Neurology Practice Questions

Q: Which of the following statements is false about Sacral Meningomyelocele?

Spasticity of the lower limbs is seen. **Explanation:** The correct answer is **A (Spasticity of the lower limbs is seen)** because this statement is false. Meningomyelocele is a type of neural tube defect where the spinal cord and meninges protrude through a vertebral defect. This results in a **Lower Motor Neuron (LMN)** type of lesion at and below the level of the defect. Consequently, patients present with **flaccid paralysis**, hypotonia, and areflexia, rather than spasticity (which is a feature of Upper Motor Neuron lesions). **Analysis of other options:** * **Option B (Hydrocephalus):** This is a common association. Over 80-90% of children with meningomyelocele develop hydrocephalus, often due to the associated **Chiari II malformation**, which obstructs CSF flow. * **Option C & D (Bladder/Bowel involvement):** Since the sacral nerves (S2-S4) control the detrusor muscle and anal sphincter, a sacral lesion typically leads to a neurogenic bladder (incontinence/dribbling) and a lax anal sphincter (fecal incontinence). **Clinical Pearls for NEET-PG:** 1. **Level of Lesion:** The most common site is the lumbosacral region. 2. **Prevention:** Supplementation of **Folic Acid (400 mcg/day)** pre-conceptionally reduces the risk by 70%. For mothers with a previous affected child, the dose is increased to **4 mg/day**. 3. **Screening:** Elevated **Maternal Serum Alpha-Fetoprotein (MSAFP)** at 16-18 weeks gestation is a key screening marker. 4. **Associated Malformation:** Always look for **Arnold-Chiari Malformation Type II** (downward displacement of the cerebellum and medulla).

Q: A 3-year-old child presents with a history of one episode of generalized tonic-clonic seizure lasting for 3-4 minutes, 6 hours ago, accompanied by a fever of 102°F and mild coryza. On examination, the child is conscious and alert, hemodynamically stable, and has no meningeal signs. Which of the following is true about the child's condition?

Intermittent prophylaxis with Clobazam is recommended.. This case describes a **Simple Febrile Seizure**. The child meets the criteria: age (6 months to 5 years), generalized seizure type, duration <15 minutes, and no recurrence within 24 hours. ### Why Option B is Correct In children with febrile seizures, **intermittent prophylaxis** is indicated if there is significant parental anxiety or a high risk of recurrence. **Clobazam** (0.5–1 mg/kg/day) or oral Diazepam is administered only during the febrile episode (starting at the onset of fever and continuing for 48–72 hours) to elevate the seizure threshold. ### Why Other Options are Incorrect * **Option A:** Long-term antiepileptic therapy (e.g., Valproate) is not indicated for simple febrile seizures. It is only considered for atypical/complex cases or if there is an underlying neurological deficit. * **Option C:** Lumbar puncture is not routinely required for a 3-year-old who is conscious, alert, and lacks meningeal signs. It is primarily considered in infants <12 months or if meningitis is clinically suspected. * **Option D:** While antipyretics like Paracetamol improve the child's comfort, clinical trials have shown they **do not reduce the risk of seizure recurrence** during that febrile illness. ### High-Yield Clinical Pearls for NEET-PG * **Most common age group:** 6 months to 5 years (Peak: 18 months). * **Simple vs. Complex:** Complex seizures are focal, last >15 minutes, or occur >1 time in 24 hours. * **Risk of Epilepsy:** Only ~1–2% (similar to the general population) for simple febrile seizures. * **Risk Factors for Recurrence:** Age <1 year, low degree of fever at onset, family history of febrile seizures, and short duration between fever onset and seizure.

Q: Which cranial nerves are affected in Moebius syndrome?

Cranial nerves 6 and 7. **Explanation:** **Moebius Syndrome** is a rare congenital neurological disorder characterized by the underdevelopment (agenesis or hypoplasia) of specific cranial nerve nuclei. **Why Option C is Correct:** The hallmark of Moebius syndrome is the **congenital paralysis of the facial nerve (CN VII) and the abducens nerve (CN VI)**, usually occurring bilaterally. * **CN VII involvement:** Leads to a "mask-like" facies, inability to smile, and difficulty with eye closure. * **CN VI involvement:** Results in lateral gaze palsy (inability to abduct the eyes), leading to internal strabismus (esotropia). **Why Other Options are Incorrect:** * **Option A & B:** While the Trigeminal nerve (CN V) can be involved in approximately 25% of cases (leading to weak mastication), it is not the defining feature. The diagnostic criteria mandate the involvement of CN VI and VII. * **Option D:** The Glossopharyngeal nerve (CN IX) and Hypoglossal nerve (CN XII) are involved in more severe variants (often associated with feeding difficulties and tongue atrophy), but they are not the primary nerves affected in the classic description of the syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Newborns often present with feeding difficulties, drooling, and an expressionless face when crying. * **Associated Features:** Frequently associated with limb abnormalities such as **Talipes equinovarus (Clubfoot)** and **Poland syndrome** (absence of pectoralis major muscle). * **Etiology:** Thought to be due to vascular disruption in the embryonic brainstem (subclavian artery steal sequence). * **Intelligence:** Most children have normal intelligence, though they may have speech delays due to motor deficits.

Q: Which of the following is NOT associated with an increased risk of future seizures in a child with a history of febrile seizures?

Late age of onset. **Explanation:** Febrile seizures are the most common seizure disorder in childhood, occurring in 2–5% of children. While most are benign, certain risk factors increase the likelihood of developing future **unprovoked seizures (epilepsy)**. **Why "Late age of onset" is the correct answer:** A **younger age of onset** (specifically <12–18 months) is a significant risk factor for the *recurrence* of febrile seizures. Conversely, a **late age of onset** does not increase the risk of future epilepsy. In fact, children who experience their first febrile seizure at an older age are statistically less likely to have recurrences or progress to epilepsy compared to infants. **Analysis of Incorrect Options:** * **Developmental delay:** Children with pre-existing neurological abnormalities or developmental delays have a significantly higher risk (up to 33%) of developing subsequent epilepsy. * **Complex febrile seizures:** Defined by duration >15 minutes, focal features, or recurrence within 24 hours. These carry a much higher risk of future epilepsy compared to simple febrile seizures. * **Positive family history:** A family history of **afebrile seizures (epilepsy)** is a well-documented risk factor for the child eventually developing epilepsy. **High-Yield Clinical Pearls for NEET-PG:** * **Risk of Epilepsy:** After a simple febrile seizure, the risk of epilepsy is ~1% (nearly the same as the general population). With risk factors, it rises to 10–15%. * **Most Important Risk Factor for Recurrence:** Age <1 year at the time of the first episode. * **Management:** Reassurance and antipyretics are key. Prophylactic anticonvulsants are generally not recommended due to side effects. * **Lumbar Puncture:** Strongly consider in infants <6–12 months to rule out meningitis, as signs of meningeal irritation may be absent.

Q: A teenager has a long history of "daydreaming" in school. EEG reveals evidence of a generalized seizure disorder, but there has never been a history of convulsive muscular activity. For the above patient with clinical symptoms and signs, select the most likely seizure type.

Absence (petit mal) seizures. ### Explanation **Correct Answer: D. Absence (petit mal) seizures** The clinical hallmark of **Absence Seizures** is a sudden, brief impairment of consciousness (typically 5–10 seconds) without loss of postural tone. These episodes are often described by teachers or parents as **"daydreaming"** or "staring spells." **Why it is correct:** * **Clinical Presentation:** The patient experiences frequent lapses in awareness but maintains muscle control (no convulsive activity), which fits the description of "daydreaming." * **EEG Findings:** The question mentions a "generalized seizure disorder." Absence seizures are primary generalized seizures. The classic EEG finding (high-yield for NEET-PG) is a **3 Hz spike-and-wave discharge**. **Why other options are incorrect:** * **A. Simple Partial Seizure:** These are focal seizures where consciousness is **preserved**. The patient would be aware of the event. * **B. Complex Partial Seizure:** While these involve impaired consciousness, they are **focal** (not generalized) and are often preceded by an **aura** or accompanied by **automatisms** (e.g., lip-smacking). They typically last longer (>30 seconds) than absence seizures. * **C. Tonic-Clonic Seizures:** These involve dramatic, symmetric convulsive muscular activity (tonic stiffening followed by clonic jerking), which the question explicitly rules out. **High-Yield Clinical Pearls for NEET-PG:** * **Age Group:** Most common in children aged 4–12 years. * **Provocation:** Episodes can be triggered by **hyperventilation** or photic stimulation. * **Drug of Choice:** **Ethosuximide** is the first-line treatment. Valproate is used if there are associated generalized tonic-clonic seizures. * **Prognosis:** Excellent; most children outgrow absence seizures by adolescence.

Q: A 6-year-old child presents with abnormal twitching of the face during sleep, which is noticed by the mother. EEG shows spikes over the centro temporal area. What is the diagnosis?

Rolandic epilepsy. ### Explanation **Correct Answer: B. Rolandic epilepsy** **Why it is correct:** The clinical presentation and EEG findings are classic for **Benign Childhood Epilepsy with Centrotemporal Spikes (BECTS)**, also known as **Rolandic Epilepsy**. This is the most common focal epilepsy syndrome in children (typically aged 3–13 years). * **Clinical Features:** Seizures typically occur during **sleep** or upon awakening. They involve the face (twitching), oropharynx (salivation, gurgling sounds), and speech arrest (anarthria), though they can secondarily generalize. * **EEG Hallmark:** The pathognomonic finding is **high-voltage spikes over the centrotemporal (Rolandic) area**, often increased during sleep. **Why the other options are incorrect:** * **A. Generalized tonic-clonic seizure (GTCS):** These involve the whole body with loss of consciousness and tonic-clonic movements from the onset. EEG would show generalized spike-and-wave discharges, not focal centrotemporal spikes. * **C. Absence seizure:** Characterized by brief "staring spells" and loss of awareness without focal twitching. The classic EEG finding is **3 Hz spike-and-wave discharges**. * **D. Subtle seizure:** These are primarily seen in **neonates** (e.g., bicycling movements, eye deviation, or lip-smacking) and do not fit the age group or the specific EEG pattern described. **High-Yield Clinical Pearls for NEET-PG:** * **Prognosis:** Excellent. Most children outgrow this condition by age 15–16 (puberty), hence the term "benign." * **Treatment:** Often not required if seizures are infrequent and nocturnal. If needed, **Carbamazepine** or Levetiracetam are first-line choices. * **Key EEG Buzzword:** "Centrotemporal spikes" or "Sylvian spikes." * **Age of Onset:** Peak incidence is between **7 and 10 years**.

Q: A child presented with mental retardation and spastic limbs with a history of perinatal distress. What is the most likely diagnosis?

Cerebral palsy. ### Explanation **Correct Option: A. Cerebral Palsy (CP)** Cerebral Palsy is a **non-progressive** motor impairment syndrome resulting from an insult to the developing brain (fetal or infant). The clinical hallmark is a combination of motor deficits (spasticity, dystonia, or ataxia) and often associated intellectual disability (mental retardation). A history of **perinatal distress** (asphyxia) is a classic risk factor leading to permanent brain injury. The presence of "spastic limbs" specifically points toward Spastic CP, the most common subtype, often involving the pyramidal tracts. **Why other options are incorrect:** * **B. Hypoxic Ischemic Encephalopathy (HIE):** While HIE is the *acute* event occurring at birth due to perinatal distress, it is a clinical stage (Sarnat staging). Cerebral Palsy is the *chronic, permanent sequela* or end-result of that initial HIE. * **C & D. Down’s (Trisomy 21) and Edward (Trisomy 18) Syndromes:** These are chromosomal anomalies. While they cause mental retardation, they typically present with distinct dysmorphic features (e.g., epicanthal folds in Down’s, clenched fists/rocker-bottom feet in Edward) and are usually associated with **hypotonia** rather than spasticity in the neonatal period. **High-Yield Clinical Pearls for NEET-PG:** * **Most common type of CP:** Spastic CP (specifically Spastic Diplegia is most associated with prematurity/PVL). * **Most common cause:** Prematurity (not birth asphyxia, though asphyxia is a significant contributor). * **Neuroimaging:** MRI is the investigation of choice; it may show Periventricular Leukomalacia (PVL). * **Early Sign:** Hand preference before the age of 1 year is a red flag for hemiplegic CP. * **Management:** Multidisciplinary; Baclofen or Botulinum toxin is used for spasticity management.

Q: Which of the following is NOT a treatment for infantile spasms?

Phenytoin. **Explanation:** Infantile spasms (West Syndrome) is a severe epileptic encephalopathy characterized by the triad of spasms, hypsarrhythmia on EEG, and developmental regression. The management focuses on specific medications that modulate the GABAergic system or the hypothalamic-pituitary-adrenal axis. **Why Phenytoin is the correct answer:** Phenytoin is a sodium channel blocker primarily used for focal seizures and generalized tonic-clonic seizures. It is **not effective** for infantile spasms and can, in some cases, exacerbate certain types of generalized seizures in infants. It does not address the underlying pathophysiology of West Syndrome. **Analysis of Incorrect Options:** * **ACTH (Adrenocorticotropic Hormone):** Historically considered the first-line treatment and the most effective agent for achieving rapid cessation of spasms and resolution of hypsarrhythmia. * **Corticosteroids (e.g., Oral Prednisolone):** Often used as an alternative to ACTH due to lower cost and ease of administration, showing comparable efficacy in high doses. * **Vigabatrin:** An irreversible inhibitor of GABA transaminase. It is the **drug of choice** specifically for infantile spasms associated with **Tuberous Sclerosis**. **High-Yield Clinical Pearls for NEET-PG:** * **West Syndrome Triad:** Spasms + Hypsarrhythmia + Mental Retardation. * **Drug of Choice (General):** ACTH or high-dose Prednisolone. * **Drug of Choice (Tuberous Sclerosis):** Vigabatrin. * **Side Effect Alert:** Vigabatrin is associated with permanent **visual field defects** (concentric peripheral field loss), requiring regular ophthalmological monitoring. * **Ketogenic Diet:** Often used as a second-line therapy for refractory cases.

Question 1

Which of the following statements is false about Sacral Meningomyelocele?

Accepted Answer

Spasticity of the lower limbs is seen

Answer

Hydrocephalus is seen

Answer

Bladder incontinence may be seen

Answer

Lax anal sphincter is present

Question 2

A 3-year-old child presents with a history of one episode of generalized tonic-clonic seizure lasting for 3-4 minutes, 6 hours ago, accompanied by a fever of 102°F and mild coryza. On examination, the child is conscious and alert, hemodynamically stable, and has no meningeal signs. Which of the following is true about the child's condition?

Accepted Answer

Intermittent prophylaxis with Clobazam is recommended.

Answer

Antiepileptics should be started and given for at least 2 years.

Answer

Lumbar puncture and CSF study should be done.

Answer

Paracetamol will decrease the recurrence risk of seizures.

Question 3

Which cranial nerves are affected in Moebius syndrome?

Accepted Answer

Cranial nerves 6 and 7

Answer

Cranial nerves 5 and 6

Answer

Cranial nerves 5 and 7

Answer

Cranial nerves 6 and 9

Question 4

Which of the following is NOT associated with an increased risk of future seizures in a child with a history of febrile seizures?

Accepted Answer

Late age of onset

Answer

Developmental delay

Answer

Complex febrile seizures

Answer

Positive family history

Question 5

A teenager has a long history of "daydreaming" in school. EEG reveals evidence of a generalized seizure disorder, but there has never been a history of convulsive muscular activity. For the above patient with clinical symptoms and signs, select the most likely seizure type.

Accepted Answer

Absence (petit mal) seizures

Answer

Simple partial seizure

Answer

Complex partial seizures

Answer

Tonic-clonic (grand mal) seizures

Question 6

A 9-year-old girl has had difficulty combing her hair and climbing stairs for 6 months. On examination, Gower sign is positive, and a maculopapular rash is present over the MCP joints. What is the next appropriate investigation to be done?

Accepted Answer

Serum creatine kinase

Answer

RA factor

Answer

Electromyography

Answer

Muscle biopsy

Question 7

A 6-year-old child presents with abnormal twitching of the face during sleep, which is noticed by the mother. EEG shows spikes over the centro temporal area. What is the diagnosis?

Accepted Answer

Rolandic epilepsy

Answer

Generalized tonic-clonic seizure (GTCS)

Answer

Absence seizure

Answer

Subtle seizure

Question 8

A child presented with mental retardation and spastic limbs with a history of perinatal distress. What is the most likely diagnosis?

Accepted Answer

Cerebral palsy

Answer

Hypoxic Ischemic Encephalopathy (HIE)

Answer

Down's syndrome

Answer

Edward syndrome

Question 9

Which of the following is NOT a treatment for infantile spasms?

Accepted Answer

Phenytoin

Answer

Corticosteroids

Answer

ACTH

Answer

Vigabatrin

Question 10

A 6-year-old boy presents with progressive weakness in muscles and difficulty walking upstairs. He has difficulty walking on his toes and exhibits a waddling gait. Calf muscle hypertrophy is noted, and his CPK levels are 10,000 LU. Which of the following is the most appropriate diagnosis?

Accepted Answer

Duchenne muscular dystrophy

Answer

Polymyositis

Answer

Congenital myopathy

Answer

Myotonia congenita

Neurology — MCQs

Neurology — MCQs

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