Neurology Practice Questions

Q: Which of the following statements about decorticate posturing is false?

More dangerous than decerebrate lesion. ***More dangerous than decerebrate lesion*** - This statement is **false**. Decorticate posturing indicates damage **above the red nucleus**, which is a less severe brain injury compared to decerebrate posturing [1]. - **Decerebrate posturing** implies more caudal brainstem damage (below the red nucleus), often involving the pons or midbrain, indicating a more severe prognosis [1]. *Acute brain injuries* - **Decorticate posturing** is a common sign of **acute brain injuries**, especially those affecting the cerebral hemispheres or internal capsule [1]. - It arises from damage to pathways carrying motor information, leading to characteristic muscle responses [1]. *Subthalamic, corticothalamic, and frontal lobe lesions* - Lesions in these areas, particularly **above the red nucleus** and involving the **corticospinal tracts**, can lead to decorticate posturing [1]. - This type of posturing occurs due to the **disinhibition of the rubrospinal tract (which mediates upper limb flexion)** and the intact vestibulospinal and reticulospinal tracts (which mediate lower limb extension) [1]. *Flexion of arm & extension of lower limb* - Decorticate posturing is characterized by **flexion of the elbows and wrists** (arms adducted and internally rotated) and **extension, internal rotation, and plantar flexion of the legs** [1]. - This specific posture is often described as "mummy baby" or "bringing hands to the core."

Q: The most common cause of pontine hemorrhage is

Hypertension. Hypertension - **Chronic hypertension** leads to the weakening and rupture of small perforating arteries in the pons, making it the most common cause of **pontine hemorrhage** [1]. - The elevated pressure damages the **endothelium** and smooth muscle layers of these vessels, predisposing them to bleeding. *Diabetes* - While diabetes can cause microvascular complications, it is not considered the most common cause of **pontine hemorrhage**. - Its primary cerebral vascular complications include increased risk of **ischemic stroke** rather than hemorrhagic stroke in the pons. *Trauma* - **Traumatic brain injury** can cause various types of intracranial hemorrhage, but isolated **pontine hemorrhage** directly due to trauma is less common than that due to hypertension [1]. - Trauma typically results in contusions, subdural, or epidural hematomas, often in superficial brain regions. *Aneurysmal rupture* - **Aneurysmal rupture** is a common cause of subarachnoid hemorrhage, particularly from the Circle of Willis, but pontine hemorrhages are rarely caused by aneurysms within the pons itself [1]. - The vessels supplying the pons are typically small and perforating, not commonly forming dissecting or saccular aneurysms.

Q: Migraine is due to

Cortical spreading depression. ***Cortical spreading depression*** - The current understanding is that **cortical spreading depression (CSD)** is the initiating event in migraine with aura, characterized by a wave of neuronal and glial depolarization that spreads across the cerebral cortex, leading to a temporary shutdown of neuronal activity [1]. - CSD is thought to activate the **trigeminal nerve**, subsequently causing the release of inflammatory neuropeptides and contributing to the pain phase [1]. *Dilatation of cranial blood vessels* - While **vasodilation of intracranial and extracranial blood vessels** does occur during the headache phase of migraine, it is now considered a *consequence* of the initial neurological events rather than the primary cause [1]. - This vasodilation contributes to the throbbing sensation of migraine pain but does not explain the aura or the initiation of the attack. *Constriction of cranial blood vessels* - **Vasoconstriction** was previously thought to be the cause of the migraine aura, but this theory has largely been disproven. - While some temporary constriction may precede CSD, it is not the primary mechanism behind the migraine attack. *Inflammation of the meninges* - While **neurogenic inflammation** of the meninges, involving the release of inflammatory mediators like **calcitonin gene-related peptide (CGRP)**, does play a role in sensitizing the trigeminal system and contributing to migraine pain, it is a downstream effect. - It is not the initial trigger for a migraine attack but rather part of the pain pathway activated by events like CSD.

Q: Which of the following is not associated with subcortical dementia?

Alzheimer's disease. ***Alzheimer's disease*** - Alzheimer's disease is primarily a **cortical dementia**, characterized by global cognitive decline, specifically affecting memory, language, and executive functions. - It involves the accumulation of **amyloid plaques** and **neurofibrillary tangles** predominantly in the cerebral cortex. *Parkinsonism* - Parkinsonism, particularly Parkinson's disease dementia, is a common cause of **subcortical dementia**. - It presents with prominent **motor symptoms** (bradykinesia, rigidity, tremor) along with cognitive impairment affecting executive function and attention. *Wilson's disease* - Wilson's disease is a genetic disorder leading to **copper accumulation**, which can cause significant damage to the basal ganglia and other subcortical structures. - This often results in a **subcortical dementia** characterized by motor symptoms, psychiatric disturbances, and cognitive decline. *Huntington's chorea* - Huntington's chorea is a neurodegenerative genetic disorder primarily affecting the **basal ganglia**, a key subcortical structure. - It is a classic example of **subcortical dementia**, presenting with characteristic choreiform movements, psychiatric disturbances, and cognitive impairment.

Q: In an EMG/NCV study, which radiculopathy is most closely associated with the H. reflex?

S1 radiculopathy. ***S1 radiculopathy*** - The **H-reflex (Hoffmann reflex)** primarily assesses the integrity of the **S1 nerve root** and the **tibial nerve** pathway. - A diminished or absent H-reflex is a sensitive indicator of **S1 radiculopathy**, often correlating with **Achilles reflex loss** [1]. *L3 radiculopathy* - **L3 radiculopathy** typically affects the **quadriceps muscle** and the **patellar reflex** [1]. - The H-reflex is not a primary diagnostic tool for isolated L3 nerve root involvement. *L4 radiculopathy* - **L4 radiculopathy** usually presents with weakness in **tibialis anterior** and altered sensation over the medial leg/foot [1]. - While it can sometimes impact the patellar reflex, the H-reflex is not the most direct or specific measure for L4 involvement. *L5 radiculopathy* - **L5 radiculopathy** often leads to weakness in **foot dorsiflexion** and **toe extension**, with sensory loss over the dorsum of the foot [1]. - It does not directly involve the reflex arc assessed by the H-reflex.

Q: An adult hypertensive male presented with sudden onset severe headache and vomiting. On examination, there is marked neck rigidity and no focal neurological deficit was found. The symptoms are most likely due to:

Subarachnoid hemorrhage. ***Subarachnoid hemorrhage*** - The sudden onset of a **"thunderclap" headache**, vomiting, and **neck rigidity** in a hypertensive patient are classic signs of subarachnoid hemorrhage [1]. - The absence of focal neurological deficits is common, as the bleeding is often in the subarachnoid space rather than directly in brain tissue. *Intracerebral hemorrhage* - While it can cause sudden headache and vomiting, an **intracerebral hemorrhage** would typically present with **focal neurological deficits** corresponding to the affected brain region. - Neck rigidity is less common unless there's significant mass effect or ventricular involvement. *Cerebral ischemia* - **Cerebral ischemia** (e.g., ischemic stroke) usually manifests with **focal neurological deficits** (e.g., weakness, aphasia), often without a severe headache or neck rigidity [2]. - Headache, if present, is usually less severe and not described as "thunderclap." *Bacterial meningitis* - **Bacterial meningitis** presents with headache, fever, and neck rigidity [1], but the onset is typically **gradual** over hours to days, not sudden. - While vomiting can occur, the acute, thunderclap nature linked to hypertension points away from infection as the primary cause.

Q: Which of the following is a characteristic feature of myasthenia gravis?

Presence of antibodies against acetylcholine receptors. ***Presence of antibodies against acetylcholine receptors*** - **Myasthenia gravis** is an **autoimmune disorder** characterized by the production of **antibodies against acetylcholine receptors** at the neuromuscular junction [1]. - These antibodies block, alter, or destroy the acetylcholine receptors, leading to impaired nerve-to-muscle communication and **muscle weakness** [2]. *Decreased levels of myosin in muscle fibers* - Myosin is a **motor protein** crucial for muscle contraction, and its decreased levels are not a primary feature of myasthenia gravis, but rather other **myopathies** or muscle wasting conditions. - The disease mechanism in myasthenia gravis is primarily at the **neuromuscular junction**, not within the muscle fibers themselves. *Absence of troponin C in muscle fibers* - **Troponin C** is a component of the troponin complex essential for **calcium-mediated muscle contraction**, found inside muscle fibers. - Its absence would lead to severe and widespread muscle dysfunction, unlike the specific and fluctuating weakness seen in **myasthenia gravis**. *Increased transmission at the myoneural junction* - Myasthenia gravis is characterized by **decreased** or **impaired transmission** at the myoneural (neuromuscular) junction due to the destruction or blockade of acetylcholine receptors [2]. - Increased transmission would lead to **muscle hyperactivity** or spasms, which is contrary to the **fatigable weakness** observed in myasthenia gravis.

Q: The most characteristic EEG finding in complex partial (psychomotor) seizures is:

Spikes over the temporal lobes. ***Spikes over the temporal lobes*** - **Complex partial seizures**, also known as **psychomotor seizures** or **temporal lobe seizures**, originate most commonly in the **temporal lobe**. - The characteristic EEG finding in these seizures is the presence of **sharp waves** or **spikes** specifically in the **temporal regions**, which can be unilateral or bilateral. *Diffuse Slowing* - **Diffuse slowing** on an EEG typically indicates **generalized brain dysfunction** or encephalopathy, which can be due to various causes like metabolic disturbances, drug effects, or widespread structural damage. - It is not a specific finding for focal seizures like complex partial seizures. *Generalized Spike and wave pattern* - A **generalized 3-Hz spike-and-wave pattern** is the hallmark EEG finding for **absence seizures** (a type of generalized seizure), not complex partial seizures. - This pattern is seen bilaterally and synchronously, reflecting a widespread cortical and thalamic network involvement. *Multifocal spikes* - **Multifocal spikes** indicate seizure activity originating from **multiple independent foci** in different brain regions. - While it points to epilepsy, it is not the most characteristic finding for a typical complex partial seizure, which usually arises from a single focus, most commonly in the temporal lobe.

Q: Which of the following drugs is approved for treatment of both relapsing-remitting AND primary progressive multiple sclerosis?

Ocrelizumab. ***Ocrelizumab*** - This **anti-CD20 monoclonal antibody** is uniquely approved for both **relapsing-remitting MS (RRMS)** and **primary progressive MS (PPMS)**. - It targets **CD20-expressing B cells**, providing comprehensive disease modification across different MS phenotypes. *Fingolimod* - This **sphingosine 1-phosphate receptor modulator** is approved only for **relapsing-remitting MS**, not primary progressive MS. - While effective for RRMS, it lacks the **dual indication** that makes Ocrelizumab the most comprehensive treatment option. *Omalizumab* - This **anti-IgE monoclonal antibody** is used for **severe allergic asthma** and **chronic idiopathic urticaria**. - It has **no role in multiple sclerosis treatment** and works through IgE-mediated allergic pathways unrelated to MS pathophysiology. *Natalizumab* - This **integrin receptor antagonist** is used for MS but is typically reserved as **second-line therapy** due to **PML risk**. - Unlike Ocrelizumab, it is **not approved for primary progressive MS** and requires careful monitoring for serious complications.

Q: Which of the following speech patterns is most indicative of Wernicke's aphasia?

Fluent but nonsensical speech. ***Fluent but nonsensical speech*** - Wernicke's aphasia is characterized by **fluent**, often grammatically correct, speech that is **devoid of meaning** and often includes **paraphasias** (word substitutions) and **neologisms** (made-up words). - Patients have significant **comprehension deficits**, making meaningful conversation difficult despite preserved speech fluency. - This is also known as **receptive aphasia** or **sensory aphasia**, caused by damage to Wernicke's area in the superior temporal gyrus. *Normal speech with comprehension* - This describes **healthy speech patterns**, where both production and understanding of language are intact. - It directly contradicts the definition of **aphasia**, which involves impairment in language abilities. *Non-fluent speech with intact comprehension* - This describes **Broca's aphasia** (expressive aphasia), where speech production is effortful and halting. - Unlike Wernicke's aphasia, patients with Broca's aphasia have **preserved comprehension** but struggle with speech output. - The key differentiator is that Wernicke's has **fluent speech with poor comprehension**, while Broca's has **non-fluent speech with good comprehension**. *Speech with meaningful content* - This indicates that the speaker can convey understandable and relevant information, which is precisely what is lacking in **Wernicke's aphasia**. - In Wernicke's aphasia, the content is typically **empty** or **circumlocutory**, making it difficult to extract any coherent meaning.

Question 1

Which of the following statements about decorticate posturing is false?

Accepted Answer

More dangerous than decerebrate lesion

Answer

Flexion of arm & extension of lower limb

Answer

Acute brain injuries

Answer

Subthalamic, corticothalamic, and frontal lobe lesions

Question 2

The most common cause of pontine hemorrhage is

Accepted Answer

Hypertension

Answer

Diabetes

Answer

Trauma

Answer

Aneurysmal rupture

Question 3

Migraine is due to

Accepted Answer

Cortical spreading depression

Answer

Dilatation of cranial blood vessels

Answer

Constriction of cranial blood vessels

Answer

Inflammation of the meninges

Question 4

Which of the following is not associated with subcortical dementia?

Accepted Answer

Alzheimer's disease

Answer

Wilson's disease

Answer

Huntington's chorea

Answer

Parkinsonism

Question 5

In an EMG/NCV study, which radiculopathy is most closely associated with the H. reflex?

Accepted Answer

S1 radiculopathy

Answer

L3 radiculopathy

Answer

L4 radiculopathy

Answer

L5 radiculopathy

Question 6

An adult hypertensive male presented with sudden onset severe headache and vomiting. On examination, there is marked neck rigidity and no focal neurological deficit was found. The symptoms are most likely due to:

Accepted Answer

Subarachnoid hemorrhage

Answer

Intracerebral hemorrhage

Answer

Cerebral ischemia

Answer

Bacterial meningitis

Question 7

Which of the following is a characteristic feature of myasthenia gravis?

Accepted Answer

Presence of antibodies against acetylcholine receptors

Answer

Decreased levels of myosin in muscle fibers

Answer

Absence of troponin C in muscle fibers

Answer

Increased transmission at the myoneural junction

Question 8

The most characteristic EEG finding in complex partial (psychomotor) seizures is:

Accepted Answer

Spikes over the temporal lobes

Answer

Diffuse Slowing

Answer

Generalized Spike and wave pattern

Answer

Multifocal spikes

Question 9

Which of the following drugs is approved for treatment of both relapsing-remitting AND primary progressive multiple sclerosis?

Accepted Answer

Ocrelizumab

Answer

Fingolimod

Answer

Omalizumab

Answer

Natalizumab

Question 10

Which of the following speech patterns is most indicative of Wernicke's aphasia?

Accepted Answer

Fluent but nonsensical speech

Answer

Normal speech with comprehension

Answer

Non-fluent speech with intact comprehension

Answer

Speech with meaningful content

Neurology — MCQs

Neurology — MCQs

On this page

Practice by Chapter

Want unlimited practice?