Neurology Practice Questions

Q: Thrombosis of which of the following cerebral vessels most commonly leads to hemiplegia?

Middle cerebral artery. The **Middle Cerebral Artery (MCA)** is the most common site for cerebral thrombosis and embolism [1]. It is the largest branch of the internal carotid artery and supplies the majority of the lateral surface of the hemisphere, including the **precentral gyrus (motor cortex)** and the **internal capsule**. 1. **Why MCA is correct:** The MCA supplies the motor areas responsible for the face, arm, and trunk. Furthermore, its deep branches (Lenticulostriate arteries) supply the posterior limb of the internal capsule, where motor fibers for the entire contralateral half of the body are densely packed. Therefore, an MCA stroke typically results in **contralateral hemiplegia** (usually affecting the face and arm more than the leg). 2. **Why other options are incorrect:** * **Anterior Cerebral Artery (ACA):** Supplies the medial surface of the brain. A stroke here causes motor deficits primarily in the **contralateral lower limb** (leg and foot), rather than total hemiplegia. * **Posterior Cerebral Artery (PCA):** Primarily supplies the occipital lobe and midbrain. Clinical presentation usually involves **visual field defects** (homonymous hemianopia) rather than primary motor loss. * **Lateral Cerebral Artery:** This is not a standard anatomical term in neuroanatomy; it is likely a distractor for the MCA. **High-Yield Facts for NEET-PG:** * **Charcot’s Artery of Cerebral Hemorrhage:** The largest of the lenticulostriate branches of the MCA; it is the most common site for hypertensive hemorrhage. * **MCA Stroke Triad:** Contralateral hemiplegia, contralateral hemisensory loss, and Aphasia (if the dominant hemisphere is involved). * **ACA Stroke:** Characterized by urinary incontinence and "leg > arm" motor deficit.

Q: Carpal tunnel syndrome is caused by all of the following conditions EXCEPT:

Addison's disease. **Explanation:** Carpal Tunnel Syndrome (CTS) is a clinical condition resulting from the compression of the **median nerve** as it passes through the carpal tunnel, beneath the flexor retinaculum. Any condition that increases the volume of the tunnel contents or decreases the size of the tunnel can lead to CTS. **Why Addison’s Disease is the correct answer:** Addison’s disease (primary adrenocortical insufficiency) is characterized by a deficiency of cortisol and aldosterone [2]. It typically leads to weight loss and dehydration, which does not cause fluid retention or space-occupying lesions in the carpal tunnel. In contrast, **Cushing’s syndrome** (excess cortisol) and **Acromegaly** are endocrine causes of CTS due to soft tissue hypertrophy [1]. **Analysis of other options:** * **Rheumatoid Arthritis:** This is a common cause due to **synovitis** (inflammation of the synovial sheaths of the flexor tendons), which increases pressure within the tunnel [1]. * **Hypothyroidism:** Myxedematous tissue and **glycosaminoglycan deposition** in the connective tissues lead to increased pressure on the median nerve. * **Diabetes Mellitus:** Chronic hyperglycemia leads to the glycosylation of collagen and microvascular changes, making the nerve more susceptible to compression and ischemia. **High-Yield Clinical Pearls for NEET-PG:** * **Most common nerve compressed:** Median nerve. * **Sensory loss:** Affects the lateral 3.5 digits (spares the thenar eminence due to the superficial palmar cutaneous branch arising proximal to the tunnel). * **Motor loss:** Weakness and atrophy of **LOAF** muscles (Lateral two Lumbricals, Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis). * **Clinical Tests:** Phalen’s test (most sensitive) and Tinel’s sign. * **Other common associations:** Pregnancy (fluid retention), Amyloidosis, and Chronic Renal Failure (hemodialysis-associated).

Q: Involvement of the pyramidal tract leads to all of the following except?

Fasciculation. This question tests the fundamental distinction between **Upper Motor Neuron (UMN)** and **Lower Motor Neuron (LMN)** lesions. [1] ### Why Fasciculation is the Correct Answer The **pyramidal tract** (Corticospinal tract) is the primary UMN pathway. [2] **Fasciculations** (visible muscle twitches) are a hallmark of **LMN lesions**, such as those affecting the anterior horn cells or peripheral nerves. [1] They occur due to the spontaneous depolarization of denervated motor units. In a pure pyramidal tract (UMN) lesion, the motor unit remains intact, so fasciculations are absent. ### Explanation of Incorrect Options (UMN Features) The other options are classic features of a pyramidal tract lesion: * **Spasticity (A):** UMN lesions lead to a loss of inhibitory control over the spinal cord, resulting in "clasp-knife" hypertonia. [3] * **Hyper-reflexia (B):** The loss of descending inhibition leads to an exaggerated muscle stretch reflex (increased deep tendon reflexes). [3] * **Positive Babinski Sign (D):** This is the pathognomonic sign of pyramidal tract damage, where the great toe dorsiflexes and other toes fan out in response to plantar stimulation. ### High-Yield Clinical Pearls for NEET-PG | Feature | UMN Lesion (Pyramidal) | LMN Lesion | | :--- | :--- | :--- | | **Muscle Tone** | Spastic (Hypertonia) [3] | Flaccid (Hypotonia) [1] | | **Reflexes** | Hyper-reflexia [3] | Hypo-reflexia/Areflexia | | **Atrophy** | Minimal (Disuse only) | Marked and Early [1] | | **Fasciculations** | Absent | **Present** [1] | | **Plantar Response** | Extensor (Babinski +) | Flexor (Normal) | **Note:** In the acute phase of a UMN lesion (e.g., acute stroke), "Spinal Shock" may occur, temporarily presenting with LMN-like features (flaccidity and areflexia) before spasticity develops.

Q: A 65-year-old diabetic woman develops weakness on the left side of the face, right arm, and right leg. She also has diplopia on left lateral gaze. What is the site of the lesion?

Left pons. ### Explanation This clinical presentation describes a **crossed hemiplegia** (ipsilateral cranial nerve palsy with contralateral motor weakness), which is the hallmark of a **brainstem lesion** [1]. **1. Why Left Pons is correct:** * **Ipsilateral Facial Weakness:** The patient has left-sided facial weakness. The facial nerve (CN VII) nucleus and fibers are located in the **pons**. In the brainstem, cranial nerve deficits occur on the same side as the lesion. * **Diplopia on Left Gaze:** This indicates a left **Abducens (CN VI) nerve** palsy [2]. The CN VI nucleus is also located in the pons. * **Contralateral Hemiparesis:** The right-sided weakness of the arm and leg is due to the involvement of the **Corticospinal tract** before it decussates in the medulla [1]. A lesion in the left pons affects the descending fibers, causing weakness on the right side of the body. * **Clinical Correlation:** This specific constellation (CN VI/VII palsy + contralateral hemiplegia) is known as **Millard-Gubler Syndrome**. **2. Why other options are incorrect:** * **Right Pons:** A lesion here would cause right-sided facial weakness and left-sided body weakness. * **Midbrain (Right/Left):** Midbrain lesions typically involve the **Oculomotor nerve (CN III)**, leading to ptosis and a "down and out" eye, rather than facial weakness or lateral gaze palsy. **3. High-Yield Pearls for NEET-PG:** * **Rule of 4s:** CN V, VI, VII, and VIII are associated with the **Pons**. * **Crossed Hemiplegia = Brainstem:** Always look for the side of the cranial nerve deficit to localize the side of the lesion [1]. * **Foville Syndrome:** Similar to Millard-Gubler but includes conjugate gaze palsy toward the side of the lesion (due to PPRF involvement). * **Diabetes:** A major risk factor for lacunar infarcts in the small perforating branches of the basilar artery supplying the pons.

Q: Which of the following is not a feature of a lateral cerebellar lesion?

Resting tremor. The cerebellum is responsible for the coordination, precision, and timing of voluntary movements. It acts as a "comparator," correcting errors during active movement. ### **Explanation of the Correct Answer** **A. Resting tremor:** This is the correct answer because resting tremors are a hallmark of **Basal Ganglia** lesions (specifically Parkinson’s disease), not cerebellar lesions. In contrast, cerebellar lesions result in **Intention tremors**, which appear or worsen during the execution of a purposeful movement and disappear at rest. ### **Analysis of Incorrect Options** * **B. Dysarthria:** Cerebellar lesions often cause "scanning speech" or "staccato speech," where words are broken into individual syllables with irregular emphasis. This is a form of motor speech disorder (dysarthria) due to poor coordination of the muscles of phonation. * **C. Nystagmus:** The cerebellum (specifically the vestibulocerebellum) coordinates eye movements. Damage leads to nystagmus, typically characterized by a fast component toward the side of the lesion. * **D. Loss of coordination:** This is the definition of **Ataxia**. Lateral cerebellar lesions affect the cerebrocerebellum, leading to decomposition of movement, dysmetria (past-pointing), and dysdiadochokinesia (inability to perform rapid alternating movements). ### **NEET-PG High-Yield Pearls** * **DANISH Mnemonic:** To remember cerebellar signs: **D**ysdiadochokinesia/Dysmetria, **A**taxia, **N**ystagmus, **I**ntention tremor, **S**lurred (scanning) speech, **H**ypotonia. * **Ipsilateral Rule:** Cerebellar lesions always manifest clinical signs on the **same side** as the lesion (ipsilateral) because the pathways decussate twice ("double-crossing"). * **Midline vs. Lateral:** Midline (vermis) lesions cause truncal ataxia and gait instability, while lateral (hemisphere) lesions cause limb ataxia and kinetic tremors.

Q: A 63-year-old man presents to the emergency department with transient symptoms of vertigo, slurred speech, diplopia, and paresthesia. He is symptom-free now, and clinical examination is entirely normal. His past medical history is significant for osteoarthritis, hypertension, and dyslipidemia. Which of the following is the most likely cause for his symptoms?

Posterior circulation transient ischemic attack (TIA). **Explanation:** The patient’s presentation is classic for a **Transient Ischemic Attack (TIA)** involving the **posterior (vertebrobasilar) circulation**. A TIA is defined as a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction [1]. 1. **Why Option A is correct:** The "4 Ds"—**D**izziness (vertigo), **D**iplopia, **D**ysarthria (slurred speech), and **D**ysphagia—along with sensory changes (paresthesia), are hallmark signs of brainstem or cerebellar ischemia [2]. The fact that the patient is now symptom-free with a normal clinical exam fits the definition of a TIA [1]. His risk factors (hypertension, dyslipidemia, age) further support an atherosclerotic etiology [3]. 2. **Why the other options are incorrect:** * **Anterior communicating artery aneurysm:** These typically present with features of subarachnoid hemorrhage (sudden "thunderclap" headache) or visual field defects due to compression, rather than transient brainstem symptoms. * **Hypertensive encephalopathy:** This presents with severe hypertension (usually Grade IV retinopathy), headache, confusion, and seizures. It does not typically cause focal, transient brainstem deficits that resolve completely. * **Pseudobulbar palsy:** This is a chronic clinical syndrome characterized by emotional lability, dysarthria, and dysphagia due to bilateral upper motor neuron lesions [2]. It is not transient or episodic. **NEET-PG High-Yield Pearls:** * **ABCD2 Score:** Used to predict the risk of stroke after a TIA (Age, Blood pressure, Clinical features, Duration, Diabetes). * **Posterior Circulation:** Supplies the "5 Cs"—Cerebellum, Cranial nerve nuclei, Colliculi, Conjugate gaze center, and Cortex (Occipital). * **Imaging:** Diffusion-weighted MRI is the gold standard to rule out an actual infarct (Stroke) in patients with TIA symptoms.

Q: A 35-year-old patient recalls episodes where he smells a pungent odor, becomes sweaty, and loses consciousness. His family member reports that while unconscious, he was having facial twitching with lip-smacking movements. What is the most probable diagnosis?

Focal seizures. **Explanation:** The clinical presentation is classic for **Focal Seizures with Impaired Awareness** (formerly known as Complex Partial Seizures), likely originating from the **Temporal Lobe**. **Why Focal Seizures is correct:** The patient experiences a sensory "aura" (olfactory hallucination/pungent odor), which is a hallmark of focal cortical involvement. The subsequent loss of consciousness accompanied by **automatisms** (lip-smacking) and autonomic symptoms (sweating) are characteristic of temporal lobe epilepsy. Facial twitching indicates motor involvement within the focal seizure. **Why the other options are incorrect:** * **Hysteria (Dissociative/Conversion Disorder):** While it can mimic seizures (pseudoseizures), the presence of specific olfactory auras and stereotyped motor patterns like lip-smacking strongly points toward an organic neurological etiology. * **Atonic Seizures:** These involve a sudden loss of muscle tone ("drop attacks") leading to collapse. They do not typically feature olfactory auras or complex automatisms. * **Myoclonic Seizures:** These are characterized by brief, shock-like jerks of a muscle or group of muscles, usually without a preceding aura or prolonged loss of consciousness with automatisms. **High-Yield Clinical Pearls for NEET-PG:** * **Temporal Lobe Epilepsy (TLE):** The most common site for focal seizures. Look for the "4 As": **A**ura (olfactory/gustatory), **A**utomatisms (lip-smacking, hand rubbing), **A**utonomic features, and **A**mnesia for the event. * **Olfactory Hallucinations:** When associated with seizures, these often suggest a lesion or focus in the **uncus** (uncinate fits). * **Todd’s Paralysis:** Post-ictal focal neurological deficit (like hemiparesis) following a focal seizure; a common distracter in exams.

Q: All of the following are characteristic features of cluster headache except:

Bilateral photophobia. Explanation: Cluster headache is a primary headache disorder classified under **Trigeminal Autonomic Cephalalgias (TACs)** [2]. The hallmark of this condition is its strictly **unilateral** nature and associated autonomic symptoms. **1. Why "Bilateral Photophobia" is the correct answer (the exception):** While photophobia can occur in cluster headaches, it is typically **ipsilateral** (on the same side as the pain). Bilateral photophobia and phonophobia are classic features of **Migraine**, not cluster headache. If a patient presents with bilateral symptoms, the diagnosis should be reconsidered. **2. Analysis of incorrect options:** * **Periodic pain:** Cluster headaches are named for their "circadian and circannual periodicity." Attacks often occur at the same time each day (often waking the patient from sleep) and occur in "clusters" lasting weeks to months, followed by long remission periods [1]. * **Conjunctival injection:** This is a cardinal autonomic symptom caused by parasympathetic overactivity. Other features include lacrimation, rhinorrhea, nasal congestion, and miosis/ptosis (Horner’s syndrome), all of which are strictly ipsilateral. * **No response to oral sumatriptan:** Oral triptans are generally **ineffective** because the peak plasma concentration is reached too slowly (30–60 minutes) to treat an attack that typically lasts only 15–180 minutes [1]. The gold standard for acute treatment is **100% Oxygen** or **Subcutaneous/Nasal Sumatriptan** [1]. **Clinical Pearls for NEET-PG:** * **Demographics:** More common in males (unlike Migraine). * **Patient Behavior:** Patients are typically **restless and agitated** (pacing), whereas migraineurs prefer to lie still in a dark room [1]. * **Prophylaxis:** **Verapamil** is the drug of choice for long-term prevention [1]. * **Trigger:** Alcohol is a potent trigger during an active cluster period.

Question 1

Thrombosis of which of the following cerebral vessels most commonly leads to hemiplegia?

Accepted Answer

Middle cerebral artery

Answer

Anterior cerebral artery

Answer

Posterior cerebral artery

Answer

Lateral cerebral artery

Question 2

Carpal tunnel syndrome is caused by all of the following conditions EXCEPT:

Accepted Answer

Addison's disease

Answer

Rheumatoid arthritis

Answer

Hypothyroidism

Answer

Diabetes mellitus

Question 3

Involvement of the pyramidal tract leads to all of the following except?

Accepted Answer

Fasciculation

Answer

Spasticity

Answer

Hyper-reflexia

Answer

Positive Babinski sign

Question 4

A 65-year-old diabetic woman develops weakness on the left side of the face, right arm, and right leg. She also has diplopia on left lateral gaze. What is the site of the lesion?

Accepted Answer

Left pons

Answer

Right pons

Answer

Right midbrain

Answer

Left midbrain

Question 5

Which of the following is not a feature of a lateral cerebellar lesion?

Accepted Answer

Resting tremor

Answer

Dysarthria

Answer

Nystagmus

Answer

Loss of coordination of movements

Question 6

A 63-year-old man presents to the emergency department with transient symptoms of vertigo, slurred speech, diplopia, and paresthesia. He is symptom-free now, and clinical examination is entirely normal. His past medical history is significant for osteoarthritis, hypertension, and dyslipidemia. Which of the following is the most likely cause for his symptoms?

Accepted Answer

Posterior circulation transient ischemic attack (TIA)

Answer

Anterior communicating artery aneurysm

Answer

Hypertensive encephalopathy

Answer

Pseudobulbar palsy

Question 7

A patient with traumatic paraplegia due to injury of the thoracic cord at T3 level is observed to have a blood pressure of 210/120. What should be the initial management?

Accepted Answer

Nifedipine

Answer

Subcutaneous LMWH

Answer

Steroids

Answer

Normal saline / Dextrose

Question 8

A 35-year-old patient recalls episodes where he smells a pungent odor, becomes sweaty, and loses consciousness. His family member reports that while unconscious, he was having facial twitching with lip-smacking movements. What is the most probable diagnosis?

Accepted Answer

Focal seizures

Answer

Hysteria

Answer

Atonic seizures

Answer

Myoclonic seizures

Question 9

A 48-year-old woman with chronic renal failure has bilaterally enlarged kidneys with multiple cysts on renal scan. She experienced a sudden onset of severe headache. A cerebral angiogram showed marked narrowing of cerebral artery branches near the base of the brain, consistent with vasospasm, and no intraparenchymal hemorrhage. Which of the following conditions MOST likely produced these findings?

Accepted Answer

Subarachnoid hemorrhage

Answer

Bacterial meningitis

Answer

Severe atherosclerosis

Answer

Malignant hypertension

Question 10

All of the following are characteristic features of cluster headache except:

Accepted Answer

Bilateral photophobia

Answer

Periodic pain

Answer

Conjunctival injection

Answer

No response to oral sumatriptan

Neurology — MCQs

Neurology — MCQs

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