Neurology Practice Questions

Q: A pinpoint pupil is a clinical sign that can indicate which of the following conditions?

Pontine hemorrhage. **Explanation:** **1. Why Pontine Hemorrhage is Correct:** Pinpoint pupils (miosis) are a classic hallmark of **pontine lesions**, specifically pontine hemorrhage. This occurs because the descending sympathetic fibers (which mediate pupillary dilation) pass through the pons. A lesion here disrupts these sympathetic pathways while leaving the parasympathetic supply (via the Oculomotor nerve) intact or unopposed. This results in extreme pupillary constriction. These are often referred to as "bilateral pinpoint pupils" and are typically associated with coma, quadriplegia, and hyperpyrexia. **2. Why the Other Options are Incorrect:** * **Barbiturate Poisoning:** While many sedative-hypnotics cause miosis, barbiturates typically cause mid-range or dilated pupils in severe toxicity due to hypoxia. **Opioid overdose** is the classic toxicological cause of pinpoint pupils, not barbiturates. * **Glaucoma:** Acute angle-closure glaucoma typically presents with a **mid-dilated, vertically oval, and fixed pupil**, accompanied by severe pain and a "stony hard" eyeball. * **Congenital Cataract:** This presents as a **leukocoria** (white pupillary reflex) rather than a change in pupil size. **3. NEET-PG High-Yield Clinical Pearls:** * **Mnemonic for Pinpoint Pupils:** "P's" – **P**ons, **P**hosphates (Organophosphates), **P**ilocarpine, and **P**oppies (Opioids). * **Horner’s Syndrome:** Also causes miosis, but it is unilateral and associated with ptosis and anhidrosis [1]. * **Argyll Robertson Pupil:** Small, irregular pupils that accommodate but do not react to light ("Prostitute’s Pupil"), seen in neurosyphilis. * **Midbrain Lesions:** Usually result in mid-position, fixed pupils.

Q: A 20-year-old man complains of increasing difficulty in hearing over the past several years. Physical examination confirms bilateral sensorineural hearing deficits. MRI discloses bilateral cerebellopontine angle tumors, consistent with schwannomas. This patient has a strong family history for benign tumors, including low-grade gliomas and meningiomas on his mother's side of the family. Which of the following is the probable diagnosis?

Neurofibromatosis type 2. ### Explanation **Correct Answer: B. Neurofibromatosis type 2 (NF2)** The hallmark of **Neurofibromatosis type 2** is the presence of **bilateral vestibular schwannomas** (acoustic neuromas), which typically present in the second or third decade of life with progressive sensorineural hearing loss, tinnitus, or imbalance. NF2 is an autosomal dominant condition caused by a mutation in the *merlin* gene on **chromosome 22**. The clinical triad of NF2 includes bilateral schwannomas, **meningiomas**, and **gliomas** (specifically ependymomas), all of which are mentioned in the patient’s clinical presentation and family history. [1] **Why other options are incorrect:** * **Neurofibromatosis type 1 (NF1):** Associated with the *neurofibromin* gene on **chromosome 17**. It presents with Cafe-au-lait spots, Lisch nodules, optic gliomas, and peripheral neurofibromas, but *not* bilateral vestibular schwannomas. * **Sturge-Weber Syndrome:** A neurocutaneous syndrome characterized by a facial **Port-wine stain** (nevus flammeus), leptomeningeal angiomas, and glaucoma. It does not involve schwannomas. * **Tuberous Sclerosis:** Characterized by the triad of seizures, mental retardation, and adenoma sebaceum. Key findings include **cortical tubers**, subependymal giant cell astrocytomas (SEGA), and renal angiomyolipomas. **Clinical Pearls for NEET-PG:** * **Mnemonic for NF2:** "22" — Chromosome **22**, **2** ears (bilateral schwannomas), and **2** eyes (juvenile posterior subcapsular lenticular opacities/cataracts). * **MISME Syndrome:** NF2 is often remembered by the acronym **M**ultiple **I**nherited **S**chwannomas, **M**eningiomas, and **E**pendymomas. * **Imaging:** MRI with gadolinium is the gold standard for diagnosing cerebellopontine (CP) angle tumors. [1]

Q: Subacute sclerosing panencephalitis (SSPE) is a complication of which viral infection?

Measles. **Explanation:** **Subacute Sclerosing Panencephalitis (SSPE)** is a rare, progressive, and fatal neurodegenerative disease caused by a persistent, aberrant infection of the central nervous system with a **mutated Measles virus**. [1] 1. **Why Measles is Correct:** SSPE occurs years (typically 5–10) after an initial measles infection, usually in children who contracted the virus before age two. [1] The underlying mechanism involves a **defective "M" (matrix) protein** of the measles virus, which prevents the virus from budding out of host cells. Instead, the virus spreads directly from cell to cell via syncytia formation, leading to widespread inflammation, demyelination, and neuronal death in both gray and white matter (hence "panencephalitis"). 2. **Why Other Options are Incorrect:** * **Rubella:** Associated with Progressive Rubella Panencephalitis (PRP), which clinically mimics SSPE but is caused by the Rubella virus. * **Mumps:** Commonly causes viral meningitis or acute encephalitis, but not a chronic sclerosing panencephalitis. * **Chickenpox (VZV):** Can cause acute cerebellar ataxia or encephalitis, and its reactivation leads to Herpes Zoster (shingles), but not SSPE. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Stages:** Characterized by behavioral changes (Stage 1), followed by pathognomonic **periodic myoclonic jerks** (Stage 2), and eventually dementia and akinetic mutism. * **EEG Finding:** Classic **periodic, high-voltage slow-wave complexes** (Radermecker complexes) synchronized with myoclonus. * **CSF Analysis:** Shows significantly **elevated anti-measles antibody titers** and oligoclonal bands (increased IgG). [2] * **Diagnosis:** Based on Dyken’s criteria. * **Prevention:** The most effective strategy is vaccination with the **MMR vaccine**. [1]

Q: Albuminocytological dissociation is associated with which condition?

Guillain-Barre syndrome. **Explanation** **Albuminocytological dissociation** is a hallmark cerebrospinal fluid (CSF) finding characterized by a **significant elevation in protein levels** (albumin) with a **normal white blood cell (WBC) count**. 1. **Guillain-Barré Syndrome (GBS):** This is the correct answer. In GBS, inflammatory demyelination of spinal nerve roots leads to the leakage of plasma proteins into the CSF [1]. However, because the inflammation is localized to the peripheral nerves and roots rather than the meninges, there is no significant cellular (pleocytic) response in the CSF. This dissociation typically appears after the first week of symptoms [1]. 2. **Why the other options are incorrect:** * **Subarachnoid Haemorrhage (SAH):** CSF shows "xanthochromia" (yellowish discoloration) and a high number of Red Blood Cells (RBCs) [2]. While protein may rise, it is not a "dissociation" as the cellular components (RBCs) are markedly elevated. * **Pyogenic Meningitis:** Characterized by "Cyto-albuminologic association." There is a massive increase in WBCs (neutrophils), high protein, and markedly low glucose. * **Encephalitis:** Usually presents with viral pleocytosis (increased lymphocytes) and mildly elevated protein, maintaining a correlation between cells and protein. **High-Yield Clinical Pearls for NEET-PG:** * **Definition:** Protein >45 mg/dL with WBC <10 cells/mm³. * **Timing:** CSF may be normal in the first 48 hours of GBS; peak protein levels are usually seen at 2–4 weeks. * **Other Associations:** Albuminocytological dissociation can also be seen in **Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)** and occasionally in **Froin’s Syndrome** (spinal canal blockage). * **Treatment of GBS:** IVIG or Plasmapheresis (Steroids are generally not effective).

Q: Automatism is seen in which type of seizures?

Complex partial seizures. **Explanation:** **Automatisms** are involuntary, repetitive, and purposeless motor activities performed during a state of impaired consciousness. They are the hallmark clinical feature of **Complex Partial Seizures** (now classified by ILAE as Focal Impaired Awareness Seizures) [1]. 1. **Why Complex Partial Seizures (B) is correct:** These seizures typically originate in the temporal lobe. The hallmark is the **impairment of consciousness**, during which the patient may perform coordinated but inappropriate movements such as lip-smacking, chewing, swallowing, or fumbling with clothes (picking at buttons) [1]. The patient is amnestic to the event afterward [2]. 2. **Why other options are incorrect:** * **Simple Partial Seizures (A):** By definition, consciousness is fully preserved [1]. While motor jerks may occur, complex, semi-purposeful automatisms are absent. * **Infantile Spasms (C):** These are characterized by sudden, brief "jackknife" flexor or extensor spasms, typically associated with Hypsarrhythmia on EEG (West Syndrome), not coordinated automatisms. * **Absence Seizures (D):** While brief automatisms (like eye blinking) *can* occur in typical absence seizures, they are much more characteristic and elaborate in complex partial seizures. Absence seizures are primarily defined by a sudden "blank stare" and immediate recovery without a post-ictal state [3]. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site** for complex partial seizures: **Mesial Temporal Lobe** (Hippocampus). * **Post-ictal confusion:** Present in complex partial seizures but **absent** in absence seizures [3]. * **EEG Finding:** Complex partial seizures show focal spikes/sharp waves; Absence seizures show classic **3 Hz spike-and-wave** discharges [3]. * **Drug of Choice:** Carbamazepine/Levetiracetam for focal seizures; Valproate/Ethosuximide for absence seizures.

Question 1

A pinpoint pupil is a clinical sign that can indicate which of the following conditions?

Accepted Answer

Pontine hemorrhage

Answer

Barbiturate poisoning

Answer

Glaucoma

Answer

Congenital cataract

Question 2

A 20-year-old man complains of increasing difficulty in hearing over the past several years. Physical examination confirms bilateral sensorineural hearing deficits. MRI discloses bilateral cerebellopontine angle tumors, consistent with schwannomas. This patient has a strong family history for benign tumors, including low-grade gliomas and meningiomas on his mother's side of the family. Which of the following is the probable diagnosis?

Accepted Answer

Neurofibromatosis type 2

Answer

Neurofibromatosis type 1

Answer

Sturge-Weber syndrome

Answer

Tuberous sclerosis

Question 3

Dissociative sensory loss is not seen in which of the following conditions?

Accepted Answer

Cauda equina syndrome

Answer

Syringomyelia

Answer

Diabetes mellitus

Answer

Damage to the spinothalamic pathway

Question 4

A patient presents with ataxia, urinary incontinence, and dementia. What is the likely diagnosis?

Accepted Answer

Normal Pressure Hydrocephalus

Answer

Alzheimer's Disease

Answer

Parkinson's disease

Answer

Steel Richardson syndrome

Question 5

A 44-year-old man presents with a noticed difference in pupil size between his right and left eye, which he believes has been present for several weeks. He reports no pain or restriction of eye movements. Examination in a dimly lit room shows both pupils to be 4mm in size. Upon light exposure, his right pupil dilates to 4mm, while his left pupil constricts to 2mm. His eye movements are normal, and the remainder of his neurological examination is unremarkable. He does not exhibit ptosis. This physical finding is indicative of which of the following pathological processes?

Accepted Answer

Abnormal dilation of an artery due to weakening of the vessel wall

Answer

Occlusion of the superior sagittal sinus

Answer

Rupture of the middle meningeal artery leading to transtentorial herniation

Answer

Rupture of the inner lumen of the internal carotid artery with thrombus formation at the site of rupture

Question 6

Subacute sclerosing panencephalitis (SSPE) is a complication of which viral infection?

Accepted Answer

Measles

Answer

Rubella

Answer

Mumps

Answer

Chickenpox

Question 7

Albuminocytological dissociation is associated with which condition?

Accepted Answer

Guillain-Barre syndrome

Answer

Subarachnoid haemorrhage

Answer

Pyogenic meningitis

Answer

Encephalitis

Question 8

Easy fatigability of muscles is seen in which of the following conditions?

Accepted Answer

Myasthenia gravis

Answer

Epilepsy

Answer

MPDS

Answer

Cerebral palsy

Question 9

Intra-arterial thrombolysis is indicated in which of the following conditions?

Accepted Answer

Suspected occlusion of a larger artery

Answer

History of subarachnoid hemorrhage

Answer

History of dementia

Answer

Stroke of > 6 hours duration

Question 10

Automatism is seen in which type of seizures?

Accepted Answer

Complex partial seizures

Answer

Simple partial seizures

Answer

Infantile spasms

Answer

Absence seizures

Neurology — MCQs

Neurology — MCQs

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