Neurology Practice Questions

Q: Out of the following areas of brain, which area is most commonly affected on brain imaging in Wilson's disease?

Basal ganglia. ***Basal ganglia*** - The **basal ganglia**, particularly the **putamen** and **globus pallidus**, are the most commonly affected brain regions due to their high susceptibility to **copper deposition** in Wilson's disease. - Imaging findings like **hyperintense lesions** on T2-weighted MRI in these areas are characteristic of neurodegeneration and edema caused by copper accumulation. *Thalamus* - While the **thalamus** can be affected in later stages of Wilson's disease, it is not typically the primary or most common site of involvement compared to the basal ganglia. - Thalamic lesions are usually seen in more advanced cases and may contribute to cognitive deficits and motor symptoms. *Sub-cortex* - The term **sub-cortex** refers to a broad region beneath the cerebral cortex, encompassing many structures, including the basal ganglia, thalamus, and white matter. - While structures within the sub-cortex are affected, "basal ganglia" is a more specific and accurate answer for the most commonly affected area. *Cerebellum* - **Cerebellar involvement** is less common than basal ganglia involvement in Wilson's disease, though it can occur in some patients. - When affected, it can lead to **ataxia** and coordination problems, but it is not the most consistently or severely damaged area.

Q: Which of the following are trigger factors for seizures? I. Sleep deprivation II. Missed doses of antiepileptic drugs III. Recreational drug misuse IV. Physical exhaustion Select the correct answer using the code given below:

I, II, III and IV. ***I, II, III and IV*** - **Sleep deprivation** significantly lowers the **seizure threshold** by altering brain excitability and neurochemical balance. - **Missed doses of antiepileptic drugs** lead to subtherapeutic drug levels, increasing the likelihood of breakthrough seizures in individuals undergoing treatment. - **Recreational drug misuse** (e.g., cocaine, amphetamines, alcohol withdrawal) can directly cause seizures by neurotoxic effects or by unmasking an underlying seizure disorder. - **Physical exhaustion** can act as a stressor, disrupting brain homeostasis and making individuals more susceptible to seizures, similar to sleep deprivation. *II and III only* - This option is incomplete as **sleep deprivation** and **physical exhaustion** are also well-established seizure triggers. *I and IV only* - This option is incomplete because **missed doses of antiepileptic drugs** and **recreational drug misuse** are critical and common triggers for seizures. *I, II and III only* - This option overlooks **physical exhaustion**, which can, similar to sleep deprivation, significantly reduce the seizure threshold.

Q: Which of the following are seen in Normal pressure hydrocephalus ? 1. Hearing loss 2. Gait disturbance 3. Incontinence 4. Cognitive decline Select the correct answer using the code given below :

2, 3 and 4. ***2, 3 and 4*** - This option correctly identifies the **Hakim-Adams triad** of Normal pressure hydrocephalus: **gait disturbance**, **urinary incontinence**, and **cognitive decline**. - The classic mnemonic "**wet, wobbly, and wacky**" describes these three cardinal features - incontinence (wet), gait instability (wobbly), and cognitive impairment (wacky). *3 and 4 only* - This option only includes **incontinence** and **cognitive decline**, missing the crucial **gait disturbance** component of the triad. - **Gait apraxia** is often the earliest and most prominent feature of NPH, making this option incomplete. *1, 2 and 3* - **Hearing loss** is not a feature of Normal pressure hydrocephalus and is incorrectly included in this option. - While it correctly includes **gait disturbance** and **incontinence**, the presence of hearing loss makes this choice inaccurate. *1, 2 and 4* - **Hearing loss** is not associated with NPH and represents a major error in this option. - Though **gait disturbance** and **cognitive decline** are correct features, including hearing loss eliminates this as a valid choice.

Q: Which of the following represents the underlying pathophysiology of the classic triad of brain tumor presentation? 1. Raised ICP 2. Seizures 3. Hemianopia 4. Focal deficit

1. Raised ICP. ***Raised ICP*** - **Increased Intracranial Pressure (ICP)** is the fundamental underlying cause of the classic triad of brain tumor symptoms [1]. - As a tumor grows, it occupies space within the rigid skull, leading to an increase in pressure that manifests as headache, nausea/vomiting, and papilledema [1]. *Anopia* - **Anopia** (complete blindness in one eye) is a specific visual field defect, not a general underlying pathophysiological mechanism for the classic triad. - While brain tumors can cause visual field defects, these are typically considered focal neurological deficits rather than the primary cause of the general triad [1]. *Focal deficit* - **Focal neurological deficits** (like hemianopia, weakness, or sensory loss) are *symptoms* caused by brain tumors, but they represent localized damage, not the overarching pathophysiology of the classic triad [1]. - The classic triad (headache, nausea/vomiting, papilledema) is a manifestation of diffuse increased pressure, not specific focal damage [1]. *Seizures* - **Seizures** are a common symptom of brain tumors, often due to irritation of cortical tissue [1]. - However, seizures are a *symptom* that can occur due to focal irritation or diffuse pressure and do not represent the primary underlying pathophysiology (raised ICP) that causes the classic triad itself [1].

Q: Genetic disorder predisposing patients to develop Berry aneurysm includes all EXCEPT:

Neurofibromatosis Type II. ***Neurofibrofomatosis Type II*** - This condition is primarily associated with **central nervous system tumors** like **vestibular schwannomas** and **meningiomas**, not Berry aneurysms [2]. - While it affects the nervous system, its vascular manifestations are typically different from those predisposing to aneurysms. *Marfan’s syndrome* - Patients with Marfan's syndrome have **fragile connective tissue** due to a defect in **fibrillin-1**, which can weaken arterial walls. - This weakness increases the risk of **aortic aneurysms** and dissections, and can also predispose to intracranial aneurysms like Berry aneurysms. *Adult polycystic kidney* - This **autosomal dominant** disorder is characterized by the formation of **cysts in the kidneys**, but also has systemic manifestations [1]. - There is a well-established association between **autosomal dominant polycystic kidney disease (ADPKD)** and an increased incidence of **Berry aneurysms**. *Fibromuscular dysplasia* - This condition involves **abnormal cellular development** in the **arterial walls**, leading to areas of narrowing and enlargement. - It commonly affects the **renal arteries** and **carotid arteries**, and is also a known risk factor for the development of **intracranial aneurysms**, including Berry aneurysms.

Q: A patient presented with violent, flinging movements. Where is the lesion causing the hemiballismus seen?

Subthalamic nucleus. ***Subthalamic nucleus*** - **Hemiballismus** is characterized by **violent, flinging movements** of one side of the body, most commonly affecting the proximal limbs [1]. - This involuntary movement disorder is typically caused by a lesion, often an **infarct** or **hemorrhage**, in the **contralateral subthalamic nucleus (STN)** [1]. *Putamen* - Lesions in the **putamen** are more commonly associated with other movement disorders such as **dystonia** or **chorea**. - The putamen is part of the **striatum** and plays a key role in the direct and indirect pathways of the basal ganglia. *Globus pallidus* - Damage to the **globus pallidus (GP)**, particularly the external segment (GPe), can lead to conditions like **dystonia** or contribute to Parkinsonian symptoms depending on the specific region affected [2]. - The globus pallidus is a central component of the **basal ganglia output** to the thalamus. *Caudate nucleus* - Lesions in the **caudate nucleus** are closely linked to **Huntington's disease**, which primarily manifests as **chorea** and cognitive decline [1]. - The caudate nucleus is primarily involved in **cognitive functions** and motor control planning.

Q: Thrombolysis can be considered in all of these conditions, except:

Blood pressure of more than 185/110 mmHg. ***Blood pressure of more than 185/110 mmHg*** - A **blood pressure** greater than **185/110 mmHg** is an absolute contraindication for thrombolysis due to the significantly increased risk of developing **hemorrhagic transformation**. - **Aggressive blood pressure control** is necessary to reduce the risk of intracranial hemorrhage before considering thrombolytics. *Ischemic stroke within 2 hours* - This is within the **therapeutic window** for thrombolysis, which typically extends up to **4.5 hours** from symptom onset [1]. - Earlier administration of thrombolytics within this window generally leads to **better outcomes** and reduced disability [1]. *Onset of symptoms <4 hours* - An onset of symptoms less than **4.5 hours** is a primary **inclusion criterion** for intravenous thrombolysis in acute ischemic stroke [1]. - This timeframe allows for the maximum benefit from **clot dissolution** while minimizing the risk of adverse events. *MRI showing density in less than 1/3rd of the area supplied by MCA* - A **diffusion-weighted MRI** showing an infarct core of less than one-third of the **Middle Cerebral Artery (MCA)** territory is an indicator that the amount of **irreversibly damaged tissue** is small. - This suggests a larger volume of **salvageable penumbra**, making thrombolysis more likely to be beneficial.

Q: What is the possible cause of irreversible dementia?

Lewy body. ***Lewy body*** - **Lewy body dementia** is a progressive, irreversible neurodegenerative disorder characterized by the abnormal accumulation of **alpha-synuclein proteins** within neurons [1]. - It presents with fluctuating cognition, recurrent visual hallucinations, and spontaneous **parkinsonism**, eventually leading to severe and irreversible cognitive decline [1]. *Vitamin B12 deficiency* - **Vitamin B12 deficiency** can cause cognitive impairment and dementia-like symptoms, but these are often **reversible** with appropriate B12 supplementation [2]. - Symptoms include **anemia**, peripheral neuropathy, and psychiatric changes, which can improve with treatment. *NPH* - **Normal Pressure Hydrocephalus (NPH)** presents with a classic triad of gait disturbance, urinary incontinence, and dementia [2]. - While it causes dementia, it is often **reversible** with surgical placement of a **ventriculoperitoneal shunt** to drain excess CSF [2]. *Hypothyroid* - **Hypothyroidism** can lead to cognitive slowing, memory impairment, and confusion, resembling dementia. - These symptoms are typically **reversible** and improve significantly with **thyroid hormone replacement therapy**.

Q: A 45-year-old male patient presented with a history of bilateral lower limb weakness, which progressed to his upper limbs in a year. On examination, he had weakness in both lower limbs and wasting in the left upper limb. Babinski sign was positive and the deep tendon reflexes were hyperactive. He has no sensory loss or any autonomic dysfunction. What is the likely diagnosis?

ALS. ***ALS*** - This patient exhibits a classic combination of **upper motor neuron (UMN)** signs (hyperactive deep tendon reflexes, positive Babinski sign) and **lower motor neuron (LMN)** signs (weakness, wasting), along with progressive limb weakness [1], [2]. These findings are characteristic of **amyotrophic lateral sclerosis (ALS)**, especially with the sparing of sensory and autonomic function [1]. - ALS is fundamentally a **motor neuron disease** that affects both UMNs and LMNs, leading to progressive muscle weakness without significant sensory deficits [1]. *GBS* - **Guillain-Barré Syndrome (GBS)** typically presents with **acute, ascending paralysis** and **areflexia** or hyporeflexia, which contradicts the hyperactive reflexes and progressive, chronic nature observed in the patient. - While GBS causes motor weakness, it is primarily a demyelinating neuropathy affecting the peripheral nervous system and usually spares upper motor neuron signs. *MS* - **Multiple sclerosis (MS)** is characterized by **demyelinating lesions** in the central nervous system, leading to a wide variety of neurological deficits, often with sensory disturbances, visual problems, and bladder dysfunction. - While MS can cause motor weakness and hyperreflexia, it usually presents with a relapsing-remitting course and significant sensory symptoms, which are absent in this patient. *Tropical spastic paraparesis* - **Tropical spastic paraparesis** primarily causes **progressive spasticity and weakness** in the lower limbs, indicative of central nervous system involvement, often linked to **HTLV-1 infection**. - While it features upper motor neuron signs, it typically does not involve the prominent muscle wasting and lower motor neuron signs observed in this patient.

Question 1

Out of the following areas of brain, which area is most commonly affected on brain imaging in Wilson's disease?

Accepted Answer

Basal ganglia

Answer

Thalamus

Answer

Sub-cortex

Answer

Cerebellum

Question 2

Which of the following are trigger factors for seizures?
I. Sleep deprivation
II. Missed doses of antiepileptic drugs
III. Recreational drug misuse
IV. Physical exhaustion

Select the correct answer using the code given below:

Accepted Answer

I, II, III and IV

Answer

II and III only

Answer

I and IV only

Answer

I, II and III only

Question 3

Which of the following are seen in Normal pressure hydrocephalus ?

1. Hearing loss
2. Gait disturbance
3. Incontinence
4. Cognitive decline

Select the correct answer using the code given below :

Accepted Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

3 and 4 only

Question 4

Which of the following represents the underlying pathophysiology of the classic triad of brain tumor presentation?

1. Raised ICP
2. Seizures
3. Hemianopia
4. Focal deficit

Accepted Answer

1. Raised ICP

Answer

3. Anopia

Answer

4. Focal deficit

Answer

2. Seizures

Question 5

Genetic disorder predisposing patients to develop Berry aneurysm includes all EXCEPT:

Accepted Answer

Neurofibromatosis Type II

Answer

Marfan’s syndrome

Answer

Adult polycystic kidney

Answer

Fibromuscular dysplasia

Question 6

A patient presented with violent, flinging movements. Where is the lesion causing the hemiballismus seen?

Accepted Answer

Subthalamic nucleus

Answer

Putamen

Answer

Globus pallidus

Answer

Caudate nucleus

Question 7

Thrombolysis can be considered in all of these conditions, except:

Accepted Answer

Blood pressure of more than 185/110 mmHg

Answer

Ischemic stroke within 2 hours

Answer

Onset of symptoms <4 hours

Answer

MRI showing density in less than 1/3rd of the area supplied by MCA

Question 8

What is the possible cause of irreversible dementia?

Accepted Answer

Lewy body

Answer

Vitamin B12 deficiency

Answer

NPH

Answer

Hypothyroid

Question 9

Patient presented with following features:

- ipsilateral loss of pain and temperature sensation in the face
- Contralateral loss of pain and temperature sensation in the body
- Horner's syndrome
- Dysphagia and hoarseness
- Ataxia and vertigo

Which artery is involved in syndrome based on above clinical features?

Accepted Answer

Posterior inferior cerebellar artery

Answer

Basilar artery.

Answer

Superior cerebellar artery

Answer

Anterior inferior cerebellar artery

Question 10

A 45-year-old male patient presented with a history of bilateral lower limb weakness, which progressed to his upper limbs in a year. On examination, he had weakness in both lower limbs and wasting in the left upper limb. Babinski sign was positive and the deep tendon reflexes were hyperactive. He has no sensory loss or any autonomic dysfunction. What is the likely diagnosis?

Accepted Answer

ALS

Answer

GBS

Answer

MS

Answer

Tropical spastic paraparesis

Neurology — MCQs

Neurology — MCQs

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