Neurology Practice Questions

Q: Bell's palsy is:

An ipsilateral lower motor neuron lesion. **Explanation:** Bell’s palsy is an acute, idiopathic peripheral facial nerve (CN VII) palsy. It is characterized by an **ipsilateral Lower Motor Neuron (LMN) lesion**, meaning the weakness occurs on the same side as the nerve damage. **1. Why Option B is Correct:** The facial nerve nucleus is located in the pons. The fibers originating from this nucleus supply the muscles of facial expression on the same side. In an LMN lesion (like Bell’s palsy), the final common pathway is disrupted, resulting in paralysis of both the **upper and lower quadrants** of the face on the ipsilateral side. Patients cannot wrinkle their forehead, close their eye, or smile on the affected side. **2. Why Other Options are Incorrect:** * **Option A:** This describes **Millard-Gubler Syndrome**, a pontine stroke involving the CN VII nucleus and the corticospinal tract, leading to "crossed hemiplegia." * **Option C & D:** An **Upper Motor Neuron (UMN) lesion** (e.g., stroke) occurs proximal to the facial nucleus. Due to bilateral cortical innervation of the forehead, a UMN lesion results in **contralateral** weakness of only the **lower half** of the face, sparing the forehead [1]. **Clinical Pearls for NEET-PG:** * **Bell’s Phenomenon:** On attempting to close the eye, the eyeball rolls upwards and outwards (seen in LMN lesions). * **Hyperacusis:** Due to paralysis of the stapedius muscle (nerve to stapedius is a branch of CN VII). * **Taste Loss:** Involvement of the chorda tympani leads to loss of taste in the anterior 2/3rd of the tongue. * **Treatment:** Oral corticosteroids (Prednisolone) are the mainstay of treatment; they are most effective when started within 72 hours [1]. Antivirals (Acyclovir) are added only in severe cases or if Ramsay Hunt Syndrome is suspected [1].

Q: Brain death is indicated by suppression of all reflexes except which of the following?

Patellar tendon reflex. The diagnosis of brain death requires the irreversible loss of all functions of the entire brain, including the brainstem [3]. The underlying medical concept is that **brain death is a clinical diagnosis** based on the absence of cerebral and brainstem functions, while the **spinal cord may remain intact.** **1. Why the Patellar Tendon Reflex is correct:** The patellar tendon reflex (knee-jerk) is a **monosynaptic spinal reflex**. Its circuit involves the peripheral nerves and the spinal cord segments (L2-L4), bypassing the brain entirely. Since the spinal cord can remain viable even when the brain is dead, spinal reflexes (including deep tendon reflexes, plantar flexion, or the "Lazarus sign") can still be elicited and do not preclude a diagnosis of brain death. **2. Why the other options are incorrect:** * **Oculovestibular reflex (Caloric testing):** This is a brainstem reflex involving the vestibular nuclei (pons/medulla) and the cranial nerves III and VI [1], [2]. Its absence is a mandatory criterion for brain death. * **Corneal reflex:** This reflex tests the integrity of the trigeminal nerve (afferent) and the facial nerve (efferent), mediated through the pons [1], [2]. * **Pharyngeal (Gag) reflex:** This is a lower brainstem reflex involving the glossopharyngeal and vagus nerves (medulla) [1], [2]. **Clinical Pearls for NEET-PG:** * **Prerequisites for Brain Death Testing:** Normothermia (>36°C), systolic BP ≥100 mmHg, and exclusion of drug intoxication or neuromuscular blocking agents [2]. * **The Apnea Test:** This is the definitive clinical test. A positive result (supporting brain death) is a $PCO_2$ >60 mmHg or >20 mmHg above baseline in the absence of respiratory effort [2]. * **Confirmatory Tests (if clinical exam is inconclusive):** Cerebral angiography (gold standard showing "no flow"), EEG (isoelectric/flat), or Transcranial Doppler.

Q: Which of the following neuronal pathways are implicated in amyotrophic lateral sclerosis?

Involves both upper and lower motor neurons. Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, is a progressive neurodegenerative disorder characterized by the selective loss of motor neurons. **Why Option D is Correct:** The hallmark of ALS is the **simultaneous involvement of both Upper Motor Neurons (UMN) and Lower Motor Neurons (LMN)** [1, 2]. * **UMN involvement** results from the degeneration of Betz cells in the motor cortex and the corticospinal tracts [1], leading to spasticity, hyperreflexia, and extensor plantar responses (Babinski sign). * **LMN involvement** results from the degeneration of anterior horn cells in the spinal cord [3] and motor nuclei in the brainstem, leading to muscle atrophy, fasciculations, and weakness [2]. **Analysis of Incorrect Options:** * **Option A:** The **posterior columns** (responsible for vibration and proprioception) are characteristically **spared** in ALS [2]. Sensory examination in an ALS patient is typically normal. * **Option B:** Conditions involving **LMN only** include Spinal Muscular Atrophy (SMA) or Polio. ALS must have UMN signs to meet diagnostic criteria (El Escorial criteria). * **Option C:** The **Raphe nuclei** are serotonergic nuclei in the brainstem involved in mood and pain modulation; they are not the primary site of pathology in ALS. **NEET-PG High-Yield Pearls:** * **Senses Spared:** In ALS, sensory systems, bowel/bladder sphincters, and extraocular muscles are typically preserved [2]. * **Genetic Marker:** Mutations in the **SOD1 gene** (Superoxide Sodmutase 1) are common in familial cases; **C9orf72** is the most common genetic cause overall. * **Drug of Choice:** **Riluzole** (glutamate antagonist) is used to extend survival; **Edaravone** (free radical scavenger) is also FDA-approved. * **Split Hand Sign:** Wasting of the thenar eminence (APB/First dorsal interosseous) with relative sparing of the hypothenar eminence is a classic clinical sign.

Q: Uncontrolled flailing of an arm is a symptom of which condition?

Hemiballismus. **Explanation:** **Hemiballismus** is characterized by sudden, wild, large-amplitude, and uncontrolled flailing movements of the limbs on one side of the body. This condition is a classic example of a hyperkinetic movement disorder. **Why Hemiballismus is correct:** The underlying pathology is a lesion of the **contralateral subthalamic nucleus (STN)**, most commonly due to a lacunar stroke. In the indirect pathway of the basal ganglia, the STN normally provides excitatory input to the Globus Pallidus internus (GPi), which inhibits the thalamus. A lesion in the STN reduces this inhibition, leading to an overactive motor cortex and the characteristic violent, "ballistic" movements. **Why the other options are incorrect:** * **Amyotrophic Lateral Sclerosis (ALS):** A progressive neurodegenerative disease affecting both Upper and Lower Motor Neurons. It presents with muscle weakness, wasting, and spasticity, not hyperkinetic flailing. * **Lower Motor Neuron (LMN) Syndrome:** Characterized by flaccid paralysis, muscle atrophy, fasciculations, and loss of reflexes. * **Dysdiadochokinesia:** A sign of **cerebellar dysfunction** defined as the inability to perform rapid, alternating movements (e.g., pronation/supination). **High-Yield Clinical Pearls for NEET-PG:** * **Site of Lesion:** Contralateral Subthalamic Nucleus (STN). * **Most Common Cause:** Vascular (Hemorrhagic or Ischemic stroke). * **Neurotransmitter:** Loss of glutamatergic output from the STN. * **Management:** Dopamine antagonists (like Haloperidol) are often used to control symptoms. * **Comparison:** Unlike Chorea (dance-like, distal), Ballismus is proximal, violent, and large-amplitude.

Q: Saccadic movements are typically present in all of the following conditions except:

Alzheimer's disease. The question asks to identify the condition where **saccadic eye movement abnormalities** are typically **not** a hallmark feature. Saccades are rapid, jerky eye movements that shift the fovea from one target to another. **1. Why Alzheimer’s Disease (AD) is the correct answer:** In Alzheimer’s disease, the primary pathology involves memory and cognitive decline due to cortical atrophy [1]. While advanced AD may show some subtle changes in smooth pursuit or antisaccades (higher-order control), **saccadic movements are typically preserved** or remain relatively normal compared to the other listed neurodegenerative disorders. It is not characterized by the prominent saccadic slowing or dysmetria seen in basal ganglia or cerebellar disorders. **2. Analysis of Incorrect Options:** * **Huntington’s Chorea:** A classic feature is the **difficulty in initiating saccades** and a characteristic **slowing of saccadic velocity**, often compensated by head thrusts [2]. * **Progressive Supranuclear Palsy (PSP):** This is the "high-yield" association for saccades. It is characterized by **vertical supranuclear gaze palsy**, specifically starting with the **slowing of downward vertical saccades**. * **Spinocerebellar Ataxia (SCA):** Many types (especially SCA2 and SCA7) are notorious for **slow saccades** and saccadic dysmetria (overshooting/undershooting) due to brainstem and cerebellar involvement [2]. **Clinical Pearls for NEET-PG:** * **PSP:** Look for "Hummingbird sign" or "Penguin sign" on MRI (midbrain atrophy) and vertical saccadic palsy. * **SCA2:** Known for having the slowest saccades among all neurodegenerative diseases. * **Smooth Pursuit vs. Saccades:** Smooth pursuit is for tracking moving objects; Saccades are for jumping between stationary objects. Both are often impaired in Parkinson-plus syndromes but spared in early AD.

Q: An 80-year-old man presents with a history of progressive gait disturbance and incontinence, initially attributed to old age and prostatism. For the past 4 months, he has experienced forgetfulness and confusion. He has a history of head trauma 25 years prior. His head CT is shown. What is the most likely diagnosis?

Normal pressure hydrocephalus. ***Normal pressure hydrocephalus*** - Classic presentation of **Hakim's triad**: gait disturbance (**wobbly**), urinary incontinence (**wet**), and cognitive impairment (**wacky**), all present in this patient. - CT shows **ventriculomegaly disproportionate to cortical atrophy**, and the **prior head trauma** is a known risk factor for **secondary NPH**. *Alzheimer's disease* - Primarily presents with **memory loss and cognitive decline** without the characteristic gait disturbance and incontinence seen early in this case. - CT typically shows **cortical atrophy** proportionate to ventricular enlargement, not isolated ventriculomegaly. *Creutzfeldt–Jakob disease* - Rapidly progressive **spongiform encephalopathy** with **myoclonus** and characteristic **EEG changes** (periodic sharp waves). - Timeline is much more **acute** (weeks to months) compared to the gradual progression described here. *Pelizaeus–Merzbacher disease* - **X-linked leukodystrophy** presenting in **infancy or childhood** with developmental delays and spasticity. - Does not present in elderly patients and lacks the **triad of symptoms** characteristic of NPH.

Q: Which of the following is likely to be found in a patient with a lesion in the shaded area?

Fluent speech output. ***Fluent speech output*** - **Wernicke's area** lesions cause **Wernicke's aphasia**, characterized by fluent but **meaningless speech** with poor comprehension. - Speech flows normally with preserved **rhythm** and **intonation**, but lacks semantic content (**word salad**). *Normal repetition* - **Wernicke's aphasia** involves impaired repetition due to damage to the **arcuate fasciculus** connection between Wernicke's and Broca's areas. - Patients struggle to repeat words or phrases accurately, distinguishing it from **conduction aphasia**. *Acalculia* - **Acalculia** (inability to perform calculations) is associated with **angular gyrus** lesions, not Wernicke's area. - The **angular gyrus** (Brodmann area 39) is posterior to Wernicke's area and part of **Gerstmann syndrome**. *Dysarthric speech pattern* - **Dysarthria** involves motor speech difficulties with slurred, slow articulation due to **brainstem** or **cerebellar** lesions. - Wernicke's area lesions preserve **motor speech function** - the problem is with **language comprehension** and **semantic content**, not articulation.

Question 1

A person develops seizures at a railway station. A wristband indicates they have epilepsy and have medication in their pocket. What is the immediate course of action?

Accepted Answer

Move them away from the train, administer their medication with small sips of water, raise their legs, and wait for the seizure to resolve.

Answer

Place a handkerchief in their mouth and restrain their hands and legs.

Answer

Move them away from the train, administer their medication with small sips of water, and wait for the seizure to resolve.

Answer

Move them away from the train, ensure they are lying down, and refer them to a hospital.

Question 2

Bell's palsy is:

Accepted Answer

An ipsilateral lower motor neuron lesion

Answer

Hemiparesis with contralateral facial nerve palsy

Answer

An ipsilateral upper motor neuron lesion

Answer

Contralateral upper motor neuron lesions

Question 3

Brain death is indicated by suppression of all reflexes except which of the following?

Accepted Answer

Patellar tendon reflex

Answer

Oculovestibular reflex

Answer

Corneal reflex

Answer

Pharyngeal reflex

Question 4

A lesion in the parietal lobe presented with sensory seizures, motor deficits, visual disorders, absence of touch perception on the opposite side, and inability to perceive simultaneous bilateral touch. This is associated with which of the following?

Accepted Answer

Unilateral parietal lobe dysfunction

Answer

Dominant parietal lobe dysfunction

Answer

Non-dominant parietal lobe dysfunction

Answer

Bilateral parietal lobe dysfunction

Question 5

Which of the following neuronal pathways are implicated in amyotrophic lateral sclerosis?

Accepted Answer

Involves both upper and lower motor neurons

Answer

Involves posterior column only

Answer

Involves lower motor neuron only

Answer

Involves Raphe nuclei

Question 6

Uncontrolled flailing of an arm is a symptom of which condition?

Accepted Answer

Hemiballismus

Answer

Amyotrophic lateral sclerosis

Answer

Lower motor neuron syndrome

Answer

Dysdiadochokinesias

Question 7

A 65-year-old man complains of difficulty in walking. He has a history of chronic subdural hematomas. Neurologic examination reveals psychomotor slowing, sphincter incontinence, and enlarged ventricles without convolutional atrophy. What is the most likely diagnosis?

Accepted Answer

Normal-pressure hydrocephalus

Answer

Huntington disease

Answer

Parkinson disease

Answer

Progressive supranuclear palsy

Question 8

Saccadic movements are typically present in all of the following conditions except:

Accepted Answer

Alzheimer's disease

Answer

Huntington's chorea

Answer

Progressive supranuclear palsy

Answer

Spinocerebellar ataxia

Question 9

An 80-year-old man presents with a history of progressive gait disturbance and incontinence, initially attributed to old age and prostatism. For the past 4 months, he has experienced forgetfulness and confusion. He has a history of head trauma 25 years prior. His head CT is shown. What is the most likely diagnosis?

Accepted Answer

Normal pressure hydrocephalus

Answer

Alzheimer’s disease

Answer

Creutzfeldt–Jakob disease

Answer

Pelizaeus–Merzbacher disease

Question 10

Which of the following is likely to be found in a patient with a lesion in the shaded area?

Accepted Answer

Fluent speech output

Answer

Normal repetition

Answer

Acalculia

Answer

Dysarthric speech pattern

Neurology — MCQs

Neurology — MCQs

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