Neurology Practice Questions

Q: Right internal carotid artery stenosis leads to all except?

Drop attacks. **Explanation:** Internal Carotid Artery (ICA) stenosis typically presents with symptoms involving the **Anterior Circulation** (Middle Cerebral Artery and Anterior Cerebral Artery territories) [1]. **Why "Drop Attacks" is the correct answer:** Drop attacks (sudden loss of muscle tone causing a fall without loss of consciousness) are a classic hallmark of **Vertebrobasilar Insufficiency (Posterior Circulation)**. They occur due to transient ischemia of the brainstem (specifically the reticular formation or pyramidal tracts). Since the ICA supplies the anterior circulation, drop attacks are not a feature of ICA stenosis. **Analysis of Incorrect Options:** * **Contralateral hemiparesis & hemi-sensory loss:** These are classic signs of ICA territory ischemia [1]. The ICA gives rise to the **Middle Cerebral Artery (MCA)**; occlusion leads to motor and sensory deficits on the opposite side of the body (face and arm > leg) [1]. * **Abulia:** This refers to a lack of willpower or initiative. It occurs due to ischemia in the **Anterior Cerebral Artery (ACA)** territory (also a branch of the ICA), affecting the frontal lobes or the basal ganglia. **Clinical Pearls for NEET-PG:** * **Amaurosis Fugax:** Transient monocular blindness ("curtain coming down") is a highly specific sign of **ipsilateral** ICA stenosis due to emboli reaching the ophthalmic artery [1]. * **Horner’s Syndrome:** Can occur in ICA dissection due to involvement of sympathetic fibers surrounding the artery. * **Posterior Circulation (Vertebrobasilar) Triad:** Vertigo, Visual field defects (Diplopia/Hemianopia), and Vestibular dysfunction (Ataxia). Drop attacks belong here.

Q: Which of the following statements is FALSE regarding Parkinsonism developing in individuals over 70 years of age?

The prognosis is worse.. **Explanation** In Parkinson’s Disease (PD), the age of onset significantly influences the clinical phenotype, progression, and treatment complications. **Why Option D is the False Statement:** Contrary to what might be assumed, the prognosis regarding **motor complications** is often considered "better" or more stable in older-onset patients compared to young-onset PD. While older patients have a higher risk of cognitive decline, they are significantly **less likely to develop motor fluctuations and levodopa-induced dyskinesias**. In young-onset PD, the disease course is longer, and the risk of severe, disabling dyskinesias is much higher, often leading to a worse long-term functional prognosis regarding motor control [1]. **Analysis of Other Options:** * **Option A:** True. Older patients have a lower risk of developing levodopa-induced dyskinesias compared to younger patients, likely due to age-related changes in dopamine receptor plasticity. * **Option B:** True. Autonomic dysfunction (orthostatic hypotension, urinary urgency) is more prevalent and severe in late-onset Parkinsonism due to the cumulative effect of aging on the autonomic nervous system [1]. * **Option C:** True. There is a strong correlation between advanced age at onset and the early development of cognitive impairment and dementia (PDD) [1]. **High-Yield NEET-PG Pearls:** * **Young-Onset PD ( 70 years):** Faster progression of **non-motor symptoms** (dementia, gait instability, falls) but lower risk of motor fluctuations [1]. * **Drug of Choice:** In patients >65-70 years, Levodopa is the first-line treatment. Dopamine agonists are often avoided due to the high risk of hallucinations and confusion in this age group [1].

Q: A 45-year-old chronic alcoholic presents with confusion, ataxia, ophthalmoplegia, and peripheral neuropathy. What is the most likely diagnosis?

Wernicke's encephalopathy. **Explanation:** The patient presents with the classic **clinical triad** of **Wernicke’s Encephalopathy (WE)**: 1. **Ophthalmoplegia** (specifically nystagmus or abducens nerve palsy) 2. **Ataxia** (gait instability) 3. **Confusion** (Global encephalopathy) **Underlying Concept:** WE is an acute, reversible biochemical lesion caused by a deficiency of **Thiamine (Vitamin B1)**. In chronic alcoholics, this deficiency arises due to poor dietary intake, impaired gastrointestinal absorption, and reduced hepatic storage. Thiamine is a co-factor for key enzymes in glucose metabolism; its absence leads to neuronal cell death, particularly in the **mammillary bodies** and the periaqueductal gray matter. **Why other options are incorrect:** * **Korsakoff’s Psychosis:** This is the chronic, often irreversible stage following WE. It is characterized by **anterograde amnesia** and **confabulation** (filling memory gaps with fabrications). While often occurring together (Wernicke-Korsakoff Syndrome), the acute triad points to WE. * **Delirium Tremens:** A severe form of alcohol withdrawal occurring 48–96 hours after the last drink. It features autonomic hyperactivity (tachycardia, hypertension), tremors, and clouded consciousness, but not ophthalmoplegia. * **Alcoholic Hallucinosis:** Occurs within 12–24 hours of abstinence. It is characterized by vivid auditory hallucinations in a state of **clear sensorium** (the patient is alert and oriented), unlike the confusion seen here. **High-Yield NEET-PG Pearls:** * **MRI Finding:** Increased T2/FLAIR signal intensity in the **mammillary bodies** (most specific) and dorsomedial thalamus. * **Management:** Immediate administration of **IV Thiamine**. * **Crucial Rule:** Always give Thiamine **before** Glucose. Administering glucose first in a thiamine-deficient patient can precipitate or worsen WE by consuming the remaining thiamine stores during glycolysis.

Q: Which of the following seizures has a clinical presentation of impaired consciousness with motor, sensory, or autonomic symptoms which are focal?

Complex partial. ### Explanation The correct answer is **Complex Partial Seizure** (now increasingly referred to as *Focal Impaired Awareness Seizure* in newer classifications). **1. Why Complex Partial is Correct:** The defining feature of a complex partial seizure is the **impairment of consciousness** (the patient is not aware of their surroundings and cannot respond appropriately) occurring alongside focal symptoms. These symptoms can be: * **Motor:** Automatisms like lip-smacking, hand-rubbing, or picking at clothes. * **Sensory/Autonomic:** Hallucinations, epigastric rising sensations, or tachycardia. Because the seizure discharge originates in a localized area of the brain (usually the temporal lobe), it is "partial" or "focal." **2. Why the Other Options are Incorrect:** * **Generalized Tonic-Clonic (GTC):** These involve the entire brain from the onset. While consciousness is lost, the motor activity is bilateral and symmetric (stiffening followed by jerking), not focal. * **Simple Partial:** In these seizures, **consciousness is fully preserved.** The patient remains aware and can describe the focal motor or sensory symptoms as they happen. * **Status Epilepticus:** This is a medical emergency defined by a seizure lasting >5 minutes or recurrent seizures without recovery of consciousness in between. It describes duration/frequency rather than a specific focal semiology. **3. NEET-PG Clinical Pearls:** * **Temporal Lobe Epilepsy (TLE):** The most common site for complex partial seizures. Look for "auras" (deja vu, jamis vu) or "gastric rising sensations." * **Post-ictal State:** Complex partial seizures are typically followed by a period of confusion or drowsiness, unlike absence seizures. * **Todd’s Paralysis:** A focal neurological deficit (like hemiparesis) following a focal seizure that resolves within 24 hours. * **Drug of Choice:** Carbamazepine or Levetiracetam are frequently used for focal seizures.

Q: All the following features are seen in Wernicke's encephalopathy except?

Confabulation. **Explanation:** Wernicke’s Encephalopathy (WE) is an acute, reversible neuropsychiatric emergency caused by **Thiamine (Vitamin B1) deficiency**, most commonly seen in chronic alcoholics. The diagnosis is clinical and is classically defined by a **triad** of symptoms: 1. **Ophthalmoplegia (Option A):** Most commonly manifests as **6th cranial nerve (Abducens) palsy**, leading to horizontal nystagmus or lateral rectus paralysis. 2. **Ataxia (Option B):** Primarily affecting gait and stance due to cerebellar involvement. 3. **Confusion (Option D):** An altered mental state or global cognitive impairment. **Why Confabulation is the correct answer:** **Confabulation** (the fabrication of memories to fill gaps) is a hallmark feature of **Korsakoff Psychosis**, not acute Wernicke’s Encephalopathy. While the two conditions are related (Wernicke-Korsakoff Syndrome), Korsakoff is the **chronic, irreversible** stage characterized by anterograde/retrograde amnesia and confabulation. Confabulation occurs when the acute confusion of WE clears, leaving behind a profound memory deficit. **High-Yield Clinical Pearls for NEET-PG:** * **The Triad:** Remember the mnemonic **CAN** (Confusion, Ataxia, Nystagmus/Ophthalmoplegia). * **Pathology:** Characterized by petechial hemorrhages in the **mammillary bodies** (most common site) and periaqueductal gray matter. * **Treatment Rule:** Always administer **Thiamine before Glucose**. Giving IV glucose first in a thiamine-deficient patient can precipitate or worsen WE by consuming the remaining B1 cofactors during glycolysis. * **Reversibility:** Ataxia and ophthalmoplegia usually respond rapidly to thiamine, but the memory deficits of Korsakoff are often permanent.

Q: A 45-year-old male hypertensive patient became unconscious while bathing. On examination, there was complete flaccid hemiplegia and the patient had difficulty in speaking, word ordering, and articulation, although could understand commands. The patient was diagnosed with a left Middle Cerebral Artery (MCA) territory infarct. What type of aphasia does the patient have?

Broca’s aphasia. **Explanation:** The patient presents with a classic **Left Middle Cerebral Artery (MCA) territory infarct**, specifically involving the **superior division**. The clinical hallmark here is the combination of right-sided hemiplegia and a **non-fluent aphasia**. 1. **Why Broca’s Aphasia is correct:** The patient has difficulty with speech production, word ordering, and articulation (non-fluent), but **comprehension is preserved** (can understand commands). This signifies damage to **Broca’s area (Brodmann areas 44, 45)** in the posterior inferior frontal gyrus [1]. Because the superior division of the MCA supplies both the motor cortex and Broca’s area, it typically presents with dense contralateral hemiplegia [1]. 2. **Why other options are incorrect:** * **Wernicke’s Aphasia:** Characterized by impaired comprehension ("word deafness") with fluent but nonsensical speech ("word salad"). It involves the inferior division of the MCA; motor deficits are usually absent. * **Global Aphasia:** Involves both Broca’s and Wernicke’s areas (total MCA stem occlusion). The patient would have both non-fluent speech and **impaired comprehension**. * **Anomic Aphasia:** The mildest form, characterized solely by difficulty in word-finding (naming objects), with intact fluency and comprehension. **Clinical Pearls for NEET-PG:** * **Broca’s = "Broken" speech:** Non-fluent, frustrated patient, comprehension intact [1]. * **Wernicke’s = "What?"/Wordy:** Fluent, unaware of deficit, comprehension lost [1]. * **Localization:** Broca’s is Frontal lobe (Superior MCA); Wernicke’s is Temporal lobe (Inferior MCA). * **Repeat after me:** Repetition is **impaired** in both Broca’s and Wernicke’s, but **preserved** in Transcortical aphasias.

Question 1

A 30-year-old female presents with headache and transient obscurations of her vision. On examination, no focal neurological deficit was seen. Which one of the following would you start her on?

Accepted Answer

Acetazolamide

Answer

Bromocriptine

Answer

Corticosteroids

Answer

Furosemide

Question 2

Right internal carotid artery stenosis leads to all except?

Accepted Answer

Drop attacks

Answer

Abulia

Answer

Contralateral hemiparesis

Answer

Contralateral hemi-sensory loss

Question 3

Which of the following statements is FALSE regarding Parkinsonism developing in individuals over 70 years of age?

Accepted Answer

The prognosis is worse.

Answer

Long-term side effects of levodopa, such as dyskinesia, are less frequent.

Answer

Autonomic disturbances are more likely to develop.

Answer

Cognitive changes and dementia are more common.

Question 4

Which one of the following is not a useful drug for the initial management of status epilepticus?

Accepted Answer

IV clobazam

Answer

IV phenytoin

Answer

IV thiopental

Answer

IV sodium valproate

Question 5

A 32-year-old patient presents with decreased pain and temperature sensation in the upper extremities, atrophy of the intrinsic muscles of the hand, and brisk deep tendon reflexes in the upper extremities. What is your diagnosis?

Accepted Answer

Syringomyelia

Answer

Amyotrophic lateral sclerosis

Answer

Multiple sclerosis

Answer

Subacute combined degeneration

Question 6

A 45-year-old chronic alcoholic presents with confusion, ataxia, ophthalmoplegia, and peripheral neuropathy. What is the most likely diagnosis?

Accepted Answer

Wernicke's encephalopathy

Answer

Korsakoff's psychosis

Answer

Delirium tremens

Answer

Alcoholic hallucinosis

Question 7

What is the most common cause of inherited peripheral neuropathy?

Accepted Answer

Charcot-Marie-Tooth disease

Answer

Hereditary neuropathy with pressure palsy

Answer

Familial amyloid polyneuropathy

Answer

Hereditary sensory neuropathy

Question 8

Which of the following seizures has a clinical presentation of impaired consciousness with motor, sensory, or autonomic symptoms which are focal?

Accepted Answer

Complex partial

Answer

Generalized tonic clonic

Answer

Simple partial

Answer

Status epilepticus

Question 9

All the following features are seen in Wernicke's encephalopathy except?

Accepted Answer

Confabulation

Answer

6th cranial nerve palsy

Answer

Ataxia

Answer

Confusion

Question 10

A 45-year-old male hypertensive patient became unconscious while bathing. On examination, there was complete flaccid hemiplegia and the patient had difficulty in speaking, word ordering, and articulation, although could understand commands. The patient was diagnosed with a left Middle Cerebral Artery (MCA) territory infarct. What type of aphasia does the patient have?

Accepted Answer

Broca’s aphasia

Answer

Wernicke’s aphasia

Answer

Global aphasia

Answer

Anomic aphasia

Neurology — MCQs

Neurology — MCQs

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