Neurology Practice Questions

Q: Which of the following about lumbar puncture is incorrect?

Post-tap headache is more common in females and old age. ***Post-tap headache is more common in females and old age*** - **Post-dural puncture headache (PDPH)** is more common in **younger patients** (adolescents and young adults) and **females**. - The incidence decreases significantly with increasing age, making the statement that it is more common in **old age** incorrect. ***Urgent indication if suspected SAH with inconclusive CT*** - If a patient presents with a **thunderclap headache** suggestive of **Subarachnoid Hemorrhage (SAH)**, and the initial **CT scan is negative**, an urgent lumbar puncture is mandatory to rule out SAH (looking for **xanthochromia**) [1], [2]. - This confirms the diagnosis in up to 3% of patients with negative CT scans or those presenting late after symptom onset. ***Can be done in thrombocytopenia (platelet count >10,000 )*** - While the ideal platelet count for an LP is >50,000, LPs can often be safely performed with extreme caution in patients with platelets as low as **20,000 to 50,000**. - A platelet count of **>10,000** would typically be considered a relative contraindication unless the risk of **intracranial pathology** outweighs the risk of spinal hematoma, but the statement implies feasibility and is technically not the most incorrect option regarding general practice guidelines. ***Meningitis is an unusual complication*** - Post-procedural **bacterial meningitis** due to contamination is an extremely rare complication of lumbar puncture when standard sterile techniques are meticulously followed. - The risk is very low (often cited as less than 1 in 10,000 procedures), hence it is considered an **unusual complication**.

Q: Which is not true regarding the procedure done with the needle shown below?

Breath holding is not necessary. ***Breath holding is not necessary*** - This statement is **FALSE** - breath holding **IS necessary** during lumbar puncture to maximize **opening pressure** measurement and reduce **CSF pressure variations**. - Patients are typically instructed to hold their breath in **expiration** to minimize movement artifacts and obtain accurate pressure readings. *Coagulopathy is not an absolute contraindication* - This statement is **TRUE** - coagulopathy is considered a **relative contraindication**, not an absolute one for lumbar puncture. - The procedure can often be performed safely after **correcting clotting abnormalities** or with careful risk-benefit assessment and meticulous technique. *Bevel should be facing upwards while inserting the needle* - This statement is **TRUE** - the needle should be inserted with the **bevel facing upwards** (or laterally in lateral position) to minimize **dural trauma**. - This orientation allows dural fibers to **spread rather than cut**, reducing the risk of **post-dural puncture headache (PDPH)**. *To be done in lateral recumbent position* - This statement is **TRUE** - **lateral recumbent position** is one of the standard positions for lumbar puncture, especially for measuring **opening pressure** accurately. - Alternative **sitting position** may be used for obese patients or those with difficult anatomical landmarks, but lateral recumbent remains a correct approach.

Q: The following test is performed for evaluating the integrity of: (Recent NEET Pattern 2016-17)

Cerebellum. ***Cerebellum*** - The image depicts a person performing a **tandem gait** (walking heel-to-toe along a straight line), which is a common test for **cerebellar function**. - The cerebellum is critical for **coordination**, balance, and **fine motor control**, including the ability to maintain a straight path during walking. *Basal ganglia* - The basal ganglia are primarily involved in the **initiation and modulation of movement**, and their dysfunction leads to characteristic movement disorders such as **Parkinsonism (bradykinesia, rigidity, tremor)** or **Huntington's disease (chorea)**. - While gait can be affected in basal ganglia disorders (e.g., shuffling gait in Parkinson's), tandem gait specifically emphasizes balance and coordination more directly attributed to cerebellar function. *Corticospinal pathway* - The **corticospinal pathway** (pyramidal tract) is responsible for **voluntary, skilled movements**, particularly of the distal limbs. - Damage to this pathway typically results in **weakness (paresis)**, spasticity, and hyperreflexia, which would manifest as difficulty with initiating or executing movements rather than purely balance and coordination issues highlighted by tandem gait. *Spinothalamic pathway* - The spinothalamic pathway transmits **pain** and **temperature** sensations from the body to the brain. - Evaluating this pathway involves sensory testing (e.g., pinprick, hot/cold sensation), which is unrelated to the motor task of tandem walking.

Q: What is the drug of choice for this medical condition showing periventricular lesions?

β-interferon. ***β-interferon*** - The MRI image shows **periventricular white matter lesions** which are characteristic of **Multiple Sclerosis (MS)**. - **Beta-interferons (β-interferon)** are a cornerstone in the treatment of **relapsing-remitting multiple sclerosis (RRMS)**, acting as disease-modifying therapies to reduce the frequency and severity of relapses and slow disease progression. *α-interferon* - **Alpha-interferon (α-interferon)** is primarily used in the treatment of certain **cancers** and **viral infections** (e.g., hepatitis B and C), not for demyelinating diseases like MS. - It has a different spectrum of biological activities and clinical applications compared to beta-interferons. *□-interferon* - The option "□-interferon" is not a recognized or standard classification for interferon subtypes in medical or pharmaceutical contexts. - This option is likely a distractor and does not represent a known therapeutic agent for any condition, including MS. *Natalizumab* - **Natalizumab** is a highly effective disease-modifying therapy for MS, but it is typically reserved for patients with **highly active MS** or those who have responded inadequately to other treatments, such as beta-interferons. - While effective, it carries a risk of inducing **progressive multifocal leukoencephalopathy (PML)**, making it a second-line or escalated therapy rather than the initial drug of choice for MS.

Q: The MRI findings shown in the image are consistent with multiple sclerosis. All of the following drugs are useful for management of this patient EXCEPT:

Intravenous immunoglobulin. ***Intravenous immunoglobulin*** - The image shows multiple **periventricular and juxtacortical white matter lesions**, characteristic of **multiple sclerosis (MS)**. IVIG is generally not a first-line treatment or disease-modifying therapy for MS. - While IVIG is used for some autoimmune neurological conditions (e.g., Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy) and acute MS exacerbations in specific cases, it is not a standard long-term management drug for MS. *Methylprednisolone* - **High-dose intravenous methylprednisolone** is the standard treatment for acute exacerbations or relapses in multiple sclerosis to reduce inflammation and shorten the duration of an attack. - It helps to restore the **blood-brain barrier** integrity and reduce edema associated with active demyelinating lesions. *Fingolimod* - Fingolimod is an **oral disease-modifying therapy (DMT)** approved for relapsing forms of MS. - It works by trapping lymphocytes in lymph nodes, preventing them from entering the central nervous system and causing demyelination. *Mitoxantrone* - Mitoxantrone is an **antineoplastic agent** that also has immunosuppressant properties, approved for worsening relapsing-remitting, secondary progressive, and progressive-relapsing MS. - It is used in more **aggressive forms of MS** due to its potential for serious side effects, including cardiotoxicity.

Q: A 12-year-old boy presents with difficulty in noting from blackboard in school. Initially refraction error was considered but visual acuity was normal. He has started complaining of diplopia on watching TV or after studying for long. He takes very long time to finish his meals and his speech becomes very difficult to understand after speaking continuously for few minutes. All tests are indicated for diagnosis except?

Anti-TPO antibody. ***Anti-TPO antibody*** - This test measures antibodies against **thyroid peroxidase**, which are associated with autoimmune thyroid conditions like Hashimoto's thyroiditis. - The patient's symptoms (diplopia, dysphagia, dysarthria, fatigue worsening with activity) are highly suggestive of **myasthenia gravis**, not a primary thyroid disorder, making Anti-TPO antibodies **not indicated** for diagnosis. *Edrophonium test* - The **edrophonium (Tensilon) test** is a classic diagnostic tool for myasthenia gravis, where rapid, temporary improvement in muscle weakness is observed after intravenous administration of edrophonium. - This test is highly indicated due to the patient's fluctuating and fatigable muscle weakness affecting ocular, bulbar, and possibly limb muscles. *Single fiber EMG* - **Single fiber electromyography (SFEMG)** is considered the most sensitive diagnostic test for myasthenia gravis. - It detects increased **neuromuscular jitter and blocking**, which are characteristic findings in myasthenia gravis due to impaired neuromuscular transmission. *Nerve conduction velocity* - Standard **nerve conduction velocity (NCV)** studies are typically normal in myasthenia gravis as it is a disorder of the neuromuscular junction, not nerve conduction itself. - However, **repetitive nerve stimulation (RNS)**, a specialized electrodiagnostic study, shows a characteristic **decremental response** (>10% reduction in amplitude) and **is indicated** for diagnosis of myasthenia gravis. - In the context of this question, NCV likely refers to standard nerve conduction studies (which are less helpful), but electrodiagnostic testing including RNS is part of the diagnostic workup.

Q: A 12-year-old boy presents with difficulty in reading from the blackboard in school. Initially refraction error was considered but visual acuity was normal. He has started complaining of diplopia on watching TV or after studying for long. He takes very long time to finish his meals and his speech becomes very difficult to understand after speaking continuously for few minutes. Anti-Acetylcholine receptor blocking antibody is detected in high titers. All are done in management except? (Recent NEET Pattern 2016-17)

Atropine. ***Atropine*** - The patient's symptoms (diplopia, dysphagia, dysarthria, and improvement with rest, along with high titers of **anti-acetylcholine receptor blocking antibody**) are classic for **myasthenia gravis (MG)** [1], [2]. - **Atropine** is an anticholinergic agent that may occasionally be used to manage muscarinic side effects of cholinesterase inhibitors (like pyridostigmine), such as bradycardia, hypersalivation, or diarrhea [3]. - However, **atropine is NOT a primary treatment modality for MG** and is not part of routine management protocols [3]. It does not address the underlying pathophysiology or improve muscle strength. - In contrast, the other options represent core components of MG management. *Pyridostigmine* - **Pyridostigmine** is an **acetylcholinesterase inhibitor** and is the **first-line symptomatic treatment** for myasthenia gravis [1]. - It increases the amount of acetylcholine available at the neuromuscular junction, improving muscle strength and function. *Steroids* - **Corticosteroids** (like prednisone) are a mainstay of **immunosuppressive therapy** for myasthenia gravis, used to reduce the autoimmune attack on acetylcholine receptors [1]. - They are typically used when symptoms are not adequately controlled by pyridostigmine alone or in moderate to severe cases. *CT chest* - A **CT scan of the chest** is crucial in the initial workup of myasthenia gravis to screen for a **thymoma**, a tumor of the thymus gland. - Thymomas are associated with MG in 10-15% of patients, and their presence often dictates the need for thymectomy. - Even in the absence of thymoma, thymic hyperplasia is common in MG patients.

Q: Which of the following is incorrect about the condition shown below?

Most common CT finding is intraventricular calcification. ***Most common CT finding is intraventricular calcification*** - This statement is **incorrect**. In neurocysticercosis, the most common CT finding is **parenchymal calcifications**, which represent the remnants of dead cysts, rather than intraventricular calcifications. - **Intraventricular calcifications** are possible but less frequent than parenchymal lesions and often arise from degenerating intraventricular cysts leading to obstructive hydrocephalus. *Most common presentation is partial seizures* - This statement is **correct**. **Partial seizures** (also known as focal seizures) are indeed the most common clinical presentation of neurocysticercosis, especially when **parenchymal cysts** are involved. - This is due to the cysts acting as a **focal irritant** within the cerebral cortex, leading to abnormal electrical activity. *Albendazole is given for 8 days* - This statement is **correct**. For neurocysticercosis, **Albendazole** is typically administered for a duration ranging from **8 days to 30 days**, depending on the number, location, and stage of the cysts. - The precise duration can vary based on clinical response and cyst resolution observed on follow-up imaging. *Steroids help in alleviating vasogenic oedema of ring enhancing lesion* - This statement is **correct**. **Corticosteroids**, such as dexamethasone, are frequently co-administered with anti-parasitic drugs like albendazole to manage the **inflammatory response** (vasogenic edema) caused by the dying parasites. - This edema often surrounds the **ring-enhancing lesions** seen on imaging and can exacerbate symptoms like seizures and headaches.

Q: A 25-year-old lady presents with reduced color vision and paresthesias. Her symptoms increase with rise of body temperature. Examine the appearance of her eyes and comment on diagnosis.

Internuclear ophthalmoplegia. ***Internuclear ophthalmoplegia*** - The clinical presentation of **reduced color vision**, **paresthesias**, and symptoms worsening with increased body temperature (**Uhthoff's phenomenon**) is highly suggestive of **multiple sclerosis**. - **Internuclear ophthalmoplegia (INO)** is a common and characteristic ocular manifestation of multiple sclerosis, causing impaired adduction of one eye during conjugate gaze with nystagmus of the abducting eye. Examination of the image would likely show such a gaze abnormality. *Horner syndrome* - **Horner syndrome** is characterized by **miosis**, **ptosis**, and **anhidrosis** on one side of the face. - These specific ocular findings and systemic symptoms (reduced color vision, paresthesias, Uhthoff's phenomenon) do not align with a classic Horner syndrome presentation. *Duane retraction syndrome* - **Duane retraction syndrome** is a congenital disorder characterized by **limited abduction** (most common) or adduction, globe retraction, and narrowing of the palpebral fissure on attempted adduction. - This is a developmental anomaly of ocular motility and does not explain the widespread neurological symptoms or the heat sensitivity described. *Hutchinson pupil* - A **Hutchinson pupil** is a fixed, dilated pupil seen in cases of **uncal herniation** due to compression of the oculomotor nerve (CN III). - This is an acute, unilateral neurological emergency and does not present with the chronic, relapsing-remitting symptoms like reduced color vision and paresthesias or Uhthoff's phenomenon.

Q: A patient has the following presentation. After administration of an intravenous drug to the patient, in 6 minutes his symptoms have resolved. The diagnosis of the patient is:

Myasthenia gravis. The question refers to an accompanying image (not provided in the text, but essential for context) showing a patient with **ptosis** (drooping eyelid) and possibly other ocular muscle weakness. The key information is that symptoms resolve within 6 minutes after administration of an intravenous drug. This rapid and complete resolution of symptoms following drug administration is highly characteristic of a specific condition and a specific diagnostic test. ***Myasthenia gravis*** - The rapid resolution of symptoms (ptosis and possibly other ocular muscle weakness) within 6 minutes after intravenous drug administration is the hallmark of a positive **Tensilon test**. - The **Tensilon test** involves injecting **edrophonium**, a short-acting acetylcholinesterase inhibitor, which temporarily increases acetylcholine at the neuromuscular junction, improving muscle strength in patients with **myasthenia gravis**. *Sixth nerve palsy* - Sixth nerve palsy (abducens nerve palsy) causes **diplopia** (double vision) and an inability to abduct the affected eye. - While symptoms may fluctuate or improve with treatment, they would not resolve completely in 6 minutes with a diagnostic agent like edrophonium. *Third nerve palsy* - Third nerve palsy (oculomotor nerve palsy) can cause **ptosis**, **diplopia**, and impairment of eye movements (inability to adduct, elevate, or depress the eye). - Nerve palsies are structural or neurological deficits that do not rapidly reverse with a cholinergic agonist like edrophonium. *Tolosa-Hunt syndrome* - Tolosa-Hunt syndrome is a rare inflammatory disorder characterized by **painful ophthalmoplegia** (paralysis of eye muscles), often affecting the third, fourth, and/or sixth cranial nerves. - It typically responds to corticosteroids, but symptoms would not resolve in 6 minutes with an intravenous drug, and the diagnostic approach is different.

Question 1

Which of the following about lumbar puncture is incorrect?

Accepted Answer

Post-tap headache is more common in females and old age

Answer

Urgent indication if suspected SAH with inconclusive CT

Answer

Can be done in thrombocytopenia (platelet count >10,000 )

Answer

Meningitis is an unusual complication

Question 2

Which is not true regarding the procedure done with the needle shown below?

Accepted Answer

Breath holding is not necessary

Answer

Bevel should be facing upwards while inserting the needle

Answer

To be done in lateral recumbent position

Answer

Coagulopathy is not an absolute contraindication

Question 3

The following test is performed for evaluating the integrity of: (Recent NEET Pattern 2016-17)

Accepted Answer

Cerebellum

Answer

Basal ganglia

Answer

Corticospinal pathway

Answer

Spinothalamic pathway

Question 4

What is the drug of choice for this medical condition showing periventricular lesions?

Accepted Answer

β-interferon

Answer

α-interferon

Answer

□-interferon

Answer

Natalizumab

Question 5

The MRI findings shown in the image are consistent with multiple sclerosis. All of the following drugs are useful for management of this patient EXCEPT:

Accepted Answer

Intravenous immunoglobulin

Answer

Methylprednisolone

Answer

Fingolimod

Answer

Mitoxantrone

Question 6

A 12-year-old boy presents with difficulty in noting from blackboard in school. Initially refraction error was considered but visual acuity was normal. He has started complaining of diplopia on watching TV or after studying for long. He takes very long time to finish his meals and his speech becomes very difficult to understand after speaking continuously for few minutes. All tests are indicated for diagnosis except?

Accepted Answer

Anti-TPO antibody

Answer

Edrophonium test

Answer

Single fiber EMG

Answer

Nerve conduction velocity

Question 7

A 12-year-old boy presents with difficulty in reading from the blackboard in school. Initially refraction error was considered but visual acuity was normal. He has started complaining of diplopia on watching TV or after studying for long. He takes very long time to finish his meals and his speech becomes very difficult to understand after speaking continuously for few minutes. Anti-Acetylcholine receptor blocking antibody is detected in high titers. All are done in management except? (Recent NEET Pattern 2016-17)

Accepted Answer

Atropine

Answer

Pyridostigmine

Answer

Steroids

Answer

CT chest

Question 8

Which of the following is incorrect about the condition shown below?

Accepted Answer

Most common CT finding is intraventricular calcification

Answer

Most common presentation is partial seizures

Answer

Albendazole is given for 8 days

Answer

Steroids help in alleviating vasogenic oedema of ring enhancing lesion

Question 9

A 25-year-old lady presents with reduced color vision and paresthesias. Her symptoms increase with rise of body temperature. Examine the appearance of her eyes and comment on diagnosis.

Accepted Answer

Internuclear ophthalmoplegia

Answer

Horner syndrome

Answer

Duane retraction syndrome

Answer

Hutchinson pupil

Question 10

A patient has the following presentation. After administration of an intravenous drug to the patient, in 6 minutes his symptoms have resolved. The diagnosis of the patient is:

Accepted Answer

Myasthenia gravis

Answer

Sixth nerve palsy

Answer

Third nerve palsy

Answer

Tolosa-Hunt syndrome

Neurology — MCQs

Neurology — MCQs

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