Neurology Multiple Choice Questions and Answers

(1) A 45-year-old man presents with an insidious onset of binocular horizontal diplopia and left sided facial pain. On examination ha has a left abducens nerve palsy and numbness over the maxillary division of the left trigeminal nerve. The most likely anatomical site of his neurological lesion is:

[A] Cavernous sinus

[B] Petrous apex

[C] Superior orbital fissure

[D] Cerebellopontine angle

Answer: Petrous apex

(2) A 75 year-old woman with acute monocular visual loss. Fundoscopy reveals a swollen pale optic disc in the affected eye. What is the mose likely diagnosis?

[A] Central retinal vein occlusion.

[B] Closed angle glaucoma.

[C] Giant cell arteritis.

[D] Optic neuritis.

Answer: Giant cell arteritis.

(3) A female patient aged 30 has a 5 years history of difficulty getting upstairs and out of a low chair and mild upper limb weakness but no pain. There is no family history. She presented with severe type 2 respiratory failure. EMG showed evidence of myopathy. The most likely diagnosis is:

[A] Polymyositis

[B] Inclusion body myositis

[C] Acid Maltase Deficiency

[D] Miller-Fisher Syndrome

Answer: Acid Maltase Deficiency

(4) A 19 year old girl presents at the antenatal clinic. She is approximately six weeks pregnant and the pregnancy was unplanned. She has a two year history of grand mal epilepsy for which she takes carbamazepine. She has had no fits for approximately six months. She wants to continue with her pregnancy if it is safe to do so. She is worried about her anticonvulsant therapy and the effects on the baby and enquires how she should be managed?

[A] Advise termination due to drug teratogenicity

[B] Continue with carbamazepine

[C] Stop carbamazepine until the second trimester

[D] Switch therapy to phenytoin

Answer: Continue with carbamazepine

(5) A 33 year old epileptic female presents with visual problems. Examination reveals a constriction of visual fields to confrontation. Which of the following may be responsible for her visual deterioration?

[A] Vigabatrin

[B] Lamotrigine

[C] Gabapentin

[D] Phenytoin

Answer: Vigabatrin

(6) Which of the following is a recognised cause of a phrenic nerve palsy?

[A] Aortic aneurysm

[B] Dermoid

[C] Ganglioneuroma

[D] Pericardial cyst

Answer: Aortic aneurysm

(7) Which of the following investigations best supports a diagnosis of new variant CJD:

[A] CSF analysis

[B] CT brain

[C] EEG

[D] MRI brain

Answer: MRI brain

(8) Which is true of herpes simplex encephalitis?

[A] brain MRI is characteristically normal

[B] fits are uncommon

[C] genital herpes is usually present

[D] temporal lobe involvement is common

Answer: temporal lobe involvement is common

(9) Which visual field defect is most likely to occur with multiple sclerosis?

[A] bitemporal hemianopia

[B] central scotoma

[C] homonymous hemianopia

[D] increased blind spot

Answer: central scotoma

(10) A 75-year-old man presents with 12 months history of cognitive impairment, parkinsonism, intermittent confusion and generalised myoclonus. He was started on 62.5 tds of sinemet. In the following 2 months he was started experiencing visual hallucinations. The most likely diagnosis is:

[A] Idiopathic Parkinson's disease

[B] Alzheimer's disease

[C] Diffuse Lewy body disease

[D] Multiple system atrophy

Answer: Diffuse Lewy body disease

(11) A 23-year-old man presents with visual loss in the right eye, diagnosed as optic neuritis.Which one of the following statements would be seen in an afferent pupillary defect?

[A] accommodation response is unaffected

[B] hypersensitive response to pilocarpine in the affected eye

[C] irregular pupil of the affected eye

[D] pupil of affected eye larger than the unaffected eye

Answer: accommodation response is unaffected

(12) Which of the following factors is the most likely to account for this problem?

[A] altered volume of distribution

[B] delayed gastric emptying

[C] first pass metabolism

[D] hepatic enzyme induction

Answer: delayed gastric emptying

(13) A previously well 27-year-old woman presents with a history of transient ischaemic attack affecting her right side and speech. She had returned to the United Kingdom from a holiday in New Zealand two days previously. On examination there was nothing abnormal to find. An ECG, chest X-ray, CT brain scan and routine haematology and biochemistry were all normal. What is the most likely underlying abnormality?

[A] atrial myxoma

[B] carotid artery stenosis

[C] embolus from paroxysmal atrial fibrillation

[D] patent foramen ovale

Answer: patent foramen ovale

(14) A 24-year-old man presents with a five month history of low back pain, radiating to his buttocks, and back stiffness worse in the morning and worse after periods of inactivity. Which of the following signs is the most likely to be present?

[A] exaggerated lumbar lordosis

[B] positive femoral stretch test

[C] positive Trendelenburg test

[D] sacroiliac joint tenderness

Answer: sacroiliac joint tenderness

(15) Which of the following is least likely to cause choreiform movements?

[A] polyarteritis nodosa

[B] polycythaemia rubra vera

[C] Rheumatic fever

[D] systemic lupus erythematosus

Answer: polyarteritis nodosa

(16) A 62-year-old man presented with difficult walking. He had a past history of diabetes mellitus and cervical spondylosis, which had required surgical decompression eight years previously. He drank 40 units of alcohol weekly. On examination there was fasciculation, wasting and weakness in the left deltoid and biceps, with weakness in the shoulder girdle muscles bilaterally. There was fasciculation in the glutei and quadriceps bilaterally, weakness of hip flexion and foot dorsiflexion, brisk reflexes in upper and lower limbs, and extensor plantar responses. There was no sensory impairment.What is the diagnosis?

[A] alcoholic myopathy

[B] diabetic amyotrophy

[C] motor neurone disease

[D] recurrent cervical cord compression

Answer: motor neurone disease

(17) Which statement is true regarding Gabapentin?

[A] is a potent hepatic enzyme inducer

[B] side effects typically include visual field defects with long-term use

[C] therapy is best monitored through measuring plasma concentrations

[D] requires dose adjustment in renal disease

Answer: requires dose adjustment in renal disease

(18) A 72 year old female presents with general slowness. Examination reveals a tremor of the hands. What frequency of tremor would you suspect in Parkinson's disease?

[A] 1 Hz

[B] 2 Hz

[C] 5 Hz

[D] 8 Hz

Answer: 5 Hz

(19) Following factors decrease large intestinal motility:

[A] Parasympathetic activity

[B] Anticholinergic agents

[C] Gastric Distension

[D] CCK-PZ

Answer: Anticholinergic agents

(20) The anticonvulsant Levetiracetecam

[A] Is used as monotherapy for the treatment of generalised convulsions

[B] Acts via the GABA receptor

[C] Is associated with induction of hepatic cytochrome p450 enzymes

[D] Is well absorbed via the oral route

Answer: Is well absorbed via the oral route

Neurology Quiz | Neurology Multiple Choice Questions and Answers

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