due to their distinct clinical features. - While all are types of headaches, their presentations vary significantly, making only one the most likely diagnosis in this scenario.

Q: Pure motor paralysis is seen in :

Polio. **Polio** - Polio primarily infects motor neurons in the **anterior horn of the spinal cord** [3], leading to **flaccid paralysis** without sensory involvement [4]. - The destruction of these motor neurons results in **muscle weakness and atrophy**, consistent with pure motor paralysis [3]. *Sub-Acute Combined Degeneration* - This condition is caused by **vitamin B12 deficiency** and affects both the **posterior and lateral columns** of the spinal cord. - It typically presents with a combination of **motor deficits** (weakness, spasticity) and **sensory deficits** (paresthesias, proprioception loss), making it not purely motor [2]. *Diabetes mellitus* - Diabetic neuropathy can cause various types of nerve damage, including **motor, sensory, and autonomic neuropathies** [2]. - While motor weakness can occur, it is rarely a **pure motor paralysis** and is often accompanied by significant sensory symptoms (e.g., numbness, tingling) [1]. *Guillain-Barré syndrome* - GBS is an acute demyelinating polyneuropathy that causes **progressive symmetrical weakness**, often starting in the lower limbs. - Although primarily motor, it can also involve **sensory disturbances** (paresthesias, pain) and autonomic dysfunction, so it is not strictly pure motor.

Q: A patient was treated for mantle cell Hodgkin lymphoma with radiation therapy. After 6 months he develops an electric shock-like pain along the spine on flexing his neck. What is the diagnosis?

Radiation-induced myelopathy. ***Radiation-induced myelopathy*** - This diagnosis is signaled by the **electric shock-like pain** along the spine upon neck flexion (Lhermitte's sign) developing 6 months after receiving **radiation therapy** for lymphoma. - This condition represents a delayed complication of radiation, affecting the **spinal cord's white matter**. *Multiple sclerosis* - While it can present with **Lhermitte's sign**, the patient's history of **radiation therapy** and its timing strongly favor myelopathy. [1] - MS is a demyelinating disease usually presenting with a **variety of neurological symptoms** over time, rather than isolated Lhermitte's sign post-radiation. *Cervical arthritis* - This condition would typically present with **neck pain and stiffness**, possibly radiating pain, and limited range of motion, but not specifically an electric shock sensation on neck flexion (Lhermitte's sign). [2] - While an osteophyte might cause compression, the specific **Lhermitte's sign** points away from simple degenerative changes. *Spinal cord compression* - While Lhermitte's sign can indicate spinal cord involvement, **spinal cord compression** usually implies an acute or subacute onset with more severe and progressive neurological deficits, such as motor weakness or sensory loss, and bladder/bowel dysfunction. [3] - Given the 6-month delay and the isolated Lhermitte's sign after radiation, **radiation-induced myelopathy** is a more specific and likely cause.

Q: A 76 year old male comes with a history of frequent falls and difficulty in looking downwards and laterally. The diagnosis is

Supranuclear palsy. Supranuclear palsy - Progressive supranuclear palsy (PSP) is characterized by early and prominent postural instability, leading to frequent falls, as well as vertical gaze palsy (difficulty looking downwards and upwards). - While the patient has difficulty looking downwards and laterally, vertical gaze palsy (specifically downward gaze) is a hallmark feature of PSP, often more pronounced than lateral gaze issues initially. Alzheimer's disease - Primarily defined by progressive memory loss and cognitive decline, not typically by early signs of falls or specific gaze palsies [1]. - While falls can occur in advanced stages, they are not the prominent presenting symptom related to gait instability and gaze deficits. Amyotropic lateral sclerosis - This is a neurologic disorder characterized by progressive muscle weakness and atrophy due to the degeneration of upper and lower motor neurons [2]. - It does not typically present with oculomotor dysfunction or early frequent falls due to balance issues. Oculomotor nerve palsy - An oculomotor nerve palsy would cause specific paresis of muscles innervated by the third cranial nerve, leading to symptoms like ptosis, dilated pupil, and ophthalmoplegia (difficulty moving the eye up, down, and medially) [3]. - It would not explain the generalized symptom of frequent falls due to central balance issues, and the gaze restriction is more localized rather than a supranuclear pattern [3].

Q: Which of the following features helps in distinguishing seizures from syncope?

Physical weakness with clear sensorium. ***Physical weakness with clear sensorium*** - This describes the **post-syncopal state**, where a patient typically feels weak but is fully aware and oriented immediately upon regaining consciousness, unlike the **post-ictal confusion** seen after a seizure [1]. - The rapid return to a clear sensorium is a key differentiating feature as syncope is a transient global cerebral hypoperfusion event without the sustained neuronal discharge of a seizure [1], [2]. *Urinary incontinence* - **Urinary incontinence** can occur in both severe syncopal episodes and seizures, making it a non-specific differentiator [1], [2]. - While more common and often tonic in seizures, brief bladder control loss can happen with significant hypotension in syncope. *Injury due to fall* - **Injury due to fall** can occur in both seizures and syncope, as both conditions involve a sudden loss of postural control [2]. - The nature of the injury might differ (e.g., specific injuries like posterior shoulder dislocation in seizures), but the fall itself is not distinctive. *Loss of consciousness* - Both **seizures** and **syncope** are characterized by a transient **loss of consciousness** [3]. - This symptom defines the core presentation of both conditions and therefore does not help in distinguishing between them.

Q: Which of the following sites is responsible for the amnestic defect in Wernicke-Korsakoff syndrome?

Mamillary body. ***Mamillary body*** - The **mamillary bodies** are the **classically recognized** anatomical substrate for the **amnestic defect** in Wernicke-Korsakoff syndrome due to their crucial role in the Papez circuit and memory formation. - Damage to these structures, caused by **thiamine deficiency**, severely impairs the ability to form new memories (anterograde amnesia) and recall past memories (retrograde amnesia). - Bilateral mamillary body lesions are consistently found in Wernicke-Korsakoff syndrome and correlate strongly with memory impairment. *Thalamus* - The **mediodorsal nucleus of the thalamus** is also critically involved in Wernicke-Korsakoff syndrome and plays a significant role in the memory deficit. - Modern research shows that thalamic damage (particularly mediodorsal nucleus) correlates strongly with amnesia severity and may contribute equally to the memory impairment. - However, **mamillary bodies** remain the **classic exam answer** when identifying the primary site for amnestic defects in this syndrome. *Subthalamic nucleus* - The **subthalamic nucleus** is primarily involved in **motor control** and is a key component of the basal ganglia circuit, not memory function. - Damage to this site is typically associated with movement disorders like **hemiballismus**, not amnesia. *Medial forebrain bundle* - The **medial forebrain bundle (MFB)** is a collection of nerve fibers connecting the brainstem, hypothalamus, and limbic areas, playing a role in **reward and motivation**. - While it contributes to overall brain function, it is not the primary site responsible for the amnestic defect in Wernicke-Korsakoff syndrome.

Q: Which of the following is a reversible cause of dementia? a) Post encephalitis b) Multi-infarct c) Hydrocephalus d) Senile dementia

Hydrocephalus. ***Hydrocephalus*** - **Normal pressure hydrocephalus (NPH)** is a classic **reversible cause of dementia**, characterized by the triad of **gait disturbance**, **urinary incontinence**, and **dementia** [1]. - Surgical intervention with a **ventriculoperitoneal shunt** can often improve or resolve the symptoms, making it a reversible condition. *Multi infarct* - **Multi-infarct dementia** is caused by multiple **small strokes** leading to damage in various brain regions. - The brain damage from these infarcts is generally **irreversible**, and while further strokes can be prevented, existing cognitive deficits typically do not resolve. *Senile dementia* - **Senile dementia** is a broad term often referring to **Alzheimer's disease** or other **neurodegenerative dementias** [1]. - These conditions are characterized by progressive and **irreversible brain degeneration**, leading to permanent cognitive decline. *Post encephalitis* - **Post-encephalitic cognitive impairment** can occur following severe brain inflammation (encephalitis) [1]. - While some recovery is possible, the resulting brain damage and associated cognitive deficits are often **permanent** or progressive, making it generally an irreversible cause of dementia.

Q: All except one constitute Benedict syndrome

Hemiparesis. Hemiparesis - Benedict syndrome, a midbrain injury, typically presents with ipsilateral oculomotor palsy, contralateral ataxia, and contralateral tremor. [3] - Hemiparesis is not a characteristic component of Benedict syndrome; it is more associated with lesions affecting the corticospinal tract. [1] Oculomotor palsy - Ipsilateral oculomotor palsy is a defining feature of Benedict syndrome resulting from damage to the oculomotor nerve nucleus or fascicles in the midbrain. [3], [4] - This typically presents as ptosis, dilated pupil, and eye deviation down and out. [5] Contralateral Ataxia - Contralateral ataxia is a key symptom caused by damage to the superior cerebellar peduncle as it decussates in the midbrain. - This leads to discoordination and an unsteady gait on the side opposite the midbrain lesion. [2] Tremors - Contralateral tremors, particularly rubral or intention tremors, are characteristic of Benedict syndrome. [2] - These tremors result from disruption of pathways involving the dentatorubrothalamic tract or its connections in the midbrain.

Q: The commonest cause of unilateral internuclear ophthalmoplegia is:

Multiple sclerosis. Multiple sclerosis - Multiple sclerosis (MS) is the **commonest cause** of **unilateral internuclear ophthalmoplegia (INO)**, especially in younger adults. - INO results from demyelination of the **medial longitudinal fasciculus (MLF)**, a common site for MS lesions. *Diabetes mellitus* - While diabetes can cause various neurological complications, **oculomotor neuropathies** associated with diabetes more often present as complete or incomplete **cranial nerve palsies**, not typically isolated INO. - These neuropathies usually affect the **third, fourth, or sixth cranial nerves** and are often painful. *Lead toxicity* - Lead toxicity can cause a variety of neurological symptoms, including **peripheral neuropathy** and **encephalopathy**. - However, it is not a recognized cause of isolated INO. *Hypertension* - Hypertension is a significant risk factor for **stroke**, which can cause INO if the infarct affects the **brainstem** and damages the MLF. - However, in cases of **unilateral INO**, particularly in the absence of other stroke symptoms, MS is a more frequent cause than a single hypertensive event.

Question 1

A patient presents with headache for one hour on awakening, associated with nasal stuffiness and reddening of eye. Suggestive of

Accepted Answer

Cluster headache

Answer

Migraine

Answer

Tension headache

Answer

All of the options

Question 2

Pure motor paralysis is seen in :

Accepted Answer

Polio

Answer

Sub-Acute Combined Degeneration

Answer

Diabetes mellitus

Answer

Guillain-Barré syndrome

Question 3

A patient was treated for mantle cell Hodgkin lymphoma with radiation therapy. After 6 months he develops an electric shock-like pain along the spine on flexing his neck. What is the diagnosis?

Accepted Answer

Radiation-induced myelopathy

Answer

Multiple sclerosis

Answer

Cervical arthritis

Answer

Spinal cord compression

Question 4

A 76 year old male comes with a history of frequent falls and difficulty in looking downwards and laterally. The diagnosis is

Accepted Answer

Supranuclear palsy

Answer

Alzheimer's disease

Answer

Amyotropic lateral sclerosis

Answer

Oculomotor nerve palsy

Question 5

Which of the following features helps in distinguishing seizures from syncope?

Accepted Answer

Physical weakness with clear sensorium

Answer

Urinary incontinence

Answer

Injury due to fall

Answer

Loss of consciousness

Question 6

Which of the following sites is responsible for the amnestic defect in Wernicke-Korsakoff syndrome?

Accepted Answer

Mamillary body

Answer

Thalamus

Answer

Subthalamic nucleus

Answer

Medial forebrain bundle

Question 7

Which of the following is a reversible cause of dementia?  
a) Post encephalitis  
b) Multi-infarct  
c) Hydrocephalus  
d) Senile dementia

Accepted Answer

Hydrocephalus

Answer

Multi infarct

Answer

Senile dementia

Answer

Post encephalitis

Question 8

Which of the following is true about trigeminal neuralgia?

Accepted Answer

Carbamazepine is the drug of choice in trigeminal neuralgia.

Answer

Can be treated with NSAID's

Answer

Is a hereditary condition

Answer

Always bilateral in distribution

Question 9

All except one constitute Benedict syndrome

Accepted Answer

Hemiparesis

Answer

Oculomotor palsy

Answer

Contralateral Ataxia

Answer

Tremors

Question 10

The commonest cause of unilateral internuclear ophthalmoplegia is:

Accepted Answer

Multiple sclerosis

Answer

Diabetes mellitus

Answer

Lead toxicity

Answer

Hypertension

Neurology — MCQs

Neurology — MCQs

On this page

Practice by Chapter

Want unlimited practice?