Neurology Practice Questions

Q: All of the following are used for the graduation of coma using the Glasgow Coma Scale, except?

Heart rate. The **Glasgow Coma Scale (GCS)** is a standardized clinical tool used to assess the level of consciousness and the severity of brain injury [1], [2]. It is based on three objective clinical parameters: **Eye opening (E)**, **Verbal response (V)**, and **Motor response (M)**. ### Explanation of Options: * **Heart Rate (Correct Answer):** Heart rate is a vital sign, not a component of the GCS [2]. While changes in heart rate (e.g., bradycardia in Cushing’s triad) can indicate increased intracranial pressure, it is not used to calculate the GCS score. * **Eye Opening (A):** Scored from 1 to 4. It assesses the brainstem's reticular activating system. * **Verbal Response (C):** Scored from 1 to 5. It assesses central nervous system integration and orientation. * **Motor Response (B):** Scored from 1 to 6. It is the most significant predictor of clinical outcome. ### High-Yield Clinical Pearls for NEET-PG: * **Score Range:** The total GCS score ranges from a **minimum of 3** (deep coma or death) to a **maximum of 15** (fully awake). There is no score of 0. * **Severity Grading:** * **Mild:** 13–15 [1] * **Moderate:** 9–12 [1] * **Severe (Coma):** ≤ 8 [1] * **Mnemonic:** *"GCS of 8, Intubate"* — Patients with a score of 8 or less usually require airway protection. * **Modified GCS:** For intubated patients, the verbal score is replaced with 'T' (e.g., E4VTM6). * **GCS-P:** A newer variant that includes **Pupillary reactivity** to better predict prognosis in neurocritical care.

Q: Wernicke-Korsakoff syndrome is characterized by all of the following except?

Loss of remote memory. **Explanation:** Wernicke-Korsakoff Syndrome (WKS) is a spectrum of neurological disorders caused by **Thiamine (Vitamin B1) deficiency**, most commonly seen in chronic alcoholics [2]. It consists of two phases: Wernicke Encephalopathy (acute) and Korsakoff Syndrome (chronic) [1]. **Why "Loss of remote memory" is the correct answer:** In Korsakoff Syndrome, the hallmark memory deficit is **anterograde amnesia** (inability to form new memories) and **retrograde amnesia** (loss of recent past memories) [1]. Crucially, **remote memory** (long-term memories from childhood or many years ago) is typically **preserved**. Patients often use **confabulation** (filling memory gaps with fabricated stories) to compensate for these deficits. **Analysis of incorrect options:** * **A. Ataxia:** This is a classic component of the Wernicke triad [1]. It manifests as a wide-based gait due to cerebellar vermis degeneration. * **B. Paralysis of ocular muscles:** Ophthalmoplegia (specifically weakness of the lateral rectus/6th nerve palsy) and nystagmus are key diagnostic signs of acute Wernicke Encephalopathy [1]. * **D. Global confusion:** An altered mental state, ranging from mild disorientation to profound encephalopathy, is the third component of the classic triad [1]. **NEET-PG High-Yield Pearls:** 1. **The Classic Triad:** Confusion, Ataxia, and Ophthalmoplegia (Goes by the mnemonic **CAN**: **C**onfusion, **A**taxia, **N**ystagmus). 2. **Pathology:** Characterized by symmetrical lesions/petechial hemorrhages in the **mammillary bodies** and periaqueductal gray matter [3]. 3. **Treatment Rule:** Always administer **Thiamine before Glucose**. Giving IV Glucose first in a thiamine-deficient patient can precipitate or worsen Wernicke Encephalopathy by exhausting remaining thiamine stores during glycolysis. 4. **MRI Finding:** Increased T2/FLAIR signal intensity in the mammillary bodies and dorsomedial thalamus.

Q: Gustatory hallucination is most commonly associated with which condition?

Temporal lobe epilepsy. **Explanation:** **Temporal lobe epilepsy (TLE)** is the correct answer because gustatory hallucinations (perceiving tastes that aren't there, often metallic or unpleasant) are a classic manifestation of **uncinate fits**. These occur when an epileptic focus involves the **uncus** or the **primary gustatory cortex** (located in the insula and the opercular part of the frontal/parietal lobes). Since the temporal lobe houses the limbic system and olfactory/gustatory processing areas, irritation here frequently results in sensory "auras" [1]. **Analysis of Incorrect Options:** * **Schizophrenia:** While auditory hallucinations are hallmark features, gustatory and olfactory hallucinations are rare and should always prompt an investigation for organic brain pathology. * **Delirium Tremens:** This severe form of alcohol withdrawal is most characteristically associated with **visual hallucinations** (e.g., seeing small animals or insects) and tactile hallucinations (formication), rather than taste. * **Cotard’s Syndrome:** This is a rare neuropsychiatric condition (nihilistic delusion) where the patient believes they are dead, rotting, or do not exist. It is not primarily associated with sensory hallucinations of taste. **High-Yield Clinical Pearls for NEET-PG:** * **Uncinate Fits:** Characterized by a triad of olfactory/gustatory hallucinations, a "dreamy state," and involuntary movements like lip-smacking (automatisms). * **Primary Gustatory Cortex:** Located in the **Insula** and **Frontal Operculum** (Brodmann area 43). * **Most common aura in TLE:** Epigastric rising sensation, followed by olfactory/gustatory disturbances [1]. * **Foster Kennedy Syndrome:** Anosmia (olfactory loss) due to a frontal lobe tumor, often confused with sensory disturbances in exams.

Q: Bell's palsy is paralysis of which nerve?

Lower motor neuron (LMN) VII nerve. ### Explanation **Bell’s palsy** is defined as an isolated, idiopathic, acute-onset **Lower Motor Neuron (LMN)** paralysis of the **VII cranial nerve (Facial nerve)**. It is the most common cause of unilateral facial paralysis worldwide. #### Why Option D is Correct: In an LMN lesion of the facial nerve, the pathology occurs at or distal to the facial nerve nucleus in the pons. This results in paralysis of **all muscles of facial expression** on the ipsilateral (same) side. This includes the inability to wrinkle the forehead, close the eye (lagophthalmos), and a drooping of the angle of the mouth. #### Why Other Options are Incorrect: * **Options A & C (V Nerve):** The V cranial nerve (Trigeminal nerve) provides sensory innervation to the face and motor innervation to the muscles of mastication. It does not control facial expression; therefore, its paralysis does not cause Bell’s palsy. * **Option B (UMN VII Nerve):** In an Upper Motor Neuron lesion (e.g., Stroke), the **forehead is spared**. This is because the part of the facial nucleus supplying the forehead receives bilateral cortical representation (innervation from both cerebral hemispheres). Since Bell's palsy involves the forehead, it cannot be a UMN lesion. #### High-Yield Clinical Pearls for NEET-PG: * **Etiology:** Likely viral prodrome (Herpes Simplex Virus is the most implicated). * **Clinical Sign:** **Bell’s Phenomenon** – Upward and outward rolling of the eyeball when the patient attempts to close the eyelid. * **Treatment:** Oral **Corticosteroids** (Prednisolone) are the mainstay of treatment and should be started within 72 hours. * **Prognosis:** Approximately 85% of patients show recovery within 3 weeks. * **Schirmer’s Test:** Used to localise the lesion; if reduced lacrimation is present, the lesion is at or proximal to the geniculate ganglion.

Q: Which among the following conditions does not cause an exaggerated jaw jerk?

Syringomyelia. **Explanation:** The **jaw jerk reflex** (masseter reflex) is a clinical test used to assess the integrity of the trigeminal nerve (CN V). It is a monosynaptic stretch reflex mediated by the trigeminal nerve's motor and sensory components, with its reflex center located in the **pons**. **Why Syringomyelia is the correct answer:** An exaggerated jaw jerk is a sign of an **Upper Motor Neuron (UMN) lesion** occurring **above the level of the pons**. Syringomyelia typically involves the cervical spinal cord (forming a syrinx). While it can cause UMN signs in the lower limbs and sensory loss in the upper limbs, it does not affect the brainstem or corticobulbar tracts above the pons. Therefore, the jaw jerk remains normal or absent in Syringomyelia. **Analysis of Incorrect Options:** * **Multiple Sclerosis (MS):** As a demyelinating disease of the Central Nervous System, MS often involves the corticobulbar tracts above the level of the pons, leading to UMN signs and an exaggerated jaw jerk. * **Motor Neurone Disease (MND):** Specifically in Amyotrophic Lateral Sclerosis (ALS), there is a combination of UMN and LMN involvement [1]. Degeneration of the corticobulbar tracts frequently results in a brisk jaw jerk [1]. * **Pseudobulbar Palsy:** This condition is defined by bilateral UMN lesions of the corticobulbar tracts (often due to strokes or MS). A hallmark clinical feature is a pathologically brisk jaw jerk, accompanied by emotional lability and dysarthria. **High-Yield Clinical Pearls for NEET-PG:** * **Localization:** A brisk jaw jerk localizes the lesion to the **midbrain or higher** (supranuclear). * **Bulbar vs. Pseudobulbar Palsy:** In Bulbar palsy (LMN), the jaw jerk is absent; in Pseudobulbar palsy (UMN), the jaw jerk is exaggerated. * **Syringomyelia:** Classically presents with "dissociated sensory loss" (loss of pain/temperature with preserved touch/vibration) in a "cape-like" distribution.

Q: A patient presents with chorea and symptoms suggestive of schizophrenia. What is the most likely diagnosis?

Huntington's disease. **Explanation:** **Huntington’s Disease (HD)** is the correct diagnosis because it classically presents with a triad of **motor, cognitive, and psychiatric symptoms**. [1] 1. **Motor:** Chorea (involuntary, jerky movements) is the hallmark. [1] 2. **Psychiatric:** Psychosis (mimicking schizophrenia), depression, and personality changes often precede motor symptoms by years. [2] 3. **Cognitive:** Progressive subcortical dementia. The underlying pathology involves the atrophy of the **caudate nucleus** and putamen (striatum) due to **CAG trinucleotide repeats** on Chromosome 4, leading to a loss of GABAergic neurons. [1] **Why other options are incorrect:** * **Creutzfeldt-Jakob disease (CJD):** Presents with rapidly progressive dementia and **myoclonus** (not chorea), often leading to death within a year. * **Dementia with Lewy bodies (DLB):** Characterized by visual hallucinations, fluctuating consciousness, and **parkinsonism** (rigidity/bradykinesia), not chorea. * **Parkinson's disease:** Presents with a triad of resting tremor, bradykinesia, and rigidity. [3] While psychosis can occur (often drug-induced), chorea is not a primary feature. **High-Yield Clinical Pearls for NEET-PG:** * **Inheritance:** Autosomal Dominant with **Anticipation** (earlier onset in successive generations, especially via paternal transmission). * **Neuroimaging:** MRI shows "box-car ventricles" due to **atrophy of the caudate nucleus**. [2] * **Neurotransmitters:** Characterized by ↓ GABA, ↓ Acetylcholine, and ↑ Dopamine. * **Treatment:** Tetrabenazine or Deutetrabenazine (VMAT2 inhibitors) are used to manage chorea by depleting dopamine. [2]

Question 1

All of the following are used for the graduation of coma using the Glasgow Coma Scale, except?

Accepted Answer

Heart rate

Answer

Eye opening

Answer

Motor response

Answer

Verbal response

Question 2

Wernicke-Korsakoff syndrome is characterized by all of the following except?

Accepted Answer

Loss of remote memory

Answer

Ataxia

Answer

Paralysis of ocular muscles

Answer

Global confusion

Question 3

Gustatory hallucination is most commonly associated with which condition?

Accepted Answer

Temporal lobe epilepsy

Answer

Schizophrenia

Answer

Delirium tremens

Answer

Cotard's syndrome

Question 4

Which of the following conditions is characterized by the absence of cardiomyopathy?

Accepted Answer

Becker Dystrophy

Answer

Duchenne Muscular Dystrophy

Answer

Myotonic Dystrophy

Answer

Myasthenia Gravis

Question 5

Which of the following statements about Alzheimer's disease is false?

Accepted Answer

Down's syndrome is associated with an increased risk of Alzheimer's disease.

Answer

Neurofibrillary tangles and senile plaques containing Ab amyloid are characteristic pathological findings.

Answer

The hippocampus is severely affected, leading to memory impairment.

Answer

Capgras syndrome is a rare delusion that may occur in patients with Alzheimer's disease.

Question 6

Triple H therapy for subarachnoid hemorrhage consists of all the following except?

Accepted Answer

Hypothermia

Answer

Hypertension

Answer

Hypervolemia

Answer

Hemodilution

Question 7

Bell's palsy is paralysis of which nerve?

Accepted Answer

Lower motor neuron (LMN) VII nerve

Answer

Upper motor neuron (UMN) V nerve

Answer

Upper motor neuron (UMN) VII nerve

Answer

Lower motor neuron (LMN) V nerve

Question 8

A 40-year-old female presented with cough, mild chest pain, and mild hoarseness of voice. Following suspicion of respiratory pathology, a chest X-ray and MRI chest were performed. Which of the following RNS findings should be suspected in this patient?

Accepted Answer

Image B

Answer

Image A

Answer

Image C

Answer

None of the above

Question 9

Which among the following conditions does not cause an exaggerated jaw jerk?

Accepted Answer

Syringomyelia

Answer

Multiple sclerosis

Answer

Motor neurone disease

Answer

Pseudobulbar palsy

Question 10

A patient presents with chorea and symptoms suggestive of schizophrenia. What is the most likely diagnosis?

Accepted Answer

Huntington's disease

Answer

Creutzfeldt-Jakob disease

Answer

Dementia with Lewy bodies

Answer

Parkinson's disease

Neurology — MCQs

Neurology — MCQs

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