Neurology Practice Questions

Q: The only intact eye movement in one and a half syndrome is?

Abduction of the contralateral eye. **Explanation:** **One-and-a-half syndrome** is a clinical condition caused by a single lesion in the **dorsal pontine tegmentum**. This lesion involves two critical structures: 1. **The Ipsilateral Parapontine Reticular Formation (PPRF)** or Abducens nucleus: Leading to an ipsilateral horizontal gaze palsy (the "one"). 2. **The Ipsilateral Medial Longitudinal Fasciculus (MLF):** Leading to an Internuclear Ophthalmoplegia (INO) in the ipsilateral eye (the "half"). **Why the correct answer is right:** * **Option B (Abduction of the contralateral eye):** This is the only movement preserved because the contralateral PPRF and the contralateral Abducens nerve (VI) are intact. When the patient attempts to look towards the side opposite the lesion, the contralateral eye can still abduct. However, it often exhibits **dissociated nystagmus** due to the associated INO. **Why the incorrect options are wrong:** * **Option A & C (Ipsilateral eye):** The ipsilateral eye is completely "frozen" in the horizontal plane. It cannot abduct (due to the PPRF/VI nucleus lesion) and cannot adduct (due to the MLF lesion). * **Option D (Adduction of the contralateral eye):** Adduction of the contralateral eye requires the ipsilateral MLF to be intact. Since the ipsilateral MLF is damaged, the signal cannot reach the contralateral eye's medial rectus during horizontal gaze. **High-Yield Clinical Pearls for NEET-PG:** * **Lesion Site:** Dorsal pontine tegmentum. * **Common Causes:** Multiple Sclerosis (younger patients) or Pontine Stroke (older patients). * **Clinical Presentation:** The patient presents with a "frozen" ipsilateral eye and a contralateral eye that can only abduct (with nystagmus). * **Convergence:** Usually **preserved** because the pathway for convergence bypasses the MLF and PPRF.

Q: Examination of a patient shows abducens nerve paresis, ipsilateral facial nerve paresis, and contralateral hemiparesis. What is the most likely diagnosis in this patient?

Millard Gubler syndrome. ### Explanation **Millard-Gubler Syndrome** is a classic **ventral pontine syndrome** caused by a lesion (typically vascular or neoplastic) in the lower part of the pons. **1. Why the correct answer is right:** The syndrome is characterized by the involvement of three key structures: * **Abducens Nerve (CN VI) fibers:** Results in **ipsilateral** lateral rectus palsy (inability to abduct the eye). * **Facial Nerve (CN VII) fibers:** Results in **ipsilateral** lower motor neuron (LMN) type facial paralysis [1]. * **Corticospinal Tract:** Since the fibers have not yet decussated (they cross at the medulla), a lesion here results in **contralateral hemiparesis** of the limbs [1]. **2. Why the other options are incorrect:** * **Raymond’s Syndrome:** This is also a ventral pontine syndrome but is more restricted. It involves the **CN VI** and the **Corticospinal tract**, but **spares the Facial Nerve (CN VII)**. * **Foville’s Syndrome:** This involves the **dorsal** tegmentum of the lower pons. While it includes CN VII and hemiparesis, its hallmark is the involvement of the **PPRF (Parabedian Pontine Reticular Formation)**, leading to **ipsilateral conjugate gaze palsy** (the patient cannot look toward the side of the lesion). **3. Clinical Pearls for NEET-PG:** * **Rule of 4s:** Remember that CN 5, 6, 7, and 8 are located in the **Pons**. * **Crossed Hemiplegia:** Any syndrome presenting with an ipsilateral cranial nerve palsy and contralateral hemiparesis indicates a **Brainstem lesion**. * **Millard-Gubler vs. Foville:** If the question mentions "gaze palsy," think Foville; if it mentions "facial palsy + abducens palsy + hemiparesis," think Millard-Gubler.

Q: Symmetrical areflexic bladder, bowel, and lower limb dysfunction occurs in which of the following conditions?

Conus medullaris syndrome. The key to distinguishing between spinal cord syndromes lies in the **symmetry** and the **level of the lesion**. **1. Why Conus Medullaris Syndrome is Correct:** The conus medullaris is the tapered terminal end of the spinal cord (ending at L1-L2). Because it is a compact area containing the sacral and coccygeal segments, a lesion here typically results in **symmetrical** and **bilateral** involvement. It presents with sudden onset of bladder and bowel dysfunction (autonomic centers are located here) and "saddle anesthesia." Since it involves the terminal cord, it presents with **Lower Motor Neuron (LMN)** signs like areflexia. **2. Why the other options are incorrect:** * **Cauda Equina Syndrome:** This involves a bundle of nerve roots below the cord. It is characterized by **asymmetrical** motor weakness and sensory loss, with a more gradual onset of bladder/bowel symptoms compared to conus medullaris syndrome. * **Nerve Root Damage:** This typically presents with radiculopathy in a specific dermatomal or myotomal distribution, usually unilateral and rarely causing symmetrical total bladder/bowel dysfunction. * **Brown-Séquard Syndrome:** This is a hemisection of the spinal cord. It presents with **asymmetrical** findings: ipsilateral loss of motor function/proprioception and contralateral loss of pain/temperature. **Clinical Pearls for NEET-PG:** * **Level:** Conus Medullaris (L1-L2); Cauda Equina (L2-Sacrum). * **Symmetry:** Conus is **Symmetrical**; Cauda Equina is **Asymmetrical**. * **Reflexes:** Both show LMN signs (areflexia), but the **Ankle Jerk** is specifically lost in Conus Medullaris lesions. * **Onset:** Conus Medullaris symptoms are sudden/abrupt; Cauda Equina is gradual.

Q: Which of the following is a characteristic feature of frontotemporal dementia?

Alzheimer's disease. **Explanation:** Frontotemporal Dementia (FTD) is a heterogeneous group of non-Alzheimer’s dementias characterized by the selective atrophy of the frontal and temporal lobes. **Why the Correct Answer is Right:** Wait, there appears to be a discrepancy in the provided key. **Alzheimer’s Disease (Option D)** is typically the primary differential diagnosis for FTD, but it is **not** a characteristic feature of FTD. In fact, FTD is distinguished from Alzheimer’s by an earlier age of onset (typically 45–65 years) and the preservation of visuospatial skills, which are lost early in Alzheimer’s [1], [2]. If the question asks for a "characteristic feature," Options A, B, and C are all subtypes or pathological variants of FTD, whereas Alzheimer's is a distinct clinical entity [1]. **Analysis of Options:** * **A. Pick’s Disease:** A pathological subtype of FTD characterized by "Pick bodies" (silver-staining tau inclusions). It is a classic feature of behavioral-variant FTD. * **B. Nonfluent Aphasia:** A clinical variant of FTD (Progressive Nonfluent Aphasia) where patients struggle with speech production and grammar but retain word comprehension. * **C. Semantic Dementia:** A clinical variant of FTD where patients lose the meaning of words and objects but maintain fluent speech. * **D. Alzheimer’s Disease:** This is a separate neurodegenerative disorder characterized by amyloid plaques and neurofibrillary tangles, primarily affecting memory and posterior cortical functions first [1]. **NEET-PG High-Yield Pearls:** 1. **Clinical Triad of FTD:** Behavioral changes (disinhibition), personality shifts, and language impairment [2]. 2. **Imaging:** "Knife-edge" atrophy of frontal and temporal lobes on MRI. 3. **Genetics:** Often associated with mutations in the **MAPT** (tau) or **GRN** (progranulin) genes. 4. **Key Distinction:** Unlike Alzheimer’s, memory is often relatively preserved in the early stages of FTD [1].

Q: Which of the following is NOT a feature of Medial medullary syndrome?

Horner's syndrome. **Medial Medullary Syndrome (Dejerine Syndrome)** occurs due to occlusion of the **anterior spinal artery** or the paramedian branches of the vertebral artery. To master this topic for NEET-PG, remember the "Rule of 4" for brainstem strokes: Medial syndromes involve the "M" structures (Motor pathway, Medial lemniscus, and Motor cranial nerve nuclei). ### Why Horner’s Syndrome is the Correct Answer: **Horner’s syndrome** (ptosis, miosis, anhidrosis) is caused by damage to the **descending sympathetic fibers** [1]. These fibers travel in the **lateral** aspect of the medulla. Therefore, Horner’s syndrome is a hallmark of **Lateral Medullary Syndrome (Wallenberg Syndrome)**, not medial. ### Explanation of Incorrect Options: * **Contralateral hemiparesis:** Caused by involvement of the **Corticospinal tract** (Pyramids) in the medial medulla. Since the fibers decussate lower down, the weakness occurs on the opposite side of the lesion [4]. * **Ipsilateral paralysis of the tongue:** The **Hypoglossal nerve (CN XII) nucleus** and its exiting fibers are located medially. Damage leads to lower motor neuron paralysis of the tongue, causing it to deviate *toward* the side of the lesion. * **Contralateral loss of proprioception:** The **Medial Lemniscus** carries fine touch, vibration, and conscious proprioception [2]. Damage here results in loss of these sensations on the opposite side of the body. ### High-Yield Clinical Pearls for NEET-PG: * **The Medial Medulla Triad:** 1. Contralateral Hemiparesis, 2. Contralateral loss of vibration/proprioception, 3. Ipsilateral CN XII palsy. * **Lateral Medullary Syndrome (Wallenberg):** Look for PICA occlusion, dysphagia (CN IX, X), and ipsilateral Horner’s [1][3]. * **Key Distinction:** Medial syndromes affect **Motor** functions; Lateral syndromes affect **Sensory** (pain/temp) and **Autonomic** functions.

Q: What is the least common symptom in Friedrich's ataxia?

Moderate mental retardation. **Explanation:** Friedreich’s Ataxia (FRDA) is an autosomal recessive trinucleotide repeat (GAA) disorder characterized by the degeneration of the spinocerebellar tracts, posterior columns, and pyramidal tracts. **Why "Moderate Mental Retardation" is the correct answer:** Cognitive function is typically **preserved** in Friedreich’s Ataxia. While some patients may exhibit mild executive dysfunction or slowed processing speed late in the disease course due to cerebellar-cerebral pathways, significant or moderate mental retardation is **not** a feature of the disease. This distinguishes it from many other neurodegenerative storage disorders. **Analysis of Incorrect Options:** * **Scoliosis:** This is a very common skeletal manifestation, occurring in approximately 75–80% of patients. it often precedes the onset of significant ataxia. * **Cardiac Abnormality:** Hypertrophic cardiomyopathy (specifically symmetric or asymmetric septal hypertrophy) is present in about 90% of patients and is the **most common cause of death**. * **Diabetes Mellitus:** Impaired glucose tolerance or frank Diabetes Mellitus occurs in about 10–20% of cases due to insulin resistance and pancreatic beta-cell dysfunction. **High-Yield Clinical Pearls for NEET-PG:** * **Genetics:** GAA repeat on Chromosome 9 (Frataxin gene), leading to mitochondrial iron overload. * **Clinical Triad:** Progressive limb and gait ataxia, absent lower limb reflexes (areflexia), and extensor plantar responses (Babinski sign). * **Other Features:** Pes cavus (high-arched feet), optic atrophy, and sensorineural hearing loss. * **Differential:** Unlike Vitamin E deficiency (which mimics FRDA), FRDA involves cardiomyopathy and skeletal deformities.

Question 1

Alternating hemiplegia is best described as?

Accepted Answer

A neurological deficit involving limbs on one side and cranial nerves on the other side

Answer

A neurological deficit involving pairs of cranial nerves

Answer

A neurological deficit involving four limbs (quadriplegia)

Answer

Neurological deficits involving cranial nerves and limbs on the same side

Question 2

Alpha Coma is seen in which condition?

Accepted Answer

Diffuse cortical damage

Answer

Hyperthermia

Answer

Neurosarcoidosis

Answer

Critical illness polyneuropathy

Question 3

The only intact eye movement in one and a half syndrome is?

Accepted Answer

Abduction of the contralateral eye

Answer

Abduction of the ipsilateral eye

Answer

Adduction of the ipsilateral eye

Answer

Adduction of the contralateral eye

Question 4

Examination of a patient shows abducens nerve paresis, ipsilateral facial nerve paresis, and contralateral hemiparesis. What is the most likely diagnosis in this patient?

Accepted Answer

Millard Gubler syndrome

Answer

Foville's syndrome

Answer

Raymond's syndrome

Answer

None of the above

Question 5

Symmetrical areflexic bladder, bowel, and lower limb dysfunction occurs in which of the following conditions?

Accepted Answer

Conus medullaris syndrome

Answer

Cauda equina syndrome

Answer

Nerve root damage

Answer

Brown-Séquard syndrome

Question 6

An elderly man presents with ataxic hemiparesis. What is the most likely diagnosis?

Accepted Answer

Cerebellar hemorrhage

Answer

Acute ischemic stroke

Answer

Friedreich's ataxia

Answer

Spinal hemisection

Question 7

Which of the following is a characteristic feature of frontotemporal dementia?

Accepted Answer

Alzheimer's disease

Answer

Pick's disease

Answer

Nonfluent aphasia

Answer

Semantic dementia

Question 8

A typical child presents with an epigastric aura, followed by a quiet period of unresponsiveness with staring, lip-smacking, picking at sheets or clothes, contralateral dystonic posturing, and postictal confusion and lethargy. What is the probable diagnosis?

Accepted Answer

Temporal lobe epilepsy

Answer

Psychogenic seizures

Answer

Panic disorder

Answer

Occipital lobe epilepsy

Question 9

Which of the following is NOT a feature of Medial medullary syndrome?

Accepted Answer

Horner's syndrome

Answer

Contralateral hemiparesis

Answer

Ipsilateral paralysis of the tongue

Answer

Contralateral loss of proprioception

Question 10

What is the least common symptom in Friedrich's ataxia?

Accepted Answer

Moderate mental retardation

Answer

Scoliosis

Answer

Cardiac abnormality

Answer

Diabetes mellitus

Neurology — MCQs

Neurology — MCQs

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