Neurology Practice Questions

Q: SAH leads to which of the following ECG changes?

T-wave inversion. ***T-wave inversion*** - Subarachnoid hemorrhage (SAH) can cause **cerebral stunning** and lead to characteristic ECG changes, including widespread deep **T-wave inversions** often resembling cardiac ischemia. - These T-wave inversions are thought to be due to an autonomic surge, particularly **sympathetic activation**, which can induce myocardial stunning or injury without direct coronary artery disease. *Deep Q waves* - **Deep Q waves** typically signify a previous **myocardial infarction** due to myocardial necrosis. - While SAH can cause cardiac issues, the primary and most common ECG change observed is not deep Q waves. *Premature ventricular complexes* - Although SAH can trigger **arrhythmias** due to autonomic instability, **premature ventricular complexes (PVCs)** are a non-specific finding and less characteristic of SAH-induced ECG changes than T-wave inversions. - PVCs can be seen in various cardiac conditions and are not uniquely indicative of SAH. *Sine wave pattern* - A **sine wave pattern** on ECG is a classic sign of **severe hyperkalemia**, indicating impending ventricular fibrillation or asystole. - This pattern is not typically associated with subarachnoid hemorrhage.

Q: A 50 -year-old man develops an excruciating headache. On examination he has nuchal rigidity. NCCT performed after 4 hours shows blood in the Sylvain fissure. What does the ECG show?

T-wave inversion. ***T-wave inversion*** - The ECG image prominently displays **deep, diffuse T-wave inversions** in multiple leads (e.g., II, aVL, V2, V5). These T-wave changes, particularly deep and widespread, are often referred to as "cerebral T waves" or "neurogenic T waves" and are characteristic findings in patients with **subarachnoid hemorrhage**. - Subarachnoid hemorrhage can cause various ECG abnormalities due to heightened **sympathetic nervous system activity** and direct myocardial injury (neurogenic stunning), leading to repolarization abnormalities. *Artifact* - **Artifacts on an ECG** typically manifest as irregular, erratic deflections or baseline wander that do not conform to physiological cardiac activity. - The T-wave inversions observed in the ECG are consistent, well-defined, and fit a pattern of cardiac repolarization disturbance, rather than random noise or movement. *Premature ventricular complexes* - **Premature ventricular complexes (PVCs)** are early, wide QRS complexes that are not preceded by a P wave. - While PVCs can occur in patients with subarachnoid hemorrhage, they are not the predominant or most striking abnormality seen in this specific ECG, which is dominated by T-wave changes. *Prominent U wave* - A **prominent U wave** is a small, positive deflection following the T wave, usually best seen in precordial leads. It is often associated with bradycardia or hypokalemia. - The ECG shows significant T-wave abnormalities, but not distinctly prominent U waves as the primary or most characteristic finding for subarachnoid hemorrhage.

Q: In the ECG tracing shown below, which of the following is correct?

Second degree AV block type 1, intranodal. ***Second degree AV block type 1, intranodal*** - The ECG shows **progressive lengthening of the PR interval** with each successive beat, followed by a **dropped QRS complex**, a classic pattern for Mobitz I (Wenckebach) AV block. - Mobitz I block is almost always due to a physiological delay within the **AV node (intranodal)**. *First degree AV block, intranodal* - First-degree AV block is characterized by a **constant, prolonged PR interval** (>0.20 seconds) without any dropped QRS complexes. - While it can be intranodal, the key feature of a dropped beat after progressive PR lengthening is absent here. *Second degree AV block type 2, infranodal* - Second degree AV block type 2 (Mobitz II) involves a **constant PR interval** for conducted beats, but with intermittent, **unheralded dropped QRS complexes**. - Mobitz II is typically due to disease in the **His-Purkinje system (infranodal)** and carries a higher risk of progression to complete heart block. *Second degree AV block type 2, intranodal* - Second-degree AV block type 2 is characterized by a **constant PR interval** with intermittently dropped beats. - While Mobitz II is usually infranodal, the hallmark of progressive PR lengthening seen in the tracing rules out Mobitz II entirely.

Q: A 65-year-old man loses consciousness at a Newyear party. On admission heart rate is 50 / min and BP is 170 / 110 mm Hg. JVP is normal. S2 is normal split and chest is bilaterally clear. The medic shows you his ECG. Troponin I value is <0.04 ng / dL. GCS is 7. Comment on the diagnosis.

Stroke. ***Stroke*** - The combination of **altered consciousness (GCS 7)**, **hypertension (BP 170/110 mmHg)**, and **bradycardia (HR 50/min)** in an elderly patient losing consciousness abruptly is highly suggestive of **Cushing's triad**, which is a sign of increased intracranial pressure often due to a stroke. - The **normal JVP and clear chest** rule out acute heart failure or pulmonary edema, and the **normal troponin I** rules out an acute myocardial infarction as the primary event. The provided ECG is essentially normal, lacking signs of acute ischemia or severe electrolyte disturbances. *STEMI* - An **ST-elevation myocardial infarction (STEMI)** would typically present with chest pain (though silent MIs can occur), and the ECG would show significant **ST-segment elevation** in at least two contiguous leads. - The patient's **troponin I is normal (<0.04 ng/dL)**, making STEMI very unlikely. *Hyperkalemia* - **Hyperkalemia** on ECG typically manifests as **tall, peaked T waves**, prolonged PR interval, wide QRS, and eventually sine wave patterns or asystole. - The provided ECG does not show these characteristic findings, rendering hyperkalemia an improbable primary diagnosis. *Stokes-Adams syndrome* - **Stokes-Adams syndrome** is characterized by recurrent syncopal attacks caused by transient **bradyarrhythmias or asystole** due to advanced AV block or sick sinus syndrome. - While the patient has bradycardia, there is no evidence of advanced AV block or asystole on the provided ECG, and the primary presentation points more strongly towards a neurological event.

Q: Which of the following statements are correct regarding a brain abscess? I. Abscesses arise when the brain is exposed directly as a result of fracture or infection of air sinus. II. Presenting features include low grade fever, confusion, seizures and focal deficits. III. MRI with contrast is the initial imaging modality of choice. IV. The aetological agents include bacteria, fungi, protozoa and viruses. Select the answer using the code given below :

I, II and III. I, II and III - This option correctly identifies that brain abscesses can result from direct exposure due to fractures or sinus infections [1], present with symptoms like fever, confusion, seizures, and focal deficits, and are best initially imaged with MRI with contrast. - While bacteria, fungi, and protozoa are common causes of brain abscesses, viruses are generally not a primary cause of brain abscess formation [1], making statement IV incorrect in its broad inclusion of viruses. I, III and IV - This option incorrectly includes statement IV, which claims viruses are etiological agents for brain abscesses. While viruses cause CNS infections, they typically lead to meningitis or encephalitis [1], not abscesses. - It also omits statement II, which accurately describes the common clinical presentation of brain abscesses, including symptoms like confusion and focal deficits. I, II and IV - This option incorrectly includes statement IV, which states that viruses are common etiologic agents for brain abscesses. Brain abscesses are primarily caused by bacteria, fungi, and parasites [1]. - It omits statement III, which correctly identifies MRI with contrast as the initial imaging modality of choice, crucial for diagnosis due to its superior soft tissue resolution. II, III and IV - This option incorrectly includes statement IV, which suggests viruses are among the etiologic agents. Viral infections of the brain typically manifest as encephalitis or meningitis [1], not abscesses. - It omits statement I, which correctly describes common routes of infection, including direct extension from adjacent structures like infected sinuses or trauma [1].

Q: Which of the following statements are correct regarding the use of benzodiazepines in the initial management of status epilepticus? I. Upto two doses may be used 5 minutes apart, if seizures are not controlled II. For Lorazepam, only a single dose should be used, even if seizures are not controlled III. Dose of midazolam at this stage is 1-15 mcg / kg / min infusion IV. Dose of both lorazepam and midazolam is 0.1 mg / kg Select the answer using the code given below :

I and IV. ***I and IV*** - According to current guidelines, **up to two doses** of a benzodiazepine may be administered 5 minutes apart if the **seizures are not controlled** after the initial dose. - The recommended dose for both **lorazepam and midazolam** in the initial management of status epilepticus is **0.1 mg/kg**. *II and IV* - This option is incorrect because statement II is false, as **multiple doses of lorazepam** can be administered if seizures are not controlled. - While statement IV is correct regarding the dosage of lorazepam and midazolam. *I and III* - This option is incorrect because statement III is false, as **1-15 mcg/kg/min infusion** is the dose for **continuous infusion** of midazolam in refractory status epilepticus, not the initial bolus dose. - Statement I is correct but paired with an incorrect statement. *II and III* - This option is incorrect because both statements II and III are false regarding the initial management of status epilepticus. - As previously stated, **multiple doses of lorazepam** can be used, and the given midazolam dose is for **continuous infusion**, not the initial bolus.

Q: Which one of the following oral drugs may be used as adjunctive therapy in the management of super-refractory status epilepticus?

Topiramate. ***Topiramate*** - **Topiramate** is an antiepileptic drug with multiple mechanisms of action, including potentiation of **GABAergic** activity, blockade of **voltage-gated sodium channels**, and antagonism of **AMPA/kainate glutamate receptors**. - Its broad-spectrum action and ability to be administered orally make it a suitable **adjunctive therapy** in complex cases like **super-refractory status epilepticus (SRSE)**, where patients have failed other conventional treatments. *Clobazam* - **Clobazam** is a **benzodiazepine** primarily used as an **anxiolytic** and antiepileptic drug, particularly for Lennox-Gastaut syndrome. - While supportive in status epilepticus, its primary role is in acute seizure termination rather than as a long-term adjunctive therapy for **super-refractory status epilepticus** post-acute phase. *Clonazepam* - **Clonazepam** is another **benzodiazepine** with potent **antiepileptic** properties. - It is effective in terminating acute seizures but is not typically used as a primary oral adjunctive agent for **super-refractory status epilepticus** due to its sedative side effects and potential for tolerance. *Lamotrigine* - **Lamotrigine** is an **antiepileptic drug** that primarily works by inhibiting **voltage-sensitive sodium channels**, thereby stabilizing neuronal membranes and modulating the release of excitatory neurotransmitters. - While effective for various seizure types, including focal and generalized seizures, it is not a first-line or common choice as an **adjunctive oral therapy** in **super-refractory status epilepticus**, which often requires drugs with faster onset or broader mechanisms beyond sodium channel blockade.

Q: Which of the following are clinical features of Fronto-Temporal dementia ? I. Personality change II. Language disturbance III. Memory may be preserved in early stages IV. Anti-cholinesterases are the drug of choice for treatment Select the correct answer using the code given below :

I, II and III. ***Correct Answer: I, II and III*** - **Fronto-temporal dementia (FTD)** is characterized by prominent **personality and behavioral changes** (disinhibition, apathy, loss of empathy) and **language disturbances** (progressive non-fluent aphasia or semantic variant aphasia). - Unlike Alzheimer's disease, **memory is often relatively preserved in the early stages** of FTD, with executive function, behavior, and social cognition being more affected initially. - **Statement IV is incorrect**: Anti-cholinesterases (donepezil, rivastigmine, galantamine) are the treatment for Alzheimer's disease and are **generally ineffective or may even worsen behavioral symptoms in FTD**. There is no FDA-approved pharmacological treatment specifically for FTD; management focuses on behavioral interventions and symptomatic treatment. *Incorrect: II, III and IV* - This option incorrectly includes **Statement IV (anti-cholinesterases)** as a clinical feature or appropriate treatment. - Anti-cholinesterases are not the drug of choice for FTD and may exacerbate behavioral symptoms. *Incorrect: I, III and IV* - This option incorrectly includes **Statement IV (anti-cholinesterases)** while missing the important language disturbance feature. - Language disturbances are a core feature of FTD, particularly in the language-variant subtypes. *Incorrect: I, II and IV* - This option incorrectly includes **Statement IV (anti-cholinesterases)** while missing the fact that memory preservation in early stages is characteristic. - The preservation of memory early on is a key distinguishing feature between FTD and Alzheimer's disease.

Q: Which of the following are causes of reversible dementia? I. Hypothyroidism II. Vitamin B12 deficiency III. Dementia with lewy body IV. Thiamine deficiency Select the correct answer using the code given below :

I, II and IV. ***I, II and IV*** - **Hypothyroidism** can cause cognitive impairment, including memory loss and slowed thinking, which are often reversible with **thyroid hormone replacement**. - **Vitamin B12 deficiency** can lead to neurological symptoms such as memory problems and cognitive decline, which can improve significantly with **B12 supplementation** [1]. - **Thiamine deficiency**, particularly in the context of Wernicke-Korsakoff syndrome, can cause severe amnesia and cognitive deficits that may be partially or fully reversible with **thiamine repletion** [1], [2]. *II, III and IV* - This option incorrectly includes **Dementia with Lewy bodies (DLB)** as a reversible cause. DLB is a progressive and irreversible neurodegenerative disease. - While II and IV are correct, the inclusion of III makes this option incorrect. *I, III and IV* - This option incorrectly includes **Dementia with Lewy bodies (DLB)** as a reversible cause. DLB is a progressive neurodegenerative dementia. - Although I and IV are correct, the presence of III makes this an invalid choice. *I, II and III* - This option incorrectly includes **Dementia with Lewy bodies (DLB)** as a reversible cause. DLB is an **irreversible neurodegenerative disorder**. - While I and II are correct, the miscategorization of III leads to this option being incorrect.

Q: Which of the following are features of Alzheimer's disease? I. It is a disorder of cerebral cortical function II. Only short term memory is affected III. Patients deny that there is anything wrong IV. Depression is commonly present Select the correct answer using the code given below :

I, III and IV. ***I, III and IV*** - Alzheimer's disease is indeed a **disorder of cerebral cortical function** [1], primarily affecting areas responsible for memory, language, and executive functions. - Patients often exhibit **anosognosia** (denial of illness), failing to recognize their cognitive deficits, and **depression** is a common comorbidity [2] that can complicate diagnosis and management. *II, III and IV* - This option incorrectly states that **only short-term memory is affected** in Alzheimer's disease; both short-term and long-term memory are progressively impaired [2]. - While denial of illness and depression are common, the underlying memory impairment is more global than just short-term memory [2]. *I, II and III* - This option incorrectly includes the statement that **only short-term memory is affected**, which is not characteristic of Alzheimer's disease. - Alzheimer's patients experience a decline in various cognitive domains, including **long-term memory** [2], language, and executive functions. *I, II and IV* - This option incorrectly includes the statement that **only short-term memory is affected**; Alzheimer's disease impacts both short-term and long-term memory [2]. - While cerebral cortical dysfunction and depression are relevant features, the denial of illness (anosognosia) is also a significant clinical presentation not included here.

Question 1

SAH leads to which of the following ECG changes?

Accepted Answer

T-wave inversion

Answer

Deep Q waves

Answer

Premature ventricular complexes

Answer

Sine wave pattern

Question 2

A 50 -year-old man develops an excruciating headache. On examination he has nuchal rigidity. NCCT performed after 4 hours shows blood in the Sylvain fissure. What does the ECG show?

Accepted Answer

T-wave inversion

Answer

Artifact

Answer

Premature ventricular complexes

Answer

Prominent U wave

Question 3

In the ECG tracing shown below, which of the following is correct?

Accepted Answer

Second degree AV block type 1, intranodal

Answer

First degree AV block, intranodal

Answer

Second degree AV block type 2, infranodal

Answer

Second degree AV block type 2, intranodal

Question 4

A 65-year-old man loses consciousness at a Newyear party. On admission heart rate is 50 / min and BP is 170 / 110 mm Hg. JVP is normal. S2 is normal split and chest is bilaterally clear. The medic shows you his ECG. Troponin I value is <0.04 ng / dL. GCS is 7. Comment on the diagnosis.

Accepted Answer

Stroke

Answer

STEMI

Answer

Hyperkalemia

Answer

Stokes-Adams syndrome

Question 5

Which of the following statements are correct regarding a brain abscess?
I. Abscesses arise when the brain is exposed directly as a result of fracture or infection of air sinus.
II. Presenting features include low grade fever, confusion, seizures and focal deficits.
III. MRI with contrast is the initial imaging modality of choice.
IV. The aetological agents include bacteria, fungi, protozoa and viruses.

Select the answer using the code given below :

Accepted Answer

I, II and III

Answer

I, III and IV

Answer

I, II and IV

Answer

II, III and IV

Question 6

Which of the following statements are correct regarding the use of benzodiazepines in the initial management of status epilepticus?
I. Upto two doses may be used 5 minutes apart, if seizures are not controlled
II. For Lorazepam, only a single dose should be used, even if seizures are not controlled
III. Dose of midazolam at this stage is 1-15 mcg / kg / min infusion
IV. Dose of both lorazepam and midazolam is 0.1 mg / kg

Select the answer using the code given below :

Accepted Answer

I and IV

Answer

II and IV

Answer

I and III

Answer

II and III

Question 7

Which one of the following oral drugs may be used as adjunctive therapy in the management of super-refractory status epilepticus?

Accepted Answer

Topiramate

Answer

Clobazam

Answer

Clonazepam

Answer

Lamotrigine

Question 8

Which of the following are clinical features of Fronto-Temporal dementia ?
I. Personality change
II. Language disturbance
III. Memory may be preserved in early stages
IV. Anti-cholinesterases are the drug of choice for treatment
Select the correct answer using the code given below :

Accepted Answer

I, II and III

Answer

II, III and IV

Answer

I, III and IV

Answer

I, II and IV

Question 9

Which of the following are causes of reversible dementia?
I. Hypothyroidism
II. Vitamin B12 deficiency
III. Dementia with lewy body
IV. Thiamine deficiency

Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

Answer

I, II and III

Question 10

Which of the following are features of Alzheimer's disease?
I. It is a disorder of cerebral cortical function
II. Only short term memory is affected
III. Patients deny that there is anything wrong
IV. Depression is commonly present

Select the correct answer using the code given below :

Accepted Answer

I, III and IV

Answer

II, III and IV

Answer

I, II and III

Answer

I, II and IV

Neurology — MCQs

Neurology — MCQs

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