Neurology Practice Questions

Q: Identify the abnormality shown in the image.

Festinating gait. ***Festinating gait*** - The image depicts a classic **flexed posture**, with the trunk bent forward and arms adducted, consistent with the characteristic stooped stance seen in Parkinson's disease. - While not visible in a static image, this posture often accompanies a shuffling, quickening gait pattern ("festination") as the patient tries to catch up with their center of gravity. *Magnetic gait* - This gait is characterized by the feeling that the feet are stuck to the floor, often seen in **frontal lobe dysfunction** or **normal pressure hydrocephalus**. - The image does not show features such as shuffling or difficulty lifting the feet from the ground typically associated with magnetic gait. *Titubation due to senility* - **Titubation** refers to an involuntary, rhythmic tremor of the head or trunk, often associated with cerebellar disease or severe weakness. - While senility can contribute to gait instability, titubation is a distinct symptom not primarily illustrated by this overall flexed posture. *Astasia abasia* - **Astasia abasia** is a functional (psychogenic) gait disorder where the patient is unable to stand (astasia) or walk (abasia) despite normal motor power and coordination in the supine position. - The image shows a person attempting to stand/walk with a specific posture, not an inability to perform these actions altogether.

Q: A 35-year-old male experiences bilateral asymmetrical ptosis and diplopia on watching TV or working on a laptop. Which test will be useful for diagnosis?

Ice pack test. ***Ice pack test*** - The patient's symptoms of **bilateral asymmetrical ptosis** and **diplopia** that worsen with activity (watching TV, working on a laptop) and improve with rest are highly suggestive of **Myasthenia Gravis**. - The **ice pack test** is a simple, non-invasive diagnostic tool for Myasthenia Gravis, where applying an ice pack to the eyelid improves ptosis by inhibiting acetylcholinesterase activity, thus making more acetylcholine available at the neuromuscular junction. *Nerve conduction velocity* - **Nerve conduction velocity (NCV)** studies are primarily used to evaluate peripheral nerve function and diagnose neuropathies, not typically for neuromuscular junction disorders like Myasthenia Gravis. - While electrodiagnostic studies like **repetitive nerve stimulation** can be used for Myasthenia Gravis, NCV alone is not the most direct or specific test for typical presentation. *Muscle biopsy* - **Muscle biopsy** is generally performed to diagnose myopathies (muscle diseases) characterized by muscle fiber abnormalities, inflammatory infiltrates, or specific dystrophies. - It is **not routinely used** for the diagnosis of Myasthenia Gravis, which is a disorder of the neuromuscular junction, not the muscle itself. *CPK-MM levels* - **Creatine phosphokinase (CPK-MM)** levels are elevated in conditions involving muscle damage or inflammation (e.g., rhabdomyolysis, myositis, muscular dystrophies). - In Myasthenia Gravis, the muscle itself is not primarily damaged, so **CPK-MM levels are typically normal**, making this test unhelpful for diagnosis.

Q: Which is correct for the image shown below?

Jendrassik maneuver. ***Jendrassik maneuver*** - The image shows a patient interlocking their fingers and pulling them apart while a patellar reflex is being tested, which is characteristic of the **Jendrassik maneuver**. - This maneuver is used to **distract the patient** and enhance the amplitude of muscle stretch reflexes, making them more perceptible. *Wartenberg sign* - The Wartenberg sign is observed when the **little finger spontaneously abducts** due to weakness of the adductor pollicis muscle, often indicating ulnar nerve neuropathy. - This sign involves observation of a specific hand posture, not an active maneuver by the patient to improve reflex testing. *Hoffman sign* - The Hoffman sign is elicited by flicking the distal phalanx of the patient's middle finger, and a positive response involves **involuntary flexion of other fingers and the thumb**. - It is an indicator of **upper motor neuron dysfunction** and is not depicted in this image. *Gordon sign* - The Gordon sign is a plantar reflex elicited by **squeezing the calf muscle**, resulting in an extensor plantar response (dorsiflexion of the great toe and fanning of other toes). - This sign is a variant of the Babinski reflex and is used to detect **pyramidal tract lesions**, which is not what is shown.

Q: Which reflex is being elicited in the patient?

Hoffmann reflex. ***Hoffmann reflex*** - The image shows the examiner **flicking the middle finger of the patient upward**, which is the technique used to elicit the Hoffmann reflex. - A positive Hoffmann reflex involves **involuntary flexion of the thumb and index finger** in response to this flick, indicating upper motor neuron dysfunction. *Wartenberg reflex* - This reflex is elicited by rapid abduction and adduction of the patient's fingers, which is not depicted in the image. - A positive Wartenberg reflex involves the patient being unable to relax from the abducted position, indicating ulnar nerve entrapment. *Finger flexion reflex* - While the Hoffmann reflex does involve finger flexion, "finger flexion reflex" is not a specific, recognized neurological reflex test with the exact technique shown. - This term is too general and does not precisely describe the specific maneuver being performed. *Supinator jerk* - The supinator jerk (also known as the brachioradialis reflex) is elicited by **tapping the brachioradialis tendon** near the wrist with a reflex hammer. - This technique is distinctly different from the flicking of the middle finger shown in the image.

Q: Which reflex is being elicited in the patient?

Hoffman reflex. ***Hoffman reflex*** - The image shows the examiner flicking or snapping the patient's **middle finger**. - A positive Hoffman sign is indicated by involuntary flexion of the thumb and/or index finger in response to this maneuver, suggesting an **upper motor neuron lesion**. *Wartenberg reflex* - This reflex involves testing for an abnormal flexion and adduction of the thumb when attempting to extend the fingers, often seen in **ulnar nerve lesions**. - The maneuver in the image does not correspond to the elicitation of the Wartenberg reflex. *Finger flexion reflex* - This is a broad term that can refer to various reflexes involving finger flexion, but it is not a specific named reflex elicited by the maneuver shown. - The specific technique of flicking the middle finger metacarpophalangeal joint is characteristic of the Hoffman reflex. *Supinator jerk* - The supinator jerk (also known as the brachioradialis reflex) is elicited by tapping the **brachioradialis tendon** near the wrist. - This test assesses the C5-C6 spinal cord segments and involves forearm supination and elbow flexion, not finger flexion as depicted.

Q: The image shows elicitation of:

Oppenheim sign. ***Oppenheim sign*** - The image demonstrates the elicitation of the **Oppenheim sign**, where a **Babinski-like reflex** (dorsiflexion of the great toe and fanning of other toes) is produced by firmly stroking down the medial aspect of the **tibia**. - This sign is used to detect **upper motor neuron lesions** and is considered a variant of the Babinski reflex. *Chaddock sign* - The Chaddock sign involves stroking the **lateral malleolus** down to the little toe to elicit dorsiflexion of the great toe, which is not what is shown in the image. - It is another variant of the Babinski reflex, indicating **pyramidal tract dysfunction**. *Babkin sign* - The Babkin sign is a **primitive reflex in infants** where pressure applied to the palms causes the infant to open its mouth and flex its head. - This reflex is not relevant to lower limb examination in adults for pyramidal tract lesions. *Gordon sign* - The Gordon sign is elicited by compressing the **calf muscles**, often by squeezing them firmly. - A positive response, dorsiflexion of the great toe, indicates **upper motor neuron pathology**, but the image shows stroking the tibia, not compressing the calf.

Q: Medial medullary syndrome occurs due to blockage of which of the following blood vessel?

A. ***A*** - Label A points to the **anterior spinal artery**, which supplies the medial medulla. Blockage of this artery leads to medial medullary syndrome. - Medial medullary syndrome is characterized by **contralateral hemiparesis**, **contralateral loss of proprioception**, and **ipsilateral hypoglossal nerve palsy**.

Q: Which reflex is being tested here?

Hoffman reflex. ***Hoffman reflex*** - The image shows the examiner flicking a patient's **distal phalanx of the middle finger**, which is the classic method for eliciting the Hoffman reflex. - A positive Hoffman sign involves **involuntary flexion of the thumb and index finger**, indicating a potential **upper motor neuron lesion** in the cervical spinal cord. *Brachioradialis reflex* - This reflex is elicited by striking the **distal radius**, about 2-3 inches above the wrist, with a reflex hammer. - The expected response is **flexion and supination** of the forearm, which is not what is shown in the image. *Finger flexor reflex* - The finger flexor reflex, or finger jerk reflex, is similar to the Hoffman but typically involves stimulating the palmar surface or the tips of all the fingers, leading to their flexion. - While related to finger flexion, the specific maneuver of flicking the middle finger's distal phalanx for involuntary thumb and index finger flexion is characteristic of the **Hoffman reflex**. *Supinator reflex* - The supinator reflex is another name for the **brachioradialis reflex**, as it involves the supinator muscle. - It is also elicited by striking the distal radius, leading to forearm flexion and supination, not the finger flick seen in the image.

Question 1

Identify the lesion. (Recent NEET Pattern 2016-17)

Accepted Answer

Right supranuclear lesion

Answer

Left supranuclear lesion

Answer

Right infranuclear lesion

Answer

Left infranuclear lesion

Question 2

Identify the abnormality shown in the image.

Accepted Answer

Festinating gait

Answer

Magnetic gait

Answer

Titubation due to senility

Answer

Astasia abasia

Question 3

A 35-year-old male experiences bilateral asymmetrical ptosis and diplopia on watching TV or working on a laptop. Which test will be useful for diagnosis?

Accepted Answer

Ice pack test

Answer

Nerve conduction velocity

Answer

Muscle biopsy

Answer

CPK-MM levels

Question 4

Which is correct for the image shown below?

Accepted Answer

Jendrassik maneuver

Answer

Wartenberg sign

Answer

Hoffman sign

Answer

Gordon sign

Question 5

Which reflex is being elicited in the patient?

Accepted Answer

Hoffmann reflex

Answer

Wartenberg reflex

Answer

Finger flexion reflex

Answer

Supinator jerk

Question 6

Which reflex is being elicited in the patient?

Accepted Answer

Hoffman reflex

Answer

Wartenberg reflex

Answer

Finger flexion reflex

Answer

Supinator jerk

Question 7

The image shows elicitation of:

Accepted Answer

Oppenheim sign

Answer

Chaddock sign

Answer

Babkin sign

Answer

Gordon sign

Question 8

All are correct about the reflex being elicited except:

Accepted Answer

Beevor sign is caudal movement of umbilicus on attempt to flex neck and upper trunk

Answer

Exaggerated abdominal reflexes can be seen in psychoneurosis

Answer

Repeated pregnancies may lead to absent abdominal reflex

Answer

Root value of upper abdomen is T7-T9

Question 9

Medial medullary syndrome occurs due to blockage of which of the following blood vessel?

Accepted Answer

A

Answer

B

Answer

C

Answer

D

Question 10

Which reflex is being tested here?

Accepted Answer

Hoffman reflex

Answer

Brachioradialis reflex

Answer

Finger flexor reflex

Answer

Supinator reflex

Neurology — MCQs

Neurology — MCQs

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