Neurology Practice Questions

Q: A 50-year-old man presents with ataxia and abnormal eye movements. Examination reveals gaze palsy. MRI was performed. What is the most likely diagnosis?

Progressive supranuclear palsy. ***Progressive supranuclear palsy*** - **Gaze palsy** (especially vertical gaze) combined with **ataxia** is pathognomonic for PSP, distinguishing it from other movement disorders. - MRI typically shows the **"hummingbird sign"** due to **midbrain atrophy**, which is characteristic of PSP. *Multiple system atrophy-cerebellar type* - Primarily presents with **cerebellar dysfunction** and **autonomic failure** (orthostatic hypotension, bladder dysfunction). - **Gaze palsy** is not a typical feature of MSA-C, which helps differentiate it from PSP. *Parkinsonism* - Classic **bradykinesia**, **rigidity**, and **resting tremor** are the hallmark features of Parkinsonism. - **Gaze palsy** and prominent **ataxia** are not characteristic of typical Parkinson's disease. *Cerebellar ataxia* - Presents with **coordination problems**, **dysmetria**, and **intention tremor** without gaze abnormalities. - **Gaze palsy** is not a feature of pure cerebellar disorders, making PSP more likely in this case.

Q: A 45-year-old hypertensive male presented with sudden onset severe headache, vomiting, and neck stiffness. On examination, he did not have any focal neurological deficit. His CT scan showed blood in the Sylvian fissure. What is the probable diagnosis?

Ruptured aneurysm. ### Explanation **Correct Answer: B. Ruptured aneurysm** The clinical presentation of "sudden onset severe headache" (often described as a **thunderclap headache**), vomiting, and signs of meningeal irritation (neck stiffness) without focal deficits is the classic triad of a **Subarachnoid Hemorrhage (SAH)** [1]. The most common cause of non-traumatic SAH is a **ruptured berry aneurysm**. The CT finding of blood in the **Sylvian fissure** is highly characteristic of a ruptured aneurysm, specifically of the **Middle Cerebral Artery (MCA)**. Unlike intraparenchymal bleeds, SAH follows the CSF spaces (fissures, sulci, and cisterns) [1]. **Why other options are incorrect:** * **A. Meningitis:** While it presents with headache, fever, and neck stiffness, it does not cause acute blood in the Sylvian fissure on a CT scan [1]. * **C. Hypertensive bleed:** These typically occur within the brain parenchyma (intracerebral hemorrhage). The most common sites are the **Putamen**, Thalamus, or Pons. They usually present with significant focal neurological deficits (e.g., hemiplegia). * **D. Stroke:** Ischemic stroke usually presents with painless, focal neurological deficits and would show an area of infarct (hypodensity) rather than acute blood (hyperdensity) on a CT scan. **Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Digital Subtraction Angiography (DSA) is the gold standard to identify the site of the aneurysm [2]. * **Initial Investigation:** Non-contrast CT (NCCT) Head is the first-line investigation (95% sensitivity in the first 24 hours) [1]. * **Complications:** Vasospasm (prevented by **Nimodipine** [2]) and Re-bleeding (most common in the first 24 hours). * **Commonest Site:** Anterior Communicating Artery (overall); however, Sylvian fissure blood specifically points to the MCA.

Q: A 36-year-old male with a family history of suicide and abnormal movements with dementia is investigated. What is the investigation of choice?

Trinucleotide repeats. **Explanation:** The clinical presentation of **abnormal movements (chorea)**, **dementia**, and a **family history of psychiatric illness (suicide)** in a young adult is a classic description of **Huntington’s Disease (HD)**. 1. **Why Trinucleotide Repeats is correct:** Huntington’s Disease is an autosomal dominant neurodegenerative disorder caused by an unstable expansion of **CAG trinucleotide repeats** in the *HTT* gene on chromosome 4. Genetic testing to quantify these repeats is the **gold standard and investigation of choice** for definitive diagnosis. A repeat count of ≥40 is fully penetrant for the disease. 2. **Why other options are incorrect:** * **Psychological examination:** While useful for assessing the severity of dementia or depression, it cannot provide a definitive diagnosis of the underlying genetic pathology. * **ECG:** Has no diagnostic value for HD; it is used for cardiac evaluation. * **MRI:** While MRI may show characteristic **atrophy of the caudate nucleus** (leading to "boxcar ventricles"), these changes often appear later in the disease. Genetic testing remains superior for early and definitive diagnosis. **High-Yield Clinical Pearls for NEET-PG:** * **Inheritance:** Autosomal Dominant with **Anticipation** (earlier onset in successive generations, especially when inherited from the father). * **Pathology:** Loss of GABAergic neurons in the Striatum (Caudate + Putamen). * **Neurotransmitters:** Decreased GABA and Acetylcholine; Increased Dopamine. * **Triad:** Motor (Chorea), Cognitive (Dementia), and Psychiatric (Depression/Suicidality) symptoms.

Q: Which one of the following is an example of Motor Neuropathy?

Dapsone neuropathy. Peripheral neuropathies are classified based on the type of nerve fibers involved: sensory, motor, or mixed (sensorimotor) [1]. Most neuropathies are mixed, making pure motor or pure sensory presentations high-yield for exams. ### **Explanation of the Correct Answer** **B. Dapsone neuropathy:** Dapsone (used in Leprosy and Dermatitis Herpetiformis) is a classic cause of a **predominantly motor, axonal neuropathy**. It typically presents with wasting and weakness of the small muscles of the hands and feet. Unlike the sensory loss seen in Leprosy itself, Dapsone toxicity specifically targets motor neurons. Other classic motor neuropathies include Lead poisoning, Guillain-Barré Syndrome (GBS), and Porphyria [1]. ### **Analysis of Incorrect Options** * **A. Sjogren’s syndrome:** This is characteristically associated with **Sensory Neuronopathy** (Ganglionopathy) due to inflammation of the dorsal root ganglia. It presents with sensory ataxia and "sicca" symptoms [2]. * **C. Tangier disease:** This is a rare genetic disorder of cholesterol transport. It typically presents with a **syringomyelia-like syndrome** (dissociated sensory loss) and orange-colored tonsils [1]. * **D. Amyloidosis:** This typically causes a **Small-Fiber Sensory Neuropathy**, often presenting with painful dysesthesia and early autonomic dysfunction. It is also a common cause of Carpal Tunnel Syndrome [3]. ### **NEET-PG High-Yield Pearls** * **Pure Motor Neuropathies (Mnemonic: "L-DOPA"):** **L**ead poisoning (radial nerve/wrist drop), **D**apsone, **O**rganophosphates, **P**orphyria, **A**cute Inflammatory Demyelinating Polyradiculoneuropathy (GBS) [1]. * **Pure Sensory Neuropathies:** Sjogren’s, Vitamin B6 toxicity, Cisplatin, and Paraneoplastic syndromes (Anti-Hu) [2]. * **Lead Poisoning vs. Dapsone:** Both cause motor neuropathy, but Lead poisoning characteristically spares the Brachioradialis muscle.

Q: Pure word blindness occurs due to lesion in which artery?

Posterior cerebral artery. **Explanation:** **Pure word blindness**, also known as **Alexia without Agraphia**, is a clinical syndrome where a patient can write but cannot read what they have written [1]. This occurs due to a lesion in the **Posterior Cerebral Artery (PCA)**, specifically involving the **left primary visual cortex** and the **splenium of the corpus callosum**. 1. **Why PCA is correct:** The PCA supplies the occipital lobe and the splenium [3]. A stroke in the left PCA causes a right homonymous hemianopia (loss of the right visual field) [2]. Because the splenium is also infarcted, visual information from the intact right occipital lobe cannot cross over to the language centers (Angular gyrus) in the left hemisphere [1]. Thus, the patient can see words but cannot process or "read" them. 2. **Why other options are incorrect:** * **Anterior Cerebral Artery (ACA):** Supplies the medial surface of the frontal and parietal lobes. Lesions typically result in contralateral lower limb weakness and urinary incontinence. * **Middle Cerebral Artery (MCA):** Supplies the lateral convexity of the brain, including Broca’s and Wernicke’s areas [1]. An MCA stroke would typically cause **Aphasia** (difficulty speaking or understanding) and **Agraphia** (inability to write), rather than pure word blindness. * **Spinal Artery:** Supplies the spinal cord; it has no role in higher cortical functions like reading or vision. **High-Yield Clinical Pearls for NEET-PG:** * **Dejerine Syndrome:** Another name for Alexia without Agraphia. * **Angular Gyrus Lesion:** Results in **Alexia WITH Agraphia** (Gerstmann Syndrome), usually involving the MCA territory [1]. * **Macular Sparing:** A classic sign of PCA territory infarcts due to collateral supply from the MCA to the occipital pole.

Question 1

A 50-year-old man presents with ataxia and abnormal eye movements. Examination reveals gaze palsy. MRI was performed. What is the most likely diagnosis?

Accepted Answer

Progressive supranuclear palsy

Answer

Multiple system atrophy-cerebellar type

Answer

Parkinsonism

Answer

Cerebellar ataxia

Question 2

A lady in her first trimester with hyperemesis gravidarum presents with diplopia, mental confusion, and nystagmus. What is the probable diagnosis?

Accepted Answer

Wernicke's syndrome

Answer

Pregnancy-induced hypertension

Answer

Occipital infarction

Answer

Pituitary apoplexy

Question 3

A patient presents with acute onset headache, fever, and seizure. What is the most likely diagnosis?

Accepted Answer

Encephalitis

Answer

Meningitis

Answer

Migraine

Answer

Subarachnoid haemorrhage

Question 4

All of the following are features of cerebellar disease except?

Accepted Answer

Hypotonia

Answer

Intention tremors

Answer

Past pointing

Answer

Ataxia

Question 5

A 45-year-old hypertensive male presented with sudden onset severe headache, vomiting, and neck stiffness. On examination, he did not have any focal neurological deficit. His CT scan showed blood in the Sylvian fissure. What is the probable diagnosis?

Accepted Answer

Ruptured aneurysm

Answer

Meningitis

Answer

Hypertensive bleed

Answer

Stroke

Question 6

A 48-year-old woman presents with a 6-month history of intermittent cranial nerve palsy that has become progressively worse in the past 2 weeks. On examination, ptosis and diplopia are evident. Her condition shows a favorable response to the anticholinesterase inhibitory drug neostigmine. What is the most likely diagnosis?

Accepted Answer

Myasthenia gravis

Answer

Cerebral palsy

Answer

Pineal gland tumor

Answer

Adenoma of the pituitary

Question 7

A 36-year-old male with a family history of suicide and abnormal movements with dementia is investigated. What is the investigation of choice?

Accepted Answer

Trinucleotide repeats

Answer

Psychological examination

Answer

ECG

Answer

MRI

Question 8

Which one of the following is an example of Motor Neuropathy?

Accepted Answer

Dapsone neuropathy

Answer

Sjogren's syndrome

Answer

Tangier disease

Answer

Amyloidosis

Question 9

Pure word blindness occurs due to lesion in which artery?

Accepted Answer

Posterior cerebral artery

Answer

Anterior cerebral artery

Answer

Middle cerebral artery

Answer

Spinal artery

Question 10

A 35-year-old female presented with paresthesias and weakness of bilateral lower limbs, a band-like sensation of tightness around the torso, painful loss of vision in both eyes, diplopia, and periorbital pain. She has a history of similar attacks with periods of normalcy in between. On examination, ataxia, papillitis (on fundus examination), facial myokymia, bladder incontinence, and constipation were noted. CSF studies revealed mononuclear cell pleocytosis along with increased IgG. Which of the following are the oral drugs approved for the above condition?

Accepted Answer

Natalizumab

Answer

Fingolimod

Answer

Teriflunomide

Answer

Glatiramer acetate

Neurology — MCQs

Neurology — MCQs

On this page

Practice by Chapter

Want unlimited practice?