Basics of Neurology MCQ Question with Answer

Correct Answer : D

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Explanation
An electroencephalogram (EEG) is one of the most well-validated tests for confirming brain death. The presence of hypothermia will confound any attempt to determine brain death; the patient must be warm to ensure the diagnosis. The mechanical ventilator may give false readings and must be discontinued to get a real picture of the patients ability to breathe. Spontaneous body movements can occur even hours after actual brain death. Corneal reflexes never occur after death.

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Correct Answer : D

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Explanation
Hypothermia should be excluded before making a diagnosis of brain death. If present, it can be the cause of a flat EEG. Carotid blood flow implies the presence of cerebral circulation, and hence the presence of some viable tissue. The absence of carotid blood flow does not help diagnosis either due to the presence of the vertebral system. Cremasteric reflexes are spinal reflexes (and not brainstem reflexes), and their presence does not exclude the diagnosis. Elevated serum aminoglycoside concentration is nonspecific, and has little bearing. Cerebral edema does not rule out brain death.

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Correct Answer : D

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Explanation
This patient is presenting with classic signs and symptoms of toxicity with an cholinergic drug. The antidote for this is with an anticholinergic drug such as atropine. Atropine will raise the heart rate and reverse the other effects of this toxidrome.

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Correct Answer : E

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Explanation
Foot drop can be associated with a variety of conditions such as dorsiflexor injuries, peripheral nerve injuries, stroke, neuropathies, drug toxicities, or diabetes. Often drop foot is caused by injury to the common peroneal nerve (also called common fibular nerve, peroneal nerve, external popliteal nerve, lateral popliteal nerve), which is derived from the dorsal branches of the fourth and fifth lumbar and the first and second sacral nerves. The common peroneal nerve branches from the sciatic nerve. It includes the deep and superficial peroneal branches. These nerves provide sensation to the anterior and lateral parts of the legs and to the top of the feet. Symptoms of common peroneal nerve injury (foot drop) may include:
Inability to point toes toward the body (dorsiflexion)
Pain
Weakness
Numbness (on the shin or top of the foot)
Loss of function of foot
High-stepping walk (called steppage gait or footdrop gait)

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Correct Answer : D

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Explanation
This patients symptoms at presentation and the family history are suggestive of Huntington disease (HD). Up to now, HD is an incurable, adult-onset, autosomal dominant inherited disorder. Characteristic features of HD include involuntary movements, dementia, and behavioral changes. The most striking neuropathology in HD occurs within the neostriatum, in which gross atrophy of the caudate nucleus and putamen is accompanied by selective neuronal loss and astrogliosis. The genetic basis of HD is the expansion of a cysteineadenosine- guanine (CAG) repeat encoding a polyglutamine tract in the N-terminus of the protein product called huntingtin. Since it is an autosomal dominant disorder, each generation is affected and through genetic anticipation, a generation may develop the disease earlier than the previous generation. Each child has 50% risk of inheriting the disease and childs risk is independent of whether their sibling has the disorder or not.
> Only their male children are at risk (choice A) is incorrect. This occurs in X-linked recessive inherited disorders.
> If one child develops the disease, siblings are not at risk (choice B) is incorrect. In autosomal dominant disorders each child has 50% risk of inheriting the disease and a childs risk is independent of whether his/her sibling has the disorder or not.
> All their children will inherit the disease (choice C) would mean 100% risk of inheriting the disease which is incorrect. Each child has 50% risk of inheriting the disease.
> Each child has 25% risk of inheriting the disease (choice E) would be consistent with an autosomal recessive inheritance pattern (where both parents are carriers); HD is an autosomal dominant inherited disease.
Key point:
Huntington disease is an autosomal dominant inherited disorder that presents with involuntary movements, dementia, and behavioral changes. Each generation is affected and each child has 50% risk of inheriting the disease. acteristic features of HD include involuntary movements, dementia, and behavioral changes. The most striking neuropathology in HD occurs within the neostriatum, in which gross atrophy of the caudate nucleus and putamen is accompanied by selective neuronal loss and astrogliosis. The genetic basis of HD is the expansion of a cysteineadenosine- guanine (CAG) repeat encoding a polyglutamine tract in the N-terminus of the protein product called huntingtin. Since it is an autosomal dominant disorder, each generation is affected and through genetic anticipation, a generation may develop the disease earlier than the previous generation. Each child has 50% risk of inheriting the disease and childs risk is independent of whether their sibling has the disorder or not.
> Only their male children are at risk (choice A) is incorrect. This occurs in X-linked recessive inherited disorders.
> If one child develops the disease, siblings are not at risk (choice B) is incorrect. In autosomal dominant disorders each child has 50% risk of inheriting the disease and a childs risk is independent of whether his/her sibling has the disorder or not.
> All their children will inherit the disease (choice C) would mean 100% risk of inheriting the disease which is incorrect. Each child has 50% risk of inheriting the disease.
> Each child has 25% risk of inheriting the disease (choice E) would be consistent with an autosomal recessive inheritance pattern (where both parents are carriers); HD is an autosomal dominant inherited disease.
Key point:
Huntington disease is an autosomal dominant inherited disorder that presents with involuntary movements, dementia, and behavioral changes. Each generation is affected and each child has 50% risk of inheriting the disease. h generation is affected and each child has 50% risk of inheriting the disease.
child has 25% risk of inheriting the disease (choice E) would be consistent with an autosomal recessive inheritance pattern (where both parents are carriers); HD is an autosomal dominant inherited disease.
Key point:
Huntington disease is an autosomal dominant inherited disorder that presents with involuntary movements, dementia, and behavioral changes. Each generation is affected and each child has 50% risk of inheriting the disease. .

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Correct Answer : A

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Explanation
This patient presents with the classic triad for normal pressure hydrocephalus: ataxia, urinary incontinence, and dementia. MRI should be the first step in the diagnosis of this condition, both to rule out other conditions and to identify changes suggestive of normal pressure hydrocephalus. These include enlargement of the ventricles with preservation of cerebral parenchyma. Brainstem auditory evoked response testing is used for evaluating cochlear problems. While some other features of normal pressure hydrocephalus overlap with those of depression and Parkinsons disease, this patients constellation of signs and symptoms are more typical for normal pressure hydrocephalus. Physical therapy is not indicated prior to making the diagnosis.

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Correct Answer : A

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Explanation
This patient has essential tremor, which is frequently a familial condition. Primidone and propranolol are the drugs most likely to provide relief of essential tremor. Other Beta-blockers such as atenolol and metroprolol may not be as effective, although results of trials are mixed. Antiparkinsonian medications such as carbidopa and bromocriptine have no effect on essential tremor. Carbamazepine is occasionally useful, but is much less likely to be effective than primidone.

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