Neurology Practice Questions

Q: True about juvenile myoclonic epilepsy - a) Focal seizure b) Generalised seizure c) Myoclonus d) Responses to Sodium Valproate e) Spike and waves in EEG

bcde. ***bcde*** - **Juvenile Myoclonic Epilepsy (JME)** is a form of **generalized epilepsy**, meaning it affects both sides of the brain from the onset [1]. - The hallmark feature of JME is **myoclonic seizures**, characterized by brief, shock-like jerks, often most prominent in the mornings [2]. It also responds well to **Sodium Valproate** and shows characteristic **spike and wave discharges** on EEG [2]. *abcd* - This option is partially correct as it includes generalized seizure, myoclonus, and response to Sodium Valproate, but incorrectly includes focal seizure and omits the characteristic EEG findings. - **Focal seizures** are inconsistent as JME is a generalized epilepsy syndrome [1]. *abde* - This option incorrectly states JME involves **focal seizures** and omits **myoclonus**, which is the defining seizure type in this syndrome [2]. - While JME does respond to Sodium Valproate and shows spike and waves, the inclusion of focal seizures and exclusion of myoclonus make this choice incorrect. *acde* - This option incorrectly includes **focal seizure** as a feature of JME, which is a generalized epilepsy. - While myoclonus, response to Sodium Valproate, and spike and waves are characteristic, the inclusion of focal seizure renders this option incorrect. *abce* - This option incorrectly includes **focal seizure** as a characteristic of JME, which is a **generalized** epilepsy. - It also omits the mention of responses to Sodium Valproate, a key pharmacological aspect of JME management [2].

Q: A 26-year-old woman complains of early fatigue and weakness in doing strenuous activity. Her symptoms are worse near the end of the day. She appears well, muscle bulk, tone, and reflexes are normal. Handgrip strength decreases with repetitive testing.For the above patient with muscle weakness, select the most likely anatomic site for the disorder

neuromuscular junction. ***neuromuscular junction*** - The **fatigability** and **end-of-day worsening** of weakness, along with the **decreased handgrip strength with repetitive testing**, are classic signs of **myasthenia gravis**, a disorder of the neuromuscular junction [1], [2]. - In myasthenia gravis, **acetylcholine receptor antibodies** block or destroy receptors at the neuromuscular junction, impairing nerve-to-muscle signal transmission [3]. *muscle* - Primary muscle disorders (myopathies) typically present with **proximal muscle weakness** but do not usually show the characteristic **fatigability with repetitive use** or end-of-day worsening. - Muscle bulk, tone, and reflexes would often be affected in significant primary muscle disease. *peripheral nerve* - Peripheral nerve disorders (neuropathies) usually cause **sensory changes** (tingling, numbness) along with motor weakness, and often present with **diminished reflexes**. - The distinguishing feature of **fatigability with repetitive testing** is not typical of peripheral neuropathies. *anterior horn cell* - Anterior horn cell disorders, such as **amyotrophic lateral sclerosis (ALS)**, cause progressive weakness, muscle atrophy, and fasciculations. - While they cause weakness, they typically do not exhibit the significant **day-to-day fluctuation** or **fatigability with repetitive use** described.

Q: Which of the following grading methods is used to evaluate the prognosis/outcome after subarachnoid hemorrhage

Hess and Hunt scale. ***Hess and Hunt scale*** - The **Hess and Hunt scale** is specifically designed to grade the severity of **subarachnoid hemorrhage (SAH)** based on clinical presentation [1]. - It correlates with the patient's **prognosis** and the risk of complications like re-bleeding and cerebral vasospasm [1][2]. *Intracerebral hemorrhage score* - This score, often referred to as the **ICH score**, is used to predict **mortality** after **intracerebral hemorrhage (ICH)**, not SAH. - It considers factors like Glasgow Coma Scale (GCS) score, age, ICH volume, and location. *Glasgow-Blatchford bleeding score* - This score is used for **upper gastrointestinal bleeding** to assess the need for intervention and predict **mortality**. - It evaluates parameters such as hemoglobin, blood pressure, urea, and comorbidities. *Glasgow coma scale* - The **Glasgow Coma Scale (GCS)** is a universal neurological assessment tool used to measure a person's level of **consciousness** [2]. - While it's a component of the Hess and Hunt scale, it is not a specific grading system for the prognosis of subarachnoid hemorrhage itself.

Q: Myasthenia gravis may be associated with:

Thymoma. ***Thymoma*** - Approximately 10-15% of patients with **myasthenia gravis** (MG) have an associated **thymoma**, a tumor of the thymus gland [1]. - The thymus gland plays a crucial role in the development of T-cells and can be involved in the production of **autoantibodies** that target acetylcholine receptors in MG. *B lymphocyte dysfunction* - While MG is an **autoimmune disease** characterized by autoantibodies produced by **B cells**, "B lymphocyte dysfunction" is a general statement and not the most specific or common association as an underlying cause or specific comorbidity. - The dysfunction is the result of the autoimmune process, not typically the initiating association. *Viral infection* - While certain **viral infections** can trigger or exacerbate autoimmune conditions, there isn't a direct or consistently strong association between a specific viral infection and the development of myasthenia gravis as a primary cause. - MG typically involves a more systemic autoimmune response targeting the **neuromuscular junction**. *Drug intake* - Some medications can *exacerbate* myasthenia gravis, or induce a myasthenia-like syndrome (e.g., **aminoglycosides**, **beta-blockers**, **magnesium**). - However, drug intake is generally not considered a primary *cause* or a common associated comorbidity that develops *with* myasthenia gravis in the same way a thymoma is.

Q: Most common symptom of Wernicke's encephalopathy

Confusion. ***Confusion*** - **Confusion** is the most common symptom of **Wernicke's encephalopathy**, occurring in over 80% of cases. - It presents as a state of altered mental status, ranging from mild disorientation to profound encephalopathy [1]. *Ocular changes* - **Ocular changes**, such as **nystagmus** and **ophthalmoplegia**, are common but present in less than 30% of patients. - While being a classic triad component, they are not the most frequently observed symptom [1]. *Ataxia* - **Ataxia**, characterized by difficulty with coordination and gait, is also part of the classic triad but occurs in less than 25% of cases [1]. - It often manifests as a wide-based, unsteady gait. *Hypothermia* - **Hypothermia** can occur in severe cases of Wernicke's encephalopathy due to **hypothalamic dysfunction**, but it is not a common presenting symptom. - It is often seen in more advanced or neglected instances of the disease.

Q: Fasciculation is seen in -

LMN type of lesion. ***LMN type of lesion*** - **Fasciculations** are spontaneous, visible twitchings of muscle bundles, indicative of **lower motor neuron (LMN) pathology** [1]. - They result from the **denervation hypersensitivity** of muscle fibers that have lost their normal nerve supply, leading to spontaneous firing [1]. *Peripheral neuropathy* - While some severe peripheral neuropathies can involve LMN damage, **fasciculations** are not a primary and consistent feature across all types. - Peripheral neuropathies often present with sensory symptoms, weakness, and **diminished reflexes** without prominent fasciculations unless there is significant axonal loss. *UMN type of lesion* - **Upper motor neuron (UMN)** lesions are characterized by spasticity, **hyperreflexia**, positive Babinski sign, and **no fasciculations** [1], [2]. - UMN lesions affect motor pathways in the brain and spinal cord *above* the anterior horn cells, so the direct innervation of muscle fibers remains intact [2]. *Myoneural junction* - Disorders of the **myoneural junction** (neuromuscular junction), such as myasthenia gravis, cause muscle weakness that fatigues with sustained effort. - These conditions do not typically cause **fasciculations**; instead, they might feature **fatigability** and **ptosis**, but not spontaneous muscle twitches.

Q: Chorea is NOT seen in

Tourette syndrome. ***Tourette syndrome*** - **Tourette syndrome** is primarily characterized by **motor and vocal tics**, which are sudden, repetitive, nonrhythmic movements or vocalizations. - While it involves involuntary movements, these are distinct from the continuous, flowing, dance-like movements of **chorea**. *Rheumatic fever* - **Sydenham's chorea** (St. Vitus' dance) is a major manifestation of **acute rheumatic fever**, particularly in children. - It is characterized by **involuntary, purposeless, jerky movements** affecting the face, trunk, and extremities. *Creutzfeldt-Jakob disease* - This rapidly progressive, fatal neurodegenerative disease often presents with various neurological symptoms including **chorea**, **myoclonus**, and ataxia. - The abnormal movements are due to widespread neuronal loss, particularly in the **basal ganglia**. *Huntington's disease* - **Huntington's disease** is a classic cause of **chorea**, characterized by progressive degeneration of neurons in the **caudate and putamen** [1]. - The chorea is typically generalized and worsens over time, accompanied by cognitive decline and psychiatric symptoms.

Q: Tic Douloureux is facial pain traveling through which of the following nerves?

Trigeminal. ***Trigeminal*** - **Tic douloureux**, also known as **trigeminal neuralgia**, is a chronic pain condition affecting the **trigeminal nerve (cranial nerve V)** [1]. - This nerve is responsible for sensory innervation of the face, and the condition presents as sudden, severe, electric shock-like pains [1]. *Hypoglossal* - The **hypoglossal nerve (cranial nerve XII)** primarily controls the **movement of the tongue**. - Dysfunction of this nerve typically manifests as speech and swallowing difficulties, not facial pain. *Vestibulocochlear* - The **vestibulocochlear nerve (cranial nerve VIII)** is responsible for **hearing and balance**. - Problems with this nerve cause symptoms like vertigo, dizziness, and hearing loss. *Facial* - The **facial nerve (cranial nerve VII)** controls **facial expressions**, taste sensation from the anterior two-thirds of the tongue, and functions of several glands. - Disorders of the facial nerve, such as Bell's palsy, cause facial weakness or paralysis, not the characteristic lancinating pain of tic douloureux.

Q: A 48-year-old man complains of muscle weakness in his right hand (dominant hand). On examination, the hand muscles are smaller than on the left, and the reflexes are decreased out of proportion to weakness. For the above patient with muscle weakness, select the most likely anatomic site for the disorder.

Peripheral nerve. ***Peripheral nerve*** - **Unilateral muscle weakness** (right hand), **atrophy** (smaller muscles), and **decreased reflexes** are classic signs of a peripheral nerve lesion, indicating damage to the nerve supply to those muscles [1]. - The combination of these findings points to a disruption of the motor unit distal to the anterior horn cell, consistent with **denervation** from a peripheral nerve injury [2]. *Neuromuscular junction* - Disorders of the neuromuscular junction, such as **myasthenia gravis**, typically cause **fatigable weakness** that worsens with activity and improves with rest. - While reflexes can be normal or mildly depressed, **muscle atrophy** is not a prominent feature, and the weakness often fluctuates rather than being a consistent, focal deficit. *Anterior horn cell* - **Anterior horn cell diseases** (e.g., **amyotrophic lateral sclerosis**) cause widespread **muscle weakness, atrophy**, and **fasciculations**, but generally also include a mixture of upper and lower motor neuron signs (e.g., spasticity with hyperreflexia, or prominent fasciculations) [2]. - The isolated, unilateral nature of the weakness and disproportionately decreased reflexes favor a peripheral nerve lesion over a more diffuse anterior horn cell process [1]. *Muscle* - Primary **muscle disorders** (**myopathies**) present with **proximal muscle weakness**, normal or mildly reduced reflexes, but often without significant atrophy until later stages. - **Sensory findings** are typically absent, and the distribution of weakness (e.g., only in one hand) is less common in generalized myopathies.

Q: A 22-year-old street vendor was found in the park having a seizure. Cops brought him to ER, unaware of any background medical history. He is continuously having seizures for 13 minutes and paramedics are not able to gain intravenous access. You ensure the airway is secure and administer oxygen, however, you are unable to gain intravenous access after two attempts. Blood glucose levels are 80mg%. Which medication would be most suitable to administer at this stage to treat patient's seizure?

Midazolam. .***Midazolam*** - **Midazolam** is a benzodiazepine that can be given via **intramuscular (IM)**, buccal, or intranasal routes, making it ideal when IV access is difficult or impossible. - Its rapid onset of action and efficacy in acute seizure management, particularly in **status epilepticus**, make it the most appropriate choice in this scenario. *Sodium Valproate* - While an effective anticonvulsant, **sodium valproate** is primarily administered **intravenously** in acute settings, which is not feasible here due to lack of IV access. - It also has a slower onset of action compared to benzodiazepines for immediate seizure cessation. *Lorazepam* - **Lorazepam** is a first-line benzodiazepine for status epilepticus but is typically given **intravenously (IV)**. - Although it can be given IM, its absorption is slower and less predictable than IM midazolam, and the question specifies difficulty in gaining IV access after two attempts. *Levetiracetam* - **Levetiracetam** is an effective anticonvulsant for status epilepticus but is generally administered **intravenously**, requiring reliable IV access. - It works more slowly than benzodiazepines and is often used as a second-line agent or adjunct once immediate seizure control is achieved.

Question 1

True about juvenile myoclonic epilepsy - a) Focal seizure b) Generalised seizure c) Myoclonus d) Responses to Sodium Valproate e) Spike and waves in EEG

Accepted Answer

bcde

Answer

abcd

Answer

abde

Answer

acde

Answer

abce

Question 2

A 26-year-old woman complains of early fatigue and weakness in doing strenuous activity. Her symptoms are worse near the end of the day. She appears well, muscle bulk, tone, and reflexes are normal. Handgrip strength decreases with repetitive testing.For the above patient with muscle weakness, select the most likely anatomic site for the disorder

Accepted Answer

neuromuscular junction

Answer

muscle

Answer

peripheral nerve

Answer

anterior horn cell

Question 3

Which of the following grading methods is used to evaluate the prognosis/outcome after subarachnoid hemorrhage

Accepted Answer

Hess and Hunt scale

Answer

Intracerebral hemorrhage score

Answer

Glasgow-Blatchford bleeding score

Answer

Glasgow coma scale

Question 4

Myasthenia gravis may be associated with:

Accepted Answer

Thymoma

Answer

B lymphocyte dysfunction

Answer

Viral infection

Answer

Drug intake

Question 5

Most common symptom of Wernicke's encephalopathy

Accepted Answer

Confusion

Answer

Ocular changes

Answer

Ataxia

Answer

Hypothermia

Question 6

Fasciculation is seen in -

Accepted Answer

LMN type of lesion

Answer

Peripheral neuropathy

Answer

UMN type of lesion

Answer

Myoneural junction

Question 7

Chorea is NOT seen in

Accepted Answer

Tourette syndrome

Answer

Rheumatic fever

Answer

Creutzfeldt-Jakob disease

Answer

Huntington's disease

Question 8

Tic Douloureux is facial pain traveling through which of the following nerves?

Accepted Answer

Trigeminal

Answer

Hypoglossal

Answer

Vestibulocochlear

Answer

Facial

Question 9

A 48-year-old man complains of muscle weakness in his right hand (dominant hand). On examination, the hand muscles are smaller than on the left, and the reflexes are decreased out of proportion to weakness. For the above patient with muscle weakness, select the most likely anatomic site for the disorder.

Accepted Answer

Peripheral nerve

Answer

Neuromuscular junction

Answer

Anterior horn cell

Answer

Muscle

Question 10

A 22-year-old street vendor was found in the park having a seizure. Cops brought him to ER, unaware of any background medical history. He is continuously having seizures for 13 minutes and paramedics are not able to gain intravenous access. You ensure the airway is secure and administer oxygen, however, you are unable to gain intravenous access after two attempts. Blood glucose levels are 80mg%. Which medication would be most suitable to administer at this stage to treat patient's seizure?

Accepted Answer

Midazolam

Answer

Sodium Valproate

Answer

Lorazepam

Answer

Levetiracetam

Neurology — MCQs

Neurology — MCQs

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