MCQs GENERAL MEDICINE: Neurology

Question 1. Concerning neuroanatomy: (a) The corticospinal tract decussates in the pons. (False) (b) The oculomotor nerve runs in close proximity to the posterior communicating artery. (True) (c) The superior colliculus is found in the midbrain. (True) (d) The trochlear (fouth cranial) nerve supplies the lateral rectus muscle. (False) (e) The spinal cord ends at the level of the lower border of L3 in the adult. (False)

Question 2. Subdural haematomas can cause: (a) Dementia. (True) (b) Pupillary change. (True) (c) Bradycardia. (True) (d) Changing level of consciousness. (True) (e) Blood-stained cerebrospinal fluid (CSF). (False)

Question 3. In a young woman with a spastic paraparesis, the following suggest a diagnosis of multiple sclerosis: (a) Delayed visual evoked potentials. (True) (b) Fasciculations. (False)(c) Raised CSF protein. (False) (d) Oligoclonal bands in the CSF. (True) (e) Periventricular white matter lesions on magnetic resonance imaging (MRI) of the brain. (True)

Question 4. Unilateral facial weakness is a recognized feature of: (a) Herpes zoster infection. (True) (b) Motor neuron disease. (False) (c) Acoustic neuroma. (True) (d) Cholesteatoma. (True) (e) Syringomyelia. (False)

Question 5. The following are true about headaches: (a) The headache of raised intracranial pressure is worst at the end of the day. (False) (b) A normal CT scan rules out subarachnoid haemorrhage. (False) (c) Amaurosis fugax may be caused by temporal arteritis. (True) (d) Neurological signs on examination rules out migraine as a diagnosis. (False) (e) Cluster headaches are more common in men than in women. (True)

Question 6. The following drugs can produce parkinsonism: (a) Chlorpromazine. (True) (b) Benzhexol. (False) (c) Bromocriptine. (False) (d) Metoclopramide. (True) (e) Haloperidol. (True)

Question 7. Concerning movement disorders: (a) Huntington's chorea presents with progressive dementia and chorea in middle age. (True) (b) Myoclonus is a feature of subacute sclerosing panencephalitis. (True) (c) Infarction of the subthalamic nucleus causes ipsilateral hemiballism. (False) (d) Chorea is commonly found in Cruetzfeldt-Jakob disease. (False) (e) Alcohol reduces benign essential tremor. (True)

Question 8. Concerning papilloedema: (a) There is loss of venous pulsation on funduscopy. (True) (b) There may be enlargement of the blind spot. (True) (c) Intracranial pressure may be normal. (True) (d) Hypocalcaemia is a recognized cause. (True) (e) It is a recognized feature in Guillain-Barré syndrome. (True)

Question 9. Ptosis may be a feature of: (a) Myotonic dystrophy. (True) (b) Horner's syndrome. (True) (c) Abducens nerve (sixth nerve ) palsy. (False) (d) Oculomotor nerve (third nerve) palsy. (True) (e) Myasthenia gravis. (True)

Question 10. Concerning the Brown-Séquard syndrome: (a) There is ipsilateral corticospinal loss below the lesion. (True) (b) There is ipsilateral loss of joint-position sense below the lesion. (True) (c) There is ipsilateral loss of two-point discrimination below the level of the lesion. (True) (d) There is ipsilateral loss of pain and temperature below the level of the lesion. (False) (e) A central disc lesion at L3 would cause a Brown-Séquard syndrome in the legs. (False)

Question 11. Concerning the brachial plexus: (a) In brachial neuritis, severe pain around the shoulder precedes rapid wasting. (True) (b) Klumpke's paralysis causes proximal arm weakness. (False) (c) Erb's palsy is caused by a lesion to C5/C6-derived regions of the brachial plexus. (True) (d) A brachial plexus lesion and an ipsilateral Horner's syndrome may indicate a Pancoast tumour. (True) (e) Vaccination may precipitate brachial neuritis. (True)

Question 12. Causes of a polyneuropathy include: (a) Diabetes. (True) (b) Guillain-Barré syndrome. (True) (c) Renal failure. (True) (d) Amyloid. (True) (e) Multiple sclerosis. (False)

Question 13. A lesion to the common peroneal nerve at the fibular head causes: (a) Weakness of eversion of the foot. (True) (b) Decreased sensation over the dorsum of the foot. (True) (c) Weakness of plantar flexion. (False) (d) If long term, wasting of tibialis anterior. (True) (e) Brisk ankle jerk. (False)

Question 14. Brainstem death may be confirmed by: (a) Extensor response of the limbs to painful stimuli. (False) (b) Absent corneal reflexes. (True) (c) Absent tendon reflexes. (False) (d) A flat EEG. (False) (e) Absent 'doll's eye' reflexes. (True)

Question 15. A homonymous hemianopia may arise from a lesion of: (a) The optic tract. (True) (b) The occipital cortex. (True) (c) The optic chiasm. (False) (d) The optic nerve. (False) (e) The optic radiation. (True)

Question 16. Dysarthria may result from a lesion of: (a) The cerebellum. (True) (b) Broca's area. (False) (c) The hypoglossal nerve. (True) (d) The basal ganglia. (True) (e) The accessory nerve. (False)

Question 17. The following are clinical features of cerebellar dysfunction (a) Postural tremor. (False) (b) Hypotonia. (True) (c) Dysphasia. (False) (d) Titubation. (True) (e) Impaired rapid altering movements. (True)

Question 18. The following clinical features may help differentiate between a syncopal attack and a seizure: (a) Upright posture at the onset. (True) (b) Convulsive movements of the limbs. (False) (c) A bitten tongue. (True) (d) Urinary incontinence. (True) (e) Prolonged malaise after the attack. (False)

Question 19. The following are features of a subarachnoid haemorrhage: (a) Fever. (True) (b) Thunderclap headache. (True) (c) Photophobia. (True) (d) Positive Kernig's sign. (True) (e) Neck stiffness. (True)

Question 20. A physiological tremor is: (a) Present at rest. (False) (b) Worsened by anxiety. (True) (c) Improved by alcohol. (False) (d) Improved by beta-blockers. (True) (e) Familial. (False)

Question 21. A lesion of the medulla on one side may give rise to : (a) An ipsilateral hemiparesis. (False) (b) A contralateral hemiparesis. (True) (c) Ipsilateral weakness of the palate. (False) (d) Contralateral weakness of the tongue. (True) (e) Contralateral third nerve palsy. (False)

Question 22. The following may be seen in a patient with a lesion of the third nerve or nucleus: (a) A fixed dilated pupil. (True) (b) Ptosis. (True) (c) Diplopia in all positions of gaze. (True) (d) A history of diabetes mellitus. (True) (e) A contralateral hemiplegia. (True)

Question 23. In a patient with a sensory ataxia: (a) Vibration may be impaired. (True) (b) The gait is characterized by 'scissoring' posture of the legs. (False) (c) Romberg's test may be positive. (True) (d) A history of alcohol abuse may be implicated in the aetiology. (True) (e) Clonus may be elicited on examination of the legs. (False)

Question 24. A patient with herpes zoster infection of the geniculate ganglion may present with: (a) An upper motor neuron facial weakness. (False) (b) Diplopia. (False) (c) Hyperacusis. (True) (d) Altered perception of taste. (True) (e) Pain from the auditory meatus. (True)

Question 25. A dissociated sensory loss may be seen in: (a) Syringomyelia. (True) (b) Anterior spinal artery occlusion. (False) (c) A radiculopathy. (False) (d) Occlusion of a middle cerebral artery. (False) (e) Compression of the spinal cord by a prolapsed intervertebral disc. (False)

 

Question 1. The following cranial nerves carry parasympathetic fibres: (a) Oculomotor. (True) (b) Trigeminal. (False) (c) Facial. (True) (d) Hypoglossal. (False) (e) Vagus. (True)

Question 2. Myasthenia gravis: (a) Is caused by antibodies to the acetylcholine receptor in the majority of cases. (True) (b) Causes muscle wasting. (False) (c) May show diurnal variation in symptoms. (True) (d) Is associated with an improvement in strength after exertion. (False) (e) May present with ophthalmoplegia. (True)

Question 3. The causes of a mixed upper and lower motor neuron picture include: (a) Guillain-Barré syndrome. (False) (b) Multiple sclerosis. (False) (c) Syringomyelia. (True) (d) Motor neuron disease. (True) (e) Taboparesis. (True)

Question 4. Bilateral lower motor neuron facial weakness may occur in: (a) Sarcoidosis. (True) (b) Guillain-Barré syndrome. (True) (c) Lyme disease. (True) (d) Lymphoma. (True) (e) Parasagittal meningioma. (False)

Question 5. In idiopathic Parkinson's disease: (a) There is degeneration primarily of the cells of the globus pallidus. (False) (b) The classical features include tremor, bradykinesia, and spasticity. (False) (c) There is an associated vertical gaze palsy. (False) (d) Anticholinergic drugs are most effective in relieving tremor. (True) (e) Treatment is aimed at reducing dopamine levels. (False)

Question 6. The following features suggest that increased tone is due to rigidity: (a) Tone is increased equally in flexors and extensors. (True) (b) Extensor plantar responses. (False) (c) Associated pill-rolling tremor. (True) (d) Clasp-knife reflex. (False) (e) Tone increases with synkinesis. (True)

Question 7. Causes of a small pupil include: (a) Horner's syndrome. (True) (b) Holmes-Adie syndrome. (False) (c) Tabes dorsalis. (True) (d) Optic neuritis. (False) (e) Pilocarpine eye-drops. (True)

Question 8. Concerning optic neuritis: (a) Visual loss is usually painless. (False) (b) White-matter abnormalities on MR imaging increase the likelihood of developing multiple sclerosis in the future. (True)(c) After recovery, some impairment of red-green colour vision may remain. (True) (d) Over 90% of patients with a history of optic neuritis go on to develop multiple sclerosis. (False) (e) It causes a delay in visual evoked potentials. (True)

Question 9. The following may cause a third nerve palsy: (a) Aneurysm of the posterior communicating artery. (True) (b) Diabetes. (True) (c) Motor neuron disease. (False) (d) Herniation of the uncus of the temporal lobe. (True) (e) Pancoast tumour. (False)

Question 10. The following typically occur within the first 24 hours of complete cervical cord transection: (a) Upgoing plantar responses. (False) (b) Fall in blood pressure. (True) (c) Loss of bladder control. (True) (d) Brisk reflexes. (False) (e) Gastric dilatation. (True)

Question 11. In motor neuron disease: (a) Fasciculations are required to make the diagnosis. (False) (b) There may be atrophy of the Betz cells in the motor cortex. (True) (c) Electromyography shows chronic partial denervation. (True) (d) There should be no signs of sensory loss. (True) (e) Familial cases account for 50%. (False)

Question 12. Causes of a mononeuropathy include: (a) Diabetes. (True) (b) Hereditary motor sensory neuropathy. (False) (c) Polyarteritis nodosa. (True) (d) Guillain-Barré syndrome. (False) (e) Lead poisoning. (True)

Question 13. Charcot joints: (a) May affect the feet in diabetes. (True) (b) Are often painful. (False) (c) May be caused by neurosyphilis. (True) (d) May affect the shoulders in syringomyelia. (True) (e) Are usually hot and swollen. (False)

Question 14. Hyposmia may arise secondary to: (a) A head injury. (True) (b) Migraine. (False) (c) Seizures. (False) (d) Antibiotic therapy. (True) (e) A frontal meningioma. (True)

Question 15. The following are causes of acute transient visual impairment: (a) Retinitis pigmentosa. (False) (b) Amaurosis fugax. (True) (c) Papilloedema. (True) (d) Migrainous aura. (True) (e) Glaucoma. (False)

Question 16. The following may be features of frontal lobe dysfunction: (a) Depression. (True) (b) Social disinhibition. (True) (c) Apraxia of gait. (True)(d) A receptive dysphasia. (False) (e) A grasp reflex. (True)

Question 17. The following may give rise to a pseudobulbar palsy (a) Poliomyelitis. (False) (b) Syringobulbia. (False) (c) Huntington's chorea. (False) (d) Occlusion of the anterior cerebral artery. (False) (e) Multiple sclerosis. (True)

Question 18. Facial sensory loss may occur with a lesion of: (a) The cerebellopontine angle. (True) (b) The facial nerve. (False) (c) The Gausserian ganglion. (True) (d) The Geniculate ganglion. (False) (e) The cavernous sinus. (True)

Question 19. Sensorineural deafness may occur secondary to: (a) Loud noise. (True) (b) Gentamicin therapy. (True) (c) Ménière's disease. (True) (d) An acoustic neuroma. (True) (e) Otosclerosis. (False)

Question 20. Choreic movements are: (a) Slow and writhing. (False) (b) Shock-like assymetrical and irregular. (False) (c) Brief, jerky and irregular. (True) (d) A sign of restlessness. (False) (e) Rhythmical and oscillatory. (False)

Question 21. Features of an upper motor neuron lesion are: (a) Brisk abdominal and cremasteric reflexes. (False) (b) Wasted muscles. (False) (c) Weakness of individual muscles. (False) (d) Hypotonia. (False) (e) Fatiguable muscle strength. (False)

Question 22. A small pupil may be seen in: (a) A lesion in the midbrain. (False) (b) Elderly patients. (True) (c) Horner's syndrome. (True) (d) Terminally ill patients taking morphine for analgesia. (True) (e) A pontine lesion. (True)

Question 23. Nystagmus may be seen in: (a) A patient with an internuclear ophthalmoplegia. (True) (b) A lesion of the pons. (True) (c) A patient who is blind. (True) (d) A patient with cerebellar dysfunction. (True) (e) A lesion of the foramen magnum. (True)

Question 24. Clinical features of a unilateral lesion of the cerebellopontine angle may be: (a) Conductive deafness on the same side. (False) (b) An ipsilateral hemiparesis. (False) (c) Ipsilateral weakness of the lower face. (False) (d) A pseudobulbar dysarthria. (False)(e) Vertigo as a prominent early symptom. (False)

Question 25. The fibres of the dorsal column pathway: (a) Carry information about temperature perception. (False) (b) Decussate in the midbrain. (False) (c) Are affected in the deficiency of vitamin B12. (True) (d) When damaged may result in a positive Romberg's test. (True) (e) Are spared following occlusion of the anterior spinal artery. (True) Available from Master Medicine