Other Neurocognitive Disorders — MCQs
Which of the following will have an organic cause?
What is the possible cause of irreversible dementia?
Which one of the following is a subcortical dementia?
Semantic memory includes all except:
Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
All of the following are prion associated diseases except?
Which of the following dementia is associated with visual hallucinations?
Which of the following is not associated with Korsakoff psychosis?
In chronic alcoholism and its complications, which of the following is seen?
A patient has been a known alcoholic for the last 20 years. He suddenly develops restlessness, tremors, and agitation. What is the most likely diagnosis?
Other Neurocognitive Disorders Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following will have an organic cause?
- A. Schizophrenia
- B. Delirium (Correct Answer)
- C. Anxiety
- D. Obsessive compulsive disorder
Explanation: ***Delirium*** - Delirium is an **acute, fluctuating disturbance of consciousness** and cognition that is directly caused by a **medical condition**, substance intoxication/withdrawal, or medication side effect [1], [2], [3]. - It always has an **underlying organic etiology** such as infection, metabolic derangements, drug toxicity, or neurological disorders [1], [2]. *Schizophrenia* - Schizophrenia is a **chronic psychiatric disorder** characterized by psychosis (hallucinations, delusions), disorganized thinking, and negative symptoms. - While it has a neurobiological basis, it is considered a **primary mental illness** and not typically caused by an acute, identifiable organic illness in the way delirium is. *Anxiety* - Anxiety disorders are characterized by excessive worry, fear, and physical symptoms of arousal. They are considered **primary mental health conditions**. - Although stress can precipitate anxiety, it is not primarily due to a **specific acute organic cause** that resolves with treatment of that cause. *Obsessive compulsive disorder* - Obsessive-compulsive disorder (OCD) is an anxiety-related disorder characterized by **recurrent, intrusive thoughts (obsessions)** and repetitive behaviors (compulsions) aimed at reducing distress. - Like other primary mental health conditions, it has a neurobiological basis but is not classified as having an **acute organic cause** in the medical sense.
Question 2: What is the possible cause of irreversible dementia?
- A. Vitamin B12 deficiency
- B. NPH
- C. Hypothyroid
- D. Lewy body (Correct Answer)
Explanation: ***Lewy body*** - **Lewy body dementia** is a progressive, irreversible neurodegenerative disorder characterized by the abnormal accumulation of **alpha-synuclein proteins** within neurons [1]. - It presents with fluctuating cognition, recurrent visual hallucinations, and spontaneous **parkinsonism**, eventually leading to severe and irreversible cognitive decline [1]. *Vitamin B12 deficiency* - **Vitamin B12 deficiency** can cause cognitive impairment and dementia-like symptoms, but these are often **reversible** with appropriate B12 supplementation [2]. - Symptoms include **anemia**, peripheral neuropathy, and psychiatric changes, which can improve with treatment. *NPH* - **Normal Pressure Hydrocephalus (NPH)** presents with a classic triad of gait disturbance, urinary incontinence, and dementia [2]. - While it causes dementia, it is often **reversible** with surgical placement of a **ventriculoperitoneal shunt** to drain excess CSF [2]. *Hypothyroid* - **Hypothyroidism** can lead to cognitive slowing, memory impairment, and confusion, resembling dementia. - These symptoms are typically **reversible** and improve significantly with **thyroid hormone replacement therapy**.
Question 3: Which one of the following is a subcortical dementia?
- A. Vit B12 deficiency
- B. Huntington's chorea (Correct Answer)
- C. Normal pressure Hydrocephalus
- D. Alzheimer's disease
Explanation: ***Huntington's chorea*** - **Huntington's disease** is a classic example of a **subcortical dementia**, characterized by prominent motor symptoms (chorea) along with cognitive decline [3]. - The pathology primarily affects the **basal ganglia**, a subcortical structure, leading to its distinctive clinical presentation [3]. *Vit B12 deficiency* - While **Vitamin B12 deficiency** can cause cognitive impairment and dementia-like symptoms, these are typically categorized as **reversible dementias** or **metabolic encephalopathies**, rather than a subcortical dementia [2]. - Its effects are widespread and not localized to subcortical structures in the primary sense of a neurodegenerative subcortical dementia. *Normal pressure Hydrocephalus* - **Normal pressure hydrocephalus (NPH)** is characterized by the triad of gait disturbance, urinary incontinence, and cognitive decline, and is often considered a **reversible cause of dementia** [2]. - Although it involves ventriculomegaly and affects white matter tracts, it is not classified as a subcortical dementia in the same neurodegenerative context as Huntington's or Parkinson's. *Alzheimer's disease* - **Alzheimer's disease** is the most common cause of **cortical dementia**, primarily affecting the cerebral cortex [1]. - It is characterized by significant deficits in memory, language, and executive functions due to cortical atrophy and neuronal loss [1].
Question 4: Semantic memory includes all except:
- A. Rules
- B. Language
- C. Events (Correct Answer)
- D. Words
Explanation: ***Events*** - **Episodic memory** is the type of long-term memory that stores information about specific **personal events** and experiences, complete with their contextual details like time and place. - Semantic memory, in contrast, involves general facts and knowledge, decoupled from specific personal experiences. *Rules* - **Semantic memory** encompasses our understanding of operating principles and **general truths**, such as the laws of physics or social conventions. - This abstract knowledge about how things work or are structured is a core component of semantic memory. *Language* - The understanding of **vocabulary**, **grammar**, and syntax necessary for communication is a key aspect of semantic memory. - This includes knowledge of word meanings, relationships between words, and how to construct grammatically correct sentences. *Words* - The meaning and definition of individual **words** are stored within **semantic memory**. - This allows us to comprehend spoken and written language and to use words appropriately in context.
Question 5: Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
- A. Statements 1 & 2 are correct, 2 is not explaining 1 (Correct Answer)
- B. Statements 1 and 2 are correct and 2 is the correct explanation for 1
- C. Statements 1 and 2 are incorrect
- D. Statement 1 is incorrect
Explanation: ***Correct: Statements 1 & 2 are correct, 2 is not explaining 1*** **Analysis of Statement 1:** - A 59-year-old patient with **flaccid bullae** and **suprabasal acantholytic split** on histopathology is the classic presentation of **Pemphigus vulgaris** - The flaccid (easily ruptured) nature of bullae distinguishes it from tense bullae seen in bullous pemphigoid - The suprabasal location of the split (just above the basal layer) with acantholysis (loss of cell-to-cell adhesion) is pathognomonic - **Statement 1 is CORRECT** ✓ **Analysis of Statement 2:** - The **"row of tombstones" or "tombstone appearance"** is indeed a diagnostic histopathological feature of Pemphigus vulgaris - This appearance results from basal keratinocytes remaining attached to the basement membrane while suprabasal cells separate due to acantholysis - The intact basal cells standing upright resemble a row of tombstones - **Statement 2 is CORRECT** ✓ **Does Statement 2 explain Statement 1?** - Statement 2 describes a **histopathological appearance** (tombstone pattern) that is a **consequence** of the suprabasal split - However, it does NOT explain the **underlying cause** of the flaccid bullae or the suprabasal split - The true explanation involves **IgG autoantibodies against desmoglein 3 (and desmoglein 1)**, which attack intercellular adhesion structures (desmosomes), causing **acantholysis** - Therefore, **Statement 2 does NOT explain Statement 1** ✗ *Incorrect: Statement 2 is the correct explanation for Statement 1* - While both statements describe features of Pemphigus vulgaris, the tombstone appearance is a descriptive finding, not an explanatory mechanism *Incorrect: Statements 1 and 2 are incorrect* - Both statements are medically accurate descriptions of Pemphigus vulgaris features *Incorrect: Statement 1 is incorrect* - Statement 1 correctly describes the cardinal clinical and histopathological features of Pemphigus vulgaris
Question 6: All of the following are prion associated diseases except?
- A. Alzheimer's disease (Correct Answer)
- B. Kuru
- C. Scrapie
- D. Creutzfeldt-Jakob disease
Explanation: ***Alzheimer's disease*** - Alzheimer's disease is primarily characterized by the accumulation of **amyloid-beta plaques** and **neurofibrillary tangles** composed of hyperphosphorylated tau protein, not by prion proteins [4]. - While it shares some features of protein **misfolding and aggregation** seen in prion diseases, its pathogenic mechanism is distinct and does not involve infectious prions [1]. *Kuru* - Kuru is a transmissible spongiform encephalopathy (TSE) caused by infectious **prion proteins**, historically linked to **ritualistic cannibalism** in New Guinea [2]. - It is one of the classic examples of a **human prion disease**, primarily affecting the central nervous system. *Creutzfeldt-Jakob disease (CJD)* - CJD is a progressive, fatal **neurodegenerative disorder** caused by **prion proteins** that can be sporadic, genetic, or acquired [3]. - It is characterized by rapidly progressive dementia and spongiform changes in the brain [3]. *Scrapie* - Scrapie is a **prion disease** that affects **sheep and goats**, causing neurological symptoms and ultimately death. - It is considered the **prototypical prion disease**, and its study provided early insights into the nature of prions. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, p. 1284. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1284-1286. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 712-713. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1292-1294.
Question 7: Which of the following dementia is associated with visual hallucinations?
- A. Lewy body dementia (Correct Answer)
- B. AIDS related Dementia
- C. Mixed dementia
- D. Huntington's disease
Explanation: ***Lewy body dementia*** - **Visual hallucinations**, particularly of well-formed and detailed images, are a **core clinical feature** of Lewy body dementia (LBD). - Other key features include **fluctuating cognition** with pronounced variations in attention and alertness, and **spontaneous parkinsonism**. *AIDS related Dementia* - Primarily presents with cognitive and motor slowing, **apathy**, and difficulty with complex tasks, rather than prominent visual hallucinations. - It is a subcortical dementia caused by **HIV infection** directly affecting the brain. *Mixed dementia* - This typically refers to a combination of **Alzheimer's disease** and **vascular dementia**, where hallucinations are not a prominent or early feature. - While visual hallucinations can occur in advanced stages of any dementia, they are not a defining characteristic of mixed dementia. *Huntington's disease* - Characterized by **chorea**, psychiatric disturbances, and cognitive decline, primarily affecting executive function. - **Visual hallucinations** are not a typical feature of Huntington's disease, although psychiatric symptoms like psychosis can occur.
Question 8: Which of the following is not associated with Korsakoff psychosis?
- A. Ophthalmoplegia (Correct Answer)
- B. Amnesia
- C. Confabulation
- D. Polyneuropathy
Explanation: ***Ophthalmoplegia*** - **Ophthalmoplegia** is a key feature of **Wernicke encephalopathy**, the acute phase preceding Korsakoff psychosis, but is not directly a symptom of Korsakoff psychosis itself. - While both conditions are linked to thiamine deficiency, **Korsakoff psychosis** primarily manifests as chronic memory deficits. *Amnesia* - **Anterograde amnesia** (inability to form new memories) and **retrograde amnesia** (loss of past memories) are defining characteristics of Korsakoff psychosis. - This severe memory impairment is a result of damage to areas like the **mammillary bodies** and **thalamus**. *Confabulation* - **Confabulation**, the fabrication of distorted or misinterpreted memories without an intention to deceive, is a common symptom in patients with Korsakoff psychosis. - This occurs as patients attempt to fill in gaps in their memory loss, often believing their own stories. *Polyneuropathy* - **Polyneuropathy**, nerve damage affecting multiple peripheral nerves, causing symptoms like pain, numbness, and muscle weakness, is associated with chronic **alcoholism** and **thiamine deficiency**. - While not a direct psychological symptom, it is frequently seen in the same patient population that develops Korsakoff psychosis due to shared etiology.
Question 9: In chronic alcoholism and its complications, which of the following is seen?
- A. Wernicke's syndrome
- B. Delirium tremens
- C. Korsakoff psychosis
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - **Wernicke's syndrome**, **Delirium tremens**, and **Korsakoff psychosis** are all well-recognized neurological and psychiatric complications associated with **chronic alcoholism** - Chronic alcohol abuse leads to nutritional deficiencies (especially **thiamine deficiency**) and neurotoxicity, predisposing individuals to these distinct but related conditions *Wernicke's syndrome* - Acute neurological disorder caused by **thiamine deficiency** - Characterized by classic triad: **ataxia**, **ophthalmoplegia**, and **confusion** - If untreated, can progress to **Korsakoff psychosis** *Delirium tremens* - Severe form of **alcohol withdrawal** in individuals with long history of heavy drinking - Symptoms include **delirium**, **severe agitation**, **tremors**, **hallucinations**, and autonomic hyperactivity (**tachycardia**, **hypertension**, **fever**) - Medical emergency requiring prompt treatment *Korsakoff psychosis* - Occurs due to chronic **thiamine deficiency**, often following Wernicke's encephalopathy - Characterized by severe **anterograde and retrograde amnesia**, **confabulation**, and relative preservation of other cognitive functions - Often results in permanent cognitive impairment
Question 10: A patient has been a known alcoholic for the last 20 years. He suddenly develops restlessness, tremors, and agitation. What is the most likely diagnosis?
- A. Alcoholic hallucinosis
- B. Wernicke's encephalopathy
- C. Korsakoff's syndrome
- D. Delirium tremens (Correct Answer)
Explanation: ***Delirium tremens*** - This condition is characterized by **restless tremors**, **agitation**, and often hallucinations, occurring in chronic alcoholics after sudden cessation or reduction of alcohol intake. - The symptoms typically appear **48-96 hours** after the last drink and can include severe autonomic hyperactivity such as tachycardia, hypertension, and hyperthermia. *Alcoholic hallucinosis* - This involves vivid auditory, visual, or tactile hallucinations that occur in a **clear sensorium**, typically 12-48 hours after decreased alcohol intake. - Unlike delirium tremens, there is usually **no significant disorientation** or severe autonomic instability. *Wernicke's encephalopathy* - This is an acute neurological condition due to **thiamine deficiency**, common in chronic alcoholics, presenting with the classical triad of **ocular disturbances** (nystagmus, ophthalmoplegia), **ataxia**, and **confusion**. - While confusion can be present, the primary symptoms described (restless tremors, agitation) are not the hallmark features. *Korsakoff's syndrome* - This is a chronic neuropsychiatric disorder that often follows untreated Wernicke's encephalopathy, characterized by **severe memory impairment** (anterograde and retrograde amnesia) and **confabulation**. - It primarily affects memory and learning, rather than acute agitation and tremors.
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