Neurology MCQs
1
With regards to SAH, all are true, EXCEPT: A Polycystic kidney disease is a risk factor B Widened QRS can be an ECG finding C Sensitivity of CT at one week is 75%
D Xanthochromia in CSF lasts for 2 weeks after event Answer
2
With regards to cerebral lobe functions all are TRUE, EXCEPT: A Gerstmann’s syndrome is a dominant parietal lobe sign
B Dressing apraxia is a nondominant parietal lobe sign C Receptive dysphasia is a dominant temporal lobe sign D Sensory and visual neglect are temporal lobe signs Answer
3
Which of the following is TRUE regarding headaches? A 50% of brain tumours don’t cause headaches
B Ergotamine is useful in migraine therapy in pregnant women C Sumatriptan for migraine headaches can only be given orally D Migraine without aura (common migraine) can last up to one week Answer
4
Causes of Benign Intracranial Hypertension include all the following EXCEPT
A The Oral Contraceptive Pill B Addisons’ disease
C Vitamin A
D Chloramphenicol
5
Regarding thrombolysis in acute ischaemic CVA – the following statements are true EXCEPT
A Important exclusion criteria includes evidence of intra-cranial haemorrhage on CT, acute infarct involving > 1/3 of MCA territory
B ‘tPA’ is the only thrombolytic agent registered for this purpose
C Current evidence supports use of ‘tPA’ within 3 hours of onset of symptoms in selected patients
D Hypertension precluding use of ‘tPA’ is defined as BP > 160/100 mmHg Answer
6
A patient presents to the ED with diplopia. Which of the following is INCONSISTENT with a diagnosis of right 3rd nerve palsy?
A Inability to fully adduct the right eye B Dilated right pupil
C Inability to fully abduct the right eye
D Right ptosis
Answer
7
Which of the following is MOST commonly the cause of epidural abscess
A Lumbar puncture
B Local spread from osteomyelitis C Penetrating trauma
D Haematogenous spread from distant source Answer
8
The Brown-Sequard syndrome refers to a hemicord syndrome consisting of A Ipsilateral loss of pain and vibration sense with contralateral motor paralysis
and loss of proprioception and temperature sense
B Ipsilateral motor paralysis, loss of pain and temperature sense with contralateral loss of proprioception and vibration sense
C Ipsilateral motor paralysis, loss of proprioception and loss of vibration sense with contralateral loss of pain and temperature sense
D Ipsilateral motor paralysis with contralateral loss of pain, proprioception, vibration and temperature sense
Answer
9
Which of the following myotomes is MOST responsible for wrist extension?
A C5 + C6
B C6 + C7
C C7 + C8
D C8 + T1
Answer
10 Which spinal levels are MOST responsible for the brachioradialis (supinator) muscle stretch reflex.?
A C5 + C6
B C6 + C7
C C7 + C8
D C8 + T1
11 Which statement is FALSE regarding TIA?
A 95% of TIA’s caused by athero thrombo-embolism, cardiogenic embolism, small vessel disease
B Management of TIA’s aimed at decreasing risk for subsequent CVA which is a major cause of death or long-term disability
C Anti-platelet therapy remains the cornerstone of therapy
D Aspirin may be commenced without head CT if TIA > 72 hrs ago Answer
12 Which statement is TRUE regarding TIA?
A There are well established management guidelines in the literature for management of patients suffering TIA
B Commencing Aspirin therapy depends on patient disposition
C Warfarin therapy needs to be commenced after therapeutic heparinisation. D There is no role for lowering Blood Pressure in ED unless evidence of
hypertensive emergency. Answer
13
A 40 yo male walks into the ED with recent onset of fever and malaise. He complains of headache, myalgia and sore throat. He also complains of recent micturition difficulty. He is known to have MS but has not had an exacerbation for “long time”. His vital signs are BP 100/50, HR 122, T 38.7, RR 24 and Pulse oximetry at 96% on room air. All of the following are true except:
A Antibiotics are likely to be a feature in his management
B Suxamethonium is not contraindicated in the event of needing intubation C A seizure in the dept. warrants a CT brain
D The presence of erythema in his throat confirms he has Viral pharyngitis Answer
14 Regarding tetanus
A Symptom resolution occurs over weeks to months
B Wound culture of C. tetani is essential for confirming diagnosis
C Neurotransmitter release in inhibitory nerves is blocked by C tetani bacteria that migrate into the CNS
D Immunisation is scheduled for children at 2, 4, 6, 12 months then starting primary school and finishing high school
E Early onset of symptoms is associated with increased mortality Answer
15 All of the following are associated with increased risk for subarachnoid haemorrhage EXCEPT
A Haemochromatosis
B Polycystic kidney disease C Alpha-1-antitrypsin deficiency D Neurofibromatosis
E Sickle cell disease Answer
16 Which statement is FALSE regarding sensory dermatomes? A S1 also covers the lateral dorsum of the foot
B L3 and S3 dermatomes are adjacent to each other in the lower back C The demonstration of a preserved peroneal dermatome may be the only
sign of an incomplete spinal cord injury
D The posterior sensory fibres from C1 supply the skin to the occiput Answer
17 Regarding the Mini Mental State Examination (MMSE), which is TRUE? A Can be substituted by the Quick Confusion Scale to assess the emotional
and intellectual functioning of the individual
B A score less than 20 indicates the presence of dementia or another cognitive disorder
C Contains six elements including Appearance, Disorders of thought, Disorders of perception, Mood and affect, Insight and judgement, and Sensorium and intelligence
D The score must be above 23 to be considered within ‘normal’ limits Answer
18
In a cranial nerve defect you would expect to find… A Impairment of downward gaze with a trochlear lesion.
B Weakness of trapezius and genioglossus from an accessory nerve injury. C Bradycardia and hypertension directly from a medullary lesion of CN X. D A lateral rectus palsy from injury to CN VI inside the cavernous sinus.
Answer
19
Which of the following is TRUE of infective neurological conditions?
A In an infant with FTT, poor feeding, constipation and impaired respiration a history of honey ingestion would encourage the use of metronidazole treatment.
B <80% of HIV/AIDS patients contract CNS infections.
C When giving steroids for meningitis they should be given after antibiotics for best effect.
D There is no role for EEG in infective encephalitis.
20 Which of the following is TRUE in regard to Transverse Myelitis? A Typically presents with an insidious gradual onset.
B Most cases will fully resolve over three-six months
C Dorsal column mediated sensory loss is much less common than lateral spinothalamic tract mediated loss.
D Can be caused by Epstein Barr virus infection.
Answer
21 Which of the following is NOT a typical associated neurological presentation of HIV infection?
A Painful sensory neuropathy B Guillain Barre syndrome
C Dementia
D Labyrinthitis
Answer
22 Which of the following is NOT a recognised cause of acute ataxia in children? A Eucalyptus oil B Carbamazepine C Measles D Salmonellosis Answer
23 All of the following are risk factors for Subarachnoid haemorrhage EXCEPT A Fibromuscular dysplasia
B Marfan’s syndrome
C Smoking
D Hormone replacement therapy
24 Which of the following is NOT representative of a dominant cerebral hemisphere stroke?
A Dysphasia
B Acalculia
C Agraphia
D Unilateral spatial neglect Answer
25 Regarding stroke, which is TRUE?
A 96% of right handed people have a right sided dominant hemisphere B Stroke of the dominant hemisphere will produce dyspraxia
C Ipsilateral cranial nerve/ cerebellar signs and contra-lateral long tract signs are indicative of a brainstem stroke
D Lateral medullary syndrome is due to a stroke of the posterior cerebral artery Answer
26 Regarding lumbar punctures, which is TRUE? A In viral meningitis the CSF glucose is always normal B CSF pressure can be reliably measured in a sitting position C Diabetic coma produces an elevation in CSF pressure
D A low body mass index increases your chance of a post LP headache Answer
27 Which of the following is FALSE in regard to Epilepsy? A Petit mal seizures are a type of generalised epilepsy
B Non convulsive status should be considered if a patient has not recovered consciousness after treatment of a seizure
C The treatment of Isoniazid induced seizures is Pyridoxine D Absence seizures are a type of partial epilepsy
28 Clinical clues that support a bacterial rather than viral aetiology in adult meningitis include all of the following EXCEPT
A Onset < 24 hours
B Headache
C Fever
D Confusion
Answer
29 Regarding acute ataxia in children which of the following is FALSE? A Cerebellar ataxia is the most common
B Drug toxicity is a common cause
C Cerebellar lesions have an insidious onset D Posterior fossa tumours are a common cause Answer
30 In regard to neuropathies, which of the following is TRUE A Botulism is caused by Ach-Receptor antibodies
B Myasthenia Gravis is an autoimmune disease with blockage of Ach-release C Myasthenia Gravis is assoc in rare cases with thymic hyperplasia
D Suxamethonium should be avoided in Guillain Barre Answer
31 In regard to neurofibromatosis which of the following is FALSE A Tetanus is more common in IVDU
B Type II Neurofibromatosis is characterised by vestibular schwannomas C Plexiform Neurofibromas are major cause of death
D Shagreen patches are yellow skin patches around the umbilicus Answer
32 Which of the following is FALSE in regard to Guillain-Barre syndrome in children?
A Cranial nerves are involved in 50% of cases B More common in late childhood (12-17 years)
C The commonest presenting symptoms are weakness and falls. D Tick paralysis is an important differential diagnosis
Answer
33 Regarding strokes, which of the following statements is CORRECT?
A Approximately 5% of ischaemic CVAs are due to emboli originating from the heart.
B Posterior cerebral artery occlusion is manifested by visual changes of homonymous hemianopia, typically with macular sparing.
C Approximately 35% of strokes are haemorrhagic.
D Atherosclerosis of the internal carotid artery usually affects the distal 2cm of the artery.
Answer
34 With regards to SAH, which of the following statements is INCORRECT? A Up to 50% of patients experience a sentinel haemorrhage in the hours to
days before the major bleed.
B Nausea and vomiting are present in 75% of patients.
C Signs of meningism, including fever, photophobia and neck stiffness, are present in 75% of patients.
D 5% of patients rebleed within the first 2 weeks after the initial haemorrhage.
36 With regards to headache which are NOT red flags? A Age>75y.o.
B Fever
C Presence for more than 4 days D Rapidity of onset
Answer
37 Features of the lateral medullary syndrome include all the following EXCEPT:
A Ipsilateral upper motor neurone signs involving CN VII, IX, X B Ipsilateral Horner’s syndrome
C Contralateral hemiplegia
D Contralateral spinothalamic loss (pain, temperature) Answer
38 Non-epileptic events of infancy include the following EXCEPT: A Infantile spasms
B Self-stimulatory episodes C Shuddering attacks
D Stereotypies
Answer
35 When writing Neurology MCQs which of the following is FALSE? A They are a chance for the examiner to flaunt obscure knowledge B They should set out confuse and baffle the candidate
C They should examine minutiae a neurology professor would be proud to know
D They should examine a candidate’s knowledge of important or frequently seen neurological conditions
39 Which of the following statements about dystonic reactions are FALSE? A It is not a life-threatening reaction
B There are four characteristic types – oculogyric, buccolingual, torticollis & tortipelvis
C Benzodiazepines are a second-line treatment
D Thought to be due to both dopaminergic and serotonergic blocking drug effects
Answer
40 Which of the following diseases does NOT cause altered sensation?
A Botulism
B Tetanus
C Motor neurone disease D Eaton Lambert syndrome
E Bell’s palsy
Answer
41 Regarding the treatment of acute ischaemic stroke, which is FALSE? A Aspirin and Clopidogrel should be given either immediately before or
immediately after thrombolysis with tPA if thrombolysis is indicated B IV Heparin is not useful as first-line therapy
C Clopidogrel has not been shown to be beneficial
D Focal mass effect with hemispheric swelling on CT scan is a contraindication to thrombolysis
42 Regarding cavernous sinus thrombosis, which is TRUE? A Is typically associated with the ‘delta sign’ on CT scan B Is suggested by palsies of the cranial nerves III, IV and VI C Is less common post-partum than sagittal sinus thrombosis D MRI has no role in its diagnosis
Answer
43 In regards to meningitis in children, which of the following is TRUE? A In infants the most common cause is N. meningitidis
B In children under 15, N meningitidis group B is the most common cause C The CSF is always abnormal in meningitis
D CSF protein is normally decreased Answer
44 With Cerebral Lobe Dysfunction, which is TRUE?
A Gerstmann's Syndrome comprises parietal dominant signs of, dressing apraxia, acalculia and agraphia
B Astereognosis represents a dominant parietal lobe sign
C Receptive dysphasia occurs with a lesion in the dominant lobe posterior third of the frontal gyrus
D Nominal dysphasia occurs with a lesion in angular gyrus of the median temporal lobe
Answer
45 Which is TRUE regarding Guillain-Barre syndrome? A EBV and CMV are thought to be the two major precipitants B There are more cases in winter than summer
C The facial nerve is commonly involved D Presentation is with a pure motor disturbance Answer
46 Which is TRUE regarding Neisseria meningitidis meningitis? A It is a Gram –ve bacillus
B It is the commonest cause of meningitis in adults + children C There are 3 known serogroups
D Humans are the only natural reservoir Answer
47 Which of the following statements is TRUE with regards encephalitis? A CMV can be treated with Aciclovir
B EEG can be diagnostic for VZV infection
C Unlike meningitis, infects both meninges and subarachnoid space D Rabies virus travels within and via peripheral neurones to reach the brain Answer
48 In hypersensitivity reactions
A Type 2 are immune complex mediated
B Post strep GN is an example of Type 2 reaction C Anaphylactoid reactions are IgE mediated D Mantoux test relies on Type 4 reactions Answer
49 In regards to the NINDS trial, which is TRUE
A The NINDS study had a representative sample of patients
B The NINDS trial resulted in a significantly decreased mortality in the treatment group
C A modified Rankin score of 2 “Slight disability but able to carry out usual activities’ was not considered a favourable outcome
D It is not resource intensive and should be reproducible by most EDs Answer
50 With regard to cavernous sinus thrombosis which is CORRECT: A Strep Pneumoniae is the causative organism in the majority of cases. B Anticoagulation has no role to play in treatment
C Lumbar puncture will reveal CSF with elevated protein and WBC in most patients
D Contrast CT may show filling defect only Answer
51 With regard to optic neuritis, which of the following is INCORRECT:
A Typically heralded by a dull retro-orbital ache, followed by monocular blurred vision over the next day.
B Associated with painless eye movements
C Central visual field defect is typical but there may be varying degrees of compromised visual acuity.
D An afferent papillary defect may be present. Answer
52 What finding in a patient with facial muscle weakness suggests a diagnosis other than Bell’s palsy?
A Sparing of the frontalis muscle
B History of preceding respiratory infection C Unilateral involvement
D Altered taste sensation Answer
53 With respect to Bacterial meningitis
A Antibiotics should not be delayed for more than 90 minutes after initial assessment in suspected cases
B Amoxicillin and Gentamicin are recommended alternative antibiotics C In the case of suspected Strep pneumoniae antibiotic resistance,
Vancomycin is recommended
D Moxifloxacin is recommended as first line treatment Answer
Answers 1. C 2. D 3. A 4. D 5. D 6. C 7. D 8. C 9. C 10. A 11. D 12. D 13. D 14. 15. 16. D 17. D 18. D
19. A (80% HSV encephalitis have abnormal EEG, 90% HIV/AIDS get CNS infections, Steroids work in children with HiB/pneumo meningitis when given 30mins BEFORE AB’s, honey can cause Botulism in infants)
20. D 21. D 22. D 23. D
24. D Cameron 354, 7.2, stroke 25. C Cameron stroke chapter 26. D DUNN, LP,458 Neurology 27. D
28. B Dunn, p 437
29. C Cameron paeds, p 243 30. D Dunn
31. D Dunn Shagreen in Tuberous Sclerosis and at lower back 32. B Cameron (Paed) p236 Commonest in children 4-9 y.o 33. B Cameron
34. D (Cameron says 20% of pts rebleed within first 2 weeks!) 35. D ACEM college guidelines
37. C Dunn page 527
38. A Cameron (Paeds)Neurology, page 231 39. D Dunn
40. B Dunn
41. A Stroke update 2007: Better Early Stroke Treatment (BEST). Emergency Medicine
Practice August 2007; 9(8).
42. B Dunn 4th Ed. Chapter 16: Neurology. 553 – 554. 43. B Cameron Paeds
44. D Dunn 4th Ed pages 510-511 45. C Dunn 4th ed p 563
46. D Dunn 4rd ed p 540
47. D A-Ganciclovir is used for CMV, B-EEG is pathognomonic for HSV, C-encephalitis is parenchymal infection, D-are you scratching yet, E- true…..Tintinalli.
48. D Type 1 IgE mediated triggering mast cells (anaphylaxis NOT anaphylactoid). Type 2-cytotoxic where Antibody or compliment factors directly destroy cells (ABO, Rhesus) Type 3 - immune complex, where antigen antibody complex are
deposited and then attract macrophages (post strep GN, serum sickness) Type 4 - cell mediated (T cells) graft rejection, protozoal infection, Mantoux. C1 esterase deficiency is not a hypersensitivity reaction, excess bradykinin synthesis causes oedema. Dunn
49. C A False-study designed incorporated an over representation of patients at less than 90 minutes B False, no statistically significant mortality difference at 3 months C True-Rankin score of 0=no symptoms, 1=able to carry out all activities. The study reported scores of 0 and 1 as favourable D False-strict management protocols existed to optimize outcome E False-CT was reviewed by consultant radiologist 50. C EB Medicine – An evidence based approach to Abnormal vision pp 15, 16.
51. B EB Medicine- An evidence Based approach to Abnormal Vision pp 13, 14. 52. A
