Neurology Practice Questions

Q: Deep brain stimulation is used in the treatment of which of the following conditions?

Parkinsonism. **Explanation:** **Deep Brain Stimulation (DBS)** is a neurosurgical procedure involving the implantation of electrodes into specific brain targets, which are connected to an implanted pulse generator (IPG). It acts as a "brain pacemaker" to modulate abnormal neural activity. **Why Parkinsonism is Correct:** DBS is a well-established, FDA-approved treatment for advanced **Parkinson’s disease**, particularly when motor fluctuations (like dyskinesia) become refractory to medical therapy (Levodopa). The most common targets are the **Subthalamic Nucleus (STN)** and the **Globus Pallidus interna (GPi)**. By delivering high-frequency electrical stimulation, DBS suppresses the overactive inhibitory output of these nuclei, thereby improving tremors, rigidity, and bradykinesia. **Why Other Options are Incorrect:** * **Depression:** While DBS is being researched for treatment-resistant depression (targeting the Subgenual Cingulate Cortex/Area 25), it is **not** a standard or first-line treatment. Electroconvulsive Therapy (ECT) remains the gold standard for refractory depression. * **Dementia & Delirium:** These are characterized by diffuse cortical dysfunction or acute metabolic/toxic insults. DBS is a focal neuromodulation technique and is not indicated for the global cognitive decline of dementia or the acute fluctuating sensorium of delirium. **High-Yield Clinical Pearls for NEET-PG:** * **Psychiatric Indications:** In psychiatry, the only FDA-approved use for DBS (under a Humanitarian Device Exemption) is for **Refractory Obsessive-Compulsive Disorder (OCD)**. The target is the **Ventral Striatum/Internal Capsule**. * **Other Targets:** * Essential Tremor: Ventral Intermediate Nucleus (Vim) of the Thalamus. * Dystonia: Globus Pallidus interna (GPi). * **Contraindication:** DBS is generally avoided in patients with significant cognitive impairment or active psychosis.

Q: A 25-year-old weightlifter experienced a severe headache during training. A CSF tap performed on the medical ward showed blood stains. What is the likely diagnosis?

Ruptured aneurysm. ### Explanation **Correct Answer: B. Ruptured aneurysm** The clinical presentation describes a classic case of **Subarachnoid Hemorrhage (SAH)** [1]. In a young adult, the most common cause of non-traumatic SAH is the rupture of a **Saccular (Berry) aneurysm** [1], [3]. 1. **Why it is correct:** The patient experienced a sudden, severe headache (often described as a "thunderclap headache" or the "worst headache of my life") triggered by physical exertion (weightlifting) [1]. Strenuous activity causes a transient spike in blood pressure, leading to the rupture of an underlying aneurysm. The presence of blood in the CSF (xanthochromia or gross blood) confirms the diagnosis of SAH, as blood leaks into the subarachnoid space [1], [2]. 2. **Why other options are incorrect:** * **Cluster Headache:** Presents as severe, unilateral periorbital pain with autonomic symptoms (tearing, rhinorrhea). It does not cause blood in the CSF. * **Embolism:** Typically causes focal neurological deficits (ischemic stroke) rather than a sudden global headache [3]. CSF is usually clear in ischemic events. * **Migraine:** While severe, migraines are usually gradual in onset, recurrent, and associated with photophobia/nausea. They do not present with hemorrhagic CSF. ### NEET-PG High-Yield Pearls * **Gold Standard Investigation:** Non-contrast CT (NCCT) Head is the initial investigation of choice (95% sensitivity in the first 24 hours) [1]. * **CSF Findings:** If CT is negative but suspicion is high, a lumbar puncture is performed [1]. Findings include high opening pressure and **Xanthochromia** (yellowish discoloration due to bilirubin, appearing 6–12 hours post-bleed). * **Common Site:** Most Berry aneurysms are located in the **Anterior Communicating Artery** (junction of the Circle of Willis). * **Associated Conditions:** Polycystic Kidney Disease (ADPKD), Ehlers-Danlos syndrome, and Coarctation of the Aorta.

Q: Which reflex is being tested?

Finger flexor Reflex. ***Finger flexor Reflex*** - This reflex is tested by **striking the examiner's finger** placed over the patient's flexed fingers, causing **flexion of the fingers and thumb**. - It tests the **C8-T1 nerve roots** and involves the **median** and **ulnar nerves** supplying the finger flexors. *Brachioradialis Reflex* - This reflex is elicited by **tapping the brachioradialis tendon** at the **radial styloid process**, causing **flexion and supination** of the forearm. - It tests the **C5-C6 nerve roots** and the **radial nerve**, not the finger flexors. *Waardenburg sign* - This refers to **Wartenberg's sign**, which is a **clinical sign** (not a reflex) indicating **ulnar nerve palsy**. - It involves **involuntary abduction** of the **little finger** due to weakness of the **palmar interossei muscles**. *Supinator reflex* - This reflex involves **tapping the dorsal aspect** of the **distal radius**, causing **supination** of the forearm. - It tests the **C6-C7 nerve roots** and **posterior interosseous nerve**, not finger flexion.

Q: Raised intracranial pressure will cause which of the following?

Papilloedema. ### Explanation **Correct Answer: C. Papilloedema** **Mechanism:** Raised Intracranial Pressure (ICP) is transmitted through the subarachnoid space to the optic nerve sheath. This pressure causes mechanical obstruction of axoplasmic flow and compression of the central retinal vein [3]. This leads to edema of the optic disc, known as **Papilloedema**. It is a hallmark sign of increased ICP, though its absence does not entirely rule out acute pressure rises [1]. **Analysis of Incorrect Options:** * **A & B (Tachycardia and Hypotension):** These are incorrect because raised ICP typically triggers the **Cushing’s Reflex** (a physiological response to maintain cerebral perfusion). The Cushing’s Triad consists of **Hypertension** (widened pulse pressure), **Bradycardia**, and **Irregular Respiration** [2]. Tachycardia and hypotension are more characteristic of hypovolemic shock. * **D (Normal looking anterior fontanelle):** In infants, the cranial sutures are not yet fused. Therefore, raised ICP characteristically causes a **Bulging (tense) anterior fontanelle**. A normal or depressed fontanelle usually indicates normal pressure or dehydration, respectively. **NEET-PG High-Yield Pearls:** * **Cushing’s Triad:** Hypertension + Bradycardia + Irregular breathing (Late sign of brain herniation) [2]. * **Early Sign of Raised ICP:** Headache (worse in the morning/stooping) and vomiting (often projectile) [1]. * **False Localizing Sign:** Sixth cranial nerve (Abducens) palsy is common in raised ICP due to its long intracranial course [1]. * **Contraindication:** Lumbar puncture is strictly contraindicated in patients with papilloedema/raised ICP due to the risk of **uncal herniation** [2].

Q: The above marked structures are seen in a condition where the most common cause of death is?

Aspiration pneumonia. ***Aspiration pneumonia*** - **Bulbar involvement** in ALS leads to **dysphagia** and impaired **swallowing reflexes**, increasing risk of aspiration of food and saliva. - Progressive **respiratory muscle weakness** reduces cough effectiveness and **respiratory reserve**, making pneumonia the leading cause of death. *Heart failure* - ALS primarily affects **motor neurons** and does not typically involve **cardiac muscle** or cause heart failure. - The **autonomic nervous system** remains largely intact in ALS, preserving cardiac function. *Renal failure* - **Kidney function** is not affected in ALS as it does not involve the **autonomic control** of renal systems. - ALS is a **motor neuron disease** that spares sensory, cognitive, and most autonomic functions including renal regulation. *Neuroparalytic coma* - While ALS causes progressive **paralysis**, patients typically remain **conscious** and cognitively intact throughout the disease course. - **Respiratory failure** from diaphragmatic weakness leads to death, but coma is not the usual terminal presentation.

Q: What is the most common physical sign of cerebral metastasis?

Focal neurological deficit. ### Explanation **Cerebral metastasis** is the most common type of intracranial tumor in adults, occurring in approximately 20–40% of cancer patients. **Why Focal Neurological Deficit is Correct:** The most common presenting **physical sign** of brain metastasis is a focal neurological deficit (found in about 50–70% of patients) [1]. This occurs because metastatic lesions are typically located at the **gray-white matter junction**, where they cause local tissue destruction, mass effect, and significant vasogenic edema [1]. Depending on the location (e.g., frontal, parietal, or temporal lobes), this manifests as hemiparesis, sensory loss, or aphasia. **Analysis of Incorrect Options:** * **A. Epilepsy (Seizures):** While common, seizures occur in only about 15–25% of patients [1]. They are more frequent in metastases involving the cortex (e.g., melanoma) but are less common than focal deficits. * **C. Papilloedema:** This is a sign of increased intracranial pressure (ICP) . While many patients suffer from headaches due to ICP, overt papilloedema is a late finding and is less frequent than specific focal deficits. * **D. Visual Defects:** These are a specific type of focal deficit (e.g., hemianopia) but are less common than motor or sensory deficits because they require specific involvement of the optic radiations or occipital cortex. **High-Yield Clinical Pearls for NEET-PG:** * **Most common primary source:** Lung cancer (most common overall), followed by Breast cancer and Melanoma. * **Most common to bleed:** Melanoma, Choriocarcinoma, Renal Cell Carcinoma (RCC), and Thyroid cancer. * **Distribution:** 80% occur in the cerebral hemispheres, 15% in the cerebellum, and 5% in the brainstem [1]. * **Imaging:** Contrast-enhanced MRI is the gold standard; lesions typically show "ring enhancement" with extensive surrounding edema [1].

Q: The triad of Wernicke's encephalopathy includes all the following except?

Visual hallucinations. **Explanation:** Wernicke’s Encephalopathy (WE) is an acute, reversible neuropsychiatric emergency caused by a deficiency of **Thiamine (Vitamin B1)**, most commonly seen in chronic alcoholics. The diagnosis is primarily clinical and is defined by a classic **triad**: 1. **Ophthalmoplegia (Option C):** Characterized by ocular signs, most commonly horizontal nystagmus and bilateral abducens (6th nerve) palsy. 2. **Ataxia (Option B):** Primarily affecting gait and stance due to cerebellar involvement. 3. **Global Confusion (Option A):** An encephalopathy characterized by disorientation, apathy, and decreased consciousness. **Visual Hallucinations (Option D)** is the correct answer because it is **not** part of the Wernicke triad. Visual hallucinations are typically associated with **Alcohol Withdrawal Delirium (Delirium Tremens)** or Alcoholic Hallucinosis, rather than acute thiamine deficiency. **High-Yield Clinical Pearls for NEET-PG:** * **Pathology:** The most characteristic lesions are found in the **mammillary bodies**, periaqueductal gray matter, and the floor of the fourth ventricle. * **Korsakoff Psychosis:** If WE is untreated, it can progress to Korsakoff syndrome, characterized by **anterograde amnesia** and **confabulation** (filling memory gaps with fabricated stories). * **Management Rule:** Always administer **Thiamine before Glucose** in a malnourished or alcoholic patient. Giving glucose first can precipitate or worsen WE by consuming the remaining thiamine stores during carbohydrate metabolism. * **MRI Finding:** Increased T2/FLAIR signal intensity in the mammillary bodies is a highly specific finding.

Q: An 18-year-old male presents with inability to walk, with rapidly evolving weakness affecting his legs and feet starting 2 days prior. Physical examination reveals inability to move his feet or ankles and difficulty raising his thighs off the bed. He has symmetrical hyporeflexia of the legs, and his sensorium is intact. He was treated 10 days previously for an upper respiratory tract infection. The immunological response producing the patient's symptoms is most intense at which of the following locations?

Spinal motor nerves. **Explanation:** The clinical presentation of rapidly evolving, symmetrical ascending weakness, hyporeflexia, and a preceding respiratory infection (10 days prior) is classic for **Guillain-Barré Syndrome (GBS)**, specifically the Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP) subtype [1]. **1. Why the Correct Answer is Right:** GBS is an immune-mediated demyelinating polyneuropathy. The underlying mechanism is **molecular mimicry**, where antibodies against pathogens (like *C. jejuni* or respiratory viruses) cross-react with gangliosides on the myelin sheath or axons of the **peripheral nerves and spinal nerve roots** [1]. The inflammatory infiltrate and demyelination are most intense at the level of the **spinal motor nerves** (nerve roots), leading to the characteristic Lower Motor Neuron (LMN) signs like flaccidity and hyporeflexia [2]. **2. Why Incorrect Options are Wrong:** * **A & C (Lateral corticospinal tracts / Precentral gyrus):** These are components of the Upper Motor Neuron (UMN) system. UMN lesions present with hyperreflexia and spasticity, whereas this patient has hyporeflexia [2]. * **B (Neuromuscular junction):** This is the site of pathology for Myasthenia Gravis or Lambert-Eaton Syndrome. These typically present with fluctuating weakness (fatigability) or ocular symptoms, rather than an acute, ascending paralysis following an infection. **High-Yield Clinical Pearls for NEET-PG:** * **Most common antecedent infection:** *Campylobacter jejuni* (associated with the AMAN variant). * **CSF Finding:** **Albuminocytologic dissociation** (High protein with normal cell count). * **Treatment:** Intravenous Immunoglobulin (IVIG) or Plasmapheresis. **Steroids are not effective.** * **Prognostic Indicator:** Vital capacity monitoring is crucial to detect impending respiratory failure [1].

Question 1

Deep brain stimulation is used in the treatment of which of the following conditions?

Accepted Answer

Parkinsonism

Answer

Depression

Answer

Dementia

Answer

Delirium

Question 2

A 25-year-old weightlifter experienced a severe headache during training. A CSF tap performed on the medical ward showed blood stains. What is the likely diagnosis?

Accepted Answer

Ruptured aneurysm

Answer

Cluster headache

Answer

Embolism

Answer

Migraine

Question 3

Which reflex is being tested?

Accepted Answer

Finger flexor Reflex

Answer

Brachioradialis Reflex

Answer

Waardenburg sign

Answer

Supinator reflex

Question 4

Raised intracranial pressure will cause which of the following?

Accepted Answer

Papilloedema

Answer

Tachycardia

Answer

Hypotension

Answer

Normal looking anterior fontanelle in infants

Question 5

A patient appears awake but is not talking and has no voluntary movements. The patient can signal with vertical eye movements. A CT scan shows infarction of the ventral pons. What is the most likely diagnosis?

Accepted Answer

Locked-in state

Answer

Coma

Answer

Abulia

Answer

Catatonia

Question 6

The above marked structures are seen in a condition where the most common cause of death is?

Accepted Answer

Aspiration pneumonia

Answer

Heart failure

Answer

Renal failure

Answer

Neuroparalytic coma

Question 7

What is the most common physical sign of cerebral metastasis?

Accepted Answer

Focal neurological deficit

Answer

Epilepsy

Answer

Papilloedema

Answer

Visual defects

Question 8

A pregnant patient presents with right-sided hemiparesis and aphasia for over 1 hour. A CT scan of the brain is normal. What is the next best step in management?

Accepted Answer

Thrombolysis

Answer

Dual antiplatelet therapy immediately

Answer

Perform MRI and catheter-guided clot extraction

Answer

Perform thrombectomy

Question 9

The triad of Wernicke's encephalopathy includes all the following except?

Accepted Answer

Visual hallucinations

Answer

Global confusion

Answer

Ataxia

Answer

Ophthalmoplegia

Question 10

An 18-year-old male presents with inability to walk, with rapidly evolving weakness affecting his legs and feet starting 2 days prior. Physical examination reveals inability to move his feet or ankles and difficulty raising his thighs off the bed. He has symmetrical hyporeflexia of the legs, and his sensorium is intact. He was treated 10 days previously for an upper respiratory tract infection. The immunological response producing the patient's symptoms is most intense at which of the following locations?

Accepted Answer

Spinal motor nerves

Answer

Lateral corticospinal tracts

Answer

Neuromuscular junction

Answer

Precentral gyrus

Neurology — MCQs

Neurology — MCQs

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