Neurology Practice Questions

Q: Opsoclonus is a feature of which of the following conditions?

Carcinoma of the lung. **Explanation:** **Opsoclonus** is a rare, high-frequency, involuntary, multivectorial eye movement disorder characterized by spontaneous, rapid, and chaotic "dancing eyes." It is often associated with myoclonus (Opsoclonus-Myoclonus-Ataxia Syndrome). **1. Why Carcinoma of the Lung is Correct:** In adults, opsoclonus is most commonly a **paraneoplastic manifestation**. It is frequently associated with **Small Cell Lung Carcinoma (SCLC)**, mediated by the **anti-Ri (ANNA-2)** antibody. The underlying mechanism involves an immune-mediated attack on the brainstem and cerebellum triggered by the underlying malignancy. **2. Analysis of Incorrect Options:** * **Retinoblastoma:** While a common pediatric ocular tumor, it does not cause opsoclonus. However, in children, opsoclonus is a classic paraneoplastic sign of **Neuroblastoma** (not Retinoblastoma). * **Focal seizure with dyscognitive changes:** Seizures typically present with rhythmic nystagmoid movements or tonic-clonic deviations, not the chaotic, non-rhythmic movements of opsoclonus. * **Wilson’s Disease:** Extrapyramidal damage in Wilson’s disease typically manifests as a "wing-beating" tremor, dystonia, or parkinsonism. Ocular findings include the **Kayser-Fleischer (KF) ring** and "sunflower cataracts," but not opsoclonus. **High-Yield Clinical Pearls for NEET-PG:** * **Pediatric Association:** Always rule out **Neuroblastoma** in a child presenting with "Dancing Eyes, Dancing Feet" (Opsoclonus-Myoclonus Syndrome). * **Adult Association:** Small Cell Lung Cancer (SCLC) and Breast Cancer. * **Anatomical Site:** Dysfunction is localized to the **omnipause neurons** in the nucleus raphe interpositus of the pons, which normally inhibit saccadic bursts. * **Key Antibody:** **Anti-Ri** is the most high-yield antibody associated with paraneoplastic opsoclonus.

Q: The Miller Fisher test is used for which of the following?

Evaluating cognition in Normal Pressure Hydrocephalus.. ### Explanation **Correct Option: A. Evaluating cognition in Normal Pressure Hydrocephalus (NPH)** The **Miller Fisher Test** (also known as the **Large Volume Lumbar Puncture** or "Tap Test") is a diagnostic and prognostic tool for Normal Pressure Hydrocephalus [1]. NPH is characterized by the classic triad of **Wet, Wobbly, and Weird** (Urinary incontinence, Gait ataxia, and Dementia/Cognitive decline) [2]. In this test, 30–50 mL of cerebrospinal fluid (CSF) is removed [1]. A positive result is defined as a documented improvement in **gait speed or cognitive function** (using scales like the MMSE) shortly after the procedure. This improvement predicts a high likelihood of success for permanent surgical shunting (VP Shunt) [2]. --- ### Why other options are incorrect: * **B. Guillain-Barré Syndrome (GBS):** While "Miller Fisher Syndrome" is a variant of GBS (characterized by Ataxia, Areflexia, and Ophthalmoplegia), there is no "Miller Fisher Test" for paralysis severity. Severity in GBS is typically assessed using the **Hughes Functional Scale**. * **C. Amyotrophic Lateral Sclerosis (ALS):** Muscle involvement and functional status in ALS are graded using the **ALS Functional Rating Scale (ALSFRS-R)**. * **D. Multiple Sclerosis (MS):** Disability in MS is measured using the **Expanded Disability Status Scale (EDSS)**. --- ### High-Yield Clinical Pearls for NEET-PG: * **NPH Imaging:** Look for "ventriculomegaly out of proportion to sulcal atrophy" and **Evans Index > 0.3**. * **Hakim’s Triad:** The clinical triad of NPH (Gait disturbance is usually the first symptom to appear and the most likely to improve after shunting). * **Miller Fisher Syndrome (GBS variant):** Associated with **anti-GQ1b antibodies**. Do not confuse the *Syndrome* with the *Test* for NPH.

Q: What is the most common site of intracranial hemorrhage in hypertensive hemorrhage?

Basal ganglia. The most common site of intracranial hemorrhage (ICH) due to chronic hypertension is the **Basal Ganglia**, specifically the **Putamen** (accounting for approximately 35–50% of cases) [1]. **1. Why Basal Ganglia is correct:** Chronic hypertension leads to degenerative changes in small, deep penetrating arteries (e.g., lenticulostriate arteries). These changes include **lipohyalinosis** and the formation of **Charcot-Bouchard aneurysms**. Because these vessels originate directly from high-pressure large arteries (like the Middle Cerebral Artery) at right angles, they are highly susceptible to rupture under sustained hypertensive stress [1]. **2. Analysis of Incorrect Options:** * **B. Brainstem:** Specifically the **Pons**, this is the most common site for *primary brainstem* hemorrhage, but it is less frequent than basal ganglia involvement [1]. * **C. Cerebellum:** A common site for hypertensive ICH (about 10%), but significantly less frequent than the supratentorial structures [1]. * **D. Hippocampus:** This is an uncommon site for primary hypertensive hemorrhage; it is more typically associated with global hypoxic-ischemic injury or atrophy in Alzheimer’s disease. **3. High-Yield Clinical Pearls for NEET-PG:** * **Order of Frequency:** Putamen (most common) > Subcortical white matter (Thalamus) > Cerebellum > Pons [1]. * **Putaminal Hemorrhage:** Often presents with contralateral hemiplegia, hemisensory loss, and conjugate gaze deviation *towards* the side of the lesion. * **Thalamic Hemorrhage:** Characterized by upward gaze palsy and "wrong-way eyes" (eyes deviate *away* from the lesion/towards the hemiparesis). * **Pontine Hemorrhage:** Classic triad of pinpoint pupils, coma, and quadriplegia [1]. * **Diagnosis:** Non-contrast CT head is the gold standard for acute hemorrhage (appears hyperdense/white).

Q: A 52-year-old man complains of episodes of severe unilateral, stabbing facial pain that is intermittent for several hours, and then disappears for several days. The pain is described as "electric shock-like" and only lasts a few seconds. Physical examination of the face and mouth is entirely normal. Which of the following treatments is most effective for this condition?

carbamazepine. ### Explanation **Diagnosis: Trigeminal Neuralgia (Tic Douloureux)** **1. Why Carbamazepine is Correct:** The clinical presentation—unilateral, paroxysmal, "electric shock-like" stabbing pain in the distribution of the trigeminal nerve (V2 or V3 branches) triggered by minor stimuli—is classic for **Trigeminal Neuralgia**. * **Mechanism:** It is often caused by vascular compression of the trigeminal nerve root. * **Treatment:** **Carbamazepine** is the first-line drug of choice. It works by blocking voltage-gated sodium channels, thereby stabilizing hyperexcitable neuronal membranes and inhibiting repetitive firing [1]. It is highly effective, with a 70-80% initial response rate. **2. Why Incorrect Options are Wrong:** * **A. Morphine:** Opioids are generally ineffective for neuropathic pain like trigeminal neuralgia and carry a high risk of dependence. * **B. Indomethacin:** This is an NSAID. While it is the drug of choice for **Paroxysmal Hemicrania** (another unilateral headache disorder), it has no role in treating the neuropathic mechanism of trigeminal neuralgia. * **C. Cimetidine:** This is an H2-receptor antagonist used for peptic ulcer disease and GERD; it has no analgesic or anticonvulsant properties. **3. Clinical Pearls for NEET-PG:** * **Second-line agents:** Oxcarbazepine (better tolerated), Baclofen, or Lamotrigine [1]. * **Surgical Management:** If medical therapy fails, **Microvascular Decompression (Janetta procedure)** is the most effective surgical intervention. * **Red Flag:** If a young patient (e.g., <40 years) presents with bilateral trigeminal neuralgia, suspect **Multiple Sclerosis** (demyelination of the nerve root entry zone). * **Monitoring:** Patients on Carbamazepine require monitoring for **hyponatremia** (SIADH-like effect) and **agranulocytosis**.

Q: What is the most common cause of headache?

Tension headache. Headaches are broadly classified into primary and secondary types [1]. **Tension-type headache (TTH)** is the most common primary headache syndrome and the most frequent cause of headache in the general population [1]. It typically presents as a bilateral, non-pulsating, "band-like" pressure of mild to moderate intensity, without the associated features of nausea or vomiting seen in migraines. **Analysis of Options:** * **A. Tension headache (Correct):** It has a lifetime prevalence of approximately 30% to 78% in the general population, making it the most common headache overall [1]. * **B. Migraine:** While migraine is the most common cause of headache for which patients **seek medical consultation**, it is second to TTH in overall prevalence. It is characterized by unilateral, throbbing pain often accompanied by photophobia and phonophobia [1], [2]. * **C. Cluster headache:** This is a rare primary headache disorder [1]. It is much less common than TTH or migraine and is characterized by severe, unilateral periorbital pain with autonomic symptoms (e.g., lacrimation, ptosis) and agitation during the headache phase [3]. * **D. Trigeminal neuralgia:** This is a facial pain syndrome, not a primary headache disorder. It involves paroxysmal, lancinating pain in the distribution of the trigeminal nerve. **High-Yield Clinical Pearls for NEET-PG:** * **Most common headache overall:** Tension-type headache [1]. * **Most common headache presenting to the ER/Clinic:** Migraine. * **Most common primary headache in males:** Cluster headache (though TTH is still more common in the general male population, the male-to-female ratio is highest in Cluster) [3]. * **Prophylaxis of choice for TTH:** Amitriptyline (Tricyclic Antidepressant).

Q: Paraneoplastic cerebellar ataxia with anti-Yo antibody positivity is seen in which of the following malignancies?

Breast and ovarian malignancy. **Explanation:** **Paraneoplastic Cerebellar Degeneration (PCD)** is an immune-mediated syndrome where the body produces antibodies against tumor antigens that cross-react with Purkinje cells in the cerebellum [1]. **1. Why Option A is Correct:** The **anti-Yo antibody** (also known as Purkinje cell cytoplasmic antibody type 1 or PCA-1) is the most common antibody associated with PCD in women. It specifically targets the **cdr2** protein. This antibody is highly specific for **gynecological malignancies (ovarian, fallopian tube, or uterine)** and **breast cancer** [2]. Patients typically present with rapidly progressive pancerebellar dysfunction (ataxia, dysarthria, nystagmus) often before the primary tumor is diagnosed. **2. Why Other Options are Incorrect:** * **Small Cell Carcinoma Lung (SCLC):** While SCLC is the most common cause of paraneoplastic syndromes overall, it is typically associated with **anti-Hu** (ANNA-1) or **anti-CV2** antibodies, not anti-Yo. * **Hodgkin’s Lymphoma:** This is classically associated with **anti-Tr** (DNER) antibodies, leading to "Ophelia syndrome" or cerebellar ataxia. * **Lung Malignancy (Non-SCLC):** Generally associated with anti-Ri (ANNA-2) antibodies, which often present with opsoclonus-myoclonus rather than pure cerebellar ataxia. **High-Yield Clinical Pearls for NEET-PG:** * **Anti-Yo:** Breast and Ovary (The "Female" antibody). * **Anti-Hu:** Small Cell Lung Cancer (associated with encephalomyelitis and sensory neuronopathy) [1]. * **Anti-Ri:** Breast and Lung (associated with Opsoclonus-Myoclonus). * **Anti-Tr:** Hodgkin’s Lymphoma. * **Lambert-Eaton Myasthenic Syndrome (LEMS):** Associated with SCLC and **Voltage-Gated Calcium Channel (VGCC)** antibodies [3]. * **NMDA Receptor Encephalitis:** Classically associated with **Ovarian Teratoma**.

Q: Which of the following is NOT a feature of a Lower Motor Neuron (LMN) lesion?

Hypertonia. To understand this question, one must distinguish between **Upper Motor Neuron (UMN)** and **Lower Motor Neuron (LMN)** lesions [1]. ### **Explanation of the Correct Answer** **Hypertonia (Option C)** is the correct answer because it is a hallmark feature of **UMN lesions**, not LMN lesions. In a UMN lesion (e.g., stroke, spinal cord injury), the inhibitory control from the motor cortex over the spinal reflex arc is lost, leading to increased muscle tone (spasticity) and brisk reflexes [2]. In contrast, an LMN lesion involves the destruction of the "final common pathway" (the alpha motor neuron), leading to a loss of muscle input, resulting in **Hypotonia** (flaccidity) [1]. ### **Analysis of Incorrect Options** * **Plantar Flexion (Option A):** This is a **normal** (downgoing) response. In LMN lesions, the plantar reflex is either normal or absent. An upward response (Babinski sign) is strictly a UMN feature. * **Absent Deep Tendon Reflexes (Option B):** LMN lesions interrupt the efferent limb of the reflex arc. Without this pathway, the muscle cannot contract in response to a stretch stimulus, leading to areflexia or hyporeflexia [3]. * **Hypotonia (Option D):** As the muscle loses its nerve supply, it loses its resting tension [1]. This "floppiness" is a classic clinical sign of LMN diseases like Polio or Peripheral Neuropathy. ### **NEET-PG High-Yield Pearls** | Feature | UMN Lesion | LMN Lesion | | :--- | :--- | :--- | | **Muscle Tone** | Hypertonia (Spasticity) | Hypotonia (Flaccidity) | | **Reflexes** | Hyperreflexia (Brisk) | Hyporeflexia/Areflexia | | **Atrophy** | Minimal (Disuse) | **Marked/Severe** | | **Fasciculations** | Absent | **Present** (Pathognomonic) | | **Plantar Reflex** | Extensor (Babinski +) | Flexor (Normal) | **Clinical Note:** Fasciculations are the most specific clinical sign for an LMN lesion, representing the spontaneous discharge of a dying motor unit [1].

Q: Hyperventilation can provoke which of the following types of seizures?

Absence seizures. ### Explanation **Correct Answer: D. Absence seizures** **Mechanism:** Hyperventilation is the most effective and classic bedside provocative maneuver for inducing **Absence Seizures** (Petit Mal) [1]. The underlying mechanism involves **hypocapnia** (decreased $CO_2$ levels), which leads to respiratory alkalosis. This alkalosis increases neuronal excitability and triggers the characteristic **3 Hz spike-and-wave discharges** on an EEG, which are the hallmark of absence seizures [1], [2]. In a clinical setting, asking a child to "blow on a pinwheel" for 3 minutes can often reproduce the clinical "staring spell." **Analysis of Incorrect Options:** * **A. Tonic-clonic seizures:** While metabolic derangements can lower the seizure threshold, generalized tonic-clonic seizures are more commonly provoked by sleep deprivation, alcohol withdrawal, or flickering lights (photosensitivity), rather than hyperventilation. * **B & C. Simple and Complex Partial Seizures:** These are focal seizures originating from a specific structural lesion or focus (e.g., temporal lobe). They are typically triggered by stress, sleep deprivation, or specific sensory stimuli, but do not have a classic association with hyperventilation-induced hypocapnia. **High-Yield Clinical Pearls for NEET-PG:** * **EEG Hallmark:** 3 Hz spike-and-wave discharges (generalized, symmetrical) [1], [2]. * **Clinical Presentation:** Brief loss of consciousness (5–10 seconds) without loss of postural tone; no post-ictal confusion [1], [2]. * **Drug of Choice:** **Ethosuximide** (blocks T-type $Ca^{2+}$ channels in the thalamus) [1], [2]. Sodium Valproate is the second line or used if there are co-existing tonic-clonic seizures. * **Contraindication:** Avoid Carbamazepine and Phenytoin in absence seizures as they can paradoxically worsen the condition.

Q: A patient presents with inability to perform simple arithmetic, impaired writing, inability to name the fingers, and difficulty distinguishing between right and left sides of their body. What is the likely site of the lesion?

Inferior parietal lobule. ### Explanation The clinical presentation described is the classic tetrad of **Gerstmann Syndrome**. This syndrome is characterized by: 1. **Acalculia** (inability to perform simple arithmetic) 2. **Agraphia** (impaired writing) 3. **Finger Agnosia** (inability to name or identify fingers) 4. **Right-Left Disorientation** **Why the Correct Answer is Right:** Gerstmann Syndrome results from a lesion in the **dominant hemisphere** (usually the left) at the **Angular Gyrus**, which is a specific part of the **Inferior Parietal Lobule (IPL)** [2]. While "Angular Gyrus" is the precise anatomical structure, "Inferior Parietal Lobule" is the broader cortical region that encompasses it. In many exams, if both are present, the specific gyrus is preferred; however, in this context, the IPL is the definitive site of the pathology. **Analysis of Incorrect Options:** * **A. Inferior temporal gyrus:** Primarily involved in visual object recognition and "what" pathway processing; lesions here lead to visual agnosia and deficits in face recognition [1]. * **B. Inferior frontal gyrus:** Contains **Broca’s area** (dominant side). Lesions result in motor/expressive aphasia, not the specific cognitive deficits of Gerstmann syndrome. * **D. Angular gyrus:** While this is the specific site, in the context of this question's construction, the IPL is the standard categorical answer. (Note: If this were a "most specific" question, Angular Gyrus would be the choice, but both are anatomically correct). **NEET-PG High-Yield Pearls:** * **Dominant Parietal Lobe Lesion:** Gerstmann Syndrome + Ideomotor/Ideational Apraxia. * **Non-Dominant Parietal Lobe Lesion:** Hemispatial neglect, Dressing apraxia, and Anosognosia (denial of deficit) [2]. * **Wernicke’s Area:** Located in the superior temporal gyrus; lesion causes sensory/receptive aphasia ("word salad").

Q: Which neuro-physiological defect is NOT typically present in right lobe involvement?

Dyscalculia. In clinical neurology, the **dominant hemisphere** (usually the left) is responsible for language and mathematical processing, while the **non-dominant hemisphere** (usually the right) manages visuo-spatial orientation and awareness of the self in space [1]. **Why Dyscalculia is the Correct Answer:** **Dyscalculia** (difficulty with arithmetic) and **Dysgraphia** (difficulty with writing) are classic components of **Gerstmann Syndrome**. This syndrome results from a lesion in the **dominant (left) angular gyrus** of the parietal lobe [2]. Since these are functions of the dominant hemisphere, they are not typically seen in right-sided (non-dominant) lesions. **Analysis of Incorrect Options:** * **Visuo-spatial defect:** The right parietal lobe is the primary center for spatial mapping [1]. Damage leads to difficulty navigating familiar environments or arranging objects in space. * **Anosognosia:** This is a hallmark of right-sided lesions. It refers to a patient's lack of awareness or denial of their neurological deficit (e.g., denying that their left arm is paralyzed). * **Dysgraphia (in the context of right-sided lesions):** While primary dysgraphia is a left-sided sign, right-sided lesions can cause "spatial dysgraphia," where the patient neglects the left side of the paper. However, in standard MCQ patterns, Dyscalculia is the more definitive "left-only" sign. **High-Yield Clinical Pearls for NEET-PG:** * **Gerstmann Syndrome Tetrad (Left Parietal):** 1. Agraphia, 2. Acalculia, 3. Finger Agnosia, 4. Right-Left Disorientation. * **Right Parietal Lobe Syndrome:** Characterized by **Hemispatial Neglect** (ignoring the left side of the world), **Constructional Apraxia** (inability to draw a clock face), and **Anosognosia**. * **Dressings Apraxia:** Highly specific for non-dominant (right) parietal lobe involvement.

Question 1

Opsoclonus is a feature of which of the following conditions?

Accepted Answer

Carcinoma of the lung

Answer

Retinoblastoma

Answer

Focal seizure with dyscognitive changes

Answer

Extrapyramidal damage in Wilson's disease

Question 2

The Miller Fisher test is used for which of the following?

Accepted Answer

Evaluating cognition in Normal Pressure Hydrocephalus.

Answer

Assessing the severity of paralysis in Guillain-Barré Syndrome.

Answer

Grading muscle involvement in Amyotrophic Lateral Sclerosis.

Answer

Measuring disability in Multiple Sclerosis.

Question 3

What is the most common site of intracranial hemorrhage in hypertensive hemorrhage?

Accepted Answer

Basal ganglia

Answer

Brainstem

Answer

Cerebellum

Answer

Hippocampus

Question 4

A 52-year-old man complains of episodes of severe unilateral, stabbing facial pain that is intermittent for several hours, and then disappears for several days. The pain is described as "electric shock-like" and only lasts a few seconds. Physical examination of the face and mouth is entirely normal. Which of the following treatments is most effective for this condition?

Accepted Answer

carbamazepine

Answer

morphine

Answer

indomethacin

Answer

cimetidine

Question 5

What is the most common cause of headache?

Accepted Answer

Tension headache

Answer

Migraine

Answer

Cluster headache

Answer

Trigeminal neuralgia

Question 6

Paraneoplastic cerebellar ataxia with anti-Yo antibody positivity is seen in which of the following malignancies?

Accepted Answer

Breast and ovarian malignancy

Answer

Breast and lung malignancy

Answer

Ovarian and small cell carcinoma lung

Answer

Small cell carcinoma lung and Hodgkin's disease

Question 7

Which of the following is NOT a feature of a Lower Motor Neuron (LMN) lesion?

Accepted Answer

Hypertonia

Answer

Plantar flexion

Answer

Absent Deep Tendon Reflexes (DTR)

Answer

Hypotonia

Question 8

Hyperventilation can provoke which of the following types of seizures?

Accepted Answer

Absence seizures

Answer

Tonic-clonic seizures

Answer

Simple partial seizures

Answer

Complex partial seizures

Question 9

A patient presents with inability to perform simple arithmetic, impaired writing, inability to name the fingers, and difficulty distinguishing between right and left sides of their body. What is the likely site of the lesion?

Accepted Answer

Inferior parietal lobule

Answer

Inferior temporal gyrus

Answer

Inferior frontal gyrus

Answer

Angular gyrus

Question 10

Which neuro-physiological defect is NOT typically present in right lobe involvement?

Accepted Answer

Dyscalculia

Answer

Visuo-spatial defect

Answer

Anosognosia

Answer

Dysgraphia

Neurology — MCQs

Neurology — MCQs

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