Neurology Practice Questions

Q: All of the following are true about Broca's aphasia except?

Repetition is preserved.. **Explanation:** Broca’s aphasia (Motor or Expressive aphasia) results from damage to **Broca’s area (Brodmann areas 44 and 45)**, located in the posterior part of the inferior frontal gyrus of the dominant hemisphere. **Why "Repetition is preserved" is the correct answer (the false statement):** In Broca’s aphasia, **repetition is significantly impaired**. Repetition requires an intact connection between the receptive (Wernicke’s) and expressive (Broca’s) areas via the arcuate fasciculus, as well as the functional integrity of both areas. Since the motor production of speech is damaged in Broca’s, the patient cannot repeat phrases spoken to them [1]. *Note: If repetition were preserved in a patient with non-fluent speech, the diagnosis would be Transcortical Motor Aphasia.* **Analysis of other options:** * **A. Lesion lies in the frontal lobe:** This is true. Broca’s area is situated in the **inferior frontal gyrus** [1]. * **B. Fluency is impaired:** This is true. It is a **non-fluent** aphasia characterized by "telegraphic speech," slow output, and great effort. * **C. Neologisms are absent:** This is true. Neologisms (creating new, meaningless words) are a hallmark of **Wernicke’s (fluent) aphasia**. Broca’s patients struggle to produce words but generally use existing ones (though often nouns/verbs only). **NEET-PG High-Yield Pearls:** * **Blood Supply:** Broca’s area is supplied by the **superior division of the Middle Cerebral Artery (MCA)**. * **Comprehension:** Remains **intact** (patients are often frustrated because they are aware of their deficit). * **Associated Deficit:** Often accompanied by **contralateral hemiparesis** (due to proximity to the motor cortex) [1]. * **Mnemonic:** **B**roca’s = **B**roken speech (non-fluent).

Q: A 63-year-old woman presents with weakness in her right hand, affecting her ability to write and button her clothes. Examination reveals marked atrophy of the forearm and hand muscles with fasciculations. Muscle tone is increased, reflexes are brisk, and sensory testing in the hand is normal. She also reports fasciculations in her thighs. Considering the patient's muscle weakness, what is the most likely anatomic site for the disorder?

anterior horn cell. The clinical presentation described is a classic manifestation of **Amyotrophic Lateral Sclerosis (ALS)**, a motor neuron disease characterized by the simultaneous involvement of both **Upper Motor Neurons (UMN)** and **Lower Motor Neurons (LMN)** [2]. ### Why Anterior Horn Cell is Correct: The **Anterior Horn Cell (AHC)** is the site of the lower motor neuron cell body [1]. Damage here results in LMN signs, while associated corticospinal tract involvement leads to UMN signs. * **LMN Signs in this patient:** Marked muscle atrophy and fasciculations (highly characteristic of AHC disease) [1]. * **UMN Signs in this patient:** Increased muscle tone (spasticity) and brisk reflexes. * **Sensory Sparing:** The absence of sensory deficits is a hallmark of AHC disorders, as the pathology is restricted to motor pathways [2]. ### Why Other Options are Incorrect: * **B. Peripheral Nerve:** While nerve lesions cause LMN signs (atrophy, weakness), they typically present with **sensory loss** (numbness/paresthesia) and **decreased/absent reflexes**, not brisk ones. * **C. Neuromuscular Junction (e.g., Myasthenia Gravis):** These disorders present with fatigable weakness and typically lack atrophy, fasciculations, or UMN signs. Reflexes remain normal. * **D. Muscle (Myopathy):** Primary muscle diseases usually cause proximal weakness (difficulty climbing stairs) rather than distal hand weakness. Fasciculations and UMN signs (brisk reflexes) are absent. ### NEET-PG High-Yield Pearls: * **The "Mixed" Picture:** Any question showing **atrophy + brisk reflexes** in the same limb points directly to ALS/Anterior Horn Cell disease [2]. * **Fasciculations:** These represent spontaneous firing of a motor unit and are the "signature" of AHC irritation [1]. * **Senses and Sphincters:** In ALS, sensory systems, ocular movements, and bowel/bladder sphincters are typically **spared** until very late stages [2].

Q: Avoiding response is due to which of the following brain lesions?

Contralateral parietal lobe lesions. **Explanation:** The **avoiding response** (or avoiding reaction) is a clinical sign characterized by an involuntary withdrawal or movement away from a tactile stimulus. It is considered a **release phenomenon** resulting from damage to the parietal lobe. **1. Why Option D is Correct:** The parietal lobe is responsible for processing sensory information and spatial awareness. When a lesion occurs in the **parietal lobe**, the normal "approach" or "grasp" tendencies (mediated by the frontal lobe) become unopposed. This results in the affected limb moving away from stimuli or the hand assuming a posture of extension and abduction when touched [2]. Because the motor and sensory pathways decussate, a lesion in one hemisphere manifests as an avoiding response in the **contralateral** (opposite) side of the body [1]. **2. Why Other Options are Incorrect:** * **Options A & B (Frontal Lobe):** Frontal lobe lesions typically produce the opposite effect—the **Grasp Reflex** [2]. In frontal lobe damage, the "avoiding" influence of the parietal lobe is lost, leading to an involuntary "approach" or grasping of objects. * **Option C (Ipsilateral):** Neurological deficits involving the cerebral hemispheres (like the parietal or frontal lobes) almost always manifest on the contralateral side of the body due to the crossing of the corticospinal and sensory tracts [1]. **Clinical Pearls for NEET-PG:** * **Frontal Lobe Lesion:** Leads to "Grasp Reflex" (Involuntary approach) [2]. * **Parietal Lobe Lesion:** Leads to "Avoiding Response" (Involuntary withdrawal). * **Magnetic Gait:** Often associated with frontal lobe/normal pressure hydrocephalus. * **Astereognosis & Hemispatial Neglect:** Classic signs of a parietal lobe lesion (specifically the non-dominant hemisphere for neglect) [3].

Q: A 25-year-old female at 16 weeks of gestation presents with excess vomiting, apathy, ataxia, nystagmus, and ophthalmoplegia. What is the most likely diagnosis?

Wernicke's encephalopathy. ### Explanation **Correct Answer: A. Wernicke’s encephalopathy** **1. Why it is correct:** The patient presents with the classic clinical triad of **Wernicke’s encephalopathy (WE)**: **Ophthalmoplegia** (including nystagmus), **Ataxia**, and **Confusion/Apathy**. In the context of pregnancy, WE is a rare but life-threatening complication of severe **Hyperemesis Gravidarum (HG)**. Prolonged vomiting leads to a critical deficiency of **Vitamin B1 (Thiamine)**. Thiamine is a co-factor for glucose metabolism; when depleted, it causes neuronal cell death, particularly in the mammillary bodies and dorsomedial thalamus. **2. Why the other options are incorrect:** * **B. Hyperemesis gravidarum:** While HG is the *underlying cause* of the thiamine deficiency, it refers specifically to the severe nausea and vomiting. Once neurological symptoms (ataxia, nystagmus) appear, the diagnosis progresses to WE. * **C. Chorea gravidarum:** This is a movement disorder characterized by involuntary, jerky, purposeless movements (chorea) during pregnancy, often associated with a history of rheumatic fever or SLE. It does not present with ophthalmoplegia or ataxia. * **D. Korsakoff’s encephalopathy:** This is the chronic, irreversible stage following WE. It is characterized by profound **anterograde amnesia and confabulation**. The acute presentation of eye signs and ataxia points specifically to Wernicke’s. **3. NEET-PG High-Yield Pearls:** * **The Golden Rule:** Always administer **Thiamine BEFORE Glucose** in a patient with HG. Giving IV dextrose first can precipitate or worsen WE by consuming the last remaining thiamine stores during glycolysis. * **Diagnosis:** Primarily clinical, but MRI may show bilateral symmetrical high signal intensities in the mammillary bodies. * **Triad:** Confusion, Ataxia, and Ophthalmoplegia (only present in ~16-38% of cases, making high clinical suspicion vital).

Q: What is the drug of choice for idiopathic intracranial hypertension?

Acetazolamide. **Explanation:** **Idiopathic Intracranial Hypertension (IIH)**, also known as Pseudotumor Cerebri, is characterized by increased intracranial pressure (ICP) without an identifiable cause (like a tumor or obstruction). **Why Acetazolamide is the Drug of Choice:** Acetazolamide is a **Carbonic Anhydrase Inhibitor**. In the CNS, carbonic anhydrase is essential for the production of Cerebrospinal Fluid (CSF) by the choroid plexus. By inhibiting this enzyme, Acetazolamide significantly reduces the rate of CSF secretion, thereby lowering intracranial pressure. It is the first-line medical therapy, often combined with weight loss [1]. **Analysis of Incorrect Options:** * **B. Glycerol & C. Mannitol:** These are **osmotic diuretics**. While they are highly effective for the *acute* management of cerebral edema or life-threatening elevations in ICP (e.g., head injury), they are not suitable for the long-term management of IIH due to the risk of rebound ICP and electrolyte imbalances. * **D. Dexamethasone:** While glucocorticoids reduce ICP in cases of vasogenic edema (associated with brain tumors or abscesses), they are **not recommended** for IIH. In fact, steroid withdrawal can sometimes trigger or worsen IIH. **Clinical Pearls for NEET-PG:** * **Classic Presentation:** Obese female of childbearing age presenting with headache, papilledema, and "whooshing" tinnitus (pulsatile). * **Side Effects of Acetazolamide:** Paresthesia (most common), metabolic acidosis, and hypokalemia [1]. * **Alternative:** If Acetazolamide is not tolerated, **Topiramate** is an alternative as it also has weak carbonic anhydrase inhibitory activity and aids in weight loss. * **Surgical Management:** If medical therapy fails and vision is threatened, Optic Nerve Sheath Fenestration or CSF shunting is performed.

Question 1

Contralateral superior quadrantanopia and sensory aphasia occurs due to occlusion of which branch of the middle cerebral artery?

Accepted Answer

M2 segment, inferior division

Answer

M2 segment, superior division

Answer

MCA stem

Answer

M1 segment

Question 2

All of the following are true about Broca's aphasia except?

Accepted Answer

Repetition is preserved.

Answer

Lesion lies in the frontal lobe.

Answer

Fluency is impaired.

Answer

Neologisms are absent.

Question 3

A 70-year-old male presents with difficulty understanding written language, with no associated difficulty in understanding auditory information. He was in good health except for a recent head trauma after an accidental fall. What is the most probable diagnosis?

Accepted Answer

Anomic aphasia

Answer

Broca's aphasia

Answer

Wernicke's aphasia

Answer

Jargon aphasia

Question 4

A patient presents with sudden onset of unilateral or bilateral weakness, sensory loss, disorder of ocular motility, and loss of facial sensation, along with ataxia. Based on these symptoms, what is the most likely site of the cerebrovascular lesion?

Accepted Answer

Basilar artery

Answer

Internal carotid artery

Answer

Middle cerebral artery

Answer

Penetrating branch of the middle cerebral artery

Question 5

A 63-year-old woman presents with weakness in her right hand, affecting her ability to write and button her clothes. Examination reveals marked atrophy of the forearm and hand muscles with fasciculations. Muscle tone is increased, reflexes are brisk, and sensory testing in the hand is normal. She also reports fasciculations in her thighs. Considering the patient's muscle weakness, what is the most likely anatomic site for the disorder?

Accepted Answer

anterior horn cell

Answer

peripheral nerve

Answer

neuromuscular junction

Answer

muscle

Question 6

All of the following statements about Myasthenia Gravis are true, except?

Accepted Answer

Anti-MuSK antibodies are directed against muscarinic ACh receptors.

Answer

Anti-AChR antibodies are the most common antibodies in generalized myasthenia gravis.

Answer

The pathogenic Anti-AChR antibodies are IgG antibodies.

Answer

The major defect is a decrease in the number of available ACh receptors.

Question 7

Avoiding response is due to which of the following brain lesions?

Accepted Answer

Contralateral parietal lobe lesions

Answer

Ipsilateral frontal lobe lesions

Answer

Contralateral frontal lobe lesions

Answer

Ipsilateral parietal lobe lesions

Question 8

A 25-year-old female at 16 weeks of gestation presents with excess vomiting, apathy, ataxia, nystagmus, and ophthalmoplegia. What is the most likely diagnosis?

Accepted Answer

Wernicke's encephalopathy

Answer

Hyperemesis gravidarum

Answer

Chorea gravidarum

Answer

Korsakoff's encephalopathy

Question 9

What is the drug of choice for idiopathic intracranial hypertension?

Accepted Answer

Acetazolamide

Answer

Glycerol

Answer

Mannitol

Answer

Dexamethasone

Question 10

A man coughed and developed sudden severe headache and fainting. What is the most probable diagnosis?

Accepted Answer

Subarachnoid hemorrhage

Answer

Migraine

Answer

Cluster headache

Answer

Posterior fossa tumor

Neurology — MCQs

Neurology — MCQs

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