Neurology Practice Questions

Q: A 15-year-old boy presented with day dreaming and decline in school performance. EEG shows.

Typical absence seizure. ***Typical absence seizure*** - The clinical presentation of **daydreaming** and decline in school performance in a 15-year-old is classic for absence seizures. - The EEG shows a characteristic **generalized 3 Hz spike-and-wave discharge**, which is pathognomonic for typical absence seizures. *Atonic seizure* - Characterized by a **sudden loss of muscle tone**, leading to falls, often referred to as "drop attacks." - EEG in atonic seizures often shows **polyspike-and-wave discharges** or generalized slow waves, but not the 3 Hz spike-and-wave pattern. *Myoclonic seizure* - Involves **brief, shock-like jerks** of a muscle or group of muscles, without loss of consciousness. - EEG typically shows **generalized polyspike-and-wave discharges** or fast spike-and-wave activity, which differs from the 3 Hz pattern. *Atypical absence seizure* - Clinical features include a **less abrupt onset and termination** of altered consciousness, often accompanied by changes in muscle tone. - EEG shows **slower spike-and-wave complexes (typically 1.5-2.5 Hz)** and more heterogeneous patterns than typical absence seizures.

Q: Which of the following is true regarding type of seizures shown in EEG?

Hyperventilation often precipitates an attack. ***Hyperventilation often precipitates an attack*** - The EEG shows a classic **3-Hz spike-and-wave pattern**, which is characteristic of **absence seizures**. - **Hyperventilation** is a common and effective activation procedure used during EEG recordings to **induce or exacerbate absence seizures**, making them more apparent. *Attack lasts for 60 to 90 seconds* - **Absence seizures** are typically brief, usually lasting only **5 to 30 seconds**, much shorter than the 60-90 seconds stated. - Longer seizures, especially those with postictal confusion, are more characteristic of **complex partial seizures** or **tonic-clonic seizures**. *Onset of disease in the first year of life* - **Childhood absence epilepsy** typically has an onset between **4 and 8 years of age**, with a peak around 5-6 years. - Seizures appearing in the first year of life would suggest other epilepsy syndromes, such as ** infantile spasms** or severe myoclonic epilepsy in infancy (Dravet syndrome). *Attack followed by postictal confusion* - Absence seizures are classic for **lacking a postictal period**; the individual typically resumes activity immediately after the seizure ends without confusion or disorientation. - **Postictal confusion** is a hallmark feature of **tonic-clonic seizures** and often complex partial seizures, indicating a more widespread and prolonged disruption of brain activity.

Q: A patient presents with facial deviation to the right, inability to close the left eye with Bell's sign, and unclear ability to produce wrinkles on the forehead based on the image. What is the most likely diagnosis?

Left lower motor neuron (LMN/peripheral) lesion. ***Left lower motor neuron (LMN/peripheral) lesion*** - Facial deviation to the **right** indicates weakness of the **left facial muscles**, as the unaffected right side pulls the face toward it. - Complete involvement of **forehead muscles** (inability to wrinkle forehead) along with **Bell's sign** indicates a **peripheral/LMN lesion** affecting the entire facial nerve. *Left upper motor neuron (UMN/central) lesion* - **Central lesions** typically **spare forehead muscles** due to bilateral cortical innervation of the upper facial muscles. - Would not cause complete facial paralysis including forehead involvement as seen in this case. *Right lower motor neuron lesion* - A **right-sided lesion** would cause facial deviation to the **left**, not to the right as described. - The clinical presentation clearly indicates **left-sided facial weakness**, not right-sided. *Right upper motor neuron lesion* - Would cause facial deviation to the **left side**, opposite to what is observed in this patient. - **Central lesions** spare the forehead due to **bilateral cortical representation**, which contradicts the forehead involvement seen here.

Q: The following diagram and its branches should be remembered. The blood vessel involved in medial medullary syndrome is anterior spinal artery.

Choice B: Anterior spinal artery. ***Choice B: Anterior spinal artery*** - The **anterior spinal artery** supplies the medial medulla, and its occlusion leads to **medial medullary syndrome**. - This syndrome is characterized by contralateral hemiparesis (due to involvement of the pyramidal tract), contralateral loss of proprioception and vibratory sensation (due to medial lemniscus involvement), and ipsilateral tongue deviation (due to hypoglossal nerve nucleus involvement).

Q: Which of the following is characteristic of Parinaud's syndrome?

Dorsal midbrain lesion. ***Dorsal midbrain lesion*** - Parinaud's syndrome, also known as the **dorsal midbrain syndrome**, is characterized by a constellation of symptoms resulting from damage to the **tectal plate** and **pretectal area** of the midbrain. - This damage often affects the **superior colliculi** and adjacent structures, impairing **vertical gaze** and **pupillary reflexes**. *Ventral midbrain lesion* - Lesions in the **ventral midbrain** typically affect the **substantia nigra** and **cerebral peduncles**, causing different symptoms. - This location would result in **parkinsonian features** or **hemiparesis**, not the characteristic eye movement abnormalities of Parinaud's syndrome. *Pontine lesion* - Pontine lesions commonly cause **horizontal gaze palsy** and **internuclear ophthalmoplegia**, not vertical gaze dysfunction. - The **paramedian pontine reticular formation (PPRF)** controls horizontal eye movements, distinct from the vertical gaze control in the midbrain. *Thalamic lesion* - Thalamic lesions typically cause **altered consciousness**, **memory deficits**, or **sensory disturbances**. - While some thalamic lesions can affect eye movements, they don't produce the specific **upward gaze paralysis** and **light-near dissociation** seen in Parinaud's syndrome.

Q: The EEG of a 16-year-old boy with early morning involuntary movements of hands in his sleep noticed by parents, was performed. Immunization is complete. What does EEG show? (Recent NEET Pattern 2016-17)

Juvenile myoclonic epilepsy. ***Juvenile myoclonic epilepsy*** - The EEG shows generalized **polyspike-and-slow-wave discharges**, which are characteristic of juvenile myoclonic epilepsy (JME), especially when associated with early morning myoclonus. - The clinical presentation of a **16-year-old boy** with **involuntary movements of hands in his sleep** (suggesting myoclonic jerks), particularly in the morning, is highly consistent with JME. *SSPE* - Subacute sclerosing panencephalitis (SSPE) typically presents with characteristic EEG patterns like **Radermacker complexes** or **periodic complexes**, which are not seen here. - Clinical features of SSPE include progressive cognitive decline, myoclonus, and other neurological deficits, usually following a measles infection, which are not described. *Benign rolandic epilepsy* - Benign rolandic epilepsy (BRE) is characterized by **centrotemporal spikes** on EEG, often exacerbated by sleep, and presents with focal seizures affecting the face and mouth. - The generalized polyspike-and-slow-wave pattern and the clinical description of hand myoclonus do not fit the profile of BRE. *Huntington chorea* - Huntington's chorea is a **neurodegenerative genetic disorder** characterized by involuntary movements (chorea), cognitive decline, and psychiatric problems. - EEG findings in Huntington's chorea are often non-specific or show generalized slowing, and it is not an epilepsy syndrome with specific high-amplitude epileptiform discharges like those seen.

Q: The EEG of the patient shows which of the following? (Recent NEET Pattern 2016-17)

Burst suppression pattern. ***Burst suppression pattern*** - The EEG shows periods of high amplitude, mixed-frequency **bursts of activity** alternating with periods of **relative electrical silence** (suppression). - This pattern is often seen in conditions like severe **hypoxic-ischemic encephalopathy**, deep **anesthesia**, or severe brain injury. *Rademecker complex* - This refers to periodic trifasic complexes, often associated with subacute sclerosing panencephalitis (SSPE), which is a **slow viral infection** of the brain. - The complexes are typically **bilateral, synchronous, and repetitive**, not characterized by alternating bursts and suppression. *3/sec spike and slow wave pattern* - This pattern is characteristic of **absence seizures (petit mal epilepsy)**, where there are generalized, synchronous 3 Hz spike-and-wave discharges. - The image does not show continuous, rhythmic 3 Hz activity but rather alternating periods of activity and flat-lining. *4-6 Hz Polyspike* - Polyspikes are a series of two or more spikes or sharp waves clustered together, often associated with **myoclonic seizures** or other generalized epilepsies. - While there are some sharp waves in the burst phases, the overall pattern is dominated by the distinct periods of suppression, not continuous polyspike activity.

Q: A 65-year-old man with dementia and poor hygiene due to urinary incontinence was evaluated. On examination: Deep tendon reflexes are brisk and gait apraxia with start hesitation is noted. CT scan was performed. What is the diagnosis?

Normal pressure hydrocephalus. ***Normal pressure hydrocephalus*** - The classic triad of **dementia**, **gait apraxia**, and **urinary incontinence** strongly points to normal pressure hydrocephalus (NPH). The CT scan shows **ventriculomegaly out of proportion to sulcal atrophy**, a key finding in NPH. - The symptoms are often reversible with **ventriculoperitoneal shunting**, making early diagnosis crucial. *Alzheimer's disease* - While it causes **dementia**, it does not typically present with gait apraxia or urinary incontinence as prominent initial features. - CT scans in Alzheimer's usually show **diffuse cerebral atrophy**, not significant ventriculomegaly disproportionate to sulcal changes. *Multi-infarct dementia* - Characterized by a **stepwise decline** in cognitive function and focal neurological deficits related to cerebrovascular events. - CT scans would typically show evidence of **multiple infarcts** or vascular lesions, which are not explicitly described as the primary finding. *Frontal lobe tumor* - Could cause dementia and gait issues, but it would typically present with other focal neurological signs depending on the tumor's location and size, as well as **mass effect or edema** on neuroimaging. - The presented symptoms align more specifically with NPH than a generalized tumor effect without additional details.

Q: A patient presents with GCS of 7 with nuchal rigidity and bloody CSF. Which is incorrect regarding this condition? (Recent NEET Pattern 2016-17)

IV ceftriaxone. **IV ceftriaxone** - The clinical presentation of **GCS of 7**, **nuchal rigidity**, and **bloody CSF** is highly suggestive of a **subarachnoid hemorrhage (SAH)**, not a bacterial infection like meningitis. - **Ceftriaxone** is an antibiotic commonly used to treat bacterial meningitis, which is not indicated here as the primary issue is hemorrhage, not infection. *Blood in sylvian fissure* - **Blood in the sylvian fissure** is a common finding in **subarachnoid hemorrhage**, as this area contains major cerebral arteries susceptible to aneurysm rupture. - CT scans often show hyperdense (bright) blood within the sulci and cisterns, including the sylvian fissure. *Seizures* - **Seizures** are a relatively common complication of **subarachnoid hemorrhage**, especially in the acute phase due to blood irritating the cerebral cortex. - They can occur in up to 10-20% of SAH patients and are a significant predictor of poorer outcomes. *Intraventricular extension* - **Intraventricular extension** of blood indicates a more severe hemorrhage and is often associated with a worse prognosis in **subarachnoid hemorrhage**. - The presence of blood within the ventricles can lead to **hydrocephalus** and increased intracranial pressure.

Q: A 50-year-old hypertensive patient develops sudden onset drooping of right face and hemiplegia. What is the diagnosis?

MCA area hemorrhage. ***MCA area hemorrhage*** - The **hyperdense lesion** on CT scan indicates **acute hemorrhage** in the MCA territory, which correlates with the sudden onset right facial droop and hemiplegia. - **Hypertension** is the most common risk factor for primary **intracerebral hemorrhage**, and MCA territory involvement typically causes contralateral face and arm weakness. *MCA area infarction* - **Infarctions** appear as **hypodense (dark) areas** on CT scan, not hyperdense lesions as described in this case. - While MCA infarction can cause similar clinical symptoms, the imaging findings clearly show hemorrhage rather than ischemic changes. *ACA area infarction* - **ACA infarction** typically presents with **leg weakness** more prominent than face/arm weakness, as the ACA supplies the medial motor cortex for lower limbs. - The imaging shows a **hyperdense hemorrhage**, not the **hypodense appearance** characteristic of infarction. *ACA area hemorrhage* - **ACA territory hemorrhage** would affect the **frontal lobe**, causing symptoms like leg weakness, **abulia** (lack of motivation), and urinary incontinence. - The clinical presentation of **facial droop and hemiplegia** involving face and arm is more characteristic of **MCA involvement** rather than ACA territory.

Question 1

A 15-year-old boy presented with day dreaming and decline in school performance. EEG shows.

Accepted Answer

Typical absence seizure

Answer

Atonic seizure

Answer

Myoclonic seizure

Answer

Atypical absence seizure

Question 2

Which of the following is true regarding type of seizures shown in EEG?

Accepted Answer

Hyperventilation often precipitates an attack

Answer

Attack lasts for 60 to 90 seconds

Answer

Onset of disease in the first year of life

Answer

Attack followed by postictal confusion

Question 3

A patient presents with facial deviation to the right, inability to close the left eye with Bell's sign, and unclear ability to produce wrinkles on the forehead based on the image. What is the most likely diagnosis?

Accepted Answer

Left lower motor neuron (LMN/peripheral) lesion

Answer

Right upper motor neuron lesion

Answer

Left upper motor neuron (UMN/central) lesion

Answer

Right lower motor neuron lesion

Question 4

The following diagram and its branches should be remembered. The blood vessel involved in medial medullary syndrome is anterior spinal artery.

Accepted Answer

Choice B: Anterior spinal artery

Answer

Choice A

Answer

Choice C

Answer

Choice D

Question 5

Which of the following is characteristic of Parinaud's syndrome?

Accepted Answer

Dorsal midbrain lesion

Answer

Ventral midbrain lesion

Answer

Thalamic lesion

Answer

Pontine lesion

Question 6

The EEG of a 16-year-old boy with early morning involuntary movements of hands in his sleep noticed by parents, was performed. Immunization is complete. What does EEG show? (Recent NEET Pattern 2016-17)

Accepted Answer

Juvenile myoclonic epilepsy

Answer

SSPE

Answer

Benign rolandic epilepsy

Answer

Huntington chorea

Question 7

The EEG of the patient shows which of the following? (Recent NEET Pattern 2016-17)

Accepted Answer

Burst suppression pattern

Answer

Rademecker complex

Answer

3/sec spike and slow wave pattern

Answer

4-6 Hz Polyspike

Question 8

A 65-year-old man with dementia and poor hygiene due to urinary incontinence was evaluated. On examination: Deep tendon reflexes are brisk and gait apraxia with start hesitation is noted. CT scan was performed. What is the diagnosis?

Accepted Answer

Normal pressure hydrocephalus

Answer

Alzheimer's disease

Answer

Multi-infarct dementia

Answer

Frontal lobe tumor

Question 9

A patient presents with GCS of 7 with nuchal rigidity and bloody CSF. Which is incorrect regarding this condition? (Recent NEET Pattern 2016-17)

Accepted Answer

IV ceftriaxone

Answer

Blood in sylvian fissure

Answer

Seizures

Answer

Intraventricular extension

Question 10

A 50-year-old hypertensive patient develops sudden onset drooping of right face and hemiplegia. What is the diagnosis?

Accepted Answer

MCA area hemorrhage

Answer

ACA area infarction

Answer

ACA area hemorrhage

Answer

MCA area infarction

Neurology — MCQs

Neurology — MCQs

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