Neurology Practice Questions

Q: Which of the following is used in the acute exacerbation of multiple sclerosis?

Methylprednisolone. The management of Multiple Sclerosis (MS) is divided into two distinct categories: treatment of acute relapses (exacerbations) and disease-modifying therapies (DMTs) for long-term prevention. **Why Methylprednisolone is correct:** The goal of treating an acute exacerbation is to reduce inflammation and speed up recovery from the neurological deficit. **High-dose intravenous Methylprednisolone (typically 1g daily for 3–5 days)** is the first-line treatment. It works by stabilizing the blood-brain barrier, reducing edema, and inhibiting inflammatory cytokines. If steroids are contraindicated or ineffective, **Plasmapheresis (Plasma Exchange)** is the next step for acute management. **Why the other options are incorrect:** * **Fingolimod (Option B):** An oral S1P receptor modulator used as a DMT to reduce the frequency of relapses in relapsing-remitting MS (RRMS). It is not used for acute attacks. * **Beta Interferon (Option C):** One of the oldest first-line DMTs used for long-term maintenance [2]. It helps prevent future relapses but has no role in treating an ongoing acute attack. * **Natalizumab (Option D):** A monoclonal antibody against α4β1-integrin. It is a highly effective DMT reserved for aggressive RRMS but is not used for acute exacerbations. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard for Diagnosis:** MRI with Gadolinium (shows "Dawson’s fingers" or periventricular plaques) [1], [3]. * **CSF Finding:** Oligoclonal bands (IgG) are present in >90% of patients [1], [3]. * **Lhermitte’s Sign:** An electric shock-like sensation down the spine upon neck flexion. * **Uhthoff’s Phenomenon:** Worsening of neurological symptoms with increased body temperature. * **DOC for Spasticity in MS:** Baclofen.

Q: What is the most common cause of death in measles?

Pneumonia. **Explanation:** **Pneumonia** is the most common cause of death associated with measles in both children and adults. Measles virus causes profound transient immunosuppression by depleting T-lymphocytes and altering cytokine responses. This predisposes patients to secondary bacterial infections (most commonly *S. pneumoniae*, *H. influenzae*, and *S. aureus*) or primary viral giant cell pneumonia (Hecht’s pneumonia) [1]. While measles is often perceived as a simple rash, respiratory complications account for nearly 60% of measles-related mortality. **Analysis of Incorrect Options:** * **Encephalitis:** While Acute Disseminated Encephalomyelitis (ADEM) and Subacute Sclerosing Panencephalitis (SSPE) are severe neurological complications with high morbidity, they occur much less frequently than respiratory complications [1]. * **Meningitis:** Measles rarely presents as isolated meningitis; neurological involvement typically manifests as encephalitis or encephalopathy. * **Dehydration:** Although diarrhea is the most common *complication* of measles overall (especially in malnourished children), it is secondary to pneumonia as a cause of death in global statistics. **NEET-PG High-Yield Pearls:** * **Most common complication:** Diarrhea. * **Most common cause of death:** Pneumonia. * **Most common CNS complication:** Acute febrile encephalitis. * **Pathognomonic sign:** Koplik spots (found opposite the lower second molars) [1]. * **Vitamin Supplementation:** Vitamin A is crucial in management as it reduces the severity of complications and mortality risk [1]. * **SSPE:** A late, fatal neurodegenerative complication occurring years after the initial infection due to a persistent mutant virus [1].

Q: Limbs elevated against gravity but not against resistance is which grade of muscle power?

Grade III. The assessment of muscle strength is standardized using the **Medical Research Council (MRC) Scale**. This scale is a high-yield topic for NEET-PG, as it provides an objective way to document neurological deficits. ### **Explanation of the Correct Answer** **Grade III** is defined as **active movement against gravity** but not against any added resistance. In this stage, the muscle has enough power to lift the limb off the bed (overcoming the weight of the limb itself), but the moment the examiner applies external pressure, the limb falls. ### **Analysis of Incorrect Options** * **Grade I (Option A):** There is only a **flicker or trace of contraction** visible or palpable (e.g., a tendon tightening), but no actual movement of the joint occurs. * **Grade II (Option B):** Active movement is possible only if **gravity is eliminated**. For example, the patient can move the arm sideways on the bed but cannot lift it up. * **Grade IV (Option D):** Active movement is possible against **gravity and some resistance**. This is a broad category often sub-divided into 4-, 4, and 4+ in clinical practice. ### **Clinical Pearls for NEET-PG** * **Grade 0:** No muscle contraction at all (total paralysis). * **Grade V:** Normal power against full resistance. * **Functional Tip:** If a patient can walk or clear their feet off the ground while climbing stairs, they have at least Grade III power in the lower limbs. * **Exam Trap:** Always distinguish between "gravity-eliminated" (Grade II) and "against gravity" (Grade III). Grade III is the "threshold" grade for functional movement.

Q: What is the investigation of choice for the diagnosis of epilepsy?

Electroencephalogram (EEG). **Explanation:** **Why EEG is the Correct Answer:** The diagnosis of epilepsy is primarily clinical, but the **Electroencephalogram (EEG)** is the gold-standard investigation of choice to support the diagnosis, classify the seizure type (focal vs. generalized), and identify specific epilepsy syndromes [1]. It works by recording the electrical activity of the cerebral cortex. The presence of **interictal epileptiform discharges (IEDs)**—such as spikes, sharp waves, or spike-and-wave complexes—provides definitive evidence of a predisposition to seizures [4]. **Why Other Options are Incorrect:** * **CT Scan:** While useful in emergency settings to rule out acute hemorrhage or large tumors, it lacks the sensitivity of MRI for identifying subtle epileptogenic lesions [2]. * **MRI:** This is the **investigation of choice for identifying the structural cause** of epilepsy (e.g., mesial temporal sclerosis, cortical dysplasia) [2]. However, it does not diagnose the electrical phenomenon of epilepsy itself. * **CSF Investigation:** This is only indicated if an infectious or inflammatory etiology (like meningitis or encephalitis) is suspected as the trigger for a seizure; it has no role in the routine diagnosis of epilepsy [2]. **High-Yield Clinical Pearls for NEET-PG:** * **Sensitivity:** A single routine EEG has a sensitivity of only ~30-50%. Sensitivity increases with sleep deprivation or repeated recordings [1]. * **Gold Standard for Seizure Classification:** Video-EEG monitoring is the gold standard for differentiating pseudoseizures (PNES) from true epileptic seizures [2]. * **Classic Pattern:** 3 Hz spike-and-wave discharges are pathognomonic for **Absence Seizures** [3]. * **Management:** If a patient has a single unprovoked seizure and a **normal EEG/MRI**, the risk of recurrence is low, and starting Anti-Epileptic Drugs (AEDs) is usually deferred.

Q: Which of the following is likely to be found in a patient with a lesion in the shaded area?

Fluent speech output. ***Fluent speech output*** - **Wernicke's aphasia** is characterized by **fluent but paraphasic speech** with preserved rhythm and intonation, distinguishing it from non-fluent aphasias. - Patients produce **word salad** or **jargon aphasia** with frequent **semantic** and **phonemic paraphasias** while maintaining normal speech flow. *Normal repetition* - **Repetition is severely impaired** in Wernicke's aphasia due to damage to the **posterior language network**. - This differentiates it from **transcortical sensory aphasia**, where repetition remains intact despite comprehension deficits. *Acalculia* - **Acalculia** (inability to perform calculations) is associated with **angular gyrus syndrome** (Gerstmann syndrome), not Wernicke's area lesions. - Wernicke's area lesions primarily affect **language comprehension** and **auditory processing**, sparing mathematical abilities. *Dysarthric speech pattern* - **Dysarthria** involves motor speech disorders affecting **articulation** and **phonation**, typically from **brainstem** or **motor cortex** lesions. - Wernicke's aphasia preserves **motor speech function** and **articulation**, as the lesion is in the **temporal lobe** rather than motor areas.

Q: Anti-GD1 antibodies are seen in which variant of Guillain-Barré syndrome?

Acute motor axonal neuropathy (AMAN). ### Explanation The correct answer is **Acute motor axonal neuropathy (AMAN)**. **1. Why AMAN is correct:** Guillain-Barré Syndrome (GBS) is an immune-mediated polyradiculoneuropathy often triggered by molecular mimicry. In the **AMAN** variant, antibodies are directed against gangliosides located at the Nodes of Ranvier, specifically **Anti-GD1a** and **Anti-GM1**. This variant is strongly associated with preceding *Campylobacter jejuni* enteritis. Unlike the classic demyelinating form, AMAN involves direct axonal damage, leading to a purely motor presentation with a more rapid progression. **2. Why the other options are incorrect:** * **AIDP (Option A):** This is the most common form of GBS in the West. It is characterized by segmental demyelination [1]. While various antibodies may be present, there is no single specific diagnostic ganglioside antibody like those found in axonal forms. * **AMSAN (Option C):** Similar to AMAN, this is an axonal form but involves both motor and sensory fibers. While Anti-GM1/GD1a can be present, the question specifically targets the classic association with AMAN. * **Miller Fisher Syndrome (Option D):** This variant is characterized by the triad of Ataxia, Areflexia, and Ophthalmoplegia [1]. It is highly specific for **Anti-GQ1b** antibodies (90% of cases), which target the dense concentration of gangliosides in the cranial nerves supplying the extraocular muscles [1]. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common variant (Global):** AIDP [1]. * **Most common variant (China/Japan/Axonal):** AMAN. * **Specific Antibody for Miller Fisher:** Anti-GQ1b (High Yield) [1]. * **Preceding Infection:** *Campylobacter jejuni* (most common), CMV, EBV, and Zika virus [1]. * **CSF Finding:** Albuminocytologic dissociation (High protein with normal cell count). * **Treatment:** IVIG or Plasmapheresis (Steroids are generally not effective in GBS).

Question 1

A 58-year-old woman with a history of alcohol abuse, coronary artery disease, and atrial fibrillation is on metoprolol, lisinopril, simvastatin, and warfarin. She develops urinary urgency and frequency and is treated with oxycodone and ciprofloxacin. Three days later, she develops a headache, dizziness, vomiting, and difficulty walking. Neurological examination reveals normal strength, sensation (including vibratory sensation), and reflexes. She has an uncoordinated, unsteady gait. Testing of coordination in the upper extremities shows past pointing and poor rapid alternating movements with her right upper extremity. In the lower extremities, her heel-shin testing also reveals poor coordination on the right. Her INR is 6.5 (normal <1; therapeutic for warfarin is 2.0-3.0). What is the most likely cause of her neurologic findings?

Accepted Answer

Right cerebellar hemorrhage

Answer

Multiple small infarcts in the basal ganglia

Answer

Cerebellar degeneration due to chronic alcohol abuse

Answer

Posterior column degeneration as a result of vitamin deficiency

Question 2

Which of the following is used in the acute exacerbation of multiple sclerosis?

Accepted Answer

Methylprednisolone

Answer

Fingolimod

Answer

Beta interferon

Answer

Natalizumab

Question 3

What is the most common cause of death in measles?

Accepted Answer

Pneumonia

Answer

Encephalitis

Answer

Meningitis

Answer

Dehydration

Question 4

An 80-year-old chronic alcoholic was diagnosed with atrial fibrillation five years ago. His son describes a stepwise decline in his father's overall memory over these years. On examination, he is having pseudobulbar affect with brisk deep tendon reflexes in the left upper extremity and up-going plantars. What is the diagnosis?

Accepted Answer

Multi-infarct dementia

Answer

Binswanger's disease

Answer

Alzheimer's disease

Answer

Vitamin B12 deficiency

Question 5

Limbs elevated against gravity but not against resistance is which grade of muscle power?

Accepted Answer

Grade III

Answer

Grade I

Answer

Grade II

Answer

Grade IV

Question 6

What is the investigation of choice for the diagnosis of epilepsy?

Accepted Answer

Electroencephalogram (EEG)

Answer

CT scan

Answer

MRI

Answer

Cerebrospinal fluid (CSF) investigation

Question 7

Which condition shows characteristic EEG findings of 3 Hz generalized spike and wave discharges?

Accepted Answer

Sub-acute sclerosing panencephalitis (SSPE)

Answer

Absence seizures

Answer

Tonic-clonic seizures

Answer

Status epilepticus

Question 8

Which of the following is likely to be found in a patient with a lesion in the shaded area?

Accepted Answer

Fluent speech output

Answer

Normal repetition

Answer

Acalculia

Answer

Dysarthric speech pattern

Question 9

Anti-GD1 antibodies are seen in which variant of Guillain-Barré syndrome?

Accepted Answer

Acute motor axonal neuropathy (AMAN)

Answer

Acute inflammatory demyelinating polyneuropathy (AIDP)

Answer

Acute motor and sensory axonal neuropathy (AMSAN)

Answer

Miller Fisher syndrome (MFS)

Question 10

Which condition is associated with a characteristic EEG finding?

Accepted Answer

Subacute sclerosing panencephalitis (SSPE)

Answer

REM sleep

Answer

Partial seizure

Answer

Absence seizure

Neurology — MCQs

Neurology — MCQs

On this page

Practice by Chapter

Want unlimited practice?