Neurology Practice Questions

Q: Which of the following is not a contraindication for the use of rtPA in stroke management?

Presence of coma. ***Presence of coma*** - While a severe neurological deficit, **coma itself is not an absolute contraindication** for rtPA if the stroke is acute ischemic and within the treatment window, and other contraindications are absent. - The decision to administer rtPA in comatose patients is complex and based on careful assessment of neurological impairment due to **ischemia**, not just a state of reduced consciousness. *BP >185/110 mm Hg* - **Elevated blood pressure** above 185/110 mmHg is a **major contraindication** for rtPA because it significantly increases the risk of **intracranial hemorrhage**. - Blood pressure must be **controlled below this threshold** before rtPA can be safely administered. *Heparin in the past 24 hrs* - Recent use of **anticoagulants**, especially heparin, within 24 hours, indicates a higher **risk of bleeding** if rtPA is given. - This significantly raises the potential for **hemorrhagic transformation** of the ischemic stroke. *Lesion occupying >1/3 of middle cerebral artery territory* - A **large ischemic lesion** (e.g., >1/3 of MCA territory) on initial imaging is a **contraindication** due to increased risk of **hemorrhagic conversion** and **edema** after reperfusion [1]. - Giving rtPA to such large lesions is associated with poorer outcomes and higher mortality [1].

Q: Paraneoplastic cerebellar ataxia in Hodgkin's disease is associated with an autoantibody.

anti-Tr. ***anti-Tr*** - The **anti-Tr (DNER)** antibody is specifically associated with **paraneoplastic cerebellar degeneration** in the context of **Hodgkin's lymphoma** [1]. - It targets the **delta/notch-like epidermal growth factor-related receptor (DNER)**, which is expressed in cerebellar Purkinje cells [1]. *anti-Yo antibodies* - **Anti-Yo (PCA-1)** antibodies are strongly associated with **paraneoplastic cerebellar degeneration** but are typically found in **gynecological cancers** (ovarian, breast) and small-cell lung cancer, not Hodgkin's. - They target the **Purkinje cell cytoplasm** and cause widespread neuronal loss. *anti-PQ antibodies* - **Anti-PQ (P/Q-type voltage-gated calcium channel)** antibodies are primarily associated with the Lambert-Eaton Myasthenic Syndrome (LEMS), a paraneoplastic syndrome causing **muscle weakness** [2]. - While LEMS can be paraneoplastic, it does not typically manifest as **cerebellar ataxia** [2]. *voltage-gated calcium channel antibodies* - While generically referring to antibodies against **voltage-gated calcium channels**, this term is most commonly linked to **Lambert-Eaton Myasthenic Syndrome (LEMS)** [2]. - LEMS typically causes **proximal muscle weakness** and autonomic dysfunction, not cerebellar ataxia [2].

Q: In the context of seizure disorders, gustatory hallucinations are most commonly associated with which of the following?

Temporal lobe epilepsy. ***Temporal lobe epilepsy*** - Gustatory hallucinations, often described as **metallic or bitter tastes**, are a characteristic type of **sensory aura** in temporal lobe seizures - Seizures originating in the **temporal lobe**, particularly involving the **insula and opercular regions**, can affect areas involved in taste perception - These hallucinations are highly localizing signs suggesting **temporal lobe origin** of seizures - Note: In psychiatric contexts, gustatory hallucinations are more commonly associated with **schizophrenia and psychotic disorders** *Generalized tonic-clonic seizures* - These seizures involve **widespread bilateral electrical activity** in the brain - Typically present with loss of consciousness, body stiffening (tonic phase), and rhythmic jerking (clonic phase) - While an aura may precede them if they evolve from a focal seizure, **isolated gustatory hallucinations are not characteristic** of primary generalized seizures *Panic disorder* - Panic disorder involves sudden episodes of intense fear with physical symptoms like **palpitations, dyspnea, chest pain, and dizziness** - Does not primarily involve **sensory hallucinations** as a core diagnostic feature - Patients may report altered perceptions during panic attacks but not true gustatory hallucinations *Substance use disorder* - Certain substances can induce hallucinations, but these are more commonly **visual or auditory** - Hallucinogens may cause complex sensory distortions, but **gustatory hallucinations are not the predominant feature** - Withdrawal states typically produce visual hallucinations (e.g., alcohol withdrawal) rather than gustatory ones

Q: Most common cause of postural hypotension is

Peripheral neuropathy. ***Peripheral neuropathy*** - Damage to **autonomic nerve fibers** in peripheral neuropathy can impair the body's ability to regulate **blood pressure** in response to gravitational changes upon standing [1]. - This leads to a failure of **vasoconstriction** and an inadequate increase in **heart rate**, resulting in a significant drop in blood pressure. *Progressive cerebellar degeneration* - This condition primarily affects **coordination** and **balance**, often leading to **ataxia** and dysarthria. - While it can manifest with various neurological symptoms, **postural hypotension** is not its most common or direct consequence. *Adrenal insufficiency* - **Adrenal insufficiency** results in inadequate production of **cortisol** and **aldosterone**, leading to **hypotension** and **volume depletion**. - While it causes hypotension, it is not the most frequent cause of **postural hypotension** across the general population. *Striatonigral degeneration* - Also known as **multiple system atrophy** (MSA-P), this condition involves the degeneration of neurons in the **striatum** and **substantia nigra**. - It often leads to **parkinsonism** and **autonomic dysfunction**, including postural hypotension, but it is less common overall than peripheral neuropathy as a cause.

Q: Fluent aphasia with preserved comprehension and impaired repetition is characteristic of which type of aphasia?

Conduction Aphasia. ***Conduction Aphasia*** - Patients with **conduction aphasia** exhibit fluent speech and good comprehension but have a striking inability to **repeat** words or sentences. - This is often caused by damage to the **arcuate fasciculus**, which connects Wernicke's and Broca's areas. *Broca's Aphasia* - Characterized by **non-fluent** speech, **impaired repetition**, and relatively preserved comprehension. - Patients struggle to form words and sentences, often using **telegraphic speech**. *Wernicke's Aphasia* - Involves **fluent** but often meaningless speech, **poor comprehension**, and **impaired repetition**. - Patients may produce **neologisms** and have difficulty understanding spoken language. *Anomic Aphasia* - The primary deficit is **word-finding difficulty**, leading to frequent pauses and circumlocutions. - However, **fluency**, **comprehension**, and **repetition** are typically well-preserved.

Q: Parkinsonism is characterized by all of the following features except:

Dystonia. ***Dystonia*** - **Dystonia**, characterized by sustained or repetitive muscle contractions leading to twisting and repetitive movements or abnormal fixed postures, is not one of the cardinal signs of parkinsonism. - While it can occur in some Parkinson's disease patients, it is not a core diagnostic feature and often indicates more advanced disease or specific medication side effects. *Rigidity* - **Rigidity** (increased muscle tone, often described as cogwheel or lead-pipe rigidity) is one of the cardinal features of parkinsonism [1], [3]. - This symptom contributes to the difficulty in movement and posture changes experienced by patients [3]. *Bradykinesia* - **Bradykinesia**, or slowness of movement, is the most debilitating and universally present symptom of parkinsonism [1], [2]. - It manifests as difficulty initiating movements, decreased amplitude of movements, and overall slowness in performing daily tasks. *Tremors at rest* - **Tremors at rest** (typically a 4-6 Hz "pill-rolling" tremor that subsides with intentional movement) is a classic symptom of Parkinson's disease, a common cause of parkinsonism [1], [3]. - This tremor is often more prominent in one limb or side of the body and is characteristic of the condition.

Q: What is the primary symptom associated with a lesion in Wernicke's area?

Fluent speech with poor comprehension. ***Fluent speech with poor comprehension*** - A lesion in **Wernicke's area** results in **Wernicke's aphasia**, where the individual can produce speech fluently but the content is often meaningless or nonsensical (word salad). [1] - The primary characteristic is a profound **difficulty in understanding** spoken and written language, despite intact hearing and vision. *Inability to understand language* - While an inability to understand language is a key component of Wernicke's aphasia, the description "fluent speech with poor comprehension" more comprehensively captures the clinical presentation by including the intact though often chaotic speech production. - This option alone does not fully encompass the unique **dissociation between fluency and comprehension** seen in Wernicke's aphasia. *Inability to repeat phrases* - The **inability to repeat phrases** is typically associated with **conduction aphasia**, which results from damage to the **arcuate fasciculus**, the connection between Wernicke's and Broca's areas. [1] - While repetition can be impaired in Wernicke's aphasia due to poor comprehension, it is not the primary defining symptom differentiating it from other aphasias. *Difficulty in forming sentences* - **Difficulty in forming sentences** and producing meaningful speech, often characterized by **non-fluent, effortful speech** and agrammatism, is a hallmark of **Broca's aphasia**. [1] - Broca's area is responsible for **speech production** and grammatical structure, not language comprehension.

Q: Which of the following conditions is least likely to be associated with normal pressure spontaneous cerebrospinal fluid (CSF) leaks?

Pseudo tumor Cerebri. ***Pseudotumor Cerebri*** - Also known as **idiopathic intracranial hypertension**, it is characterized by symptoms of **increased intracranial pressure** but with **normal CSF composition** and **no identifiable intracranial mass** [1]. - CSF leaks, especially spontaneous ones with normal pressure, typically result from **low intracranial pressure (intracranial hypotension)**, which is the opposite of pseudotumor cerebri . *Empty Sella Syndrome* - This condition involves the **sella turcica** (the bony structure housing the pituitary gland) being partially or completely filled with CSF, often due to a **defect in the sellar diaphragm**. - It arises from **idiopathic intracranial hypertension** which is also referred to as **pseudotumor cerebri**, but in some cases, it can be associated with **spontaneous CSF leaks** as the brain sags and pulls on the dura. *Encephalocele* - An **encephalocele** is a rare birth defect where there's a **protrusion of the brain and its meninges** through a defect in the skull. - This can be a source of **spontaneous CSF leaks** if the dura mater or skin covering the encephalocele is compromised. *Meningocele* - A **meningocele** is a type of **spina bifida** where the **meninges protrude through a defect in the vertebral column** forming a sac filled with CSF. - Like encephaloceles, these defects in continuous meningeal coverings can be a source of **spontaneous CSF leaks**.

Q: In a cerebellar lesion, which symptom is typically not observed?

Resting tremors. ***Resting tremors*** - **Resting tremors** are characteristic of **basal ganglia dysfunction**, typically seen in conditions like Parkinson's disease [2]. - Cerebellar lesions are more associated with **intention tremors**, which occur during voluntary movement, rather than at rest. *Dysmetria* - **Dysmetria** is the inability to accurately control the range, force, and direction of movement, leading to **over- or under-shooting targets**. - It is a classic sign of **cerebellar damage**, indicating impaired coordination and proprioception. *Dysdiadochokinesia* - **Dysdiadochokinesia** refers to the impaired ability to perform **rapid alternating movements**, such as pronation and supination [1]. - This symptom directly reflects cerebellar dysfunction in coordinating muscle actions [1]. *Ataxia* - **Ataxia** is a broad term for **lack of muscle coordination** during voluntary movements, leading to an unsteady gait and impaired balance [3], [4]. - It is a hallmark symptom of **cerebellar lesions**, affecting motor control and equilibrium [3].

Question 1

Which test is most useful in diagnosing a clinically occult lesion in multiple sclerosis?

Accepted Answer

MRI for detecting white matter lesions in multiple sclerosis

Answer

Evoked potentials for diagnosing clinically occult lesions in multiple sclerosis

Answer

CT scan for large hemispheral strokes

Answer

Evoked potentials for brainstem involvement in stroke

Question 2

Which of the following is not a contraindication for the use of rtPA in stroke management?

Accepted Answer

Presence of coma

Answer

BP >185/110 mm Hg

Answer

Heparin in the past 24 hrs

Answer

Lesion occupying >1/3 of middle cerebral artery territory

Question 3

Paraneoplastic cerebellar ataxia in Hodgkin's disease is associated with an autoantibody.

Accepted Answer

anti-Tr

Answer

anti-Yo antibodies

Answer

anti-PQ antibodies

Answer

voltage-gated calcium channel antibodies

Question 4

In the context of seizure disorders, gustatory hallucinations are most commonly associated with which of the following?

Accepted Answer

Temporal lobe epilepsy

Answer

Generalized tonic-clonic seizures

Answer

Panic disorder

Answer

Substance use disorder

Question 5

Most common cause of postural hypotension is

Accepted Answer

Peripheral neuropathy

Answer

Progressive cerebellar degeneration

Answer

Adrenal insufficiency

Answer

Striatonigral degeneration

Question 6

Fluent aphasia with preserved comprehension and impaired repetition is characteristic of which type of aphasia?

Accepted Answer

Conduction Aphasia

Answer

Broca's Aphasia

Answer

Wernicke's Aphasia

Answer

Anomic Aphasia

Question 7

Parkinsonism is characterized by all of the following features except:

Accepted Answer

Dystonia

Answer

Rigidity

Answer

Bradykinesia

Answer

Tremors at rest

Question 8

What is the primary symptom associated with a lesion in Wernicke's area?

Accepted Answer

Fluent speech with poor comprehension

Answer

Inability to understand language

Answer

Inability to repeat phrases

Answer

Difficulty in forming sentences

Question 9

Which of the following conditions is least likely to be associated with normal pressure spontaneous cerebrospinal fluid (CSF) leaks?

Accepted Answer

Pseudo tumor Cerebri

Answer

Empty Sella Syndrome

Answer

Encephalocele

Answer

Meningiocele

Question 10

In a cerebellar lesion, which symptom is typically not observed?

Accepted Answer

Resting tremors

Answer

Dysmetria

Answer

Dysdiadochokinesia

Answer

Ataxia

Neurology — MCQs

Neurology — MCQs

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