Neurology Practice Questions

Q: What is the MOST COMMON side effect of vagal nerve stimulation?

voice changes. ***voice changes*** - **Voice changes**, such as **hoarseness** or dysphonia, are the most frequently reported side effect due to the proximity of the stimulator to the **recurrent laryngeal nerve** [1]. - These changes often occur during stimulation and can be managed by adjusting the device settings. *coughing* - While **coughing** can occur, it is a less common side effect compared to voice changes. - It results from irritation of the **laryngeal or pharyngeal branches** of the vagus nerve. *nausea* - **Nausea** is a less common side effect and typically occurs due to activation of the **gastrointestinal afferent fibers** of the vagus nerve [2]. - It usually resolves with adjustment of stimulation parameters or over time. *throat discomfort* - **Throat discomfort** or pain can occur, but it is less frequent than voice changes and may be associated with the surgical implantation site or local irritation from the lead. - It is distinct from the functional changes in voice caused by direct nerve stimulation.

Q: Which of the following is NOT a feature of seizures or syncope?

Nausea and tunneling of vision are features of syncope.. ***Nausea and tunneling of vision are features of syncope.*** - **Nausea** and **tunneling of vision** are **prodromal symptoms** specific to syncope, occurring due to reduced cerebral blood flow before loss of consciousness [1], [4]. - These symptoms are **NOT features of seizures**, which typically have sudden onset without warning symptoms like nausea or visual changes [1]. *Becomes immediately unconscious* - Both **seizures** and **syncope** are characterized by sudden loss of consciousness, making this a common feature of both conditions [2], [4]. - This **immediate unconscious state** distinguishes both conditions from gradual neurological changes or other causes of altered mental status [3]. *No precipitating factors* - **Seizures** often occur without identifiable precipitating factors, making their onset sudden and unpredictable. - **Syncope** can also occur without obvious triggers, though it may be precipitated by **orthostatic stress**, dehydration, or emotional factors [1]. *Tonic or clonic seizures lasting more than 60 seconds* - While typical **generalized tonic-clonic seizures** usually last less than 60 seconds, seizures **CAN last longer** than 60 seconds [2]. - **Status epilepticus** refers to seizures lasting more than 5 minutes or recurrent seizures without recovery, making prolonged seizures still a feature of seizure disorders.

Q: Which one of the following is the characteristic feature of juvenile myoclonic epilepsy?

Myoclonic seizures frequently occur in morning. ***Myoclonic seizures frequently occur in morning*** - A key diagnostic feature of **juvenile myoclonic epilepsy (JME)** is the occurrence of **myoclonic jerks**, specifically upon **waking up or in the morning** after sleep [1]. - These jerks are often exacerbated by **sleep deprivation** and certain stimuli. *Complete remission is common* - While treatment with **antiepileptic drugs (AEDs)** can achieve good seizure control, **complete remission** (i.e., being seizure-free without medication) is relatively uncommon [1]. - Most patients with JME require **lifelong medication** to prevent seizure recurrence [1]. *Response to anticonvulsants is poor* - JME generally has a **good prognosis** with appropriate medication, particularly with **valproic acid**, which is highly effective [1]. - The disease is typically **well-controlled** with AEDs, and response to treatment is often favorable [1]. *Associated absence seizures can occur in some patients but not the majority.* - **Absence seizures** are a common associated seizure type in individuals with JME, affecting about **one-third of patients** [1]. - **Generalized tonic-clonic seizures (GTCS)** are also very common, affecting over **90%** of JME patients, often appearing after the myoclonic jerks [1].

Q: Which of the following is not part of the classic triad of Parkinson's disease?

Preserved postural reflexes. ***Preserved postural reflexes*** - **Loss of postural reflexes** is a key feature of Parkinson's disease, leading to balance problems and falls, not preserved reflexes [4]. - The classic triad focuses on motor symptoms, and the inability to maintain posture is a direct consequence of the disease's progression [4]. *Rigidity* - **Rigidity**, or increased muscle tone, is a fundamental motor symptom in Parkinson's, often described as **cogwheel** or **lead-pipe rigidity** [2]. - This symptom contributes to the characteristic stiffness and reduced range of motion seen in affected individuals. *Resting tremors* - **Resting tremors**, typically a pill-rolling tremor that disappears with voluntary movement, are a hallmark symptom of Parkinson's disease [2]. - This involuntary shaking at rest is often one of the earliest and most recognizable signs of the condition [3]. *Bradykinesia* - **Bradykinesia**, or slowness of movement, is a core diagnostic criterion for Parkinson's disease [1]. - It manifests as difficulty initiating movements, reduced amplitude of movements, and overall decreased spontaneous movement.

Q: An adolescent female has headaches that are intermittent in episodes, associated with tinnitus, vertigo, and hearing loss. There is a history of similar complaints in her mother. What is the most likely diagnosis?

Basilar migraine. ***Basilar migraine*** - This diagnosis is characterized by **headaches**, **tinnitus**, **vertigo**, and **hearing loss**, which are all symptoms of **basilar artery involvement**. - The familial history (**similar complaints in her mother**) suggests a genetic predisposition often seen with migraines [1]. *Cervical spondylosis* - This condition involves **degenerative changes** in the cervical spine, often presenting with neck pain, stiffness, and radicular symptoms. - It does not typically cause **hearing loss**, and while it can cause headaches and vertigo, the combination of symptoms and family history points away from spondylosis. *Temporal arteritis* - This is a **vasculitic condition** usually affecting older adults (>50 years) and presents with unilateral headache, scalp tenderness, and jaw claudication [2]. - It is unlikely in an **adolescent female** and does not typically involve the specific constellation of tinnitus and vertigo found here. *Vestibular neuronitis* - This condition causes **acute, severe vertigo**, often preceded by a viral infection, and can last for days or weeks. - While it causes vertigo, it is typically **not associated with headache** or hearing loss and is usually a self-limiting episode rather than intermittent.

Q: On electromyography, all of the following features suggest denervation, EXCEPT:

Less insertional activity is observed in denervated muscles. ***Less insertional activity is observed in denervated muscles*** - **Decreased insertional activity** is actually seen in **fibrotic** or **fatty infiltrated muscle**, not denervated. - In denervated muscle, **increased insertional activity** (brief discharge of motor unit potentials) is typically observed. *Giant polyphasic potentials arise from motor units* - **Giant polyphasic potentials** are characteristic of chronic denervation followed by reinnervation, indicating **motor unit remodeling** [1]. - They reflect a larger, more complex motor unit where remaining nerves sprout to reinnervate orphaned muscle fibers [1]. *Presence of positive sharp waves* - **Positive sharp waves** are a common sign of **acute denervation** and muscle fiber irritability. - They indicate spontaneous depolarization of muscle fibers that have lost their nerve supply. *Spontaneous firing of motor units* - **Spontaneous firing of motor units** (fibrillations and fasciculations) is a hallmark of denervation [1]. - **Fibrillations** are spontaneous discharges of individual muscle fibers, while **fasciculations** are visible twitches of muscle bundles caused by spontaneous firing of a motor unit [1].

Q: An 85-year-old man presents with a sudden onset of severe occipital headache, vomiting on two occasions, and double vision. He has a history of hypertension. His examination findings are a Glasgow Coma Scale of 15/15, mild neck stiffness, and normal power in both upper and lower limbs. Where is the likely site of pathology?

Posterior communicating artery. ***Posterior communicating artery*** - Aneurysms in the **posterior communicating artery** are notorious for causing **oculomotor nerve (CN III) palsy**, leading to **double vision** due to impairment of eye movements. [2] - The sudden onset of severe **occipital headache** and **vomiting** suggests a subarachnoid hemorrhage, which is a common presentation of a ruptured cerebral aneurysm. [1] *Anterior communicating artery* - Aneurysms here typically present with **bifrontal headaches** and can cause **visual field defects** or **cranial nerve deficits** affecting the optic chiasm. - It usually does not specifically cause **double vision** due to oculomotor nerve involvement as a primary symptom. *Lenticulostriate artery* - These are small perforating arteries that supply the **basal ganglia** and **internal capsule**. - Rupture most commonly causes **intracerebral hemorrhage**, leading to motor or sensory deficits depending on the affected area, but less typically presents with isolated double vision or occipital headache. *P1 Segment of Posterior cerebral artery* - Aneurysms in the **P1 segment** are rare and typically involve structures around the **midbrain**, potentially causing specific neurological deficits like **contralateral hemiparesis** or **visual defects**. - While rupture can cause subarachnoid hemorrhage, presentation with isolated double vision from oculomotor nerve palsy is less characteristic than with a posterior communicating artery aneurysm.

Q: Not seen in case of hemorrhage in MCA territory is:

Urinary incontinence. ***Urinary incontinence*** - Urinary incontinence is typically associated with **anterior cerebral artery (ACA)** territory lesions, which affect the **paracentral lobule** responsible for bladder control. - MCA territory hemorrhage primarily impacts motor, sensory, speech, and attentional functions, not direct bladder control. *Contralateral hemiplegia* - Hemorrhage in the MCA territory commonly affects the **motor cortex** and its descending tracts, leading to **weakness or paralysis** on the opposite side of the body [1]. - This is a very common and expected symptom in MCA strokes. *Aphasia* - If the dominant hemisphere (usually left) is affected,MCA territory hemorrhage often involves **Broca's and Wernicke's areas**, leading to various forms of **aphasia** (expressive or receptive speech difficulties) [1]. - This is a hallmark symptom of dominant MCA strokes. *Dysarthria* - Dysarthria, or difficulty with articulation of speech, can result from MCA territory hemorrhage affecting the motor pathways that control the **muscles of speech** [1]. - It often co-occurs with hemiplegia and other motor deficits.

Q: Which of the following is not a treatment option for patients with relapsing-remitting multiple sclerosis?

Cyclophosphamide. ***Cyclophosphamide*** - This is an **immunosuppressant** primarily used in severe autoimmune conditions or certain cancers, not a standard maintenance treatment for **relapsing-remitting multiple sclerosis (RRMS)**. - While it has been explored for severe, rapidly worsening MS, it is not considered a first-line or common treatment option for RRMS due to its significant toxicity and side effect profile. *IFN-β1b* - **Interferon beta-1b** is a well-established **disease-modifying therapy** for RRMS, shown to reduce the frequency and severity of relapses. - It works by modulating the immune system to decrease inflammation and demyelination in the central nervous system. *IFN-β1a* - **Interferon beta-1a** (both intramuscular and subcutaneous formulations) is also a widely used **disease-modifying therapy** for RRMS. - Similar to interferon beta-1b, it helps to reduce relapse rates and slow the progression of disability in patients with RRMS. *Glatiramer acetate* - This is another common **disease-modifying therapy** for RRMS, which acts as a "decoy" myelin basic protein. - It works by inducing **T-cell anergy** and shifting the immune response from pro-inflammatory to anti-inflammatory, reducing attacks on myelin.

Q: What is Broca's aphasia?

Non-fluent aphasia. ***Non-fluent aphasia*** - Broca's aphasia is characterized by **non-fluent speech**, meaning speech is effortful, slow, and consists of short phrases with many pauses. [1] - Patients typically have **relatively preserved comprehension** but significant difficulty with speech production and repetition. [1] *Fluent aphasia* - This describes conditions like **Wernicke's aphasia**, where speech is fluent but often lacks meaning. [1] - Patients with fluent aphasia typically have **poor comprehension**, which is not the primary feature of Broca's aphasia. *Sensory aphasia* - This is another term for **Wernicke's aphasia**, primarily characterized by **impaired comprehension** of spoken and written language. - While it involves language deficits, the core issue is receptive, not expressive as in Broca's aphasia. *Conduction aphasia* - Conduction aphasia is characterized by **impaired repetition** despite relatively fluent speech and good comprehension. [1] - It results from damage to the **arcuate fasciculus**, connecting Broca's and Wernicke's areas. [1]

Question 1

What is the MOST COMMON side effect of vagal nerve stimulation?

Accepted Answer

voice changes

Answer

nausea

Answer

coughing

Answer

throat discomfort

Question 2

Which of the following is NOT a feature of seizures or syncope?

Accepted Answer

Nausea and tunneling of vision are features of syncope.

Answer

Becomes immediately unconscious

Answer

No precipitating factors

Answer

Tonic or clonic seizures lasting more than 60 seconds

Question 3

Which one of the following is the characteristic feature of juvenile myoclonic epilepsy?

Accepted Answer

Myoclonic seizures frequently occur in morning

Answer

Complete remission is common

Answer

Response to anticonvulsants is poor

Answer

Associated absence seizures can occur in some patients but not the majority.

Question 4

Which of the following is not part of the classic triad of Parkinson's disease?

Accepted Answer

Preserved postural reflexes

Answer

Rigidity

Answer

Resting tremors

Answer

Bradykinesia

Question 5

An adolescent female has headaches that are intermittent in episodes, associated with tinnitus, vertigo, and hearing loss. There is a history of similar complaints in her mother. What is the most likely diagnosis?

Accepted Answer

Basilar migraine

Answer

Cervical spondylosis

Answer

Temporal arteritis

Answer

Vestibular neuronitis

Question 6

On electromyography, all of the following features suggest denervation, EXCEPT:

Accepted Answer

Less insertional activity is observed in denervated muscles

Answer

Spontaneous firing of motor units

Answer

Giant polyphasic potentials arise from motor units

Answer

Presence of positive sharp waves

Question 7

An 85-year-old man presents with a sudden onset of severe occipital headache, vomiting on two occasions, and double vision. He has a history of hypertension. His examination findings are a Glasgow Coma Scale of 15/15, mild neck stiffness, and normal power in both upper and lower limbs. Where is the likely site of pathology?

Accepted Answer

Posterior communicating artery

Answer

Lenticulostriate artery

Answer

P1 Segment of Posterior cerebral artery

Answer

Anterior communicating artery

Question 8

Not seen in case of hemorrhage in MCA territory is:

Accepted Answer

Urinary incontinence

Answer

Contralateral hemiplegia

Answer

Aphasia

Answer

Dysarthria

Question 9

Which of the following is not a treatment option for patients with relapsing-remitting multiple sclerosis?

Accepted Answer

Cyclophosphamide

Answer

IFN-β1b

Answer

IFN-β1a

Answer

Glatiramer acetate

Question 10

What is Broca's aphasia?

Accepted Answer

Non-fluent aphasia

Answer

Fluent aphasia

Answer

Sensory aphasia

Answer

Conduction aphasia

Neurology — MCQs

Neurology — MCQs

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