Neurology Practice Questions

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.

Q: Which of the following is a known risk factor for Alzheimer's disease?

Down’s syndrome. ***Down’s syndrome*** - Individuals with **Down’s syndrome** have an extra copy of chromosome 21, which carries the **amyloid precursor protein (APP)** gene. - Overexpression of APP leads to increased production of **beta-amyloid plaques**, a hallmark pathology of Alzheimer's disease, causing nearly all individuals with Down's syndrome to develop AD pathology by middle age [1]. *Klinefelter syndrome* - **Klinefelter syndrome** involves an extra X chromosome (47, XXY) and is associated with conditions like infertility and learning difficulties. - It is not a known direct risk factor for **Alzheimer's disease**. *Hypothyroidism* - **Hypothyroidism** can cause cognitive impairment and memory problems, which are often reversible with thyroid hormone replacement. - While it can mimic some symptoms of dementia, it is not a direct risk factor for the development of **Alzheimer's disease** itself. *Rheumatoid arthritis* - **Rheumatoid arthritis** is a chronic autoimmune inflammatory disease primarily affecting the joints. - While chronic inflammation is a general risk factor for various health issues, rheumatoid arthritis is not specifically identified as a direct or significant risk factor for **Alzheimer's disease**.

Q: A female patient presents to you with a unilateral headache. It is associated with nausea, photophobia, and phonophobia. What is the drug of choice for acute management?

Sumatriptan. ***Sumatriptan*** - **Sumatriptan**, a **triptan**, is an effective abortive therapy for **acute migraine attacks** due to its selective serotonin 5-HT1B/1D receptor agonist action, leading to vasoconstriction and inhibition of neurogenic inflammation. - The symptoms described—**unilateral headache**, nausea, **photophobia**, and **phonophobia**—are classic features of migraine. *Flunarizine* - **Flunarizine** is a **calcium channel blocker** used for migraine **prophylaxis**, not for acute treatment. - It is typically prescribed for patients experiencing frequent or severe migraine attacks to reduce their incidence. *Propranolol* - **Propranolol** is a **beta-blocker** primarily used for migraine **prophylaxis**. - It helps prevent migraine attacks by modulating cerebral blood flow and neuronal excitability, but it is not effective for acute pain relief during an attack. *Topiramate* - **Topiramate** is an **antiepileptic drug** often used for migraine **prophylaxis**. - It works by various mechanisms, including altering neurotransmitter activity, but it does not provide acute symptomatic relief for an ongoing migraine attack.

Q: Thrombosis of posterior inferior cerebellar artery causes:

Lateral Medullary Syndrome (Wallenberg's syndrome). ***Lateral Medullary Syndrome (Wallenberg's syndrome)*** - Thrombosis of the **posterior inferior cerebellar artery (PICA)** is the most common cause of **Lateral Medullary Syndrome**, also known as Wallenberg's syndrome. - This syndrome is characterized by a constellation of symptoms including **dysphagia**, **hoarseness** [2], **ataxia**, **vertigo**, **Horner's syndrome** [3], and ipsilateral facial/contralateral body **sensory loss**. *Weber's syndrome* - Weber's syndrome results from an **occlusion of paramedian branches of the posterior cerebral artery**, affecting the **midbrain**. - It is characterized by **ipsilateral oculomotor nerve palsy** and **contralateral hemiplegia** or hemiparesis [1]. *No effect* - Thrombosis of an artery, especially one supplying a critical brain region like the **brainstem**, will always have a significant effect due to **ischemia** and subsequent damage to neural structures. - The PICA supplies crucial areas of the **lateral medulla** and **inferior cerebellum**, making a "no effect" outcome highly improbable. *Medial Medullary Syndrome* - Medial Medullary Syndrome typically results from an **occlusion of the vertebral artery** or its **medial medullary branches**. - Symptoms include **contralateral hemiparesis** (affecting the arm and leg), **ipsilateral tongue deviation**, and **contralateral loss of proprioception and vibratory sense**.

Q: Which of the following statements about Weber’s syndrome is incorrect?

Weber's syndrome involves the anterior cerebral artery.. ***Weber's syndrome involves the anterior cerebral artery.*** - **Weber's syndrome** is caused by a lesion in the **midbrain**, typically affecting the paramedian branches of the **posterior cerebral artery** that supply this region, not the anterior cerebral artery. - The **anterior cerebral artery** supplies parts of the frontal and parietal lobes and the corpus callosum, and its occlusion would lead to different neurological deficits, such as contralateral leg weakness. *Ipsilateral Oculomotor nerve palsy is a feature of Weber's syndrome.* - This statement is **correct**. **Weber's syndrome** specifically involves damage to the **oculomotor nerve fascicles** as they traverse the midbrain. - Damage to the oculomotor nerve causes **ipsilateral oculomotor nerve palsy**, characterized by a dilated pupil and ophthalmoplegia [2]. *Contralateral Parkinsonism is a feature of Weber's syndrome.* - This statement is **incorrect** as **Parkinsonism** is not a feature of **Weber's syndrome**. - **Weber's syndrome** typically involves the **cerebral peduncle**, leading to **contralateral hemiplegia**, not Parkinsonism. *Contralateral hemiplegia is a feature of Weber's syndrome.* - This statement is **correct**. The lesion in **Weber's syndrome** typically affects the **corticospinal tracts** within the **cerebral peduncle** at the level of the midbrain. - Damage to these descending motor pathways results in **contralateral hemiplegia** or hemiparesis, affecting the limbs on the opposite side of the body from the lesion [1].

Q: What is the earliest feature of 3rd cranial nerve involvement in a patient with diabetes mellitus?

Ptosis or diplopia. **Ptosis or diplopia** - In diabetic neuropathy affecting the **oculomotor nerve (CN III)**, the **parasympathetic fibers** responsible for pupillary constriction are typically spared initially [3]. - **Ischemic damage** primarily affects the somatic motor fibers, leading to weakness of the extraocular muscles supplied by CN III, resulting in **ptosis** (due to levator palpebrae superioris weakness) and **diplopia** (due to misalignment of the eyes) [1]. *Normal light reflex* - A normal light reflex indicates that the **parasympathetic fibers** (which control pupillary constriction) are intact, which is often the case in early diabetic CN III palsies [2]. - While the light reflex remains normal, other CN III palsy symptoms like ptosis and diplopia will already be evident [1]. *Abnormal light reflex* - An abnormal light reflex (dilated pupil) suggests involvement of the **parasympathetic fibers**, which is less common in the *earliest stages* of diabetic CN III neuropathy [2]. - When an abnormal light reflex is present, it often points to a **compressive lesion** rather than an ischemic one, making it a later or atypical feature in diabetes [2]. *Eye pain* - **Pain** can accompany CN III palsies, especially in diabetic neuropathy, due to involvement of nearby sensory fibers. - However, pain is a **subjective symptom** and not the *earliest physical sign* that objectively indicates the specific dysfunction of the CN III motor pathway.

Q: What is Prosopagnosia?

Difficulty in identifying known faces. ***Difficulty in identifying known faces*** - **Prosopagnosia**, also known as **face blindness**, is a neurological disorder characterized by an inability to recognize familiar faces. - Individuals with prosopagnosia may have trouble recognizing even close family members or their own reflection, despite having intact vision and general intellectual function. - This is a specific type of agnosia limited to face recognition. *Impairment of consciousness* - Impairment of consciousness refers to a reduced state of awareness or responsiveness, often seen in conditions like coma or delirium. - This is a broad neurological state and does not specifically describe the inability to recognize faces. *Being unaware of one's problems* - This symptom is known as **anosognosia**, which is a lack of insight into one's own neurological deficits or illness. - Anosognosia is a problem of self-awareness, not specifically face recognition. *Failure to identify objects* - The inability to identify objects is a form of **agnosia**, specifically **associative visual agnosia** if the person can see the object but not recognize it. - While prosopagnosia is a type of agnosia, it is highly specific to faces, whereas object agnosia refers to a broader failure in object recognition.

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

Thalamus. ***Thalamus*** - Damage to the **medial dorsal nucleus of the thalamus** is a key pathological finding in Wernicke's Korsakoff syndrome, directly contributing to the severe **anterograde and retrograde amnesia** [1]. - The thalamus plays a crucial role in memory consolidation and retrieval, acting as a relay station for information processing between cortical and subcortical structures. *Mammillary body* - While **mammillary body damage** is characteristic of Wernicke-Korsakoff syndrome, it is primarily associated with the **acute Wernicke encephalopathy phase** and contributes to the overall amnesia through its connections with the thalamus and hippocampus, rather than being the sole site for the amnestic defect [1]. - The mammillary bodies are part of the **Papez circuit**, which is important for episodic memory, but their lesion alone doesn't fully explain the complete amnestic syndrome. *Hippocampus* - The **hippocampus** is critical for the formation of new memories, and its damage typically causes **anterograde amnesia**, as seen in conditions like temporal lobe epilepsy or anoxia. - While memory is affected, direct **hippocampal lesions are not the primary pathology** in Wernicke-Korsakoff syndrome; the memory impairment arises from damage to structures *connected* to the hippocampus, such as the thalamus and mammillary bodies. *Periventricular Grey matter* - The **periventricular grey matter** is involved in various autonomic functions and pain modulation, not directly in memory formation or retrieval. - While lesions in this area can occur in Wernicke-Korsakoff syndrome, they are not considered the primary cause of the **amnestic defect**.

Q: Which of the following is the most common initial presenting feature of multiple sclerosis:

Optic Neuritis. ***Optic Neuritis*** - **Optic neuritis** is a very common initial symptom of multiple sclerosis, occurring in 20-25% of patients. - It presents with **unilateral vision loss** (often painful), blurred vision, and a central scotoma, reflecting inflammation and demyelination of the optic nerve [1]. *Cerebellar Ataxia* - While **cerebellar ataxia** (impaired coordination, balance, speech) can occur in MS, it is less common as an initial presenting symptom. - It often develops later in the disease course due to demyelination in the **cerebellum** or its connections [1]. *Internuclear ophthalmoplegia* - **Internuclear ophthalmoplegia (INO)** is a specific eye movement disorder common in MS but rarely the very first symptom [1]. - It results from a lesion in the **medial longitudinal fasciculus (MLF)**, causing impaired adduction of one eye during conjugate gaze with nystagmus in the abducting eye. *Diplopia* - **Diplopia** (double vision) can be an early symptom of MS, but it is less frequent as the very first presentation compared to optic neuritis [1]. - It typically arises from lesions affecting the **cranial nerves** controlling eye movements (III, IV, VI) or their brainstem nuclei.

Question 1

In which type of aphasia is comprehension intact?

Accepted Answer

Broca's aphasia

Answer

Wernicke's aphasia

Answer

Global aphasia

Answer

Transcortical sensory aphasia

Question 2

What is the cause of loss of pain and temperature sensation on the ipsilateral face and contralateral body due to thrombosis?

Accepted Answer

Thrombosis of the posterior inferior cerebellar artery (PICA)

Answer

Thrombosis of the superior cerebellar artery

Answer

Thrombosis of the anterior inferior cerebellar artery (AICA)

Answer

Thrombosis of the posterior cerebral artery

Question 3

Which of the following is a known risk factor for Alzheimer's disease?

Accepted Answer

Down’s syndrome

Answer

Klinefelter syndrome

Answer

Rheumatoid arthritis

Answer

Hypothyroidism

Question 4

A female patient presents to you with a unilateral headache. It is associated with nausea, photophobia, and phonophobia. What is the drug of choice for acute management?

Accepted Answer

Sumatriptan

Answer

Flunarizine

Answer

Propranolol

Answer

Topiramate

Question 5

Thrombosis of posterior inferior cerebellar artery causes:

Accepted Answer

Lateral Medullary Syndrome (Wallenberg's syndrome)

Answer

Weber's syndrome

Answer

No effect

Answer

Medial Medullary Syndrome

Question 6

Which of the following statements about Weber’s syndrome is incorrect?

Accepted Answer

Weber's syndrome involves the anterior cerebral artery.

Answer

Ipsilateral Oculomotor nerve palsy is a feature of Weber's syndrome.

Answer

Contralateral Parkinsonism is a feature of Weber's syndrome.

Answer

Contralateral hemiplegia is a feature of Weber's syndrome.

Question 7

What is the earliest feature of 3rd cranial nerve involvement in a patient with diabetes mellitus?

Accepted Answer

Ptosis or diplopia

Answer

Abnormal light reflex

Answer

Normal light reflex

Answer

Eye pain

Question 8

What is Prosopagnosia?

Accepted Answer

Difficulty in identifying known faces

Answer

Impairment of consciousness

Answer

Being unaware of one's problems

Answer

Failure to identify objects

Question 9

Which of the following sites is responsible for the amnestic defect in Wernicke's Korsakoff syndrome:

Accepted Answer

Thalamus

Answer

Hippocampus

Answer

Mammillary body

Answer

Periventricular Grey matter

Question 10

Which of the following is the most common initial presenting feature of multiple sclerosis:

Accepted Answer

Optic Neuritis

Answer

Cerebellar Ataxia

Answer

Internuclear ophthalmoplegia

Answer

Diplopia

Neurology — MCQs

Neurology — MCQs

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