Neurology Practice Questions

Q: Huntington's disease is commonly seen in age group between

25 - 45 years. ***25 - 45 years*** - Huntington's disease typically manifests in **mid-adulthood**, with symptoms commonly appearing between the ages of **30 and 50**, making the 25-45 age range a good approximation for the onset of symptoms. - While it can occur at younger or older ages, most cases fall within this period, characterized by progressive **motor, cognitive, and psychiatric symptoms**. *15 - 35 years* - While **juvenile Huntington's disease** does occur, it is much less common and typically presents before age 20. - The majority of cases fall outside this range for initial symptom onset, making this option less representative of the "commonly seen" age group. *35 - 55 years* - This range overlaps significantly with the common onset age but extends slightly older, making it a plausible but slightly less precise answer than 25-45 years, given that many patients develop symptoms before age 35. - The onset of the disease typically begins a bit earlier than the upper end of this range. *45 - 65 years* - Onset in this age range is considered **late-onset Huntington's disease**, which occurs in a minority of patients. - The majority of individuals experience symptoms earlier in life, making this an unlikely range for the most common presentation.

Q: What does hypomimia refer to?

Reduced facial expressiveness. ***Reduced facial expressiveness*** - **Hypomimia** specifically describes a reduction in the **range and intensity of facial expressions**, often making the face appear mask-like. - It is a common feature of certain neurological conditions, such as **Parkinson's disease**, where it contributes to an appearance of flat affect. *Impaired motor function* - While hypomimia can be associated with neurological conditions that cause impaired motor function, it is a specific symptom rather than a general description of motor impairment. - Impaired motor function encompasses a much broader range of issues, including **weakness, tremor, and gait disturbances**, which are not exclusively defined by facial expressions. *Deficit of expression through gestures* - A deficit in expression through gestures refers to a reduction in the use of **body language** and hand movements to communicate. - While related to overall non-verbal communication, it is distinct from the specific reduction in facial movements seen in hypomimia. *Difficulty in verbal communication* - Difficulty in verbal communication refers to problems with **speech production** (e.g., dysarthria) or **language comprehension/expression** (e.g., aphasia). - This is a separate domain of communication from facial expressiveness.

Q: Maximum dose of rTPA in acute ischaemic stroke is

90 mg. ***90 mg*** - The standard dose of **recombinant tissue plasminogen activator (rTPA)**, also known as **alteplase**, for acute ischemic stroke is **0.9 mg/kg** with a maximum dose of 90 mg. - This dose is given as a 10% bolus over 1 minute, followed by the remaining 90% infused over 60 minutes. *60 mg* - A 60 mg dose would be suboptimal for most adult patients, as it falls significantly below the recommended 0.9 mg/kg standard dosing, potentially leading to **insufficient thrombolysis**. - While a maximum of 90 mg is set, a 60 mg dose is not typically the target dose unless the patient's weight is exceptionally low, which is not stated here. *100 mg* - A 100 mg dose **exceeds the maximum recommended dose** of 90 mg for rTPA in acute ischemic stroke, regardless of the patient's weight. - Administering a dose higher than 90 mg increases the risk of **intracranial hemorrhage** and other bleeding complications without providing additional therapeutic benefit. *120 mg* - A 120 mg dose is significantly **higher than the maximum recommended dose** for rTPA in acute ischemic stroke (90 mg). - Such an excessive dose would greatly increase the risk of serious adverse events, particularly **symptomatic intracranial hemorrhage**, and is not medically indicated.

Q: What is the most serious neurological complication of herpes simplex virus infection?

Herpes simplex encephalitis. ***Herpes simplex encephalitis*** - This is a severe and often fatal neurological condition caused by HSV-1, leading to **inflammation** and **damage to brain tissue**. [1] - It presents with symptoms such as **fever**, **headache**, **altered mental status**, and **seizures**, requiring urgent antiviral treatment. [1] *Herpes keratitis* - This involves inflammation of the **cornea** due to HSV, leading to eye pain, redness, and vision changes. - While it can cause significant ocular morbidity, it is not considered the most serious neurological complication as it primarily affects the eye. *Genital herpes* - This is a sexually transmitted infection caused by HSV-2 (and sometimes HSV-1), characterized by **painful sores** and **blisters** on the genitals. [2] - Although it can have neurological symptoms like **neuralgia** or ascending myelitis, it is not the most serious direct neurological complication. *Temporal lobe involvement* - While the **temporal lobes** are frequently affected in herpes simplex encephalitis, this option describes a *symptom* or *location* of involvement rather than the overarching diagnosis of the most serious neurological complication itself. [1] - It highlights a characteristic feature of HSV encephalitis but doesn't encapsulate the full severity of the disease in the same way as the diagnostic term "herpes simplex encephalitis."

Q: What is the most common cause of embolic stroke?

Intra-cardiac thrombi. ***Intra-cardiac thrombi*** - **Atrial fibrillation** is the most common cardiac condition leading to the formation of thrombi within the heart, which can then embolize to the brain [1]. - Other cardiac sources include **valvular heart disease** (e.g., prosthetic valves, endocarditis) and myocardial infarction with mural thrombi [1]. *Particulate matter from IV drug injections* - While an important cause of **septic emboli**, which can lead to stroke, it is not the most common overall cause of embolic stroke. - This typically presents with different clinical features, often including **fever** and signs of infection. *Protein C deficiency* - This is a **hereditary thrombophilia** that increases the risk of **venous thrombosis** more significantly than arterial emboli leading to ischemic stroke [2]. - It leads to a procoagulant state, but its direct contribution to embolic stroke is less common than cardiac sources. *Antiphospholipid syndrome* - This is an **autoimmune disorder** that causes both arterial and venous thromboses, leading to recurrent strokes. - While a significant cause of stroke, especially in younger individuals, it is less common than cardiac sources like atrial fibrillation as an overall cause of embolic stroke.

Q: Which of the following is NOT classified as a fluent aphasia?

Broca's Aphasia. ***Broca's Aphasia*** - Broca's aphasia is characterized by **non-fluent speech**, meaning speech is slow, effortful, and hesitant with poor articulation. It is often described as **telegraphic** due to the omission of small grammatical words. - While comprehension is relatively preserved, patients struggle significantly with speech production and repetition. *Anomie Aphasia* - Anomic aphasia is classified as a **fluent aphasia** where the primary deficit is in **word-finding** (anomia). - Patients can speak fluently and comprehend well, but they frequently pause and use circumlocutions due to difficulty recalling specific nouns. *Wernicke's Aphasia* - Wernicke's aphasia is a type of **fluent aphasia** characterized by seemingly effortless, grammatically correct speech that is often **nonsensical** or filled with paraphasias. - A key feature is a profound impairment in **auditory comprehension**, meaning patients struggle to understand spoken language. *Conduction Aphasia* - Conduction aphasia is a **fluent aphasia** where the predominant deficit is in **repetition** due to damage to the arcuate fasciculus connecting Wernicke's and Broca's areas. - Speech fluency and comprehension are relatively preserved, but patients have significant difficulty repeating words or phrases, especially complex ones.

Q: In which type of aphasia is comprehension intact?

Broca's aphasia. ***Broca's aphasia*** - Patients with **Broca's aphasia** typically have **intact comprehension** (though it might be mildly impaired for complex sentences). - The primary deficit is in **fluent speech production**, leading to telegraphic and effortful speech. *Wernicke's aphasia* - Characterized by **poor comprehension**, making it difficult for the patient to understand spoken or written language. - Speech is typically **fluent but meaningless**, often described as "word salad." *Global aphasia* - Involves severe impairment in **both comprehension and production** of language. - It results from widespread damage affecting both **Broca's and Wernicke's areas** and the connections between them. *Transcortical sensory aphasia* - Patients exhibit **poor auditory comprehension** despite being able to repeat words and phrases. - This condition affects the connection between **Wernicke's area** and other cortical areas, preserving repetition but impairing understanding.

Q: Which of the following is a known risk factor for Alzheimer's disease?

Down’s syndrome. ***Down’s syndrome*** - Individuals with **Down’s syndrome** have an extra copy of chromosome 21, which carries the **amyloid precursor protein (APP)** gene. - Overexpression of APP leads to increased production of **beta-amyloid plaques**, a hallmark pathology of Alzheimer's disease, causing nearly all individuals with Down's syndrome to develop AD pathology by middle age [1]. *Klinefelter syndrome* - **Klinefelter syndrome** involves an extra X chromosome (47, XXY) and is associated with conditions like infertility and learning difficulties. - It is not a known direct risk factor for **Alzheimer's disease**. *Hypothyroidism* - **Hypothyroidism** can cause cognitive impairment and memory problems, which are often reversible with thyroid hormone replacement. - While it can mimic some symptoms of dementia, it is not a direct risk factor for the development of **Alzheimer's disease** itself. *Rheumatoid arthritis* - **Rheumatoid arthritis** is a chronic autoimmune inflammatory disease primarily affecting the joints. - While chronic inflammation is a general risk factor for various health issues, rheumatoid arthritis is not specifically identified as a direct or significant risk factor for **Alzheimer's disease**.

Q: A female patient presents to you with a unilateral headache. It is associated with nausea, photophobia, and phonophobia. What is the drug of choice for acute management?

Sumatriptan. ***Sumatriptan*** - **Sumatriptan**, a **triptan**, is an effective abortive therapy for **acute migraine attacks** due to its selective serotonin 5-HT1B/1D receptor agonist action, leading to vasoconstriction and inhibition of neurogenic inflammation. - The symptoms described—**unilateral headache**, nausea, **photophobia**, and **phonophobia**—are classic features of migraine. *Flunarizine* - **Flunarizine** is a **calcium channel blocker** used for migraine **prophylaxis**, not for acute treatment. - It is typically prescribed for patients experiencing frequent or severe migraine attacks to reduce their incidence. *Propranolol* - **Propranolol** is a **beta-blocker** primarily used for migraine **prophylaxis**. - It helps prevent migraine attacks by modulating cerebral blood flow and neuronal excitability, but it is not effective for acute pain relief during an attack. *Topiramate* - **Topiramate** is an **antiepileptic drug** often used for migraine **prophylaxis**. - It works by various mechanisms, including altering neurotransmitter activity, but it does not provide acute symptomatic relief for an ongoing migraine attack.

Question 1

Huntington's disease is commonly seen in age group between

Accepted Answer

25 - 45 years

Answer

15 - 35 years

Answer

35 - 55 years

Answer

45 - 65 years

Question 2

What does hypomimia refer to?

Accepted Answer

Reduced facial expressiveness

Answer

Deficit of expression through gestures

Answer

Impaired motor function

Answer

Difficulty in verbal communication

Question 3

Maximum dose of rTPA in acute ischaemic stroke is

Accepted Answer

90 mg

Answer

60 mg

Answer

100 mg

Answer

120 mg

Question 4

What is the most serious neurological complication of herpes simplex virus infection?

Accepted Answer

Herpes simplex encephalitis

Answer

Herpes keratitis

Answer

Genital herpes

Answer

Temporal lobe involvement

Question 5

What is the most common cause of embolic stroke?

Accepted Answer

Intra-cardiac thrombi

Answer

Particulate matter from IV drug injections

Answer

Protein C deficiency

Answer

Antiphospholipid syndrome

Question 6

Which of the following is NOT classified as a fluent aphasia?

Accepted Answer

Broca's Aphasia

Answer

Anomic Aphasia

Answer

Wernicke's Aphasia

Answer

Conduction Aphasia

Question 7

In which type of aphasia is comprehension intact?

Accepted Answer

Broca's aphasia

Answer

Wernicke's aphasia

Answer

Global aphasia

Answer

Transcortical sensory aphasia

Question 8

Which of the following is a known risk factor for Alzheimer's disease?

Accepted Answer

Down’s syndrome

Answer

Klinefelter syndrome

Answer

Rheumatoid arthritis

Answer

Hypothyroidism

Question 9

What is the cause of loss of pain and temperature sensation on the ipsilateral face and contralateral body due to thrombosis?

Accepted Answer

Thrombosis of the posterior inferior cerebellar artery (PICA)

Answer

Thrombosis of the superior cerebellar artery

Answer

Thrombosis of the anterior inferior cerebellar artery (AICA)

Answer

Thrombosis of the posterior cerebral artery

Question 10

A female patient presents to you with a unilateral headache. It is associated with nausea, photophobia, and phonophobia. What is the drug of choice for acute management?

Accepted Answer

Sumatriptan

Answer

Flunarizine

Answer

Propranolol

Answer

Topiramate

Neurology — MCQs

Neurology — MCQs

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