Neurology Practice Questions

Q: Bell's palsy is paralysis of which nerve?

Lower motor neuron (LMN) VII nerve. ### Explanation **Bell’s palsy** is defined as an isolated, idiopathic, acute-onset **Lower Motor Neuron (LMN)** paralysis of the **VII cranial nerve (Facial nerve)**. It is the most common cause of unilateral facial paralysis worldwide. #### Why Option D is Correct: In an LMN lesion of the facial nerve, the pathology occurs at or distal to the facial nerve nucleus in the pons. This results in paralysis of **all muscles of facial expression** on the ipsilateral (same) side. This includes the inability to wrinkle the forehead, close the eye (lagophthalmos), and a drooping of the angle of the mouth. #### Why Other Options are Incorrect: * **Options A & C (V Nerve):** The V cranial nerve (Trigeminal nerve) provides sensory innervation to the face and motor innervation to the muscles of mastication. It does not control facial expression; therefore, its paralysis does not cause Bell’s palsy. * **Option B (UMN VII Nerve):** In an Upper Motor Neuron lesion (e.g., Stroke), the **forehead is spared**. This is because the part of the facial nucleus supplying the forehead receives bilateral cortical representation (innervation from both cerebral hemispheres). Since Bell's palsy involves the forehead, it cannot be a UMN lesion. #### High-Yield Clinical Pearls for NEET-PG: * **Etiology:** Likely viral prodrome (Herpes Simplex Virus is the most implicated). * **Clinical Sign:** **Bell’s Phenomenon** – Upward and outward rolling of the eyeball when the patient attempts to close the eyelid. * **Treatment:** Oral **Corticosteroids** (Prednisolone) are the mainstay of treatment and should be started within 72 hours. * **Prognosis:** Approximately 85% of patients show recovery within 3 weeks. * **Schirmer’s Test:** Used to localise the lesion; if reduced lacrimation is present, the lesion is at or proximal to the geniculate ganglion.

Q: Which among the following conditions does not cause an exaggerated jaw jerk?

Syringomyelia. **Explanation:** The **jaw jerk reflex** (masseter reflex) is a clinical test used to assess the integrity of the trigeminal nerve (CN V). It is a monosynaptic stretch reflex mediated by the trigeminal nerve's motor and sensory components, with its reflex center located in the **pons**. **Why Syringomyelia is the correct answer:** An exaggerated jaw jerk is a sign of an **Upper Motor Neuron (UMN) lesion** occurring **above the level of the pons**. Syringomyelia typically involves the cervical spinal cord (forming a syrinx). While it can cause UMN signs in the lower limbs and sensory loss in the upper limbs, it does not affect the brainstem or corticobulbar tracts above the pons. Therefore, the jaw jerk remains normal or absent in Syringomyelia. **Analysis of Incorrect Options:** * **Multiple Sclerosis (MS):** As a demyelinating disease of the Central Nervous System, MS often involves the corticobulbar tracts above the level of the pons, leading to UMN signs and an exaggerated jaw jerk. * **Motor Neurone Disease (MND):** Specifically in Amyotrophic Lateral Sclerosis (ALS), there is a combination of UMN and LMN involvement [1]. Degeneration of the corticobulbar tracts frequently results in a brisk jaw jerk [1]. * **Pseudobulbar Palsy:** This condition is defined by bilateral UMN lesions of the corticobulbar tracts (often due to strokes or MS). A hallmark clinical feature is a pathologically brisk jaw jerk, accompanied by emotional lability and dysarthria. **High-Yield Clinical Pearls for NEET-PG:** * **Localization:** A brisk jaw jerk localizes the lesion to the **midbrain or higher** (supranuclear). * **Bulbar vs. Pseudobulbar Palsy:** In Bulbar palsy (LMN), the jaw jerk is absent; in Pseudobulbar palsy (UMN), the jaw jerk is exaggerated. * **Syringomyelia:** Classically presents with "dissociated sensory loss" (loss of pain/temperature with preserved touch/vibration) in a "cape-like" distribution.

Q: A patient presents with chorea and symptoms suggestive of schizophrenia. What is the most likely diagnosis?

Huntington's disease. **Explanation:** **Huntington’s Disease (HD)** is the correct diagnosis because it classically presents with a triad of **motor, cognitive, and psychiatric symptoms**. [1] 1. **Motor:** Chorea (involuntary, jerky movements) is the hallmark. [1] 2. **Psychiatric:** Psychosis (mimicking schizophrenia), depression, and personality changes often precede motor symptoms by years. [2] 3. **Cognitive:** Progressive subcortical dementia. The underlying pathology involves the atrophy of the **caudate nucleus** and putamen (striatum) due to **CAG trinucleotide repeats** on Chromosome 4, leading to a loss of GABAergic neurons. [1] **Why other options are incorrect:** * **Creutzfeldt-Jakob disease (CJD):** Presents with rapidly progressive dementia and **myoclonus** (not chorea), often leading to death within a year. * **Dementia with Lewy bodies (DLB):** Characterized by visual hallucinations, fluctuating consciousness, and **parkinsonism** (rigidity/bradykinesia), not chorea. * **Parkinson's disease:** Presents with a triad of resting tremor, bradykinesia, and rigidity. [3] While psychosis can occur (often drug-induced), chorea is not a primary feature. **High-Yield Clinical Pearls for NEET-PG:** * **Inheritance:** Autosomal Dominant with **Anticipation** (earlier onset in successive generations, especially via paternal transmission). * **Neuroimaging:** MRI shows "box-car ventricles" due to **atrophy of the caudate nucleus**. [2] * **Neurotransmitters:** Characterized by ↓ GABA, ↓ Acetylcholine, and ↑ Dopamine. * **Treatment:** Tetrabenazine or Deutetrabenazine (VMAT2 inhibitors) are used to manage chorea by depleting dopamine. [2]

Q: Opsoclonus is a feature of which of the following conditions?

Carcinoma of the lung. **Explanation:** **Opsoclonus** is a rare, high-frequency, involuntary, multivectorial eye movement disorder characterized by spontaneous, rapid, and chaotic "dancing eyes." It is often associated with myoclonus (Opsoclonus-Myoclonus-Ataxia Syndrome). **1. Why Carcinoma of the Lung is Correct:** In adults, opsoclonus is most commonly a **paraneoplastic manifestation**. It is frequently associated with **Small Cell Lung Carcinoma (SCLC)**, mediated by the **anti-Ri (ANNA-2)** antibody. The underlying mechanism involves an immune-mediated attack on the brainstem and cerebellum triggered by the underlying malignancy. **2. Analysis of Incorrect Options:** * **Retinoblastoma:** While a common pediatric ocular tumor, it does not cause opsoclonus. However, in children, opsoclonus is a classic paraneoplastic sign of **Neuroblastoma** (not Retinoblastoma). * **Focal seizure with dyscognitive changes:** Seizures typically present with rhythmic nystagmoid movements or tonic-clonic deviations, not the chaotic, non-rhythmic movements of opsoclonus. * **Wilson’s Disease:** Extrapyramidal damage in Wilson’s disease typically manifests as a "wing-beating" tremor, dystonia, or parkinsonism. Ocular findings include the **Kayser-Fleischer (KF) ring** and "sunflower cataracts," but not opsoclonus. **High-Yield Clinical Pearls for NEET-PG:** * **Pediatric Association:** Always rule out **Neuroblastoma** in a child presenting with "Dancing Eyes, Dancing Feet" (Opsoclonus-Myoclonus Syndrome). * **Adult Association:** Small Cell Lung Cancer (SCLC) and Breast Cancer. * **Anatomical Site:** Dysfunction is localized to the **omnipause neurons** in the nucleus raphe interpositus of the pons, which normally inhibit saccadic bursts. * **Key Antibody:** **Anti-Ri** is the most high-yield antibody associated with paraneoplastic opsoclonus.

Q: The Miller Fisher test is used for which of the following?

Evaluating cognition in Normal Pressure Hydrocephalus.. ### Explanation **Correct Option: A. Evaluating cognition in Normal Pressure Hydrocephalus (NPH)** The **Miller Fisher Test** (also known as the **Large Volume Lumbar Puncture** or "Tap Test") is a diagnostic and prognostic tool for Normal Pressure Hydrocephalus [1]. NPH is characterized by the classic triad of **Wet, Wobbly, and Weird** (Urinary incontinence, Gait ataxia, and Dementia/Cognitive decline) [2]. In this test, 30–50 mL of cerebrospinal fluid (CSF) is removed [1]. A positive result is defined as a documented improvement in **gait speed or cognitive function** (using scales like the MMSE) shortly after the procedure. This improvement predicts a high likelihood of success for permanent surgical shunting (VP Shunt) [2]. --- ### Why other options are incorrect: * **B. Guillain-Barré Syndrome (GBS):** While "Miller Fisher Syndrome" is a variant of GBS (characterized by Ataxia, Areflexia, and Ophthalmoplegia), there is no "Miller Fisher Test" for paralysis severity. Severity in GBS is typically assessed using the **Hughes Functional Scale**. * **C. Amyotrophic Lateral Sclerosis (ALS):** Muscle involvement and functional status in ALS are graded using the **ALS Functional Rating Scale (ALSFRS-R)**. * **D. Multiple Sclerosis (MS):** Disability in MS is measured using the **Expanded Disability Status Scale (EDSS)**. --- ### High-Yield Clinical Pearls for NEET-PG: * **NPH Imaging:** Look for "ventriculomegaly out of proportion to sulcal atrophy" and **Evans Index > 0.3**. * **Hakim’s Triad:** The clinical triad of NPH (Gait disturbance is usually the first symptom to appear and the most likely to improve after shunting). * **Miller Fisher Syndrome (GBS variant):** Associated with **anti-GQ1b antibodies**. Do not confuse the *Syndrome* with the *Test* for NPH.

Q: What is the most common site of intracranial hemorrhage in hypertensive hemorrhage?

Basal ganglia. The most common site of intracranial hemorrhage (ICH) due to chronic hypertension is the **Basal Ganglia**, specifically the **Putamen** (accounting for approximately 35–50% of cases) [1]. **1. Why Basal Ganglia is correct:** Chronic hypertension leads to degenerative changes in small, deep penetrating arteries (e.g., lenticulostriate arteries). These changes include **lipohyalinosis** and the formation of **Charcot-Bouchard aneurysms**. Because these vessels originate directly from high-pressure large arteries (like the Middle Cerebral Artery) at right angles, they are highly susceptible to rupture under sustained hypertensive stress [1]. **2. Analysis of Incorrect Options:** * **B. Brainstem:** Specifically the **Pons**, this is the most common site for *primary brainstem* hemorrhage, but it is less frequent than basal ganglia involvement [1]. * **C. Cerebellum:** A common site for hypertensive ICH (about 10%), but significantly less frequent than the supratentorial structures [1]. * **D. Hippocampus:** This is an uncommon site for primary hypertensive hemorrhage; it is more typically associated with global hypoxic-ischemic injury or atrophy in Alzheimer’s disease. **3. High-Yield Clinical Pearls for NEET-PG:** * **Order of Frequency:** Putamen (most common) > Subcortical white matter (Thalamus) > Cerebellum > Pons [1]. * **Putaminal Hemorrhage:** Often presents with contralateral hemiplegia, hemisensory loss, and conjugate gaze deviation *towards* the side of the lesion. * **Thalamic Hemorrhage:** Characterized by upward gaze palsy and "wrong-way eyes" (eyes deviate *away* from the lesion/towards the hemiparesis). * **Pontine Hemorrhage:** Classic triad of pinpoint pupils, coma, and quadriplegia [1]. * **Diagnosis:** Non-contrast CT head is the gold standard for acute hemorrhage (appears hyperdense/white).

Q: A 52-year-old man complains of episodes of severe unilateral, stabbing facial pain that is intermittent for several hours, and then disappears for several days. The pain is described as "electric shock-like" and only lasts a few seconds. Physical examination of the face and mouth is entirely normal. Which of the following treatments is most effective for this condition?

carbamazepine. ### Explanation **Diagnosis: Trigeminal Neuralgia (Tic Douloureux)** **1. Why Carbamazepine is Correct:** The clinical presentation—unilateral, paroxysmal, "electric shock-like" stabbing pain in the distribution of the trigeminal nerve (V2 or V3 branches) triggered by minor stimuli—is classic for **Trigeminal Neuralgia**. * **Mechanism:** It is often caused by vascular compression of the trigeminal nerve root. * **Treatment:** **Carbamazepine** is the first-line drug of choice. It works by blocking voltage-gated sodium channels, thereby stabilizing hyperexcitable neuronal membranes and inhibiting repetitive firing [1]. It is highly effective, with a 70-80% initial response rate. **2. Why Incorrect Options are Wrong:** * **A. Morphine:** Opioids are generally ineffective for neuropathic pain like trigeminal neuralgia and carry a high risk of dependence. * **B. Indomethacin:** This is an NSAID. While it is the drug of choice for **Paroxysmal Hemicrania** (another unilateral headache disorder), it has no role in treating the neuropathic mechanism of trigeminal neuralgia. * **C. Cimetidine:** This is an H2-receptor antagonist used for peptic ulcer disease and GERD; it has no analgesic or anticonvulsant properties. **3. Clinical Pearls for NEET-PG:** * **Second-line agents:** Oxcarbazepine (better tolerated), Baclofen, or Lamotrigine [1]. * **Surgical Management:** If medical therapy fails, **Microvascular Decompression (Janetta procedure)** is the most effective surgical intervention. * **Red Flag:** If a young patient (e.g., <40 years) presents with bilateral trigeminal neuralgia, suspect **Multiple Sclerosis** (demyelination of the nerve root entry zone). * **Monitoring:** Patients on Carbamazepine require monitoring for **hyponatremia** (SIADH-like effect) and **agranulocytosis**.

Q: What is the most common cause of headache?

Tension headache. Headaches are broadly classified into primary and secondary types [1]. **Tension-type headache (TTH)** is the most common primary headache syndrome and the most frequent cause of headache in the general population [1]. It typically presents as a bilateral, non-pulsating, "band-like" pressure of mild to moderate intensity, without the associated features of nausea or vomiting seen in migraines. **Analysis of Options:** * **A. Tension headache (Correct):** It has a lifetime prevalence of approximately 30% to 78% in the general population, making it the most common headache overall [1]. * **B. Migraine:** While migraine is the most common cause of headache for which patients **seek medical consultation**, it is second to TTH in overall prevalence. It is characterized by unilateral, throbbing pain often accompanied by photophobia and phonophobia [1], [2]. * **C. Cluster headache:** This is a rare primary headache disorder [1]. It is much less common than TTH or migraine and is characterized by severe, unilateral periorbital pain with autonomic symptoms (e.g., lacrimation, ptosis) and agitation during the headache phase [3]. * **D. Trigeminal neuralgia:** This is a facial pain syndrome, not a primary headache disorder. It involves paroxysmal, lancinating pain in the distribution of the trigeminal nerve. **High-Yield Clinical Pearls for NEET-PG:** * **Most common headache overall:** Tension-type headache [1]. * **Most common headache presenting to the ER/Clinic:** Migraine. * **Most common primary headache in males:** Cluster headache (though TTH is still more common in the general male population, the male-to-female ratio is highest in Cluster) [3]. * **Prophylaxis of choice for TTH:** Amitriptyline (Tricyclic Antidepressant).

Q: Paraneoplastic cerebellar ataxia with anti-Yo antibody positivity is seen in which of the following malignancies?

Breast and ovarian malignancy. **Explanation:** **Paraneoplastic Cerebellar Degeneration (PCD)** is an immune-mediated syndrome where the body produces antibodies against tumor antigens that cross-react with Purkinje cells in the cerebellum [1]. **1. Why Option A is Correct:** The **anti-Yo antibody** (also known as Purkinje cell cytoplasmic antibody type 1 or PCA-1) is the most common antibody associated with PCD in women. It specifically targets the **cdr2** protein. This antibody is highly specific for **gynecological malignancies (ovarian, fallopian tube, or uterine)** and **breast cancer** [2]. Patients typically present with rapidly progressive pancerebellar dysfunction (ataxia, dysarthria, nystagmus) often before the primary tumor is diagnosed. **2. Why Other Options are Incorrect:** * **Small Cell Carcinoma Lung (SCLC):** While SCLC is the most common cause of paraneoplastic syndromes overall, it is typically associated with **anti-Hu** (ANNA-1) or **anti-CV2** antibodies, not anti-Yo. * **Hodgkin’s Lymphoma:** This is classically associated with **anti-Tr** (DNER) antibodies, leading to "Ophelia syndrome" or cerebellar ataxia. * **Lung Malignancy (Non-SCLC):** Generally associated with anti-Ri (ANNA-2) antibodies, which often present with opsoclonus-myoclonus rather than pure cerebellar ataxia. **High-Yield Clinical Pearls for NEET-PG:** * **Anti-Yo:** Breast and Ovary (The "Female" antibody). * **Anti-Hu:** Small Cell Lung Cancer (associated with encephalomyelitis and sensory neuronopathy) [1]. * **Anti-Ri:** Breast and Lung (associated with Opsoclonus-Myoclonus). * **Anti-Tr:** Hodgkin’s Lymphoma. * **Lambert-Eaton Myasthenic Syndrome (LEMS):** Associated with SCLC and **Voltage-Gated Calcium Channel (VGCC)** antibodies [3]. * **NMDA Receptor Encephalitis:** Classically associated with **Ovarian Teratoma**.

Question 1

Bell's palsy is paralysis of which nerve?

Accepted Answer

Lower motor neuron (LMN) VII nerve

Answer

Upper motor neuron (UMN) V nerve

Answer

Upper motor neuron (UMN) VII nerve

Answer

Lower motor neuron (LMN) V nerve

Question 2

A 40-year-old female presented with cough, mild chest pain, and mild hoarseness of voice. Following suspicion of respiratory pathology, a chest X-ray and MRI chest were performed. Which of the following RNS findings should be suspected in this patient?

Accepted Answer

Image B

Answer

Image A

Answer

Image C

Answer

None of the above

Question 3

Which among the following conditions does not cause an exaggerated jaw jerk?

Accepted Answer

Syringomyelia

Answer

Multiple sclerosis

Answer

Motor neurone disease

Answer

Pseudobulbar palsy

Question 4

A patient presents with chorea and symptoms suggestive of schizophrenia. What is the most likely diagnosis?

Accepted Answer

Huntington's disease

Answer

Creutzfeldt-Jakob disease

Answer

Dementia with Lewy bodies

Answer

Parkinson's disease

Question 5

Opsoclonus is a feature of which of the following conditions?

Accepted Answer

Carcinoma of the lung

Answer

Retinoblastoma

Answer

Focal seizure with dyscognitive changes

Answer

Extrapyramidal damage in Wilson's disease

Question 6

The Miller Fisher test is used for which of the following?

Accepted Answer

Evaluating cognition in Normal Pressure Hydrocephalus.

Answer

Assessing the severity of paralysis in Guillain-Barré Syndrome.

Answer

Grading muscle involvement in Amyotrophic Lateral Sclerosis.

Answer

Measuring disability in Multiple Sclerosis.

Question 7

What is the most common site of intracranial hemorrhage in hypertensive hemorrhage?

Accepted Answer

Basal ganglia

Answer

Brainstem

Answer

Cerebellum

Answer

Hippocampus

Question 8

A 52-year-old man complains of episodes of severe unilateral, stabbing facial pain that is intermittent for several hours, and then disappears for several days. The pain is described as "electric shock-like" and only lasts a few seconds. Physical examination of the face and mouth is entirely normal. Which of the following treatments is most effective for this condition?

Accepted Answer

carbamazepine

Answer

morphine

Answer

indomethacin

Answer

cimetidine

Question 9

What is the most common cause of headache?

Accepted Answer

Tension headache

Answer

Migraine

Answer

Cluster headache

Answer

Trigeminal neuralgia

Question 10

Paraneoplastic cerebellar ataxia with anti-Yo antibody positivity is seen in which of the following malignancies?

Accepted Answer

Breast and ovarian malignancy

Answer

Breast and lung malignancy

Answer

Ovarian and small cell carcinoma lung

Answer

Small cell carcinoma lung and Hodgkin's disease

Neurology — MCQs

Neurology — MCQs

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