Neurology Practice Questions

Q: Which of the following statements is false regarding Multiple Sclerosis (MS)?

The pathological hallmark is axonal degeneration.. **Explanation:** **1. Why Option C is the correct (False) statement:** The pathological hallmark of Multiple Sclerosis (MS) is **demyelination**, not axonal degeneration [1]. MS is primarily an immune-mediated inflammatory disease where the myelin sheath surrounding the axons in the Central Nervous System (CNS) is destroyed by T-cells and B-cells [1]. While axonal loss/degeneration does occur (and is the major cause of permanent disability), it is a **secondary** process or a later consequence of the primary demyelinating insult. **2. Analysis of other options:** * **Option A:** This is a true statement. MS shows a strong female predilection (approx. 3:1 ratio) and typically presents in young adults (peak age 20–40 years) [1]. * **Option B:** These are well-established environmental risk factors. Low Vitamin D levels, cigarette smoking, and Epstein-Barr Virus (EBV) infection are high-yield risk factors associated with MS. * **Option C:** This is true. The **HLA-DRB1*15:01** allele is the strongest genetic risk factor identified, contributing significantly to the disease's heritability. **3. High-Yield Clinical Pearls for NEET-PG:** * **Lhermitte’s Sign:** An electric shock-like sensation radiating down the spine upon neck flexion (indicates cervical cord involvement). * **Uhthoff’s Phenomenon:** Worsening of neurological symptoms (especially vision) with increased body temperature. * **McDonald Criteria:** Used for diagnosis; requires "dissemination in time and space" [1]. * **CSF Findings:** Presence of **Oligoclonal bands** (IgG) not found in the serum [1]. * **MRI:** The gold standard investigation; look for **Dawson’s fingers** (periventricular demyelinating plaques) [1]. * **Treatment:** Acute relapses are managed with **IV Methylprednisolone**; Disease-Modifying Therapies (DMTs) like Interferon-beta or Ocrelizumab are used for long-term management [1].

Q: A man presents with aphasia, characterized by an inability to name objects and poor repetition, while comprehension, fluency, and articulation remain unaffected. What is the likely diagnosis?

Conduction aphasia. The clinical presentation described is a classic case of **Conduction Aphasia**. The hallmark of this condition is a **disproportionate impairment in repetition** despite preserved fluency and comprehension. **1. Why Conduction Aphasia is correct:** Conduction aphasia results from a lesion in the **arcuate fasciculus**, the white matter tract that connects Wernicke’s area (comprehension) to Broca’s area (production) [1]. Because both areas are intact, the patient can understand speech and produce fluent sentences. However, because the "bridge" between them is damaged, they cannot relay information from the sensory to the motor area, leading to poor repetition and word-finding difficulties (anomia) [1]. **2. Analysis of Incorrect Options:** * **Anomic Aphasia:** While it involves difficulty naming objects, repetition is typically **preserved**. It is the mildest form of aphasia. * **Transcortical Sensory Aphasia:** Similar to Wernicke’s (poor comprehension), but **repetition is remarkably preserved**. It occurs due to lesions in the watershed areas surrounding Wernicke’s area. * **Broca’s Aphasia:** Characterized by non-fluent, "telegraphic" speech and impaired articulation [1]. Comprehension is preserved, but repetition is impaired. **3. NEET-PG High-Yield Pearls:** * **The Repetition Test:** This is the most critical step in differentiating standard aphasias from "Transcortical" aphasias. In all Transcortical aphasias, repetition is **intact**. * **Arcuate Fasciculus:** Classically associated with conduction aphasia; located in the parietal operculum [1]. * **Paraphasic Errors:** Patients with conduction aphasia often make phonemic errors (e.g., saying "pork" instead of "fork") and will repeatedly try to correct themselves.

Q: Epilepsia partialis continua is present in which of the following conditions?

Rasmussen's encephalitis. **Explanation:** **Epilepsia Partialis Continua (EPC)** is a rare form of focal status epilepticus characterized by continuous, rhythmic, and repetitive muscle jerks (myoclonus) involving a specific body part (usually a hand or face). It remains localized to the site of origin but can persist for hours, days, or even years. [1] **1. Why Rasmussen’s Encephalitis is correct:** Rasmussen’s Encephalitis (RE) is the classic and most common cause of EPC in children. It is a progressive, chronic inflammatory disease (likely autoimmune) affecting one cerebral hemisphere. The localized cortical inflammation leads to intractable focal seizures, of which EPC is a hallmark feature. Over time, it results in progressive hemiparesis and cognitive decline. **2. Why the other options are incorrect:** * **Japanese Encephalitis (JE):** While JE is a common cause of viral encephalitis in India, it typically presents with generalized seizures, movement disorders (parkinsonism due to thalamic involvement), and altered sensorium, rather than the localized, continuous focal jerking of EPC. * **Tuberculosis Meningitis (TBM):** TBM primarily involves the basal meninges. While it can cause seizures due to infarcts or hydrocephalus, EPC is not a characteristic or defining feature of this condition. **Clinical Pearls for NEET-PG:** * **Definition:** EPC is defined as focal motor seizures occurring at least every few seconds for a minimum of one hour. * **Site of Pathology:** The "pacemaker" for EPC is located in the **Motor Cortex (Brodmann area 4)**. * **Other Causes:** In adults, EPC is often caused by focal cortical lesions like tumors, strokes, or metabolic derangements (e.g., Non-ketotic Hyperglycemic Coma). [1] * **Treatment of RE:** Often requires hemispherectomy in refractory cases to stop the progression of the disease.

Q: All of the following manifestations may be associated with lacunar infarcts, except:

Quadriplegia. **Explanation:** Lacunar infarcts are small (0.2 to 15 mm in diameter) subcortical strokes resulting from the occlusion of small penetrating branches of the cerebral arteries (e.g., lenticulostriate, thalamoperforating arteries). They are typically caused by **lipohyalinosis** or microatheroma secondary to chronic hypertension or diabetes. **Why Quadriplegia is the Correct Answer:** Quadriplegia (paralysis of all four limbs) implies a massive, bilateral involvement of the motor pathways, usually localized to the cervical spinal cord or the brainstem (e.g., a large basilar artery occlusion). Lacunar infarcts, by definition, are focal and small. While a lacunar stroke in the internal capsule can cause dense hemiplegia (one side), it cannot anatomically involve enough territory to cause simultaneous quadriplegia. **Analysis of Incorrect Options:** * **Pure Motor Loss:** The most common lacunar syndrome. It occurs due to an infarct in the **posterior limb of the internal capsule** or the basis pontis. * **Pure Sensory Loss:** Occurs due to a lacunar infarct in the **ventral posterolateral (VPL) nucleus of the thalamus** [1]. * **Ataxia:** Seen in **Ataxic Hemiparesis**, a classic lacunar syndrome where weakness and ataxia occur on the same side, typically due to lesions in the internal capsule or pons. **NEET-PG High-Yield Pearls:** 1. **Five Classic Lacunar Syndromes:** 1) Pure Motor Hemiparesis, 2) Pure Sensory Stroke, 3) Ataxic Hemiparesis, 4) Clumsy Hand-Dysarthria Syndrome, and 5) Mixed Sensorimotor Stroke. 2. **Key Risk Factor:** Hypertension is the single most important risk factor [2]. 3. **Imaging:** MRI (DWI) is more sensitive than CT for detecting these small lesions. 4. **Absence of "Cortical Signs":** Lacunar infarcts **never** present with aphasia, agnosia, neglect, or visual field defects, as the cerebral cortex is spared.

Q: Eaton Lambert syndrome is associated with which of the following?

Anti P/Q antibody. **Lambert-Eaton Myasthenic Syndrome (LEMS)** is a paraneoplastic autoimmune disorder of the neuromuscular junction, most commonly associated with **Small Cell Lung Cancer (SCLC)** [1]. ### Explanation of Options: * **A. Anti P/Q antibody (Correct):** LEMS is caused by autoantibodies directed against **presynaptic P/Q-type voltage-gated calcium channels (VGCC)** [1]. These antibodies block the influx of calcium into the nerve terminal, preventing the release of acetylcholine into the synaptic cleft, which leads to muscle weakness [1]. * **B. Anti-Hu antibody:** These are typically associated with **Paraneoplastic Encephalomyelitis** or sensory neuronopathy, also seen in Small Cell Lung Cancer, but not LEMS [2]. * **C. Anti-Jo-1 antibody:** This is a classic marker for **Dermatomyositis/Polymyositis**, specifically associated with "Antisynthetase Syndrome" (interstitial lung disease, Raynaud's, and mechanic's hands). * **D. Large cell carcinoma:** LEMS is strongly associated with **Small Cell Lung Cancer (SCLC)** (approx. 50-60% of cases), not large cell carcinoma [1]. ### High-Yield Clinical Pearls for NEET-PG: * **Clinical Triad:** Proximal muscle weakness (starts in lower limbs), autonomic dysfunction (dry mouth, erectile dysfunction), and depressed deep tendon reflexes. * **The "Lambert Sign":** Unlike Myasthenia Gravis, strength and reflexes in LEMS **improve with repeated muscle contraction** (post-exercise facilitation). * **Electrophysiology (NCS/EMG):** Shows a **"Decrement-Increment"** pattern. There is a low baseline compound muscle action potential (CMAP) that shows a **significant increment (>100%)** following high-frequency repetitive nerve stimulation or brief exercise. * **Treatment:** The first-line symptomatic treatment is **Amifampridine (3,4-diaminopyridine)**, which prolongs the depolarization of the presynaptic membrane [1].

Q: A female presented with a severe headache of sudden onset. On CT scan, a diagnosis of subarachnoid hemorrhage is made. What is the most common cause of subarachnoid hemorrhage?

Berry aneurysm rupture. **Explanation:** **Subarachnoid Hemorrhage (SAH)** is characterized by bleeding into the subarachnoid space, typically presenting as a "thunderclap headache" (the worst headache of one's life). 1. **Why Berry Aneurysm is Correct:** The most common cause of **spontaneous (non-traumatic)** SAH is the rupture of a **Berry (saccular) aneurysm**, accounting for approximately 80% of cases. These aneurysms typically occur at the bifurcations of arteries within the Circle of Willis, most commonly at the junction of the **Anterior Communicating Artery**. 2. **Why Other Options are Incorrect:** * **Middle Meningeal Artery:** Rupture of this artery (usually due to trauma at the pterion) leads to an **Epidural Hematoma (EDH)**, characterized by a biconvex/lens-shaped bleed on CT and a classic "lucid interval." * **Basilar Artery:** While aneurysms can occur here, they are far less common than those in the anterior circulation. * **Subdural Venous Sinuses:** Tearing of the bridging veins (which drain into these sinuses) results in a **Subdural Hematoma (SDH)**, typically seen as a crescent-shaped bleed on CT in elderly or alcoholic patients. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Digital Subtraction Angiography (DSA) is the gold standard for identifying the site of the aneurysm. * **Initial Investigation:** Non-contrast CT (NCCT) Head (shows hyperdensity in cisterns and sulci). * **Associated Conditions:** Berry aneurysms are associated with **ADPKD**, Ehlers-Danlos syndrome, and Coarctation of the Aorta. * **Complication:** Vasospasm is a major delayed complication (3–14 days); **Nimodipine** (a calcium channel blocker) is used to improve outcomes.

Q: Which type of headache typically affects young to middle-aged men, is unilateral, oculo-temporal, excruciating, and associated with lacrimation and rhinorrhoea?

Cluster headache. **Explanation:** **Cluster Headache** is the correct answer as it perfectly matches the clinical triad of **demographics** (young to middle-aged males), **location** (unilateral, oculo-temporal), and **autonomic symptoms**. It is a type of Trigeminal Autonomic Cephalalgia (TAC). The pain is described as "boring" or "suicide headache" due to its excruciating intensity. The hallmark is the association with ipsilateral parasympathetic hyperactivity (lacrimation, rhinorrhoea, nasal congestion) and sympathetic paralysis (partial Horner’s syndrome). **Why other options are incorrect:** * **Migraine:** More common in females. While unilateral, the pain is typically pulsatile/throbbing, lasts longer (4–72 hours), and is associated with nausea, vomiting, photophobia, and phonophobia rather than autonomic signs. * **Trigeminal Neuralgia:** Characterized by brief, "electric-shock-like" paroxysms of pain triggered by touching "trigger zones" (washing face, shaving). It usually affects the V2 or V3 distribution, not specifically the ocular region. * **Tension Headache:** The most common type of headache; it is typically bilateral, "band-like," and lacks autonomic symptoms or extreme intensity. **High-Yield Clinical Pearls for NEET-PG:** * **Prophylaxis:** Verapamil (Drug of Choice). * **Acute Treatment:** 100% Oxygen inhalation (7–10 L/min) or subcutaneous Sumatriptan. * **Periodicity:** Attacks occur in "clusters" (e.g., once or twice a year, lasting weeks), often occurring at the same time each day, frequently waking the patient from sleep (circadian rhythm involvement). * **Horner’s Syndrome:** Cluster headache is a classic cause of transient or permanent post-ganglionic Horner’s syndrome.

Q: Hemiplegia is commonly associated with infarction of the area of distribution of which artery?

Middle cerebral artery. **Explanation:** The **Middle Cerebral Artery (MCA)** is the most common site for cerebral infarction [1] and the primary artery associated with classic hemiplegia. This is because the MCA supplies the majority of the **primary motor cortex** (precentral gyrus) and the **internal capsule** (via lenticulostriate branches). Specifically, the MCA covers the motor areas for the face and upper limbs. Since the corticospinal tract fibers are densely packed in the internal capsule, an MCA stroke often results in contralateral hemiplegia (paralysis of the face, arm, and leg). **Analysis of Incorrect Options:** * **Anterior Cerebral Artery (ACA):** ACA infarction typically leads to motor and sensory deficits primarily affecting the **contralateral lower limb** (leg and foot), as it supplies the medial aspect of the cerebral hemisphere. It rarely causes total hemiplegia. * **Posterior Cerebral Artery (PCA):** PCA occlusion primarily affects the visual cortex (occipital lobe) and thalamus. The hallmark is **contralateral homonymous hemianopia** with macular sparing, rather than motor hemiplegia. * **Anterior Communicating Artery:** This is a common site for **berry aneurysms** (leading to subarachnoid hemorrhage) but is not a major supply vessel to the motor cortex; thus, its occlusion does not typically cause hemiplegia. **High-Yield Clinical Pearls for NEET-PG:** * **Lenticulostriate Arteries:** Branches of the MCA known as the "arteries of cerebral hemorrhage" (Charcot’s artery); they are the most common site for hypertensive bleeds. * **MCA Stroke Rule:** Contralateral hemiplegia + Hemianesthesia + Aphasia (if dominant hemisphere) or Hemispatial neglect (if non-dominant). * **ACA Stroke Rule:** Leg > Arm involvement.

Question 1

Which of the following statements is false regarding Multiple Sclerosis (MS)?

Accepted Answer

The pathological hallmark is axonal degeneration.

Answer

It is more common in women, with an age of onset typically between 20-40 years.

Answer

Risk factors include vitamin D deficiency and cigarette smoking.

Answer

HLA DRB1 in MHC class II is associated with approximately 10% of disease risk.

Question 2

A man presents with aphasia, characterized by an inability to name objects and poor repetition, while comprehension, fluency, and articulation remain unaffected. What is the likely diagnosis?

Accepted Answer

Conduction aphasia

Answer

Anomic aphasia

Answer

Transcortical sensory aphasia

Answer

Broca's aphasia

Question 3

Epilepsia partialis continua is present in which of the following conditions?

Accepted Answer

Rasmussen's encephalitis

Answer

Japanese encephalitis

Answer

Tuberculosis meningitis

Answer

None of the above

Question 4

Reversible dementia is a feature of which of the following conditions?

Accepted Answer

Hypothyroidism

Answer

Alzheimer's disease

Answer

Pick's disease

Answer

Multi-infarct dementia

Question 5

All of the following manifestations may be associated with lacunar infarcts, except:

Accepted Answer

Quadriplegia

Answer

Pure motor loss

Answer

Pure sensory loss

Answer

Ataxia

Question 6

Eaton Lambert syndrome is associated with which of the following?

Accepted Answer

Anti P/Q antibody

Answer

Anti HU antibody

Answer

Anti Jo 1 antibody

Answer

Large cell carcinoma

Question 7

A female presented with a severe headache of sudden onset. On CT scan, a diagnosis of subarachnoid hemorrhage is made. What is the most common cause of subarachnoid hemorrhage?

Accepted Answer

Berry aneurysm rupture

Answer

Middle meningeal artery

Answer

Basilar artery

Answer

Subdural venous sinuses

Question 8

A 58-year-old male presents with a history of ipsilateral facial paralysis and contralateral hemiplegia. A plain CT scan of the head is provided. What is the most likely diagnosis?

Accepted Answer

Basilar artery stroke

Answer

Anterior Cerebral Artery (ACA) stroke

Answer

Posterior Cerebral Artery (PCA) stroke

Answer

Posterior Inferior Cerebellar Artery (PICA) stroke

Question 9

Which type of headache typically affects young to middle-aged men, is unilateral, oculo-temporal, excruciating, and associated with lacrimation and rhinorrhoea?

Accepted Answer

Cluster headache

Answer

Migraine

Answer

Trigeminal neuralgia

Answer

Tension headache

Question 10

Hemiplegia is commonly associated with infarction of the area of distribution of which artery?

Accepted Answer

Middle cerebral artery

Answer

Anterior cerebral artery

Answer

Posterior cerebral artery

Answer

Anterior communicating artery

Neurology — MCQs

Neurology — MCQs

On this page

Practice by Chapter

Want unlimited practice?