Neurology — MCQs
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A mother brought her child who has got a vascular plaque like lesion over the lateral aspect of forehead mainly involving ophthalmic and maxillary division of trigeminal nerve. Mother says that the lesion has remained unchanged since birth. Also mother gives a history that the child is on valproate for seizure disorder. What is the MOST probable diagnosis?
Meningomyelocele with progressive hydrocephalus is commonly seen in
A newborn developed periventricular leukomalacia following ischemic infarction. What can be the most common sequelae in this child?
Child was seen taking off clothes while watching TV; he suddenly closed eyes for some time and was lethargic after some time. He had probably
Give the most probable diagnosis of a 1 yr. old child of normal intelligence with features of hypotonia. On examination there are tongue fasciculations and he keeps his body in a frog like position ?
A 9 year old female patient has come for routine dental examination. She is unable to articulate her words properly. General examination reveals muscle weakness and stiffness, irregular gait, uncoordinated and involuntary movements, chewing and swallowing difficulties as well as speech problems. Which of the following may not be an etiologic factor for this condition?
A 9 year old female patient has come for a routine dental examination. She is unable to articulate her words properly. General examination reveals muscle weakness and stiffness, irregular gait, uncoordinated and involuntary movements, chewing and swallowing difficulties as well as speech problems. Which of the following reflexes maybe absent in this patient?
Febrile seizure persisting continuously beyond ____ should be treated with midazolam nasal spray:
Which of the following is true about febrile convulsions?
A 7-year old boy presents with a right-sided hemangioma and left-sided focal seizures. The most likely diagnosis is:
Neurology Indian Medical PG Practice Questions and MCQs
Question 221: A mother brought her child who has got a vascular plaque like lesion over the lateral aspect of forehead mainly involving ophthalmic and maxillary division of trigeminal nerve. Mother says that the lesion has remained unchanged since birth. Also mother gives a history that the child is on valproate for seizure disorder. What is the MOST probable diagnosis?
- A. Infantile hemangioma
- B. Tuberous sclerosis
- C. Sturge weber syndrome (Correct Answer)
- D. Incontinentia pigmenti
Explanation: ***Sturge weber syndrome*** - The classic presentation of a **vascular plaque-like lesion** (port-wine stain) in the distribution of the **trigeminal nerve** (ophthalmic and maxillary divisions) from birth, combined with a history of **seizure disorder**, strongly points to Sturge-Weber syndrome. - This neurocutaneous disorder is characterized by a **facial cutaneous angioma**, **leptomeningeal angioma** (leading to seizures), and often **ocular involvement** like glaucoma. *Infantile hemangioma* - While also a vascular lesion, **infantile hemangiomas** typically proliferate in the first few months of life and then involute, rather than being present as a stable "plaque" from birth. - They also don't typically follow a specific trigeminal nerve distribution and are not directly associated with a primary **seizure disorder** as a core feature. *Tuberous sclerosis* - Tuberous sclerosis presents with characteristic clinical features, including **facial angiofibromas** (adenoma sebaceum), **shagreen patches**, and **ash-leaf spots**, which are distinct from a flat vascular plaque. - Although seizures are common in tuberous sclerosis due to **cortical tubers**, the facial skin lesion described does not fit the typical dermatological manifestations of this condition. *Incontinentia pigmenti* - This condition presents with highly characteristic **skin lesions** that evolve through distinct stages, including vesicular, verrucous, and hyperpigmented (swirl-like patterns), which do not match the description of a vascular plaque. - While it can be associated with neurological issues like **seizures**, the dermatological findings are the primary differentiating factor here.
Question 222: Meningomyelocele with progressive hydrocephalus is commonly seen in
- A. Vein of Galen malformation
- B. Dandy-Walker malformation
- C. Choroid plexus papilloma
- D. Arnold-Chiari II (Correct Answer)
Explanation: ***Arnold Chiari II*** - **Arnold Chiari II malformation** is characterized by the downward displacement of the **cerebellar vermis and tonsils**, along with the brainstem, through the foramen magnum. - This malformation is almost always associated with **meningomyelocele** and often leads to **hydrocephalus** due to obstruction of CSF flow at the level of the foramen magnum and aqueductal stenosis. *Vein of Galen malformation* - A **Vein of Galen malformation** is an arteriovenous malformation located in the brain, which can cause high-output cardiac failure in neonates. - It can lead to hydrocephalus due to venous congestion but is not typically associated with **meningomyelocele**. *Dandy-Walker malformation* - **Dandy-Walker malformation** involves a hypoplastic or absent **cerebellar vermis**, cystic dilation of the fourth ventricle, and an enlarged posterior fossa. - While it often presents with hydrocephalus, it is not directly associated with **meningomyelocele**. *Choroid plexus papilloma* - A **Choroid plexus papilloma** is a rare, benign tumor that typically causes **hydrocephalus** due to **overproduction of CSF**. - It is not associated with **meningomyelocele** or Chiari malformations.
Question 223: A newborn developed periventricular leukomalacia following ischemic infarction. What can be the most common sequelae in this child?
- A. Hypotonia
- B. Spastic quadriplegia
- C. Spastic diplegia (Correct Answer)
- D. Intellectual disability
Explanation: ***Spastic diplegia*** - **Periventricular leukomalacia (PVL)** primarily damages the **white matter** adjacent to the ventricles, including descending motor tracts controlling leg movement. - This specific damage pattern often leads to **spasticity predominantly in the lower limbs**, characteristic of spastic diplegia. *Hypotonia* - While hypotonia may be present acutely in some hypoxic-ischemic injuries, it is not the **most common chronic sequela** of PVL. - PVL specifically damages **upper motor neuron pathways**, predominantly leading to spasticity rather than hypotonia in the long term. *Spastic quadriplegia* - Spastic quadriplegia implies **severe motor impairment** in all four limbs, usually resulting from more widespread or extensive brain damage. - PVL typically affects the motor tracts to the legs more severely, making spastic diplegia a more common and specific outcome. *Intellectual disability* - While **cognitive impairment** can be a complication of PVL, it is not the most common **motor sequela**. - **Motor disorders**, particularly spastic diplegia, are the hallmark clinical presentation following PVL.
Question 224: Child was seen taking off clothes while watching TV; he suddenly closed eyes for some time and was lethargic after some time. He had probably
- A. febrile seizures
- B. Absence seizures
- C. GTCS
- D. Temporal lobe epilepsy (Correct Answer)
Explanation: ***Temporal lobe epilepsy*** - The behavior described, such as **taking off clothes** (automatisms) and subsequent **lethargy** (postictal state), is highly characteristic of a **complex partial seizure**, which often originates in the temporal lobe. - **Eyes closing** during the event and partial awareness suggest that the seizure involved altered consciousness without a complete loss of awareness, typical of focal seizures with impaired awareness. *febrile seizures* - Febrile seizures are typically generalized tonic-clonic seizures that occur in children with a **fever**, which is not mentioned in the scenario. - The described actions like taking off clothes and sudden eye closure are not typical presentations of a classic febrile seizure. *Absence seizures* - Absence seizures involve **brief staring spells** and a momentary loss of consciousness, without the complex motor behaviors (automatisms) like taking off clothes. - There is typically no significant postictal lethargy associated with absence seizures; the child usually resumes activity immediately after the event. *GTCS* - **Generalized tonic-clonic seizures (GTCS)** involve a complete loss of consciousness, followed by tonic (stiffening) and clonic (jerking) phases, often with a loud cry and tongue biting. - While GTCS can lead to postictal lethargy, the specific automatisms (taking off clothes) and the partial impairment of consciousness are more indicative of a focal seizure.
Question 225: Give the most probable diagnosis of a 1 yr. old child of normal intelligence with features of hypotonia. On examination there are tongue fasciculations and he keeps his body in a frog like position ?
- A. Guillain-Barré Syndrome
- B. Limb girdle atrophy
- C. Spinal muscular atrophy (Correct Answer)
- D. Down's syndrome
Explanation: ***Spinal muscular atrophy*** - The combination of **hypotonia**, **normal intelligence**, **tongue fasciculations**, and a **frog-leg position** in an infant is highly characteristic of **Spinal Muscular Atrophy (SMA)**, particularly Type 1 (Werdnig-Hoffmann disease). - **Tongue fasciculations** are a key diagnostic sign resulting from denervation of the tongue muscles, and the **frog-leg position** is a compensatory posture due to proximal muscle weakness. *Guillain-Barré Syndrome* - **Guillain-Barré Syndrome (GBS)** is an acute, post-infectious demyelinating polyneuropathy that typically presents with **rapidly progressive ascending paralysis** and areflexia. - While GBS can cause hypotonia, it is rare in infants under 1 year of age and usually presents with an acute onset, unlike the more chronic presentation implied by the frog-leg position often seen in SMA. *Limb girdle atrophy* - **Limb-girdle muscular dystrophies** typically manifest later in childhood or adolescence, not usually in a 1-year-old infant. - These conditions primarily affect the **proximal muscles** of the shoulders and hips, causing weakness, but **tongue fasciculations** are not a typical feature. *Down's syndrome* - **Down syndrome** is characterized by distinctive **facial features**, intellectual disability, and often congenital heart defects, which are not mentioned here. - While **hypotonia** is common in Down syndrome, **tongue fasciculations** are not a feature, and intelligence is not normal.
Question 226: A 9 year old female patient has come for routine dental examination. She is unable to articulate her words properly. General examination reveals muscle weakness and stiffness, irregular gait, uncoordinated and involuntary movements, chewing and swallowing difficulties as well as speech problems. Which of the following may not be an etiologic factor for this condition?
- A. Hypothyroidism (Correct Answer)
- B. Head trauma
- C. Premature birth
- D. Meningitis
Explanation: ***Hypothyroidism*** - While **hypothyroidism** can cause developmental delays and neurological symptoms, it typically does not present with the specific constellation of **uncoordinated, involuntary movements** and **stiffness (spasticity)** characteristic of cerebral palsy. - The symptoms described are highly suggestive of **cerebral palsy**, and hypothyroidism is not considered a direct etiologic factor for this condition. *Head trauma* - **Head trauma**, particularly during infancy or childhood, can lead to **brain damage** that manifests as cerebral palsy-like symptoms. - The resulting neurological injury can cause **muscle weakness**, **spasticity**, and **uncoordinated movements**. *Premature birth* - **Premature birth** is a significant risk factor for **cerebral palsy** due to the increased vulnerability of the developing brain to injury before full term. - Complications such as **intraventricular hemorrhage** or **periventricular leukomalacia** are common in premature infants and can lead to the described neurological deficits. *Meningitis* - **Meningitis**, an infection of the membranes surrounding the brain and spinal cord, can cause **brain damage** and lead to long-term neurological sequelae. - The inflammation and potential for **ischemia** or **infarction** can result in motor deficits, **spasticity**, and **speech problems**, consistent with cerebral palsy.
Question 227: A 9 year old female patient has come for a routine dental examination. She is unable to articulate her words properly. General examination reveals muscle weakness and stiffness, irregular gait, uncoordinated and involuntary movements, chewing and swallowing difficulties as well as speech problems. Which of the following reflexes maybe absent in this patient?
- A. Parachute reflex (Correct Answer)
- B. Tonic labyrinthine reflex
- C. Startle reflex
- D. Asymmetric tonic neck reflex
Explanation: ***Parachute reflex*** - The clinical presentation describes **Cerebral Palsy (CP)** with motor impairment, dysarthria, and dysphagia. - The **parachute reflex** is a **protective reflex** that appears at 8-9 months and should **persist throughout life**. - It involves automatic extension of arms when the child is tilted forward, protecting against falls. - In children with CP, this protective reflex may be **absent or impaired**, indicating significant motor dysfunction affecting protective responses. - At 9 years of age, absence of this reflex is **abnormal and clinically significant**. *Tonic labyrinthine reflex* - This is a **primitive reflex** present at birth that normally **integrates (disappears) by 4-6 months** of age. - Its **absence** at 9 years would be **normal** (it should already be gone). - In CP, the problem is **persistence** of this reflex beyond infancy, not its absence, leading to extensor or flexor tone changes with head position. *Startle reflex* - The startle reflex (Moro reflex in infants) is a **primitive reflex** that should **integrate by 3-6 months** of age. - Its **absence** at 9 years would be **normal and expected**. - In CP, the abnormality is **persistence** or exaggerated responses, not absence, contributing to hypertonicity and exaggerated startle responses. *Asymmetric tonic neck reflex (ATNR)* - This **primitive reflex** (fencing posture) should **integrate by 4-6 months** of age. - Its **absence** at 9 years would be **normal** (it should already be integrated). - In CP, the problem is **persistence** of ATNR beyond infancy, not its absence, which interferes with midline activities, rolling, and hand-to-mouth coordination.
Question 228: Febrile seizure persisting continuously beyond ____ should be treated with midazolam nasal spray:
- A. 3 minutes
- B. 10 minutes
- C. 5 minutes (Correct Answer)
- D. 8 minutes
Explanation: ***5 minutes*** - Febrile seizures lasting longer than **5 minutes** are considered **prolonged** and require immediate intervention to prevent progression to status epilepticus. - **Midazolam nasal spray** is a convenient and effective first-line treatment for prolonged or status epilepticus due to its rapid absorption and anticonvulsant properties. *3 minutes* - While it's important to monitor febrile seizures, 3 minutes is generally too short a duration to initiate emergency medication for treatment. - Many febrile seizures self-terminate within this timeframe, and medical intervention is typically reserved for longer-lasting events. *10 minutes* - Waiting until 10 minutes to administer medication for a prolonged febrile seizure is generally too long and increases the risk of complications such as **status epilepticus** and potential neuronal damage. - Prompt intervention between 5-10 minutes is recommended to prevent these adverse outcomes. *8 minutes* - Similar to waiting 10 minutes, waiting 8 minutes to administer medication for a prolonged febrile seizure is generally too long. - Early intervention after the **5-minute mark** is crucial to improve outcomes and prevent further seizure activity.
Question 229: Which of the following is true about febrile convulsions?
- A. Recurrent in nature
- B. Occurs at 6 years onwards
- C. No spontaneous remission
- D. Follows high temperature (Correct Answer)
Explanation: ***Follows high temperature*** - Febrile convulsions are **directly associated with fever** and occur during febrile illness, typically when body temperature rises above **38°C (100.4°F)**. - By definition, a febrile seizure occurs in children aged **6 months to 5 years** during a **febrile illness** in the absence of CNS infection or other defined cause. - The seizure may occur during the **rising phase of fever** or when the temperature is already elevated, making this statement the most accurate characterization. *Recurrent in nature* - While febrile convulsions CAN recur, only approximately **30-40% of children** experience recurrent episodes. - The **majority (60-70%)** of children have only a **single episode**, so stating they are "recurrent in nature" is inaccurate. - Risk factors for recurrence include: young age at first episode, family history, and brief duration between fever onset and seizure. *No spontaneous remission* - This is incorrect; febrile convulsions have **excellent prognosis** with spontaneous resolution. - Individual episodes typically last only **a few minutes** and resolve spontaneously without intervention. - The condition itself remits as children grow older, with febrile seizures becoming **rare after age 5-6 years**. *Occurs at 6 years onwards* - This is incorrect; febrile convulsions occur in children between **6 months and 5 years of age**, with peak incidence around **18 months**. - Febrile seizures are **rare after age 6 years**, and a new-onset seizure with fever in an older child warrants investigation for other causes such as CNS infection or epilepsy.
Question 230: A 7-year old boy presents with a right-sided hemangioma and left-sided focal seizures. The most likely diagnosis is:
- A. Incontinentia pigmenti
- B. Sturge-Weber disease (Correct Answer)
- C. Neurofibromatosis
- D. Hypermelanosis of Ito
Explanation: ***Sturge-Weber disease*** - The classic presentation of a **facial hemangioma** (port-wine stain) and **focal seizures** on the contralateral side is highly characteristic of Sturge-Weber disease. - This neurocutaneous syndrome involves a **leptomeningeal angioma** on the same side as the facial hemangioma, leading to neurological symptoms. *Incontinentia pigmenti* - This X-linked dominant disorder primarily affects females and presents with **skin lesions** that evolve through vesicular, verrucous, and hyperpigmented stages, often in a **linear pattern**. - While it can cause neurological symptoms, a unilateral hemangioma and contralateral focal seizures are not typical. *Neurofibromatosis* - Neurofibromatosis Type 1 (NF1) is characterized by **café-au-lait spots**, **axillary/inguinal freckling**, and **neurofibromas**. - While seizures can occur, the combination of a unilateral hemangioma and contralateral focal seizures is not the hallmark presentation of neurofibromatosis. *Hypermelanosis of Ito* - This condition is characterized by **streaky or whorled hyperpigmentation** patterns on the skin, often following Blaschko's lines. - While neurological abnormalities can be associated, the primary cutaneous manifestation is diffuse hyperpigmentation, not a focal hemangioma.
Practice by Chapter
Seizure Disorders and Epilepsy
Practice Questions
Febrile Seizures
Practice Questions
Headache Disorders
Practice Questions
Cerebral Palsy
Practice Questions
Neural Tube Defects
Practice Questions
Neuromuscular Disorders
Practice Questions
Neurodegenerative Disorders
Practice Questions
CNS Infections
Practice Questions
Hydrocephalus
Practice Questions
Movement Disorders
Practice Questions
Traumatic Brain Injury
Practice Questions
Neuroimaging in Pediatrics
Practice Questions
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