Neurology Practice Questions

Q: Which of the following clinical tests when positive suggests presence of sensory ataxia?

Romberg test. A positive Romberg test indicates **sensory ataxia**, where the patient sways or falls when standing with feet together and eyes closed [1]. This occurs due to impaired **proprioception**, forcing reliance on visual input for balance, which is lost when eyes are closed [2]. *Adson test* - The Adson test is used to assess for **thoracic outlet syndrome**. - It involves palpating the radial pulse while the patient rotates the head towards the affected side, extends the neck, and takes a deep breath. A diminished or absent pulse suggests **vascular compression**. *Stinchfield test* - The Stinchfield test is used to assess for hip joint pathology or dysfunction, often related to **femoroacetabular impingement** or **labral tears**. - It involves resisted hip flexion while the patient is supine, causing pain if positive. *Crossed SLR test* - The crossed straight leg raise (SLR) test, or Well-leg SLR test, is a highly specific test for **lumbar radiculopathy**, indicating **disc herniation**. - It is positive if raising the *unaffected* leg causes pain to radiate down the *affected* leg.

Q: Todd's paralysis is experienced following which type of seizure?

Focal seizures. ***Focal seizures*** - **Todd's paralysis** is a transient post-ictal focal weakness or paralysis that occurs after a **focal seizure**, specifically a **focal motor seizure** [1]. - It typically affects the body part that was involved in the seizure activity and can last from minutes to hours. *Absence seizures* - These seizures are characterized by brief, sudden lapses of consciousness without loss of postural tone and are often described as "staring spells" [4]. - They do not typically involve significant motor activity or post-ictal phenomena like paralysis [4]. *Myoclonic seizures* - Myoclonic seizures involve sudden, brief, shock-like jerks of a muscle or group of muscles [2]. - While they are a type of motor seizure, they do not typically lead to post-ictal focal weakness or paralysis. *Generalized seizures* - This category includes various seizure types affecting both hemispheres of the brain from the onset, such as tonic-clonic seizures [4]. - While **tonic-clonic seizures** can result in post-ictal confusion and drowsiness, they do not typically cause isolated, focal paralysis known as Todd's paralysis [3].

Q: Which of the following is not a feature of Wernicke's Korsakoff Syndrome?

Normal pupillary response. ***Normal pupillary response*** - Patients with **Wernicke-Korsakoff Syndrome** often present with **abnormal pupillary responses**, such as sluggish or unequal pupils, as part of their ophthalmoplegia. - A **normal pupillary response** would generally argue against the severe brainstem dysfunction seen in Wernicke's encephalopathy. *Ataxia* - **Ataxia**, particularly **gait ataxia**, is a classic neurological sign of **Wernicke's encephalopathy**, resulting from cerebellar dysfunction due to thiamine deficiency [3], [4]. - It contributes to the characteristic triad of symptoms along with ophthalmoplegia and confusion [3]. *Psychosis* - While not a direct component of the classical triad, **psychotic features** such as **hallucinations and delusions** can be observed in patients with **Korsakoff's psychosis**, which is the chronic sequela of untreated Wernicke's encephalopathy. - This is primarily due to damage to the limbic system, affecting memory and emotional processing. *Ophthalmoplegia* - **Ophthalmoplegia**, often presenting as **nystagmus**, **lateral rectus palsy**, or **conjugate gaze palsies**, is a cardinal feature of **Wernicke's encephalopathy** [3]. - It results from damage to brainstem nuclei involved in eye movement control, secondary to **thiamine deficiency** [1], [2].

Q: Huntington's disease is commonly seen in age group between

25 - 45 years. ***25 - 45 years*** - Huntington's disease typically manifests in **mid-adulthood**, with symptoms commonly appearing between the ages of **30 and 50**, making the 25-45 age range a good approximation for the onset of symptoms. - While it can occur at younger or older ages, most cases fall within this period, characterized by progressive **motor, cognitive, and psychiatric symptoms**. *15 - 35 years* - While **juvenile Huntington's disease** does occur, it is much less common and typically presents before age 20. - The majority of cases fall outside this range for initial symptom onset, making this option less representative of the "commonly seen" age group. *35 - 55 years* - This range overlaps significantly with the common onset age but extends slightly older, making it a plausible but slightly less precise answer than 25-45 years, given that many patients develop symptoms before age 35. - The onset of the disease typically begins a bit earlier than the upper end of this range. *45 - 65 years* - Onset in this age range is considered **late-onset Huntington's disease**, which occurs in a minority of patients. - The majority of individuals experience symptoms earlier in life, making this an unlikely range for the most common presentation.

Q: What does hypomimia refer to?

Reduced facial expressiveness. ***Reduced facial expressiveness*** - **Hypomimia** specifically describes a reduction in the **range and intensity of facial expressions**, often making the face appear mask-like. - It is a common feature of certain neurological conditions, such as **Parkinson's disease**, where it contributes to an appearance of flat affect. *Impaired motor function* - While hypomimia can be associated with neurological conditions that cause impaired motor function, it is a specific symptom rather than a general description of motor impairment. - Impaired motor function encompasses a much broader range of issues, including **weakness, tremor, and gait disturbances**, which are not exclusively defined by facial expressions. *Deficit of expression through gestures* - A deficit in expression through gestures refers to a reduction in the use of **body language** and hand movements to communicate. - While related to overall non-verbal communication, it is distinct from the specific reduction in facial movements seen in hypomimia. *Difficulty in verbal communication* - Difficulty in verbal communication refers to problems with **speech production** (e.g., dysarthria) or **language comprehension/expression** (e.g., aphasia). - This is a separate domain of communication from facial expressiveness.

Q: What is the most serious neurological complication of herpes simplex virus infection?

Herpes simplex encephalitis. ***Herpes simplex encephalitis*** - This is a severe and often fatal neurological condition caused by HSV-1, leading to **inflammation** and **damage to brain tissue**. [1] - It presents with symptoms such as **fever**, **headache**, **altered mental status**, and **seizures**, requiring urgent antiviral treatment. [1] *Herpes keratitis* - This involves inflammation of the **cornea** due to HSV, leading to eye pain, redness, and vision changes. - While it can cause significant ocular morbidity, it is not considered the most serious neurological complication as it primarily affects the eye. *Genital herpes* - This is a sexually transmitted infection caused by HSV-2 (and sometimes HSV-1), characterized by **painful sores** and **blisters** on the genitals. [2] - Although it can have neurological symptoms like **neuralgia** or ascending myelitis, it is not the most serious direct neurological complication. *Temporal lobe involvement* - While the **temporal lobes** are frequently affected in herpes simplex encephalitis, this option describes a *symptom* or *location* of involvement rather than the overarching diagnosis of the most serious neurological complication itself. [1] - It highlights a characteristic feature of HSV encephalitis but doesn't encapsulate the full severity of the disease in the same way as the diagnostic term "herpes simplex encephalitis."

Q: What is the most common cause of embolic stroke?

Intra-cardiac thrombi. ***Intra-cardiac thrombi*** - **Atrial fibrillation** is the most common cardiac condition leading to the formation of thrombi within the heart, which can then embolize to the brain [1]. - Other cardiac sources include **valvular heart disease** (e.g., prosthetic valves, endocarditis) and myocardial infarction with mural thrombi [1]. *Particulate matter from IV drug injections* - While an important cause of **septic emboli**, which can lead to stroke, it is not the most common overall cause of embolic stroke. - This typically presents with different clinical features, often including **fever** and signs of infection. *Protein C deficiency* - This is a **hereditary thrombophilia** that increases the risk of **venous thrombosis** more significantly than arterial emboli leading to ischemic stroke [2]. - It leads to a procoagulant state, but its direct contribution to embolic stroke is less common than cardiac sources. *Antiphospholipid syndrome* - This is an **autoimmune disorder** that causes both arterial and venous thromboses, leading to recurrent strokes. - While a significant cause of stroke, especially in younger individuals, it is less common than cardiac sources like atrial fibrillation as an overall cause of embolic stroke.

Q: Maximum dose of rTPA in acute ischaemic stroke is

90 mg. ***90 mg*** - The standard dose of **recombinant tissue plasminogen activator (rTPA)**, also known as **alteplase**, for acute ischemic stroke is **0.9 mg/kg** with a maximum dose of 90 mg. - This dose is given as a 10% bolus over 1 minute, followed by the remaining 90% infused over 60 minutes. *60 mg* - A 60 mg dose would be suboptimal for most adult patients, as it falls significantly below the recommended 0.9 mg/kg standard dosing, potentially leading to **insufficient thrombolysis**. - While a maximum of 90 mg is set, a 60 mg dose is not typically the target dose unless the patient's weight is exceptionally low, which is not stated here. *100 mg* - A 100 mg dose **exceeds the maximum recommended dose** of 90 mg for rTPA in acute ischemic stroke, regardless of the patient's weight. - Administering a dose higher than 90 mg increases the risk of **intracranial hemorrhage** and other bleeding complications without providing additional therapeutic benefit. *120 mg* - A 120 mg dose is significantly **higher than the maximum recommended dose** for rTPA in acute ischemic stroke (90 mg). - Such an excessive dose would greatly increase the risk of serious adverse events, particularly **symptomatic intracranial hemorrhage**, and is not medically indicated.

Q: In which type of aphasia is comprehension intact?

Broca's aphasia. ***Broca's aphasia*** - Patients with **Broca's aphasia** typically have **intact comprehension** (though it might be mildly impaired for complex sentences). - The primary deficit is in **fluent speech production**, leading to telegraphic and effortful speech. *Wernicke's aphasia* - Characterized by **poor comprehension**, making it difficult for the patient to understand spoken or written language. - Speech is typically **fluent but meaningless**, often described as "word salad." *Global aphasia* - Involves severe impairment in **both comprehension and production** of language. - It results from widespread damage affecting both **Broca's and Wernicke's areas** and the connections between them. *Transcortical sensory aphasia* - Patients exhibit **poor auditory comprehension** despite being able to repeat words and phrases. - This condition affects the connection between **Wernicke's area** and other cortical areas, preserving repetition but impairing understanding.

Question 1

What is the condition characterized by difficulty in recognizing faces?

Accepted Answer

Inability to recognize familiar faces despite normal vision.

Answer

Inability to recognize objects due to visual impairment.

Answer

Difficulty in recognizing voices or sounds.

Answer

Difficulty in distinguishing between similar-looking objects.

Question 2

Which of the following clinical tests when positive suggests presence of sensory ataxia?

Accepted Answer

Romberg test

Answer

Adson test

Answer

Stinchfield test

Answer

Crossed SLR test

Question 3

Todd's paralysis is experienced following which type of seizure?

Accepted Answer

Focal seizures

Answer

Myoclonic seizures

Answer

Absence seizures

Answer

Generalized seizures

Question 4

Which of the following is not a feature of Wernicke's Korsakoff Syndrome?

Accepted Answer

Normal pupillary response

Answer

Ataxia

Answer

Psychosis

Answer

Ophthalmoplegia

Question 5

Huntington's disease is commonly seen in age group between

Accepted Answer

25 - 45 years

Answer

15 - 35 years

Answer

35 - 55 years

Answer

45 - 65 years

Question 6

What does hypomimia refer to?

Accepted Answer

Reduced facial expressiveness

Answer

Deficit of expression through gestures

Answer

Impaired motor function

Answer

Difficulty in verbal communication

Question 7

What is the most serious neurological complication of herpes simplex virus infection?

Accepted Answer

Herpes simplex encephalitis

Answer

Herpes keratitis

Answer

Genital herpes

Answer

Temporal lobe involvement

Question 8

What is the most common cause of embolic stroke?

Accepted Answer

Intra-cardiac thrombi

Answer

Particulate matter from IV drug injections

Answer

Protein C deficiency

Answer

Antiphospholipid syndrome

Question 9

Maximum dose of rTPA in acute ischaemic stroke is

Accepted Answer

90 mg

Answer

60 mg

Answer

100 mg

Answer

120 mg

Question 10

In which type of aphasia is comprehension intact?

Accepted Answer

Broca's aphasia

Answer

Wernicke's aphasia

Answer

Global aphasia

Answer

Transcortical sensory aphasia

Neurology — MCQs

Neurology — MCQs

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