Neurology Practice Questions

Q: Most common cause of postural hypotension is

Peripheral neuropathy. ***Peripheral neuropathy*** - Damage to **autonomic nerve fibers** in peripheral neuropathy can impair the body's ability to regulate **blood pressure** in response to gravitational changes upon standing [1]. - This leads to a failure of **vasoconstriction** and an inadequate increase in **heart rate**, resulting in a significant drop in blood pressure. *Progressive cerebellar degeneration* - This condition primarily affects **coordination** and **balance**, often leading to **ataxia** and dysarthria. - While it can manifest with various neurological symptoms, **postural hypotension** is not its most common or direct consequence. *Adrenal insufficiency* - **Adrenal insufficiency** results in inadequate production of **cortisol** and **aldosterone**, leading to **hypotension** and **volume depletion**. - While it causes hypotension, it is not the most frequent cause of **postural hypotension** across the general population. *Striatonigral degeneration* - Also known as **multiple system atrophy** (MSA-P), this condition involves the degeneration of neurons in the **striatum** and **substantia nigra**. - It often leads to **parkinsonism** and **autonomic dysfunction**, including postural hypotension, but it is less common overall than peripheral neuropathy as a cause.

Q: Fluent aphasia with preserved comprehension and impaired repetition is characteristic of which type of aphasia?

Conduction Aphasia. ***Conduction Aphasia*** - Patients with **conduction aphasia** exhibit fluent speech and good comprehension but have a striking inability to **repeat** words or sentences. - This is often caused by damage to the **arcuate fasciculus**, which connects Wernicke's and Broca's areas. *Broca's Aphasia* - Characterized by **non-fluent** speech, **impaired repetition**, and relatively preserved comprehension. - Patients struggle to form words and sentences, often using **telegraphic speech**. *Wernicke's Aphasia* - Involves **fluent** but often meaningless speech, **poor comprehension**, and **impaired repetition**. - Patients may produce **neologisms** and have difficulty understanding spoken language. *Anomic Aphasia* - The primary deficit is **word-finding difficulty**, leading to frequent pauses and circumlocutions. - However, **fluency**, **comprehension**, and **repetition** are typically well-preserved.

Q: Parkinsonism is characterized by all of the following features except:

Dystonia. ***Dystonia*** - **Dystonia**, characterized by sustained or repetitive muscle contractions leading to twisting and repetitive movements or abnormal fixed postures, is not one of the cardinal signs of parkinsonism. - While it can occur in some Parkinson's disease patients, it is not a core diagnostic feature and often indicates more advanced disease or specific medication side effects. *Rigidity* - **Rigidity** (increased muscle tone, often described as cogwheel or lead-pipe rigidity) is one of the cardinal features of parkinsonism [1], [3]. - This symptom contributes to the difficulty in movement and posture changes experienced by patients [3]. *Bradykinesia* - **Bradykinesia**, or slowness of movement, is the most debilitating and universally present symptom of parkinsonism [1], [2]. - It manifests as difficulty initiating movements, decreased amplitude of movements, and overall slowness in performing daily tasks. *Tremors at rest* - **Tremors at rest** (typically a 4-6 Hz "pill-rolling" tremor that subsides with intentional movement) is a classic symptom of Parkinson's disease, a common cause of parkinsonism [1], [3]. - This tremor is often more prominent in one limb or side of the body and is characteristic of the condition.

Q: What is the primary symptom associated with a lesion in Wernicke's area?

Fluent speech with poor comprehension. ***Fluent speech with poor comprehension*** - A lesion in **Wernicke's area** results in **Wernicke's aphasia**, where the individual can produce speech fluently but the content is often meaningless or nonsensical (word salad). [1] - The primary characteristic is a profound **difficulty in understanding** spoken and written language, despite intact hearing and vision. *Inability to understand language* - While an inability to understand language is a key component of Wernicke's aphasia, the description "fluent speech with poor comprehension" more comprehensively captures the clinical presentation by including the intact though often chaotic speech production. - This option alone does not fully encompass the unique **dissociation between fluency and comprehension** seen in Wernicke's aphasia. *Inability to repeat phrases* - The **inability to repeat phrases** is typically associated with **conduction aphasia**, which results from damage to the **arcuate fasciculus**, the connection between Wernicke's and Broca's areas. [1] - While repetition can be impaired in Wernicke's aphasia due to poor comprehension, it is not the primary defining symptom differentiating it from other aphasias. *Difficulty in forming sentences* - **Difficulty in forming sentences** and producing meaningful speech, often characterized by **non-fluent, effortful speech** and agrammatism, is a hallmark of **Broca's aphasia**. [1] - Broca's area is responsible for **speech production** and grammatical structure, not language comprehension.

Q: Which of the following conditions is least likely to be associated with normal pressure spontaneous cerebrospinal fluid (CSF) leaks?

Pseudo tumor Cerebri. ***Pseudotumor Cerebri*** - Also known as **idiopathic intracranial hypertension**, it is characterized by symptoms of **increased intracranial pressure** but with **normal CSF composition** and **no identifiable intracranial mass** [1]. - CSF leaks, especially spontaneous ones with normal pressure, typically result from **low intracranial pressure (intracranial hypotension)**, which is the opposite of pseudotumor cerebri . *Empty Sella Syndrome* - This condition involves the **sella turcica** (the bony structure housing the pituitary gland) being partially or completely filled with CSF, often due to a **defect in the sellar diaphragm**. - It arises from **idiopathic intracranial hypertension** which is also referred to as **pseudotumor cerebri**, but in some cases, it can be associated with **spontaneous CSF leaks** as the brain sags and pulls on the dura. *Encephalocele* - An **encephalocele** is a rare birth defect where there's a **protrusion of the brain and its meninges** through a defect in the skull. - This can be a source of **spontaneous CSF leaks** if the dura mater or skin covering the encephalocele is compromised. *Meningocele* - A **meningocele** is a type of **spina bifida** where the **meninges protrude through a defect in the vertebral column** forming a sac filled with CSF. - Like encephaloceles, these defects in continuous meningeal coverings can be a source of **spontaneous CSF leaks**.

Q: In a cerebellar lesion, which symptom is typically not observed?

Resting tremors. ***Resting tremors*** - **Resting tremors** are characteristic of **basal ganglia dysfunction**, typically seen in conditions like Parkinson's disease [2]. - Cerebellar lesions are more associated with **intention tremors**, which occur during voluntary movement, rather than at rest. *Dysmetria* - **Dysmetria** is the inability to accurately control the range, force, and direction of movement, leading to **over- or under-shooting targets**. - It is a classic sign of **cerebellar damage**, indicating impaired coordination and proprioception. *Dysdiadochokinesia* - **Dysdiadochokinesia** refers to the impaired ability to perform **rapid alternating movements**, such as pronation and supination [1]. - This symptom directly reflects cerebellar dysfunction in coordinating muscle actions [1]. *Ataxia* - **Ataxia** is a broad term for **lack of muscle coordination** during voluntary movements, leading to an unsteady gait and impaired balance [3], [4]. - It is a hallmark symptom of **cerebellar lesions**, affecting motor control and equilibrium [3].

Q: In a patient with a pontine hemorrhage, what clinical presentation would be expected?

Quadriplegia. ***Quadriplegia*** - Pontine hemorrhages often cause **quadriplegia** because the **corticospinal tracts** that control motor function for all four limbs pass through the pons [2]. - The sudden onset and severity of a pontine bleed can lead to immediate and widespread motor neuron dysfunction, resulting in complete paralysis. *Asymmetrical mydriasis* - **Asymmetrical mydriasis** (unequal pupil dilation) typically indicates uncal herniation or direct oculomotor nerve (cranial nerve III) compression, usually due to supratentorial mass lesions [1]. - Pontine lesions more commonly cause **pinpoint pupils** (miosis) due to disruption of the descending sympathetic pathways. *Ataxic hemiparesis* - **Ataxic hemiparesis** is characterized by weakness on one side of the body accompanied by ipsilateral ataxia, often associated with lacunar infarcts in the pons or cerebellum. - While a pontine lesion could cause this, a large pontine hemorrhage is more likely to result in diffuse motor deficits like quadriplegia rather than an isolated ataxic hemiparesis. *Hypothermia* - **Hypothermia** due to central nervous system damage is primarily associated with lesions affecting the hypothalamus, which is a key thermoregulatory center. - Pontine hemorrhages, while severe, are not typically the primary cause of isolated hypothermia; instead, they often cause **hyperthermia** (central fever) due to sympathetic storm or dysregulation.

Q: Fine tremors are primarily associated with which of the following conditions?

Essential tremor. Essential tremor - Essential tremor is characterized by **fine, rhythmic tremors** that often affect the hands and can worsen with activity or stress. - It's typically an **action tremor**, meaning it occurs during voluntary movement, contrasting with resting tremors seen in other conditions. *Parkinson's disease* - Parkinson's disease primarily presents with a **resting tremor**, which is most noticeable when the affected limb is at rest [1]. - The tremor in Parkinson's is often described as a **"pill-rolling"** tremor, distinct from the fine action tremor of essential tremor [1]. *Multiple sclerosis* - Tremors in multiple sclerosis are typically **intention tremors**, meaning they appear or worsen during goal-directed movements, such as reaching for an object [2]. - These tremors are often **coarser and more irregular** than the fine tremors associated with essential tremor [2]. *None of the options* - This option is incorrect because essential tremor is a specific condition well-known for its characteristic fine tremor.

Q: A woman with bilateral headaches that worsen with emotional stress, who has two children both doing poorly in school, is diagnosed with:

Tension headache. ***Tension headache*** - **Tension headaches** are often described as a bilateral dull, constant ache, frequently associated with **stress** and muscle tension, as suggested by the patient's emotional stress with her children's schooling. - The lack of typical migraine features like **pulsating pain**, **photophobia**, **phonophobia**, or aura, and the bilateral nature, favor tension headache over migraine. *Migraine* - **Migraines** typically present as unilateral, pulsating pain, often accompanied by **nausea**, vomiting, photophobia, or phonophobia. - While stress can be a trigger, the **bilateral presentation** and absence of other hallmark migraine features make it less likely. *Cluster headache* - **Cluster headaches** are characterized by severe, unilateral pain, frequently around the eye (periorbital), and are associated with **autonomic symptoms** like lacrimation, rhinorrhea, or ptosis. - They occur in "clusters" over days or weeks and are not typically bilateral or primarily triggered by emotional stress in this manner. *Trigeminal neuralgia* - **Trigeminal neuralgia** causes sudden, severe, shock-like pain in the distribution of the trigeminal nerve, often triggered by light touch, chewing, or speaking. - It is not typically described as a continuous bilateral headache worsened by emotional stress.

Q: Which of the following is a known trigger for Bell's palsy?

Local and systemic infections. ***Local and systemic infections*** - Viral infections, particularly **herpes simplex virus (HSV-1)**, are strongly implicated in the etiology of Bell's palsy due to inflammation and demyelination of the **facial nerve** [1]. - Other infections such as **varicella-zoster virus**, **Epstein-Barr virus**, and **cytomegalovirus** have also been identified as triggers [3]. *Exposure to cold* - While historically believed to be a cause, **cold exposure** has not been scientifically proven to directly trigger Bell's palsy. - The sensation of cold may exacerbate symptoms due to nerve sensitivity, but it is not a direct etiologic factor. *Tooth extraction* - Tooth extraction is not a widely recognized trigger for Bell's palsy; however, **dental procedures** involving local anesthesia or trauma *can sometimes* lead to temporary facial nerve dysfunction, but this is distinct from Bell's palsy. - Such cases are usually due to direct nerve damage or hematoma, rather than the inflammation seen in Bell's palsy. *None of the options* - Since **local and systemic infections** are well-established triggers for Bell's palsy, this option is incorrect [2]. - The underlying mechanism involves **inflammation and swelling** of the facial nerve, often linked to viral reactivation.

Question 1

Most common cause of postural hypotension is

Accepted Answer

Peripheral neuropathy

Answer

Progressive cerebellar degeneration

Answer

Adrenal insufficiency

Answer

Striatonigral degeneration

Question 2

Fluent aphasia with preserved comprehension and impaired repetition is characteristic of which type of aphasia?

Accepted Answer

Conduction Aphasia

Answer

Broca's Aphasia

Answer

Wernicke's Aphasia

Answer

Anomic Aphasia

Question 3

Parkinsonism is characterized by all of the following features except:

Accepted Answer

Dystonia

Answer

Rigidity

Answer

Bradykinesia

Answer

Tremors at rest

Question 4

What is the primary symptom associated with a lesion in Wernicke's area?

Accepted Answer

Fluent speech with poor comprehension

Answer

Inability to understand language

Answer

Inability to repeat phrases

Answer

Difficulty in forming sentences

Question 5

Which of the following conditions is least likely to be associated with normal pressure spontaneous cerebrospinal fluid (CSF) leaks?

Accepted Answer

Pseudo tumor Cerebri

Answer

Empty Sella Syndrome

Answer

Encephalocele

Answer

Meningiocele

Question 6

In a cerebellar lesion, which symptom is typically not observed?

Accepted Answer

Resting tremors

Answer

Dysmetria

Answer

Dysdiadochokinesia

Answer

Ataxia

Question 7

In a patient with a pontine hemorrhage, what clinical presentation would be expected?

Accepted Answer

Quadriplegia

Answer

Asymmetrical mydriasis

Answer

Ataxic hemiparesis

Answer

Hypothermia

Question 8

Fine tremors are primarily associated with which of the following conditions?

Accepted Answer

Essential tremor

Answer

Parkinson's disease

Answer

Multiple sclerosis

Answer

None of the options

Question 9

A woman with bilateral headaches that worsen with emotional stress, who has two children both doing poorly in school, is diagnosed with:

Accepted Answer

Tension headache

Answer

Migraine

Answer

Cluster headache

Answer

Trigeminal neuralgia

Question 10

Which of the following is a known trigger for Bell's palsy?

Accepted Answer

Local and systemic infections

Answer

Exposure to cold

Answer

Tooth extraction

Answer

None of the options

Neurology — MCQs

Neurology — MCQs

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