Neurology Practice Questions

Q: Which of the following drugs is preferred in the management of primary progressive multiple sclerosis?

Ocrelizumab. ***Ocrelizumab*** - **Ocrelizumab** is the first and only FDA-approved disease-modifying therapy for **primary progressive multiple sclerosis (PPMS)**, demonstrating a reduction in disability progression. - It is a **monoclonal antibody** that selectively targets CD20-positive B cells, believed to play a critical role in the pathogenesis of MS. *Natalizumab* - **Natalizumab** is approved for **relapsing-remitting multiple sclerosis (RRMS)**, not primary progressive MS [1]. - It works by blocking the migration of immune cells into the **central nervous system**, but carries a risk of **progressive multifocal leukoencephalopathy (PML)**. *Alemtuzumab* - **Alemtuzumab** is used for **relapsing forms of MS**, particularly in patients who have had an inadequate response to other MS drugs [1]. - It is known for its durable efficacy but also its significant side effects, including **autoimmune conditions** and **infusion reactions**. *Fingolimod* - **Fingolimod** is an oral medication approved for **relapsing forms of MS**, but not for primary progressive MS [1]. - It acts by trapping lymphocytes in the **lymph nodes**, preventing them from entering the central nervous system.

Q: Reversible dementia is seen in?

Hypothyroidism. ***Hypothyroidism*** - **Hypothyroidism** can lead to cognitive impairment, including memory loss, slowed thinking, and executive dysfunction, which are reversible with appropriate **thyroid hormone replacement therapy**. - This condition is often characterized by other systemic symptoms like fatigue, weight gain, and cold intolerance, which also improve with treatment. *Pick's disease* - **Pick's disease** is a type of **frontotemporal dementia** caused by progressive degeneration of brain cells, primarily in the frontal and temporal lobes. - It is a **neurodegenerative** disorder, meaning it is progressive and irreversible. *Alzheimer's disease* - **Alzheimer's disease** is the most common cause of dementia, characterized by the accumulation of **amyloid plaques** and **neurofibrillary tangles** in the brain [1]. - It is a **progressive and irreversible neurodegenerative disease** with no cure [2]. *Subacute demyelination of spinal cord* - **Subacute demyelination of the spinal cord** typically refers to conditions like **subacute combined degeneration** due to **vitamin B12 deficiency** [1]. - While this can cause neurological symptoms, including cognitive changes, its primary impact is on the spinal cord and peripheral nerves, and "dementia" in the classic sense is not the primary or defining feature of spinal cord demyelination itself, although B12 deficiency can cause broader cognitive issues [1].

Q: Prosopagnosia is:

Inability to recognize face. ***Inability to recognize face*** - **Prosopagnosia**, or **face blindness**, is a cognitive disorder characterized by an impaired ability to recognize familiar faces, including one's own. - This condition is often associated with damage to the **fusiform face area** in the brain, typically in the right hemisphere. *Inability to read* - The inability to read is known as **alexia** or **dyslexia**, which is distinct from the visual recognition deficit seen in prosopagnosia. - Alexia primarily involves difficulties with processing written language, not the visual recognition of faces. *Anosmia* - **Anosmia** refers to the complete or partial loss of the sense of smell and is a disorder affecting the olfactory system. - It is unrelated to visual processing or face recognition. *Inability to write* - The inability to write is termed **agraphia** or **dysgraphia**, a neurological condition that impairs writing ability. - This condition affects motor skills and language processing related to writing, not visual face recognition.

Q: All the following are indications for brain imaging in epilepsy, except:

Epilepsy starts after the age of 5 years. Address the indications for brain imaging in epilepsy based on clinical guidelines. ***Epilepsy starts after the age of 5 years*** - The recommendation for **brain imaging** is typically suggested for epilepsy onset after the age of **16 years** to rule out structural causes, rather than age 5 [2]. An onset at age 5 does not exclude the possibility of idiopathic epilepsy, which often does not require imaging [1]. - While it's a good practice to image any new onset epilepsy, age 5 by itself is not a specific indication that *demands* imaging beyond standard workup if no other red flags are present. *EEG shows a focal seizure source* - A **focal seizure source identified on EEG** strongly indicates a structural lesion in the brain that could be responsible for the seizures [2]. - **Brain imaging** (e.g., MRI) is essential to identify the underlying **structural abnormality**, such as a tumor, malformation, or scar tissue [2]. *Control of seizures is difficult* - Poorly controlled or **refractory seizures** warrant further investigation with brain imaging to look for an **underlying structural cause** that might be amenable to surgical intervention or require alternative therapies [2]. - This suggests the possibility of a lesion that is not responding to standard anti-epileptic drugs, necessitating a search for the **etiology of intractability** [3]. *Seizures have focal features clinically* - **Focal clinical features** (e.g., twitching of one limb, sensory disturbances on one side) strongly point to a specific area of the brain where the seizures originate [4]. - **Brain imaging** is crucial to identify any **structural lesion** (e.g., tumor, malformation, stroke) corresponding to the clinically localized area of seizure onset [2].

Q: Todd's palsy can occur after episode of

Focal motor seizures. ***Focal motor seizures*** - **Todd's palsy** is a localized **postictal paresis** or paralysis that occurs after a focal seizure, especially **focal motor seizures** [1]. - It results from **neuronal exhaustion** in the seizure focus, leading to a temporary loss of function in the affected body part. *Generalised tonic clonic seizures* - While generalized tonic-clonic seizures can be followed by a postictal state, **Todd's palsy** is specifically associated with **focal onset seizures** [1]. - The diffuse nature of generalized seizures typically leads to global postictal confusion and fatigue rather than localized weakness [3]. *Myoclonic seizures* - Myoclonic seizures are characterized by **brief, shock-like jerks** and usually do not cause postictal weakness as they involve very short bursts of muscle activity [2]. - They are typically too brief and diffuse to induce the focal, prolonged neuronal exhaustion that leads to Todd's palsy. *Atonic seizures* - Atonic seizures cause a sudden loss of muscle tone, leading to falls, but they do not typically result in **postictal focal paralysis** like Todd's palsy [2]. - The brief, generalized loss of tone is not followed by a specific, localized neurological deficit.

Q: A 25-year-old woman presents with intermittent double vision and fatigue. Her symptoms are worse at the end of the day. She reports no other focal muscle weakness or sensory symptoms. On examination her eye movements, motor strength, and reflexes in the upper and lower limbs are normal. Repetitive handgrip exercises cause loss of strength in the grip. A CXR reveals an anterior mediastinal mass. Which of the following is the most likely diagnosis of the anterior mediastinal mass?

thymoma. ***thymoma*** - The patient's symptoms of **intermittent double vision** and **fatigue, worsening at the end of the day**, are highly suggestive of **myasthenia gravis** [1]. - Approximately 15-20% of patients with myasthenia gravis have a **thymoma**, which is typically found as an **anterior mediastinal mass** on CXR [2]. *lymphoma* - While lymphoma can present as an anterior mediastinal mass, it is not typically associated with the specific neurological symptoms of **myasthenia gravis**. - Lymphoma often presents with systemic symptoms like **fever, night sweats, and weight loss**, which are not described here. *teratoma* - A teratoma is a germ cell tumor that can occur in the anterior mediastinum but does not typically cause **neuromuscular symptoms** like those seen in myasthenia gravis. - They can sometimes be associated with paraneoplastic syndromes, but not usually with symptoms directly pointing to **acetylcholine receptor antibodies** [2]. *thyroid* - An ectopic thyroid gland or thyroid mass in the mediastinum is rare and would not explain the patient's **myasthenic symptoms** [2]. - Thyroid masses are usually asymptomatic unless they cause **compression symptoms** or are hormonally active.

Q: Most common clinical presentation of juvenile myoclonic epilepsy -

Myoclonus. ***Myoclonus*** - **Juvenile myoclonic epilepsy (JME)** is classically characterized by sudden, brief, involuntary muscle jerks, particularly in the morning or upon awakening [1]. - These **myoclonic jerks** are often the first and most prominent symptom reported by patients. *Generalised tonic clonic seizures in awake state* - While **generalized tonic-clonic seizures (GTCS)** do occur in JME, they typically appear later in the disease course and are often triggered by sleep deprivation or alcohol [1]. - The initial and most common presentation, however, remains the **myoclonic jerks**. *Generalised tonic clonic seizures in sleep* - **GTCS** in JME are more common upon **awakening** rather than during sleep, and often follow initial myoclonic jerks [1]. - Seizures occurring predominantly during sleep would suggest other epilepsy syndromes. *Absence seizures* - **Absence seizures** are seen in other forms of generalized epilepsy, such as **childhood absence epilepsy**, but are not a primary or most common feature of JME [1, 2]. - While some patients with JME might experience absence-like phenomena, it's not the defining or most frequent presentation [1].

Q: Absence seizures are characterized on EEG by:

3 Hz spike and wave. ***3 Hz spike and wave*** - **Absence seizures** are classically characterized by a **generalized, synchronous 3 Hz spike-and-wave discharge** pattern on EEG. - This pattern is seen bilaterally and symmetrically, reflecting the generalized nature of the seizure. *Generalized polyspikes* - **Generalized polyspikes** (multiple spikes) are often associated with other types of generalized seizures, such as **myoclonic seizures**, rather than typical absence seizures. - While reflecting generalized activity, the specific **3 Hz spike-and-wave** is the hallmark of absence seizures. *Hypsarrhythmia* - **Hypsarrhythmia** is a chaotic, high-amplitude, irregular pattern seen in **infantile spasms** (West syndrome), not absence seizures. - It is characterized by random high-voltage slow waves and spikes in all derivations. *1-2 Hz spike & wave* - A **slow spike-and-wave pattern (1-2.5 Hz)** is typically associated with **Lennox-Gastaut syndrome**, a severe epileptic encephalopathy. - This differs significantly from the faster **3 Hz spike-and-wave** characteristic of typical absence seizures.

Question 1

Which of the following drugs is preferred in the management of primary progressive multiple sclerosis?

Accepted Answer

Ocrelizumab

Answer

Natalizumab

Answer

Alemtuzumab

Answer

Fingolimod

Question 2

Reversible dementia is seen in?

Accepted Answer

Hypothyroidism

Answer

Pick's disease

Answer

Alzheimer's disease

Answer

Subacute demyelination of spinal cord

Question 3

Following statement are true about tremors except:

Accepted Answer

Essential tremor is an uncommon movement disorder affecting 5%of population

Answer

Normal individuals can have physiologic tremor that manifest as mild high frequency, postural or action tremors.

Answer

PD is characterised by resting tremor

Answer

Tremor consist of alternate contraction of agonist and antagonist muscle in oscillating rhythmic manner

Question 4

Prosopagnosia is:

Accepted Answer

Inability to recognize face

Answer

Inability to read

Answer

Anosmia

Answer

Inability to write

Question 5

All the following are indications for brain imaging in epilepsy, except:

Accepted Answer

Epilepsy starts after the age of 5 years

Answer

EEG shows a focal seizure source

Answer

Control of seizures is difficult

Answer

Seizures have focal features clinically

Question 6

Todd's palsy can occur after episode of

Accepted Answer

Focal motor seizures

Answer

Generalised tonic clonic seizures

Answer

Myoclonic seizures

Answer

Atonic seizures

Question 7

A 25-year-old woman presents with intermittent double vision and fatigue. Her symptoms are worse at the end of the day. She reports no other focal muscle weakness or sensory symptoms. On examination her eye movements, motor strength, and reflexes in the upper and lower limbs are normal. Repetitive handgrip exercises cause loss of strength in the grip. A CXR reveals an anterior mediastinal mass. Which of the following is the most likely diagnosis of the anterior mediastinal mass?

Accepted Answer

thymoma

Answer

lymphoma

Answer

teratoma

Answer

thyroid

Question 8

Most common clinical presentation of juvenile myoclonic epilepsy -

Accepted Answer

Myoclonus

Answer

Generalised tonic clonic seizures in awake state

Answer

Generalised tonic clonic seizures in sleep

Answer

Absence seizures

Question 9

Absence seizures are characterized on EEG by:

Accepted Answer

3 Hz spike and wave

Answer

Generalized polyspikes

Answer

Hypsarrhythmia

Answer

1-2 Hz spike & wave

Question 10

In benign intracranial hypertension-

Accepted Answer

Normal or small ventricles are characteristic findings

Answer

Brain scan is not required in young women as sagittal sinus thrombosis is rare

Answer

There is a restriction of upgaze

Answer

Optic nerve fenestration is one of the treatment options that should be considered early to prevent vision loss in benign intracranial hypertension

Neurology — MCQs

Neurology — MCQs

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