Neurology Practice Questions

Q: Subacute sclerosing panencephalitis (SSPE) is a complication of which viral infection?

Measles. **Explanation:** **Subacute Sclerosing Panencephalitis (SSPE)** is a rare, progressive, and fatal neurodegenerative disease caused by a persistent, aberrant infection of the central nervous system with a **mutated Measles virus**. [1] 1. **Why Measles is Correct:** SSPE occurs years (typically 5–10) after an initial measles infection, usually in children who contracted the virus before age two. [1] The underlying mechanism involves a **defective "M" (matrix) protein** of the measles virus, which prevents the virus from budding out of host cells. Instead, the virus spreads directly from cell to cell via syncytia formation, leading to widespread inflammation, demyelination, and neuronal death in both gray and white matter (hence "panencephalitis"). 2. **Why Other Options are Incorrect:** * **Rubella:** Associated with Progressive Rubella Panencephalitis (PRP), which clinically mimics SSPE but is caused by the Rubella virus. * **Mumps:** Commonly causes viral meningitis or acute encephalitis, but not a chronic sclerosing panencephalitis. * **Chickenpox (VZV):** Can cause acute cerebellar ataxia or encephalitis, and its reactivation leads to Herpes Zoster (shingles), but not SSPE. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Stages:** Characterized by behavioral changes (Stage 1), followed by pathognomonic **periodic myoclonic jerks** (Stage 2), and eventually dementia and akinetic mutism. * **EEG Finding:** Classic **periodic, high-voltage slow-wave complexes** (Radermecker complexes) synchronized with myoclonus. * **CSF Analysis:** Shows significantly **elevated anti-measles antibody titers** and oligoclonal bands (increased IgG). [2] * **Diagnosis:** Based on Dyken’s criteria. * **Prevention:** The most effective strategy is vaccination with the **MMR vaccine**. [1]

Q: Albuminocytological dissociation is associated with which condition?

Guillain-Barre syndrome. **Explanation** **Albuminocytological dissociation** is a hallmark cerebrospinal fluid (CSF) finding characterized by a **significant elevation in protein levels** (albumin) with a **normal white blood cell (WBC) count**. 1. **Guillain-Barré Syndrome (GBS):** This is the correct answer. In GBS, inflammatory demyelination of spinal nerve roots leads to the leakage of plasma proteins into the CSF [1]. However, because the inflammation is localized to the peripheral nerves and roots rather than the meninges, there is no significant cellular (pleocytic) response in the CSF. This dissociation typically appears after the first week of symptoms [1]. 2. **Why the other options are incorrect:** * **Subarachnoid Haemorrhage (SAH):** CSF shows "xanthochromia" (yellowish discoloration) and a high number of Red Blood Cells (RBCs) [2]. While protein may rise, it is not a "dissociation" as the cellular components (RBCs) are markedly elevated. * **Pyogenic Meningitis:** Characterized by "Cyto-albuminologic association." There is a massive increase in WBCs (neutrophils), high protein, and markedly low glucose. * **Encephalitis:** Usually presents with viral pleocytosis (increased lymphocytes) and mildly elevated protein, maintaining a correlation between cells and protein. **High-Yield Clinical Pearls for NEET-PG:** * **Definition:** Protein >45 mg/dL with WBC <10 cells/mm³. * **Timing:** CSF may be normal in the first 48 hours of GBS; peak protein levels are usually seen at 2–4 weeks. * **Other Associations:** Albuminocytological dissociation can also be seen in **Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)** and occasionally in **Froin’s Syndrome** (spinal canal blockage). * **Treatment of GBS:** IVIG or Plasmapheresis (Steroids are generally not effective).

Q: Automatism is seen in which type of seizures?

Complex partial seizures. **Explanation:** **Automatisms** are involuntary, repetitive, and purposeless motor activities performed during a state of impaired consciousness. They are the hallmark clinical feature of **Complex Partial Seizures** (now classified by ILAE as Focal Impaired Awareness Seizures) [1]. 1. **Why Complex Partial Seizures (B) is correct:** These seizures typically originate in the temporal lobe. The hallmark is the **impairment of consciousness**, during which the patient may perform coordinated but inappropriate movements such as lip-smacking, chewing, swallowing, or fumbling with clothes (picking at buttons) [1]. The patient is amnestic to the event afterward [2]. 2. **Why other options are incorrect:** * **Simple Partial Seizures (A):** By definition, consciousness is fully preserved [1]. While motor jerks may occur, complex, semi-purposeful automatisms are absent. * **Infantile Spasms (C):** These are characterized by sudden, brief "jackknife" flexor or extensor spasms, typically associated with Hypsarrhythmia on EEG (West Syndrome), not coordinated automatisms. * **Absence Seizures (D):** While brief automatisms (like eye blinking) *can* occur in typical absence seizures, they are much more characteristic and elaborate in complex partial seizures. Absence seizures are primarily defined by a sudden "blank stare" and immediate recovery without a post-ictal state [3]. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site** for complex partial seizures: **Mesial Temporal Lobe** (Hippocampus). * **Post-ictal confusion:** Present in complex partial seizures but **absent** in absence seizures [3]. * **EEG Finding:** Complex partial seizures show focal spikes/sharp waves; Absence seizures show classic **3 Hz spike-and-wave** discharges [3]. * **Drug of Choice:** Carbamazepine/Levetiracetam for focal seizures; Valproate/Ethosuximide for absence seizures.

Q: Which of the following is used in the acute exacerbation of multiple sclerosis?

Methylprednisolone. The management of Multiple Sclerosis (MS) is divided into two distinct categories: treatment of acute relapses (exacerbations) and disease-modifying therapies (DMTs) for long-term prevention. **Why Methylprednisolone is correct:** The goal of treating an acute exacerbation is to reduce inflammation and speed up recovery from the neurological deficit. **High-dose intravenous Methylprednisolone (typically 1g daily for 3–5 days)** is the first-line treatment. It works by stabilizing the blood-brain barrier, reducing edema, and inhibiting inflammatory cytokines. If steroids are contraindicated or ineffective, **Plasmapheresis (Plasma Exchange)** is the next step for acute management. **Why the other options are incorrect:** * **Fingolimod (Option B):** An oral S1P receptor modulator used as a DMT to reduce the frequency of relapses in relapsing-remitting MS (RRMS). It is not used for acute attacks. * **Beta Interferon (Option C):** One of the oldest first-line DMTs used for long-term maintenance [2]. It helps prevent future relapses but has no role in treating an ongoing acute attack. * **Natalizumab (Option D):** A monoclonal antibody against α4β1-integrin. It is a highly effective DMT reserved for aggressive RRMS but is not used for acute exacerbations. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard for Diagnosis:** MRI with Gadolinium (shows "Dawson’s fingers" or periventricular plaques) [1], [3]. * **CSF Finding:** Oligoclonal bands (IgG) are present in >90% of patients [1], [3]. * **Lhermitte’s Sign:** An electric shock-like sensation down the spine upon neck flexion. * **Uhthoff’s Phenomenon:** Worsening of neurological symptoms with increased body temperature. * **DOC for Spasticity in MS:** Baclofen.

Q: What is the most common cause of death in measles?

Pneumonia. **Explanation:** **Pneumonia** is the most common cause of death associated with measles in both children and adults. Measles virus causes profound transient immunosuppression by depleting T-lymphocytes and altering cytokine responses. This predisposes patients to secondary bacterial infections (most commonly *S. pneumoniae*, *H. influenzae*, and *S. aureus*) or primary viral giant cell pneumonia (Hecht’s pneumonia) [1]. While measles is often perceived as a simple rash, respiratory complications account for nearly 60% of measles-related mortality. **Analysis of Incorrect Options:** * **Encephalitis:** While Acute Disseminated Encephalomyelitis (ADEM) and Subacute Sclerosing Panencephalitis (SSPE) are severe neurological complications with high morbidity, they occur much less frequently than respiratory complications [1]. * **Meningitis:** Measles rarely presents as isolated meningitis; neurological involvement typically manifests as encephalitis or encephalopathy. * **Dehydration:** Although diarrhea is the most common *complication* of measles overall (especially in malnourished children), it is secondary to pneumonia as a cause of death in global statistics. **NEET-PG High-Yield Pearls:** * **Most common complication:** Diarrhea. * **Most common cause of death:** Pneumonia. * **Most common CNS complication:** Acute febrile encephalitis. * **Pathognomonic sign:** Koplik spots (found opposite the lower second molars) [1]. * **Vitamin Supplementation:** Vitamin A is crucial in management as it reduces the severity of complications and mortality risk [1]. * **SSPE:** A late, fatal neurodegenerative complication occurring years after the initial infection due to a persistent mutant virus [1].

Question 1

A 44-year-old man presents with a noticed difference in pupil size between his right and left eye, which he believes has been present for several weeks. He reports no pain or restriction of eye movements. Examination in a dimly lit room shows both pupils to be 4mm in size. Upon light exposure, his right pupil dilates to 4mm, while his left pupil constricts to 2mm. His eye movements are normal, and the remainder of his neurological examination is unremarkable. He does not exhibit ptosis. This physical finding is indicative of which of the following pathological processes?

Accepted Answer

Abnormal dilation of an artery due to weakening of the vessel wall

Answer

Occlusion of the superior sagittal sinus

Answer

Rupture of the middle meningeal artery leading to transtentorial herniation

Answer

Rupture of the inner lumen of the internal carotid artery with thrombus formation at the site of rupture

Question 2

Subacute sclerosing panencephalitis (SSPE) is a complication of which viral infection?

Accepted Answer

Measles

Answer

Rubella

Answer

Mumps

Answer

Chickenpox

Question 3

Albuminocytological dissociation is associated with which condition?

Accepted Answer

Guillain-Barre syndrome

Answer

Subarachnoid haemorrhage

Answer

Pyogenic meningitis

Answer

Encephalitis

Question 4

Easy fatigability of muscles is seen in which of the following conditions?

Accepted Answer

Myasthenia gravis

Answer

Epilepsy

Answer

MPDS

Answer

Cerebral palsy

Question 5

Intra-arterial thrombolysis is indicated in which of the following conditions?

Accepted Answer

Suspected occlusion of a larger artery

Answer

History of subarachnoid hemorrhage

Answer

History of dementia

Answer

Stroke of > 6 hours duration

Question 6

Automatism is seen in which type of seizures?

Accepted Answer

Complex partial seizures

Answer

Simple partial seizures

Answer

Infantile spasms

Answer

Absence seizures

Question 7

A 58-year-old woman with a history of alcohol abuse, coronary artery disease, and atrial fibrillation is on metoprolol, lisinopril, simvastatin, and warfarin. She develops urinary urgency and frequency and is treated with oxycodone and ciprofloxacin. Three days later, she develops a headache, dizziness, vomiting, and difficulty walking. Neurological examination reveals normal strength, sensation (including vibratory sensation), and reflexes. She has an uncoordinated, unsteady gait. Testing of coordination in the upper extremities shows past pointing and poor rapid alternating movements with her right upper extremity. In the lower extremities, her heel-shin testing also reveals poor coordination on the right. Her INR is 6.5 (normal <1; therapeutic for warfarin is 2.0-3.0). What is the most likely cause of her neurologic findings?

Accepted Answer

Right cerebellar hemorrhage

Answer

Multiple small infarcts in the basal ganglia

Answer

Cerebellar degeneration due to chronic alcohol abuse

Answer

Posterior column degeneration as a result of vitamin deficiency

Question 8

Which of the following is used in the acute exacerbation of multiple sclerosis?

Accepted Answer

Methylprednisolone

Answer

Fingolimod

Answer

Beta interferon

Answer

Natalizumab

Question 9

What is the most common cause of death in measles?

Accepted Answer

Pneumonia

Answer

Encephalitis

Answer

Meningitis

Answer

Dehydration

Question 10

An 80-year-old chronic alcoholic was diagnosed with atrial fibrillation five years ago. His son describes a stepwise decline in his father's overall memory over these years. On examination, he is having pseudobulbar affect with brisk deep tendon reflexes in the left upper extremity and up-going plantars. What is the diagnosis?

Accepted Answer

Multi-infarct dementia

Answer

Binswanger's disease

Answer

Alzheimer's disease

Answer

Vitamin B12 deficiency

Neurology — MCQs

Neurology — MCQs

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