Neuropathology Practice Questions

Q: Which of the following drugs has anxiolytic action with the least sedation?

Buspirone. ### Explanation **Correct Answer: A. Buspirone** **Mechanism and Rationale:** Buspirone is a unique anxiolytic agent that acts as a **selective partial agonist at the 5-HT1A receptors**. Unlike benzodiazepines, it does not interact with the GABA-A receptor complex. Because of its selective serotonergic mechanism, it lacks the sedative, hypnotic, anticonvulsant, and muscle-relaxant properties typical of other anxiolytics. It is the drug of choice for Generalized Anxiety Disorder (GAD) when the patient needs to remain alert (e.g., drivers, students). **Analysis of Incorrect Options:** * **B. Triazolam:** A short-acting benzodiazepine primarily used as a hypnotic for insomnia. It causes significant sedation and has a high risk of rebound insomnia. * **C. Alprazolam:** A potent benzodiazepine used for panic disorders and GAD. While effective, it causes dose-dependent sedation, psychomotor impairment, and carries a risk of dependence. * **D. Chlordiazepoxide:** A long-acting benzodiazepine used mainly for alcohol withdrawal. It has active metabolites that cause prolonged sedation and "hangover" effects. **High-Yield Clinical Pearls for NEET-PG:** * **"The 3 No’s" of Buspirone:** No Sedation, No Tolerance/Dependence (low abuse potential), and No interaction with Alcohol. * **Delayed Onset:** Unlike benzodiazepines, Buspirone takes **2–4 weeks** to show therapeutic effects; it is not useful for acute anxiety or panic attacks. * **Side Effects:** Most common side effects include dizziness, nausea, and headache. * **Metabolism:** It is metabolized by **CYP3A4**; its levels increase significantly if taken with grapefruit juice or rifampin.

Q: Which of the following is not seen in Tuberous sclerosis?

McCollum plaques. **Explanation:** **Tuberous Sclerosis Complex (TSC)** is an autosomal dominant neurocutaneous syndrome (phakomatosis) caused by mutations in the **TSC1 (Hamartin)** or **TSC2 (Tuberin)** genes. It is characterized by the development of benign tumors (hamartomas) in multiple organs [1]. **Why McCollum Plaques is the correct answer:** **McCollum plaques** are irregular endocardial thickenings usually found in the **left atrium**, resulting from jet lesions in **Mitral Regurgitation** (Rheumatic Heart Disease). They have no association with Tuberous Sclerosis. The characteristic cardiac finding in TSC is actually **Cardiac Rhabdomyoma** [1]. **Analysis of Incorrect Options (Features seen in TSC):** * **Shagreen patches:** These are leathery, thickened, "orange-peel" textured skin patches typically found on the lower back (lumbosacral region). They represent connective tissue nevi. * **Adenoma sebaceum:** A misnomer, as these are actually **facial angiofibromas** [1]. They appear as reddish papules in a malar distribution (butterfly area of the face). * **Depigmented nevi:** Also known as **Ash-leaf spots**. These are often the earliest clinical sign of TSC and are best visualized using a **Wood’s lamp**. **High-Yield Clinical Pearls for NEET-PG:** * **Vogt’s Triad:** Seizures, Mental retardation, and Adenoma sebaceum (seen in only ~30% of cases). * **CNS findings:** Cortical tubers, Subependymal nodules (SEN), and **Subependymal Giant Cell Astrocytoma (SEGA)** [1]. * **Renal findings:** Bilateral **Renal Angiomyolipomas** (risk of hemorrhage) [1]. * **Pulmonary findings:** Lymphangioleiomyomatosis (LAM), primarily in females [1]. * **Ungual fibromas:** Also known as Koenen tumors (flesh-colored growths around nails). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1318-1319.

Q: Tau protein inclusions are involved in:

Alzheimer’s disease. ***Alzheimer's disease*** - **Tau protein** aggregation leads to the formation of **neurofibrillary tangles (NFTs)**, which are characteristic pathological hallmarks of Alzheimer's disease, particularly in the hippocampus and cortex [1]. - Hyperphosphorylation of Tau causes it to dissociate from microtubules, destabilizing the neuronal cytoskeleton and ultimately leading to **synaptic dysfunction** and cell death [2]. *Huntington's disease* - This disorder is caused by an expansion of a **CAG triplet repeat** in the *HTT* gene, leading to the accumulation of misfolded **Huntingtin protein**. - It is characterized by atrophy of the **caudate nucleus** and putamen (striatum) and is not primarily linked to Tauopathies. *Amyotrophic lateral sclerosis* - ALS is primarily characterized by the aggregation of **TDP-43** (Tar DNA-binding protein 43) in motor neurons, a distinct type of proteinopathy. - While some cases of ALS overlap with Frontotemporal Dementia (FTD) which can involve Tauopathies, classic ALS pathology is defined by **TDP-43 inclusions**. *CNS lymphoma* - CNS lymphoma is a **primary central nervous system (CNS) tumor**, usually a non-Hodgkin B-cell lymphoma. - Diagnosis relies on identifying atypical lymphoid cells and is not associated with misfolded Tau protein inclusions, which are features of **neurodegenerative diseases** [3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1292-1295. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 721-722. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1288-1289.

Q: A patient had a road traffic accident (RTA). NCCT head was normal on admission. The patient later died after several days in the ICU due to coma. Brain biopsy revealed multiple punctate hemorrhages. What is the diagnosis?

Diffuse axonal injury. ***Diffuse axonal injury*** - This condition is caused by **traumatic shearing forces** due to sudden acceleration-deceleration, as seen in RTAs, leading to widespread axonal damage [1][2]. - A key feature is a discrepancy between clinical severity (e.g., coma) and initial imaging, as non-contrast CT scans are often normal [2]. The presence of **multiple punctate hemorrhages** on biopsy or sensitive MRI sequences (like the one shown) is characteristic [2]. *Ischemic injury* - This results from reduced blood flow causing a stroke, not direct trauma, and presents with focal neurological deficits corresponding to an arterial territory [3]. - Pathologically, it leads to **liquefactive necrosis** in a specific vascular distribution, not diffuse punctate hemorrhages [3]. *Intraventricular bleeding* - This refers to hemorrhage within the ventricular system and would be clearly visible as a **hyperdensity** on an initial NCCT head scan [3]. - It is a distinct type of intracranial bleed and does not present as microscopic, diffuse parenchymal hemorrhages [3]. *Subdural hemorrhage* - This involves bleeding into the space between the dura and arachnoid mater, usually from torn bridging veins. - It appears as a **crescent-shaped** hyperdensity on a CT scan and is typically evident immediately after trauma. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 700-701. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 701-702. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 706-707.

Question 1

Which of the following is not a finding in viral encephalitis?

Accepted Answer

Astroglial proliferation

Answer

Perivascular mononuclear infiltrate

Answer

Intranuclear and intracytoplasmic inclusion bodies

Answer

None of the above

Question 2

Lisch nodules (Pigmented Iris hamartomas) are seen in which condition?

Accepted Answer

Neurofibromatosis

Answer

Niemann Pick disease

Answer

Ochronosis

Answer

Glycogen storage disease

Question 3

Which of the following drugs has anxiolytic action with the least sedation?

Accepted Answer

Buspirone

Answer

Triazolam

Answer

Alprazolam

Answer

Chlordiazepoxide

Question 4

Which of the following is not seen in Tuberous sclerosis?

Accepted Answer

McCollum plaques

Answer

Shagreen patch

Answer

Adenoma sebaceum

Answer

Depigmented nevi

Question 5

A 10-year-old male child with short stature presents with complaints of frequent headaches over the past 6 months, slowly progressive loss of vision of the right eye, difficulty in walking, frequent mood changes, and excessive thirst. MRI brain showed a tumor in the sellar region, which was resected. HPE examination showed reticular epithelial cells with appearances reminiscent of the enamel pulp of developing teeth, along with calcifications and wet keratin nodules. The gene involved in causing this condition is also involved in causing which other condition?

Accepted Answer

Hepatocellular carcinoma

Answer

Melanoma

Answer

Neuroblastoma

Answer

Chronic myeloid leukemia

Question 6

A 1-year-old boy presents with a delay in motor development. Progressive muscle weakness and blindness ensue, and the patient dies within a year. The brain at autopsy shows swollen neurons that contain numerous lysosomes filled with lipid. Which of the following is the most likely diagnosis?

Accepted Answer

Tay-Sachs disease

Answer

AL amyloidosis

Answer

Hurler syndrome

Answer

Phenylketonuria

Question 7

Tau protein inclusions are involved in:

Accepted Answer

Alzheimer’s disease

Answer

Amyotrophic lateral sclerosis

Answer

Huntington's disease

Answer

CNS lymphoma

Question 8

Which among the following best describes 'Neuropraxia'?

Accepted Answer

Intact axon; Damaged nerve sheath

Answer

None of the above

Answer

Damaged axon and nerve sheath

Answer

Damaged axon; Intact nerve sheath

Question 9

A patient had a road traffic accident (RTA). NCCT head was normal on admission. The patient later died after several days in the ICU due to coma. Brain biopsy revealed multiple punctate hemorrhages. What is the diagnosis?

Accepted Answer

Diffuse axonal injury

Answer

Subdural hemorrhage

Answer

Intraventricular bleeding

Answer

Ischemic injury

Question 10

The CSF findings in bacterial meningitis would include which of the following?

Accepted Answer

Elevated protein and decreased glucose

Answer

Elevated WBC count with normal glucose

Answer

Decreased protein and elevated glucose

Answer

Normal white blood cell count

Neuropathology — MCQs

Neuropathology — MCQs

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