Examination Preparation

MCQs

Question 1:

Which of the following features best differentiates acute disseminated encephalomyelitis (ADEM) from multiple sclerosis (MS) at initial presentation?

  1. Presence of oligoclonal bands in the CSF

  2. Large, poorly demarcated bilateral white matter lesions on MRI

  3. Optic neuritis as the sole presenting feature

  4. Relapsing-remitting course with discrete attacks

Answer: (B) ADEM typically presents with large, bilateral, poorly demarcated bilateral white matter lesions on MRI

Question 2:

Which of the following findings is most characteristic of AIDP? dissociation in CSF

  1. Rapidly ascending symmetric weakness with hyperreflexia

  2. Progressive weakness with areflexia and albuminocytologic

  3. Fluctuating weakness with preserved reflexes and fatigability

  4. Sensory ataxia with preserved motor strength

Answer: (B) Progressive weakness with areflexia and albuminocytologic dissociation in CSF

Question 3:

Which of the following is most characteristic of Wernicke encephalopathy?

  1. Peripheral neuropathy and optic neuritis

  2. Ophthalmoplegia, ataxia, and confusion

  3. Seizures and hemiparesis

  4. Spastic paraparesis and cognitive decline

Answer: (B) The classic triad of ophthalmoplegia, ataxia, and confusion is seen in Wernicke’s Encephalopathy

Question 4:

Which of the following CSF findings is most characteristic of Alzheimer’s disease?

  1. Increased A\(\beta\)42, decreased tau

  2. Decreased A\(\beta\)42, increased phosphorylated tau

  3. Increased A\(\beta\)42, normal tau

  4. Normal A\(\beta\)42, increased tau

Answer: (B) Decreased A\(\beta\)42, increased phosphorylated tau

Question 5:

Which of the following imaging findings is most characteristic of cerebral amyloid angiopathy? susceptibility-weighted MRI

  1. Deep basal ganglia hemorrhage with microbleeds in the thalamus

  2. Lobar microbleeds and cortical superficial siderosis on

  3. Subarachnoid hemorrhage with perimesencephalic distribution

  4. Diffuse leukoencephalopathy without hemorrhagic lesions

Answer: (B) Lobar microbleeds and cortical superficial siderosis on susceptibility weighted imaging on MRI

Question 6:

Which of the following is a typical feature of amyloid neuropathy?

  1. Rapid onset asymmetric neuropathy with preserved autonomic function

  2. Length-dependent symmetric sensorimotor neuropathy with prominent autonomic involvement

  3. Pure motor neuropathy with brisk reflexes

  4. Demyelinating neuropathy with conduction block

Answer: (B) Length-dependent symmetric sensorimotor neuropathy with prominent autonomic involvement

Question 7:

Which of the following findings is most characteristic of ALS?

  1. Sensory loss and absent reflexes

  2. Ocular motility restriction and sphincter incontinence

  3. Coexistence of upper and lower motor neuron signs in the same limb

  4. Symmetric proximal weakness with myalgia

Answer: (C) Coexistence of upper and lower motor neuron signs in the same limb.

Question 8:

Which brain region is most susceptible to injury in anoxic brain injury?

  1. Thalamus

  2. Hippocampus

  3. Pons

  4. Occipital lobe

Answer: (B) Hippocampus.

Question 9:

Which of the following findings is most characteristic of anterior interosseous nerve syndrome?

  1. Loss of thumb abduction

  2. Sensory loss over the lateral three and a half fingers

  3. Weakness of flexor pollicis longus and index finger flexion without

  4. sensory loss

  5. Loss of wrist extension

Answer: (C) Weakness of flexor pollicis longus and index finger flexion without sensory loss.

Question 10:

Which MRI finding is most characteristic of chronic arachnoiditis?

  1. Diffuse spinal cord swelling

  2. "Empty thecal sac" sign with nerve root clumping

  3. Intramedullary ring-enhancing lesions

  4. Disc herniation with foraminal narrowing

Answer: (B) "Empty thecal sac" sign with nerve root clumping.

Question 11:

Which of the following is the most characteristic clinical feature of Arnold–Chiari malformation type I?

  1. Severe visual loss with optic neuritis

  2. Headache exacerbated by coughing or Valsalva maneuvers

  3. Rapidly progressive dementia

  4. Peripheral neuropathy with glove-and-stocking distribution

Answer: (B) Headache exacerbated by coughing or Valsalva maneuvers.

Question 12:

Which of the following clinical features is most characteristic of chronic arsenic toxicity?

  1. Proximal muscle weakness with preserved reflexes

  2. Rapidly progressive optic neuritis

  3. Painful, distal sensorimotor polyneuropathy with skin

  4. hyperpigmentation

  5. Acute cerebellar ataxia with nystagmus

Answer: (C) Painful, distal sensorimotor polyneuropathy with skin hyperpigmentation.

Question 13:

Which of the following findings is most characteristic of Autoimmune Autonomic Gangliopathy?

  1. Symmetric sensorimotor polyneuropathy with distal weakness

  2. Acute flaccid paralysis with preserved reflexes

  3. Severe orthostatic hypotension with preserved motor and sensory function

  4. Rapidly progressive cerebellar ataxia with ophthalmoplegia

Answer: (C) Severe orthostatic hypotension with preserved motor and sensory function.

Question 14:

Which of the following findings is most characteristic of anti-NMDA receptor encephalitis?

  1. Rapidly progressive cerebellar ataxia with Purkinje cell loss

  2. Subacute psychiatric symptoms followed by dyskinesias and autonomic instability

  3. Acute ascending weakness with albuminocytologic dissociation

  4. Sudden onset hemiparesis with restricted diffusion on MRI

Answer: (B) Subacute psychiatric symptoms followed by dyskinesias and autonomic instability are classic for anti-NMDA receptor encephalitis.

Question 15:

Which of the following findings is most characteristic of axillary nerve injury?

  1. Weakness of elbow flexion and sensory loss over the lateral forearm

  2. Weakness of shoulder abduction beyond 15\(^\circ\) and numbness over the lateral shoulder

  3. Wasting of supraspinatus and infraspinatus with preserved deltoid strength

  4. Loss of wrist extension with sensory loss over the dorsal hand

Answer: (B) Weakness of shoulder abduction beyond 15\(^\circ\) and numbness over the lateral shoulder.

Question 16:

Which of the following is the most strongly associated etiological factor in Bell’s palsy?

  1. Epstein–Barr virus infection

  2. Herpes simplex virus type 1 reactivation

  3. Varicella-zoster virus reactivation

  4. Autoimmune demyelination

Answer: (B) Herpes simplex virus type 1 reactivation

Question 17:

Which of the following is the most characteristic finding of posterior canal BPPV?

  1. Persistent downbeat nystagmus without positional trigger

  2. Vertigo lasting several hours with hearing loss

  3. Vertigo lasting seconds with upbeat torsional nystagmus on

  4. Dix-Hallpike maneuver

  5. Horizontal nystagmus on caloric testing

Answer: (C) Vertigo lasting seconds with upbeat torsional nystagmus on Dix-Hallpike maneuver.

Question 18:

Which of the following findings best differentiates botulism from Guillain-Barré syndrome (AIDP)?

  1. Presence of areflexia

  2. Sensory loss

  3. Cranial nerve involvement

  4. Normal sensory examination with descending paralysis

Answer: (D) Normal sensory examination with descending paralysis

Question 19:

Which of the following findings most strongly suggests a preganglionic brachial plexus injury?

  1. Absence of biceps reflex

  2. Deltoid muscle wasting

  3. Presence of Horner’s syndrome

  4. Sensory loss over the thumb

Answer: (C) Presence of Horner’s syndrome – This finding indicates involvement proximal to the dorsal root ganglion, suggesting a preganglionic lesion.

Question 20:

Which of the following imaging findings is most characteristic of a brain abscess?

  1. Homogeneous enhancement on contrast MRI

  2. Ring-enhancing lesion with restricted diffusion on DWI

  3. Calcified mass with surrounding gliosis

  4. Hypodense lesion with no mass effect

Answer: (B) Ring-enhancing lesion with restricted diffusion on DWI is characteristic of a brain abscess and helps distinguish it from neoplastic lesions.

Question 21:

Which of the following findings most strongly supports a diagnosis of carpal tunnel syndrome?

  1. Sensory loss in the little finger

  2. Thenar muscle atrophy with preserved hypothenar strength

  3. Proximal forearm pain radiating to the shoulder

  4. Loss of the triceps reflex

Answer: (B) Thenar muscle atrophy with preserved hypothenar strength

Question 22:

Which of the following clinical findings is most specific for cauda equina syndrome?

  1. Severe low back pain

  2. Bilateral leg weakness

  3. Saddle anesthesia

  4. Urinary urgency

Answer: (C) Saddle anesthesia is the most specific sign of cauda equina syndrome and strongly indicates lumbosacral nerve root involvement.

Question 23:

Which cranial nerve is most commonly affected first in cavernous sinus thrombosis?

  1. Oculomotor nerve (CN III)

  2. Trochlear nerve (CN IV)

  3. Trigeminal nerve (V1)

  4. Abducens nerve (CN VI)

Answer: (D) Abducens nerve (CN VI) is often the first to be affected.

Question 24:

Which of the following findings is most characteristic of central retinal artery occlusion?

  1. Flame-shaped hemorrhages and dilated veins

  2. Cherry-red spot on the macula and pale retina

  3. Optic disc swelling with peripapillary hemorrhages

  4. Cotton wool spots and microaneurysms

Answer: (B) A cherry-red spot on the macula with a pale, edematous retina is the classic finding in central retinal artery occlusion.

Question 25:

Which of the following factors is most strongly associated with the formation of a cerebral (saccular) aneurysm?

  1. Chronic hypertension

  2. Cigarette smoking

  3. Oral contraceptive use

  4. Diabetes mellitus

Answer: (B) Cigarette smoking.

Question 26:

Which of the following findings is most characteristic of spastic diplegic cerebral palsy?

  1. Flaccid paralysis of the lower limbs with absent reflexes

  2. Progressive muscle weakness with fasciculations

  3. Scissoring gait with increased tone and hyperreflexia in the legs

  4. Rapidly progressive dystonia and cognitive decline

Answer: (C) Scissoring gait with increased tone and hyperreflexia in the legs

Question 27:

Which of the following statements regarding cerebral venous sinus thrombosis is TRUE?

  1. Anticoagulation is contraindicated in the presence of intracerebral hemorrhage.

  2. Headache is an uncommon presenting feature of CVST.

  3. MR venography is the gold standard for diagnosis.

  4. CVST most commonly affects elderly men with atherosclerosis.

Answer: (C) MR venography is the gold standard for diagnosis.

Question 28:

Which of the following is the most effective first-line treatment for cervical dystonia?

  1. Oral baclofen

  2. Botulinum toxin injection

  3. Deep brain stimulation

  4. Levodopa

Answer: (B) Botulinum toxin injection

Question 29:

Which of the following clinical findings most strongly suggests cervical myelopathy over peripheral neuropathy?

  1. Distal sensory loss in a stocking-glove distribution

  2. Hyporeflexia in the lower extremities

  3. Positive Babinski sign

  4. Reduced ankle jerk reflexes

Answer: (C) Positive Babinski sign

Question 30:

Which of the following findings is most characteristic of Charcot-Marie-Tooth disease?

  1. Asymmetric proximal weakness with brisk reflexes

  2. Symmetric distal weakness with pes cavus and reduced reflexes

  3. Acute onset of ascending weakness and areflexia

  4. Sensory neuronopathy with profound proprioceptive loss

Answer: (B) Symmetric distal weakness with pes cavus and reduced reflexes is the hallmark of Charcot-Marie-Tooth disease.

Question 31:

Which of the following findings is most characteristic of CIDP compared to AIDP (Guillain-Barré syndrome)?

  1. Rapid progression of weakness over 7 days

  2. Albuminocytologic dissociation in CSF

  3. Relapsing course with symmetric sensorimotor involvement over 3 months

  4. Predominant cranial nerve involvement

Answer: (C) CIDP is characterized by a chronic or relapsing course with progression beyond 8 weeks, distinguishing it from AIDP.

Question 32:

Which of the following MRI features is most characteristic of CLIPPERS?

  1. Ring-enhancing lesions with central necrosis

  2. Diffuse white matter hyperintensities sparing the brainstem

  3. Punctate, pepper-like gadolinium-enhancing lesions in the pons

  4. Cortical ribboning with restricted diffusion

Answer: (C) Punctate, pepper-like gadolinium-enhancing lesions in the pons.

Question 33:

Which of the following is considered first-line preventive therapy for cluster headache?

  1. Topiramate

  2. Propranolol

  3. Verapamil

  4. Indomethacin

Answer: (C) Verapamil is the first-line preventive agent for cluster headaches, requiring ECG monitoring during dose titration.

Question 34:

Which of the following best describes the pathophysiology of CRPS?

  1. Primary demyelination of peripheral nerves

  2. Autoimmune attack on synovial tissue

  3. Aberrant neuroinflammatory and sympathetic response following tissue injury

  4. Ischemic necrosis due to arterial occlusion

Answer: (C) Aberrant neuroinflammatory and sympathetic response following tissue injury

Question 35:

Which of the following clinical features most strongly suggests corticobasal syndrome?

  1. Symmetric resting tremor responsive to levodopa

  2. Alien limb phenomenon with cortical sensory loss

  3. Vertical gaze palsy and early postural instability

  4. Early memory loss with preserved motor function

Answer: (B) Alien limb phenomenon with cortical sensory loss

Question 36:

Which of the following findings is most characteristic of sporadic Creutzfeldt-Jakob disease?

  1. MRI showing temporal lobe hyperintensity and CSF NMDA receptor antibodies

  2. CSF positive for 14-3-3 protein and periodic sharp wave complexes on

  3. EEG

  4. Progressive memory decline with hippocampal atrophy on MRI over 5 years

Answer: (B) CSF positive for 14-3-3 protein and periodic sharp wave complexes on EEG

Question 37:

Which of the following findings is most characteristic of critical illness myopathy?

  1. Asymmetric distal weakness with sensory loss

  2. Normal muscle biopsy with demyelinating changes on nerve conduction

  3. Symmetric proximal weakness with preserved sensation

  4. Rapidly fluctuating ptosis and diplopia

Answer: (C) Symmetric proximal weakness with preserved sensation

Question 38:

Which of the following is the most characteristic feature of critical illness neuropathy?

  1. Rapidly ascending paralysis with albuminocytologic dissociation

  2. Symmetric distal weakness with reduced CMAPs and preserved sensory potentials

  3. Predominant bulbar involvement with ophthalmoplegia

  4. Sensory ataxia with areflexia and severe proprioceptive loss

Answer: (B) Symmetric distal weakness with reduced CMAPs and preserved sensory potentials

Question 39:

Which clinical feature most strongly suggests advanced cubital tunnel syndrome?

  1. Positive Phalen’s sign

  2. Atrophy of hypothenar muscles with clawing of the fourth and fifth

  3. digits

  4. Loss of sensation in the radial three and a half digits

  5. Wrist drop with inability to extend fingers

Answer: (B) Atrophy of hypothenar muscles with clawing of the fourth and fifth digits

Question 40:

Which histopathological feature is most characteristic of dermatomyositis?

  1. Endomysial inflammation with CD8+ T cells

  2. Rimmed vacuoles and inclusion bodies

  3. Perifascicular atrophy with perivascular inflammation

  4. Necrotizing vasculitis with fibrinoid necrosis

Answer: (C) Perifascicular atrophy with perivascular inflammation

Question 41:

Which of the following findings is most characteristic of diabetic amyotrophy?

  1. Symmetric distal sensory loss with preserved strength

  2. Proximal thigh pain followed by asymmetric weakness and muscle

  3. wasting

  4. Rapidly progressive bulbar weakness and fasciculations

  5. Severe orthostatic hypotension with absent sweat response

Answer: (B) Proximal thigh pain followed by asymmetric weakness and

Question 42:

Which of the following is the most common clinical presentation of diabetic neuropathy?

  1. Acute mononeuropathy

  2. Proximal motor neuropathy

  3. Symmetric distal sensorimotor polyneuropathy

  4. Cranial nerve palsy

Answer: (C) Symmetric distal sensorimotor polyneuropathy

Question 43:

Which of the following features is most characteristic of DADS

  1. associated with IgM monoclonal gammopathy?

  2. Rapid progression with proximal weakness

  3. Severe autonomic dysfunction

  4. Predominant distal sensory involvement with anti-MAG antibodies

  5. Frequent cranial nerve palsies

Answer: (D) Predominant distal sensory involvement with anti-MAG antibodies

Question 44:

Which of the following MRI findings is most characteristic of herpes simplex encephalitis?

  1. Bilateral occipital lobe hyperintensity

  2. Unilateral temporal lobe FLAIR hyperintensity with hemorrhagic features

  3. Symmetric thalamic involvement

  4. Diffuse cortical demyelination

Answer: (B) Unilateral temporal lobe FLAIR hyperintensity with hemorrhagic features

Question 45:

Which of the following is considered a first-line treatment for essential tremor?

  1. Levodopa

  2. Propranolol

  3. Amantadine

  4. Ropinirole

Answer: (B) Propranolol

Question 46:

Which of the following EEG findings is most characteristic of primary generalized epilepsy?

  1. Focal sharp waves over the temporal lobe

  2. Periodic lateralized epileptiform discharges (PLEDs)

  3. Triphasic waves

  4. Generalized spike-and-wave discharges

Answer: (D) Generalized spike-and-wave discharges

Question 47:

Which of the following is a characteristic clinical feature of Fabry’s disease?

  1. Early-onset proximal muscle weakness

  2. Angiokeratomas in the lower trunk and genital region

  3. Cerebellar ataxia with demyelinating neuropathy

  4. Bilateral optic neuritis

Answer: (B) Angiokeratomas in the lower trunk and genital region

Question 48:

Which of the following is a characteristic clinical feature of facioscapulohumeral muscular dystrophy (FSHD)?

  1. Early involvement of distal lower limb muscles

  2. Symmetric limb weakness with early respiratory failure

  3. Asymmetric weakness involving facial and shoulder muscles

  4. Severe cardiac involvement in early stages

Answer: (C) Asymmetric weakness involving facial and shoulder muscles

Question 49:

Which of the following clinical findings is most characteristic of femoral neuropathy?

  1. Foot drop with sensory loss over the dorsum of the foot

  2. Weakness of knee extension with absent patellar reflex

  3. Loss of ankle jerk with calf atrophy

  4. Sensory loss in the perineal region with urinary incontinence

Answer: (B) Weakness of knee extension with absent patellar reflex

Question 50:

Which of the following best explains the underlying mechanism of fibromyalgia?

  1. Autoimmune-mediated inflammation of muscle tissue

  2. Central nervous system amplification of pain signaling

  3. Demyelination of peripheral nerves

  4. Synovial inflammation of large joints

Answer: (B) Central nervous system amplification of pain signaling

Question 51:

Which of the following genetic findings is diagnostic of Fragile X syndrome?

  1. CGG repeat expansion >200 in the FMR1 gene with promoter

  2. methylation

  3. GAA repeat expansion in the FXN gene

  4. CAG repeat expansion in the HTT gene

  5. Deletion of 15q11-q13 region

Answer: (A) CGG repeat expansion >200 in the FMR1 gene with promoter

Question 52:

What is the genetic defect responsible for Friedreich’s ataxia?

  1. CGG repeat expansion in the FMR1 gene

  2. GAA repeat expansion in the FXN gene

  3. CAG repeat expansion in the ATXN3 gene

  4. CTG repeat expansion in the DMPK gene

Answer: (B) GAA repeat expansion in the FXN gene

Question 53:

Which of the following features most strongly suggests frontotemporal dementia over Alzheimer’s disease?

  1. Early prominent memory impairment

  2. Visual hallucinations

  3. Social disinhibition and loss of empathy

  4. Fluctuating cognition

Answer: (C) Social disinhibition and loss of empathy

Question 54:

Which of the following findings is most characteristic of genitofemoral neuralgia?

  1. Motor weakness in the quadriceps muscle

  2. Burning pain radiating to the medial calf

  3. Sharp inguinal and genital pain worsened by hip extension

  4. Sensory loss in the perianal region

Answer: (C) Sharp inguinal and genital pain worsened by hip extension.

Question 55:

Which of the following features is most characteristic of glossopharyngeal neuralgia?

  1. Continuous dull pain in the maxillary region

  2. Stabbing pain triggered by swallowing and radiating to the ear

  3. Numbness of the anterior two-thirds of the tongue

  4. Bilateral constant burning pain in the mandible

Answer: (B) Stabbing pain triggered by swallowing and radiating to the ear.

Question 56:

Which of the following is the most characteristic feature of HaNDL syndrome?

  1. Chronic, progressive headaches with papilledema

  2. Recurrent headaches with transient focal neurological deficits and CSF lymphocytosis

  3. Visual hallucinations and cognitive decline with abnormal MRI

  4. Persistent hemiparesis and elevated protein without pleocytosis

Answer: (B) Recurrent headaches with transient focal neurological deficits and CSF lymphocytosis

Question 57:

Which of the following findings most reliably distinguishes hemifacial spasm from tics?

  1. Presence of pain during spasms

  2. Occurrence during sleep

  3. Bilateral facial involvement

  4. Association with sensory deficits

Answer: (B) Occurrence during sleep

Question 58:

Which of the following findings most reliably distinguishes pure hereditary spastic paraplegia from complex forms?

  1. Presence of optic atrophy

  2. Absence of sensory loss and cerebellar signs

  3. Early onset before age 10

  4. Rapid progression with upper limb involvement

Answer: (B) Absence of sensory loss and cerebellar signs

Question 59:

Which of the following findings is most characteristic of Holmes-Adie Syndrome?

  1. Bilateral pinpoint pupils with intact light response

  2. Dilated pupil with slow constriction to near effort and absent Achilles reflexes

  3. Rapidly reactive pupils with preserved deep tendon reflexes

  4. Fixed mid-position pupils unresponsive to light or near effort

Answer: (B) Dilated pupil with slow constriction to near effort and absent Achilles reflexes

Question 60:

Which of the following features is most characteristic of hyperkalemic periodic paralysis?

  1. Prolonged episodes of paralysis triggered by carbohydrate-rich meals

  2. Short episodes of weakness associated with elevated serum potassium

  3. Symmetric paralysis lasting several days with hypokalemia

  4. Frequent respiratory involvement during attacks

Answer: (B) Short episodes of weakness associated with elevated serum potassium

Question 61:

Which of the following is the most common precipitating factor for attacks of hypokalemic periodic paralysis?

  1. Fasting

  2. Heavy carbohydrate meal followed by rest

  3. Prolonged exercise without rest

  4. Infection

Answer: (B) Heavy carbohydrate meal followed by rest

Question 62:

Which of the following is a hallmark histopathologic feature of IgG4-related disease?

  1. Caseating granulomas

  2. Perivascular demyelination

  3. Storiform fibrosis with IgG4-positive plasma cells

  4. Amyloid deposition

Answer: (C). Storiform fibrosis with IgG4-positive plasma cells

Question 63:

Which of the following features is most characteristic of immune checkpoint inhibitor-associated myasthenia gravis compared to idiopathic myasthenia gravis?

  1. Presence of thymoma

  2. Gradual onset over several years

  3. Frequent association with myositis or myocarditis

  4. Predominantly sensory neuropathy

Answer: (C) Frequent association with myositis or myocarditis

Question 64:

Which of the following is most characteristic of inclusion body myositis?

  1. Rapidly progressive symmetric proximal muscle weakness

  2. Presence of anti-Mi-2 antibodies

  3. Asymmetric involvement of quadriceps and finger flexors with rimmed vacuoles on biopsy

  4. Dramatic improvement with corticosteroid therapy

Answer: (C) Asymmetric involvement of quadriceps and finger flexors with rimmed vacuoles on biopsy is the hallmark of IBM. Unlike other inflammatory myopathies, IBM presents with asymmetric distal and proximal weakness, is refractory to immunosuppression, and requires all three pathological features (inflammation, rimmed vacuoles, protein inclusions) for definite diagnosis.

Question 65:

Which of the following findings is most characteristic of Jugular Foramen Syndrome?

  1. Bilateral ophthalmoplegia with ptosis

  2. Dysphagia, hoarseness, and shoulder weakness

  3. Trigeminal neuralgia with facial numbness

  4. Facial paralysis with hearing loss

Answer: (B) Dysphagia, hoarseness, and shoulder weakness due to IX, X, XI involvement

Question 66:

Which of the following neuropathological features is characteristic of kuru?

  1. Demyelination with macrophage infiltration

  2. Spongiform degeneration with PrP deposition

  3. Neuronal necrosis with neutrophilic inflammation

  4. Lymphocytic perivascular cuffing

Answer: (B) Spongiform degeneration with PrP deposition.Kuru is a prion disease characterized by spongiform changes, neuronal loss, and accumulation of abnormal prion protein in the cerebellum and brainstem without inflammatory response.

Question 67:

Which of the following findings best differentiates Lambert–Eaton myasthenic syndrome (LEMS) from myasthenia gravis?

  1. Presence of ptosis and diplopia early in disease

  2. Incremental increase in CMAP amplitude after high-frequency stimulation

  3. Decremental response to low-frequency repetitive nerve stimulation

  4. Positive acetylcholine receptor antibodies

Answer: (B) Incremental increase in CMAP amplitude after high-frequency stimulation is characteristic of LEMS and helps differentiate it from myasthenia gravis.

Question 68:

Which of the following features most strongly supports a diagnosis of Lewy body dementia over Alzheimer’s disease?

  1. Early memory loss with hippocampal atrophy on MRI

  2. Fluctuating cognition, recurrent visual hallucinations, and

  3. parkinsonism occurring within one year of each other

  4. Gradual visuospatial decline without hallucinations

  5. Stepwise progression of cognitive deficits

Answer: (B) Fluctuating cognition, recurrent visual hallucinations, and arkinsonism occurring within one year of each other are classic features of Lewy body dementia.

Question 69:

Which of the following features most strongly suggests a diagnosis of limb-girdle muscular dystrophy (LGMD)?

  1. Sensory loss with distal muscle weakness

  2. Fluctuating weakness with fatigability

  3. Symmetrical proximal muscle weakness with elevated CK

  4. Rapid progression with ocular involvement

Answer: (C) Symmetrical proximal muscle weakness with elevated CK is characteristic of LGM

Question 70:

Which of the following findings is most characteristic of spontaneous intracranial hypotension?

  1. Headache that worsens with lying down and improves when upright

  2. Diffuse pachymeningeal enhancement with orthostatic headache

  3. Sudden thunderclap headache with normal MRI findings

  4. Headache associated with papilledema and elevated CSF pressure

Answer: (B) Diffuse pachymeningeal enhancement with orthostatic headache.

Question 71:

Which of the following clinical findings most strongly suggests lumbosacral plexopathy rather than lumbar radiculopathy?

  1. Pain radiating down the posterior leg in an S1 distribution

  2. Weakness confined to hip flexors with dermatomal sensory loss

  3. Patchy sensory deficits involving multiple non-dermatomal regions

  4. Isolated absent ankle reflex with plantar flexion weakness

Answer: (C) Patchy sensory deficits involving multiple non-dermatomal regions.

Question 72:

Which of the following autoantibodies is most strongly associated with neuropsychiatric lupus?

  1. Anti-centromere antibody

  2. Anti-ribosomal P antibody

  3. Anti-mitochondrial antibody

  4. Anti-Jo-1 antibody

Answer: (B) Anti-ribosomal P antibody.

Question 73:

Which of the following clinical findings is most characteristic of Lyme neuroborreliosis?

  1. Rapidly progressive dementia with spastic paraparesis

  2. Painful radiculopathy with lymphocytic meningitis weeks after a tick bite

  3. Flaccid paralysis with albuminocytologic dissociation

  4. Sudden-onset hemiparesis and aphasia due to large-vessel occlusion

Answer: (B) Painful radiculopathy with lymphocytic meningitis weeks after a tick bite.

Question 74:

Which of the following features is most characteristic of primary CNS ymphoma on MRI?

  1. Heterogeneous ring enhancement with central necrosis

  2. Homogeneous enhancement with periventricular localization and restricted diffusion

  3. Non-enhancing lesion with diffuse white matter involvement

  4. Peripheral cortical lesion with blooming on susceptibility imaging

Answer: (B) Homogeneous enhancement with periventricular localization and restricted diffusion.

Question 75:

A 57-year-old man presents with nausea, vomiting, hiccups, left-sided weakness, and tongue deviation to the right. MRI shows a right medial medullary infarct. Which artery is most likely occluded?

  1. Posterior inferior cerebellar artery

  2. Anterior spinal artery

  3. Basilar artery

  4. Superior cerebellar artery

Answer: (B) Anterior spinal artery

Question 76:

Which of the following features best distinguishes stroke-like episodes in MELAS from typical ischemic strokes?

  1. Onset before age 40 with sudden focal neurological deficits

  2. Elevated serum lactate during acute episodes

  3. Cortical involvement with hemiparesis and aphasia

  4. MRI lesions confined to the territory of the middle cerebral artery

Answer: (B) Elevated serum lactate during acute episodes Stroke-like episodes in MELAS are metabolic in origin, associated with lactic acidosis, and the lesions typically do not conform to vascular territories.

Question 77:

Which of the following MRI features is most characteristic of a meningioma?

  1. Ring-enhancing lesion with central necrosis

  2. Extra-axial mass with dural tail and homogeneous enhancement

  3. Butterfly-shaped lesion crossing the corpus callosum

  4. Irregular intra-axial lesion with poor enhancement

Answer: (B) Extra-axial mass with dural tail and homogeneous enhancement.This imaging pattern strongly suggests a meningioma due to its duralattachment and vascularity.

Question 78:

Which of the following cerebrospinal fluid (CSF) findings is most characteristic of bacterial meningitis?

  1. Lymphocytic pleocytosis, normal glucose, mildly elevated protein

  2. Neutrophilic pleocytosis, low glucose, elevated protein

  3. Lymphocytic pleocytosis, low glucose, elevated protein

  4. Eosinophilic pleocytosis, normal glucose, elevated protein

Answer: (B) Neutrophilic pleocytosis, low glucose, elevated protein This CSF profile is classic for bacterial meningitis due to the intense neutrophilic inflammatory response and increased metabolic consumption of glucose.

Question 79:

Which of the following clinical features most strongly suggests meralgia paresthetica rather than lumbar radiculopathy?

  1. Pain radiating from the back into the thigh with associated knee extension weakness

  2. Burning and tingling localized to the anterolateral thigh without motor weakness

  3. Sensory loss in the medial thigh accompanied by hip flexor weakness

  4. Absent patellar reflex and sensory loss over the anterior knee

Answer: (B) Burning and tingling localized to the anterolateral thigh without motor weakness Meralgia paresthetica is characterized by a purely sensory disturbance in the distribution of the lateral femoral cutaneous nerve.

Question 80:

Which of the following is most characteristic of MGUS-associated neuropathy?

  1. Rapidly progressive asymmetric weakness with cranial nerve involvement

  2. Distal symmetric demyelinating neuropathy associated with IgM paraprotein

  3. Acute flaccid paralysis following infection

  4. Sensory neuropathy with severe autonomic dysfunction

Answer: (B) Distal symmetric demyelinating neuropathy associated with IgM paraprotein

Question 81:

Which of the following features most strongly supports a diagnosis of migraine with aura rather than transient ischemic attack (TIA)?

  1. Sudden onset of visual field loss without positive phenomena

  2. Gradual progression of visual scintillations followed by headache

  3. Unilateral headache lasting less than 30 minutes

  4. Complete resolution of symptoms within 5 minutes

Answer: (B) Gradual progression of visual scintillations followed by headache Migraine aura typically develops gradually over 5–20 minutes,is often positive (e.g., visual scintillations), and is followed by a headache, whereas TIA is abrupt, negative, and often not followed by headache.

Question 82:

Which of the following features is most characteristic of Miller Fisher Syndrome?

  1. Progressive ascending limb weakness with early respiratory

  2. involvement

  3. Bilateral ophthalmoplegia, ataxia, and areflexia with positive

  4. anti-GQ1b antibodies

  5. Sudden onset vertical gaze palsy with altered consciousness

  6. Ptosis and fatigable weakness that improves with rest

Answer: (B) Bilateral ophthalmoplegia, ataxia, and areflexia with positive anti-GQ1b antibodies This triad, along with anti-GQ1b positivity, is highly characteristic of Miller Fisher Syndrome and helps distinguish it from other neuromuscular disorders such as classic GBS.

Question 83:

Which of the following features most strongly suggests mononeuritis multiplex?

  1. Symmetric distal sensory neuropathy progressing slowly over years

  2. Acute, asymmetric, multifocal involvement of non-contiguous nerves

  3. Predominant demyelination with conduction block in multiple nerves

  4. Pure motor neuropathy without sensory involvement

Answer: (B) Acute, asymmetric, multifocal involvement of non-contiguous nerves Mononeuritis multiplex classically presents with abrupt,asymmetric deficits involving multiple non-contiguous nerves due to ischemic infarction from vasculitic inflammation.

Question 84:

oindent Which of the following is most characteristic of Morvan disease?

  1. Acute ascending paralysis with albuminocytologic dissociation

  2. Neuromyotonia with severe insomnia, dysautonomia, and anti-CASPR2 antibodies

  3. Flaccid paralysis after exposure to botulinum toxin

  4. Visual hallucinations and parkinsonism due to basal ganglia lesions

Answer: (B) Neuromyotonia with severe insomnia, dysautonomia, and anti-CASPR2 antibodies This constellation of features, especially with VGKC-complex antibodies, is highly specific for Morvan disease.

Question 85:

oindent Which of the following angiographic findings is most characteristic of Moyamoya disease?

  1. Segmental beading of medium-sized arteries

  2. “Puff of smoke” appearance from basal collateral networks

  3. Fusiform aneurysm of the posterior circulation

  4. String-of-pearls appearance in the extracranial carotid artery

Answer: (B) “Puff of smoke” appearance from basal collateral networks,This appearance on angiography is the hallmark of Moyamoya disease,representing proliferative collateral vessels in response to progressive intracranial arterial stenosis.

Question 86:

Which of the following features most strongly distinguishes MADSAM from ultifocal motor neuropathy (MMN)?

  1. Presence of conduction block on nerve conduction studies

  2. Asymmetric, multifocal involvement of peripheral nerves

  3. Prominent sensory symptoms and deficits

  4. Response to intravenous immunoglobulin (IVIg)

Answer: (C) Prominent sensory symptoms and deficits MADSAM typically affects both motor and sensory fibers, whereas MMN is characterized by purely motor involvement.

Question 87:

Which of the following features most strongly supports a diagnosis of multifocal motor neuropathy rather than amyotrophic lateral sclerosis (ALS)?

  1. Presence of upper motor neuron signs

  2. Symmetric proximal weakness

  3. Conduction block on motor nerve conduction studies without sensory involvement

  4. Rapid progression with bulbar involvement

Answer: (C) Conduction block on motor nerve conduction studies without sensory involvement. This electrophysiologic finding is characteristic of MMN and differentiates it from ALS, which shows diffuse lower and upper motor neuron involvement without conduction block.

Question 88:

Which of the following MRI findings is most characteristic of multiple Sclerosis?

  1. Symmetrical basal ganglia calcifications

  2. Ovoid periventricular lesions oriented perpendicular to the ventricles (Dawson’s fingers)

  3. Cortical ribbon hyperintensity on T1-weighted imaging

  4. Ring-enhancing lesions with central necrosis

Answer: (B) Ovoid periventricular lesions oriented perpendicular to the ventricles (Dawson’s fingers) These lesions reflect demyelinating plaques along medullary veins and are a hallmark imaging feature of MS.

Question 89:

Which of the following best describes the primary pathophysiological defect in Duchenne muscular dystrophy?

  1. Loss of acetylcholine receptors at the neuromuscular junction

  2. Absence of dystrophin leading to sarcolemmal instability

  3. Autoimmune-mediated inflammation of muscle fibers

  4. Defective mitochondrial oxidative phosphorylation

Answer: (B) Absence of dystrophin leading to sarcolemmal instability

Question 90:

Which of the following best distinguishes myasthenia gravis from Lambert-Eaton myasthenic syndrome (LEMS)?

  1. Presence of proximal muscle weakness

  2. Presence of ocular symptoms such as ptosis and diplopia

  3. Improvement of strength with repeated stimulation

  4. Association with malignancy

Answer: (B) Presence of ocular symptoms such as ptosis and diplopia Ocular involvement is characteristic of MG and rare in LEMS, which typically improves with repeated activity due to presynaptic facilitation.

Question 91:

Which of the following features most reliably distinguishes MOGAD from AQP4-positive NMOSD?

  1. Presence of longitudinally extensive transverse myelitis

  2. Severe optic neuritis

  3. Good visual recovery and steroid responsiveness

  4. Female predominance

Answer: (C) Good visual recovery and steroid responsiveness While both diseases can cause optic neuritis and extensive myelitis, MOGAD is characterized by better recovery and higher responsiveness to corticosteroids compared to AQP4-positive NMOS

Question 92:

Which of the following findings best distinguishes myopathy from neuropathy?

  1. Proximal muscle weakness with preserved reflexes

  2. Muscle atrophy and fasciculations

  3. Loss of vibration and proprioception

  4. Distal muscle weakness and sensory loss

Answer: (A) Proximal muscle weakness with preserved reflexes Myopathies characteristically present with proximal weakness and preserved reflexes and sensation, whereas neuropathies typically cause distal weakness, sensory deficits, and reduced reflexes.

Question 93:

Which of the following findings is most characteristic of dermatomyositis compared to polymyositis?

  1. Endomysial CD8\(^{+}\) T-cell infiltration

  2. Perivascular inflammation with complement deposition

  3. Rimmed vacuoles with protein inclusions

  4. Distal asymmetric muscle weakness

Answer: (B) Perivascular inflammation with complement deposition. Dermatomyositis is distinguished by perivascular and perifascicular inflammation, complement activation, and characteristic cutaneous manifestations, whereas polymyositis shows endomysial CD8\(^{+}\) T-cell infiltration.

Question 94:

Which of the following clinical features best distinguishes myotonia congenita from paramyotonia congenita?

  1. Muscle hypertrophy

  2. Worsening of stiffness with repeated muscle activity

  3. Association with CLCN1 gene mutation

  4. Autosomal recessive inheritance pattern

Answer: (B) Worsening of stiffness with repeated muscle activity Myotonia congenita is characterized by the warm-up phenomenon, where stiffness improves with repeated activity, whereas paramyotonia congenita typically worsens with activity and cold exposure.

Question 95:

Which of the following findings is most characteristic of myotonic dystrophy?

  1. Proximal muscle weakness with early contractures

  2. Fluctuating muscle weakness worsened by activity

  3. Difficulty releasing grip after handshakes and early cataracts

  4. Rapidly progressive symmetric proximal weakness in childhood

Answer: (C) Difficulty releasing grip after handshakes and early cataracts — these are classic manifestations of myotonic dystrophy,reflecting myotonia and multisystem involvement.

Question 96:

Which of the following genetic mutations is most commonly associated with NARP syndrome?

  1. POLG gene mutation

  2. MT-ATP6 gene mutation

  3. FXN gene mutation

  4. OPA1 gene mutation

Answer: (B) MT-ATP6 gene mutation NARP syndrome is most often caused by a point mutation in the MT-ATP6 gene encoding a subunit of mitochondrial ATP synthase, leading to impaired oxidative phosphorylation.

Question 97:

Which of the following features most strongly suggests neuralgic amyotrophy rather than cervical radiculopathy?

  1. Pain radiating from the neck to the arm with dermatomal sensory loss

  2. Acute onset of severe shoulder pain followed days later by patcy muscle weakness

  3. Muscle weakness accompanied by brisk reflexes and spasticity

  4. Symmetric distal weakness and sensory loss in a stocking-glove distribution

Answer: (B) Acute onset of severe shoulder pain followed days later by patchy muscle weakness This temporal pattern is highly characteristic of neuralgic amyotrophy and differentiates it from cervical radiculopathy,

Question 98:

oindent Which of the following findings is most characteristic of Neurofibromatosis type 1?

  1. Bilateral vestibular schwannomas

  2. Multiple café-au-lait macules and axillary freckling

  3. Ependymomas of the spinal cord

  4. Multiple meningiomas without cutaneous involvement

Answer: (B) Multiple café-au-lait macules and axillary freckling

Question 99:

oindent Which of the following features most reliably distinguishes NMOSD from multiple sclerosis?

  1. Presence of periventricular brain lesions

  2. Oligoclonal bands in the cerebrospinal fluid

  3. Longitudinally extensive spinal cord lesions involving three or more vertebral segments

  4. Subcortical U-fiber lesions on brain MRI

Answer: (C) Longitudinally extensive spinal cord lesions involving three or more vertebral segments LETM is a hallmark of NMOSD and contrasts with the typically short-segment lesions seen in MS.

Question 100:

Which of the following clinical findings is most characteristic of tabes dorsalis in neurosyphilis?

  1. Hyperreflexia and spastic paraparesis

  2. Sensory ataxia with lightning pains

  3. Fluctuating muscle weakness with fatigability

  4. Bilateral internuclear ophthalmoplegia

Answer: (B) Sensory ataxia with lightning pains

Question 101:

Which of the following findings is most characteristic of non-arteritic anterior ischemic optic neuropathy (NAION)?

  1. Painful vision loss with demyelinating lesions on MRI

  2. Optic disc edema with peripapillary hemorrhages and altitudinal field defect

  3. Bilateral simultaneous optic disc pallor and severe headache

  4. Progressive, painless central vision loss over months

Answer: (B) Optic disc edema with peripapillary hemorrhages and altitudinal field defect.

Question 102:

Which of the following is a distinguishing clinical feature of occipital neuralgia?

  1. Continuous dull bilateral headache associated with photophobia and nausea

  2. Sudden, stabbing paroxysms of pain radiating from the occipital region towards the vertex

  3. Pain predominantly located in the periorbital region with tearing and nasal congestion

  4. Tension type headaches across the front of head.

Answer: (B) Sudden, stabbing paroxysms of pain radiating from the occipital region towards vertex

Question 103:

Which of the following findings best distinguishes ocular myasthenia gravis from a third nerve palsy?

  1. Ptosis with pupillary involvement

  2. Ophthalmoplegia with pain

  3. Fluctuating ptosis and diplopia with normal pupils

  4. Fixed, dilated pupil with impaired accommodation

Answer: (C) Fluctuating ptosis and diplopia with normal pupils

Question 104:

Which of the following best distinguishes oculopharyngeal muscular dystrophy (OPMD) from myasthenia gravis?

  1. Presence of bilateral ptosis

  2. Dysphagia affecting both solids and liquids

  3. Slow, non-fluctuating progression of symptoms

  4. Involvement of proximal limb muscles

Answer: (C) Slow, non-fluctuating progression of symptoms

Question 105:

Which of the following genetic alterations is characteristic of oligodendroglioma and has significant diagnostic and prognostic implications?

  1. TP53 mutation

  2. BRAF V600E mutation

  3. 1p/19q co-deletion

  4. NF1 deletion

Answer: (C) 1p/19q co-deletion

Question 106:

Which bedside finding most supports neurogenic orthostatic hypotension?

  1. SBP drop 22 mmHg and HR rise 30 bpm on standing

  2. SBP drop 25 mmHg with HR rise only 4 bpm on standing

  3. SBP drop 10 mmHg with HR rise 25 bpm on standing

  4. SBP stable with HR rise 35 bpm on standing

Answer: (B) SBP drop 25 mmHg with minimal HR increase suggests impaired autonomic compensation (neurogenic).

Question 107:

Which of the following best characterizes orthostatic tremor?

  1. A 4–6 Hz resting tremor affecting distal limbs, improving with movement

  2. A high-frequency (13–18 Hz) synchronous tremor occurring exclusively while standing

  3. A variable-frequency tremor suppressed by distraction and associated

  4. with psychiatric illness

Answer: (B) A high-frequency (13–18 Hz) synchronous tremor occurring while standing

Question 108:

oindent Which of the following antibodies is most commonly associated with paraneoplastic cerebellar degeneration in a patient with breast cancer?

  1. Anti-Hu (ANNA-1)

  2. Anti-Yo (PCA-1)

  3. Anti-Ri (ANNA-2)

  4. Anti-Ma2

Answer: (B) Anti-Yo (PCA-1)

Question 109:

Which of the following features most strongly supports a diagnosis of idiopathic Parkinson’s disease?

  1. Early postural instability within 6 months of onset

  2. Rapid progression with poor response to levodopa

  3. Symmetric onset of rigidity and tremor

  4. Asymmetric onset with clear levodopa responsiveness

Answer: (D) Asymmetric onset with clear levodopa responsiveness

Question 110:

Which of the following features most strongly suggests a demyelinating rather than axonal peripheral neuropathy?

  1. Length-dependent distal sensory loss

  2. Significantly slowed nerve conduction velocity

  3. Muscle wasting and fasciculations

  4. Reduced compound motor action potential amplitude

Answer: (B) Significantly slowed nerve conduction velocity

Question 111:

Which of the following features most reliably distinguishes peroneal neuropathy at the fibular neck from L5 radiculopathy?

  1. Foot drop

  2. Sensory loss over the dorsum of the foot

  3. Weakness of ankle dorsiflexion

  4. Preservation of ankle inversion strength

Answer: (D) Preservation of ankle inversion strength

Question 112:

Which of the following clinical findings most strongly supports a diagnosis of piriformis syndrome rather than lumbar radiculopathy?

  1. Weakness of ankle dorsiflexion

  2. Positive straight leg raise test

  3. Tenderness over the sciatic notch with pain on hip internal rotation

  4. Dermatomal sensory loss in the L5 distribution

Answer: (C) Tenderness over the sciatic notch with pain on hip internal rotation.

Question 113:

oindent Which of the following is the first-line treatment for a macroprolactinoma?

  1. Transsphenoidal surgical resection

  2. Dopamine agonist therapy

  3. External beam radiotherapy

  4. Observation with periodic imaging

Answer: (B) Dopamine agonist therapy

Question 114:

Which of the following is the most immediate life-saving intervention in a patient presenting with pituitary apoplexy and hypotension?

  1. Intravenous mannitol

  2. Emergency transsphenoidal surgery

  3. Intravenous corticosteroid therapy

  4. Broad-spectrum antibiotics

  5. Observation with serial imaging

Answer: (C) Intravenous corticosteroid therapy

Question 115:

Which of the following findings most strongly supports a diagnosis of POEMS syndrome over CIDP?

  1. Symmetric sensorimotor polyneuropathy

  2. Elevated VEGF levels and sclerotic bone lesions

  3. Presence of anti-ganglioside antibodies

  4. Rapid onset of weakness with cranial nerve involvement

Answer: (B) Elevated VEGF levels and sclerotic bone lesions

Question 116:

Which of the following features best distinguishes polymyalgia rheumatica from polymyositis?

  1. Bilateral proximal muscle weakness

  2. Elevated creatine kinase levels

  3. Elevated ESR and CRP

  4. Rapid response to low-dose corticosteroids

Answer: (D) Rapid response to low-dose corticosteroids

Question 117:

oindent Which of the following histopathological features is most characteristic of polymyositis?

  1. Perifascicular atrophy with complement-mediated vascular damage

  2. Endomysial infiltration by CD8T cells invading non-necrotic fibers

  3. Rimmed vacuoles with protein inclusions

  4. Granulomatous inflammation with multinucleated giant cells

Answer: (B) Endomysial infiltration by CD8 T cells invading non-necrotic fibers

Question 118:

Which of the following features best differentiates porphyria neuropathy from Guillain-Barré syndrome?

  1. Presence of severe sensory loss and albuminocytologic dissociation

  2. Predominantly motor axonal neuropathy with preserved sensation

  3. Rapid onset following a viral illness

  4. High cerebrospinal fluid protein with normal cell count

Answer: (B) Predominantly motor axonal neuropathy with preserved sensation

Question 119:

Which of the following best describes post-concussion syndrome (PCS)?

  1. Structural brain injury with progressive neurological deterioration following traumatic brain injury

  2. A chronic neurodegenerative condition characterized by abnormal protein aggregation

  3. A constellation of cognitive, emotional, and somatic symptoms

  4. persisting beyond the typical recovery period after a mild traumatic

Answer: (C) A constellation of cognitive, emotional, and somatic symptoms

Question 120:

Which of the following features most strongly supports a diagnosis of posterior cortical atrophy over typical Alzheimer’s disease?

  1. Early impairment of episodic memory

  2. Prominent visuospatial dysfunction with preserved visual acuity

  3. Early aphasia and apraxia of speech

  4. Parkinsonism and visual hallucinations

Answer: (B) Prominent visuospatial dysfunction with preserved visual acuity

Question 121:

Which of the following clinical findings best distinguishes posterior interosseous nerve syndrome from radial tunnel syndrome?

  1. Pain in the lateral forearm during pronation

  2. Paresthesia over the dorsum of the hand

  3. Motor weakness of finger extension without sensory deficit

  4. Tenderness over the lateral epicondyle

Answer: (C) Motor weakness of finger extension without sensory deficit

Question 122:

Which of the following MRI findings is most characteristic of PRES?

  1. Restricted diffusion in the basal ganglia with hemorrhage

  2. Bilateral parieto-occipital vasogenic edema on T2/FLAIR

  3. Diffuse leptomeningeal enhancement with mass effect

  4. Unilateral cortical infarction in the MCA territory

Answer: (B) Bilateral parieto-occipital vasogenic edema on T2/FLAIR PRES

Question 123:

Which of the following findings is most characteristic of POTS?

  1. A sustained drop in systolic blood pressure of >20 mmHg within 3 minutes of standing

  2. A sustained heart rate increase of >30 bpm within 10 minutes of standing without orthostatic hypotension

  3. Sinus bradycardia during tilt-table testing

  4. Absence of sympathetic activation upon standing

Answer: (B) A sustained heart rate increase of more than 30 bpm within 10 minutes of standing without orthostatic hypotension.

Question 124:

Which of the following findings is most suggestive of primary lateral sclerosis rather than amyotrophic lateral sclerosis?

  1. Rapid progression to respiratory failure within 2 years

  2. Presence of fasciculations on EMG

  3. Slowly progressive spastic paraparesis without muscle atrophy

  4. Mixed upper and lower motor neuron signs at onset

Answer: (C) Slowly progressive spastic paraparesis without muscle atrophy

Question 125:

Which of the following clinical features is most characteristic of the semantic variant of primary progressive aphasia?

  1. Effortful, agrammatic speech with apraxia of speech

  2. Word-finding pauses with impaired repetition

  3. Fluent but empty speech with loss of word meaning

  4. Early impairment of episodic memory

Answer: (C) Fluent but empty speech with loss of word meaning Semantic

Question 126:

Which of the following findings is most characteristic of sporadic Creutzfeldt-Jakob disease (sCJD)?

  1. Rapidly progressive dementia over several years

  2. Presence of oligoclonal bands in the CSF

  3. Periodic sharp-wave complexes on EEG

  4. Enhancement of basal ganglia on gadolinium MRI

Answer: (C) Periodic sharp-wave complexes on EEG

Question 127:

Which of the following MRI findings is most characteristic of PML?

  1. Ring-enhancing lesions with mass effect

  2. Multifocal white matter lesions without enhancement or mass effect

  3. Basal ganglia involvement with hemorrhage

  4. Periventricular lesions with gadolinium enhancement

Answer: (B) Multifocal white matter lesions without enhancement or mass effect.

Question 128:

Which of the following features most reliably distinguishes Progressive Muscular Atrophy from Amyotrophic Lateral Sclerosis at initial presentation?

  1. Fasciculations

  2. Hyperreflexia

  3. Absence of upper motor neuron signs

  4. Bulbar involvement

Answer: (C) Absence of upper motor neuron signs

Question 129:

Which of the following features most reliably distinguishes progressive supranuclear palsy from Parkinson’s disease?

  1. Rest tremor

  2. Early vertical gaze palsy

  3. Bradykinesia

  4. Levodopa responsiveness

Answer: (B) Early vertical gaze palsy Vertical supranuclear gaze palsy,

Question 130:

Which of the following findings is most characteristic of idiopathic intracranial hypertension (pseudotumor cerebri)?

  1. Asymmetric limb weakness

  2. Bilateral papilledema with normal CSF composition

  3. Low CSF opening pressure on lumbar puncture

  4. Ring-enhancing lesions on MRI

Answer: (B) Bilateral papilledema with normal CSF composition

Question 131:

Which of the following clinical features is most characteristic of pudendal neuralgia?

  1. Perineal pain worsened by standing

  2. Perineal pain that wakes the patient from sleep

  3. Perineal pain relieved by sitting on a toilet seat

  4. Presence of significant motor deficits in the lower limbs

Answer: (C) Perineal pain relieved by sitting on a toilet seat

Question 132:

Which of the following findings best differentiates posterior interosseous nerve (PIN) syndrome from a proximal radial neuropathy?

  1. Wrist drop and sensory loss over the dorsum of the hand

  2. Isolated finger and thumb extension weakness without sensory loss

  3. Triceps weakness with diminished reflexes

  4. Numbness in the lateral forearm and palm

Answer: (B) Isolated finger and thumb extension weakness without sensory

Question 133:

Which of the following findings is most consistent with S1 radiculopathy?

  1. Diminished patellar reflex and quadriceps weakness

  2. Diminished ankle reflex and weakness of plantar flexion

  3. Sensory loss over the anterior thigh and weakness of hip flexion

  4. Weakness of dorsiflexion with preserved reflexes

Answer: (B) Diminished ankle reflex and weakness of plantar flexion

Question 134:

Which of the following features most reliably distinguishes Ramsay Hunt syndrome from Bell’s palsy?

  1. Sudden-onset peripheral facial weakness

  2. Loss of taste in the anterior two-thirds of the tongue

  3. Vesicular eruption in the external auditory canal

  4. Hyperacusis on the affected side

Answer: (C) Vesicular eruption in the external auditory canal

Question 135:

Which of the following clinical features is most characteristic of restless legs syndrome?

  1. Muscle weakness during exertion

  2. Sensory loss in a stocking-glove pattern

  3. Discomfort that worsens with rest and improves with movement

  4. Dermatomal pain radiating down the leg

Answer: (C) Discomfort that worsens with rest and improves with movement

Question 136:

Which of the following features most reliably distinguishes reversible cerebral vasoconstriction syndrome (RCVS) from primary angiitis of the CNS (PACNS)?

  1. Presence of thunderclap headache

  2. Multifocal segmental narrowing of cerebral arteries

  3. Reversibility of angiographic abnormalities within 12 weeks

  4. Occurrence of ischemic stroke

Answer: (C) Reversibility of angiographic abnormalities within 12 weeks

Question 137:

Which of the following is the most common neurological manifestation of neurosarcoidosis?

  1. Optic neuritis

  2. Facial nerve palsy

  3. Myelopathy

  4. Hypothalamic dysfunction

Answer: (B) Facial nerve palsy Cranial neuropathies, particularly facial nerve palsy is common in neurosarcoidosis.

Question 138:

Which of the following clinical features best distinguishes serotonin syndrome from neuroleptic malignant syndrome?

  1. Hyperthermia

  2. Altered mental status

  3. Clonus and hyperreflexia

  4. Elevated creatine kinase

Answer: (C) Clonus and hyperreflexia These features are characteristic of Serotonin Syndrome

Question 139:

Which of the following neurological manifestations is most characteristic of Sjögren’s syndrome?

  1. Distal symmetric demyelinating polyneuropathy

  2. Sensory neuronopathy due to dorsal root ganglion involvement

  3. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP)

  4. Lambert-Eaton myasthenic syndrome

Answer: (B) Sensory neuronopathy due to dorsal root ganglion involvement

Question 140:

Which of the following findings is most characteristic of small fiber neuropathy?

  1. Absent vibration sense with reduced nerve conduction velocity

  2. Reduced intraepidermal nerve fiber density with normal nerve conduction studies

  3. Fasciculations and distal weakness with muscle atrophy

  4. Abnormal proprioception and positive Romberg sign

Answer: (B) Reduced intraepidermal nerve fiber density with normal NCS

Question 141:

Which of the following findings is most characteristic of myelomeningocele in spina bifida?

  1. Presence of a CSF-filled sac without neurological deficits

  2. Vertebral arch defect with meninges and spinal cord protrusion

  3. Isolated vertebral defect with a tuft of hair and no symptoms

  4. Fat-containing mass overlying the spine without involvement of neural tissue

Answer: (B) Vertebral arch defect with meninges and spinal cord

Question 142:

Which of the following is a characteristic feature of spinal shock?

  1. Spastic paralysis with hyperreflexia below the lesion

  2. Flaccid paralysis with areflexia below the lesion

  3. Autonomic dysreflexia with severe hypertension

  4. Loss of consciousness and brainstem reflexes

Answer: (B) Flaccid paralysis with areflexia below the lesion

Question 143:

Which of the following genetic changes is most commonly associated with spinal muscular atrophy?

  1. Deletion of the dystrophin gene on Xp21

  2. Mutation in the SMN1 gene on chromosome 5q13

  3. Expansion of CTG repeats in the DMPK gene

  4. Mutation in the RYR1 gene on chromosome 19

Answer: (B) Mutation in the SMN1 gene on chromosome 5q13

Question 144:

Which of the following findings is most characteristic of Stiff Person Syndrome?

  1. Rapidly progressive distal muscle weakness with fasciculations

  2. Continuous motor unit firing relieved by GABAergic therapy

  3. Recurrent demyelinating lesions on MRI

  4. Muscle fiber necrosis with lymphocytic infiltration

Answer: (B) Continuous motor unit firing relieved by GABAergic therapy

Question 145:

Which of the following findings is most suggestive of a cardioembolic source of stroke?

  1. Progressive neurological deficits over several hours

  2. Lacunar infarcts in the basal ganglia

  3. Simultaneous infarcts in multiple vascular territories

  4. Stroke preceded by transient monocular blindness

Answer: (C) Simultaneous infarcts in multiple vascular territories

Question 146:

s Question: Which of the following is the most common cause of spontaneous intracerebral hemorrhage?

  1. Cerebral amyloid angiopathy

  2. Hypertensive small vessel disease

  3. Arteriovenous malformation

  4. Cerebral venous thrombosis

Answer: (B) Hypertensive small vessel disease

Question 147:

oindent Which of the following is the most appropriate next step for a patient presenting with a large vessel occlusion within 6 hours of symptom onset and no contraindications?

  1. Administer high-dose steroids

  2. Begin dual antiplatelet therapy immediately

  3. Proceed with mechanical thrombectomy

  4. Delay intervention until MRI confirms infarct size

Answer: (C) Proceed with mechanical thrombectomy

Question 148:

Which of the following clinical features most strongly suggests a lacunar stroke rather than a large vessel cortical stroke?

  1. Global aphasia and right hemiparesis

  2. Homonymous hemianopia and neglect

  3. Pure motor hemiparesis without cortical signs

  4. Sudden visual loss with retinal artery occlusion

Answer: (C) Pure motor hemiparesis without cortical signs.

Question 149:

Which of the following is the most sensitive investigation for detecting subarachnoid hemorrhage when CT scan is negative and suspicion remains high?

  1. Magnetic resonance imaging (MRI) of the brain

  2. Lumbar puncture demonstrating xanthochromia

  3. CT angiography

  4. Electroencephalography (EEG)

Answer: (B) Lumbar puncture demonstrating xanthochromia.

Question 150:

Which of the following best describes the typical CT appearance of a subdural hemorrhage?

  1. Lentiform (biconvex) hematoma crossing dural reflections

  2. Crescent-shaped hematoma crossing suture lines

  3. Round, focal hyperdensity confined by sutures

  4. Intraventricular hyperdensity after trauma

Answer: (B) Crescent-shaped hematoma crossing suture lines

Question 151:

Which of the following findings is most suggestive of suprascapular nerve entrapment at the spinoglenoid notch?

  1. Weakness of shoulder abduction and external rotation

  2. Isolated infraspinatus weakness with preserved supraspinatus

  3. strength

  4. Loss of sensation over the lateral shoulder

  5. Global atrophy of all rotator cuff muscles

Answer: (B) Isolated infraspinatus weakness with preserved supraspinatus

Question 152:

Which of the following findings is most characteristic of syringomyelia?

  1. Loss of vibration and position sense in a stocking-glove distribution

  2. Dissociated sensory loss with preserved dorsal column modalities

  3. Rapid onset flaccid paralysis of all four limbs

  4. Cranial nerve involvement with ophthalmoplegia

Answer: (B) Dissociated sensory loss with preserved dorsal column sensation

Question 153:

Which of the following best explains the pathophysiology of tardive dyskinesia?

  1. Loss of dopaminergic neurons in the substantia nigra

  2. Upregulation and hypersensitivity of D\(_2\) receptors in the basal ganglia

  3. Autoimmune-mediated basal ganglia destruction

  4. Increased serotonin receptor density in the frontal cortex

Answer: (B) Upregulation and hypersensitivity of D\(_2\) receptors in the basal ganglia

Question 154:

Which of the following physical examination findings is most characteristic of tarsal tunnel syndrome?

  1. Pain with resisted plantar flexion of the ankle

  2. Positive Tinel’s sign posterior to the medial malleolus

  3. Calf tenderness with dorsiflexion of the foot

  4. Pain over the plantar fascia with first-step activity

Answer: (B) Positive Tinel’s sign posterior to the medial malleolus

Question 155:

Which of the following features is most characteristic of giant cell arteritis?

  1. Necrotizing vasculitis involving medium-sized muscular arteries

  2. Granulomatous inflammation with multinucleated giant cells and disruption of the internal elastic lamina

  3. Immune complex deposition in glomerular capillaries

  4. Antineutrophil cytoplasmic antibody (ANCA) positivity

Answer: (B) Granulomatous inflammation with multinucleated giant cells and disruption of the internal elastic lamina.

Question 156:

Which of the following clinical findings is most characteristic of temporomandibular joint syndrome?

  1. Unilateral facial numbness

  2. Jaw deviation with clicking during mouth opening

  3. Pulsatile preauricular bruit

  4. Severe otalgia with tympanic membrane erythema

Answer: (B) Jaw deviation with clicking during mouth opening TMJ

Question 157:

Which of the following clinical findings is most suggestive of neurogenic thoracic outlet syndrome?

  1. Limb cyanosis and venous distension

  2. Digital ischemia and diminished distal pulses

  3. Weakness of intrinsic hand muscles with ulnar sensory loss

  4. Sudden onset of arm swelling following exertion

Answer: (C) Weakness of intrinsic hand muscles with ulnar sensory loss

Question 158:

Which of the following clinical features best distinguishes tics from other movement disorders?

  1. Rhythmic, repetitive, and non-suppressible nature of movements

  2. Sudden, suppressible movements preceded by an urge

  3. Continuous, flowing movements without premonitory sensation

  4. Occurrence only during sleep

Answer: (B) Sudden, suppressible movements preceded by an urge

Question 159:

Which of the following findings most strongly suggests a vascular cause of tinnitus?

  1. High-pitched ringing that is worse in quiet environments

  2. Unilateral tinnitus with associated hearing loss

  3. Pulsatile tinnitus synchronous with the heartbeat

  4. Intermittent tinnitus associated with vertigo

Answer: (C) Pulsatile tinnitus synchronous with the heartbeat.

Question 160:

Which of the following findings most strongly supports the diagnosis of Tolosa-Hunt Syndrome?

  1. Bilateral proptosis with optic disc edema

  2. Rapid resolution of painful ophthalmoplegia with corticosteroid therapy

  3. Slowly progressive ophthalmoplegia with systemic features

  4. Cranial nerve involvement associated with high-grade fever and leukocytosis

Answer: (B) Rapid resolution of painful ophthalmoplegia with corticosteroid therapy

Question 161:

Which of the following is most characteristic of Tourette syndrome?

  1. Presence of motor tics for less than one year

  2. Onset after 21 years of age

  3. Multiple motor and at least one vocal tic lasting for more than one year

  4. Progressive weakness and spasticity

Answer: (C) Multiple motor and at least one vocal tic lasting for more than one year

Question 162:

Which of the following statements regarding TIA is most accurate?

  1. Symptoms must resolve within 6 hours to qualify as a TIA

  2. Evidence of acute infarction on MRI excludes the diagnosis of TI

  3. TIAs rarely precede ischemic strokes.

  4. Cardioembolic sources are less common than small-vessel disease in

Answer: (D)

Question 163:

Which of the following findings most strongly suggests neuromyelitis optica spectrum disorder rather than idiopathic transverse myelitis?

  1. A lesion involving fewer than two vertebral segments

  2. Presence of oligoclonal bands in CSF

  3. Positive aquaporin-4 (AQP4) antibodies

  4. Rapid recovery without immunotherapy

Answer: (C) Positive aquaporin-4 (AQP4) antibodies

Question 164:

Which of the following features most strongly suggests secondary rather than classical trigeminal neuralgia?

  1. Unilateral, electric shock-like pain triggered by touch

  2. Pain limited to V2 and V3 divisions

  3. Presence of facial numbness between attacks

  4. Good response to carbamazepine

Answer: (C) Presence of facial numbness between attacks

Question 165:

Which clinical feature most reliably distinguishes trochlear nerve palsy from skew deviation?

  1. Diplopia worse on downgaze

  2. Compensatory head tilt

  3. Torsional deviation toward excyclotorsion

  4. Increased hypertropia with head tilt toward the affected side

Answer: (D) Increased hypertropia with head tilt toward the affected side

Question 166:

A 39-year-old male with a history of pulmonary tuberculosis presents with seizures. MRI of the brain shows a ring-enhancing lesion in the left motor cortex with a hypointense center and hyperintense rim. MR spectroscopy demonstrates a prominent lipid-lactate peak and reduced N-acetylaspartate (NAA) levels. Which of the following diagnostic findings most strongly supports tuberculoma over other ring-enhancing lesions?

  1. Presence of restricted diffusion

  2. Detection of Mycobacterium tuberculosis DNA by PCR in cerebrospinal fluid

  3. Visualization of a scolex within the cystic lesion on MRI

  4. Elevated choline-to-creatine ratio

Answer: (B) Detection of Mycobacterium tuberculosis DNA by PCR in cerebrospinal fluid. Restricted diffusion favors abscess, elevated choline-to-creatine suggest malignancy and scolex in cystic lesion suggests neurocysticercosis.

Question 167:

Which of the following is the most effective diagnostic test for confirming ulnar neuropathy at the wrist?

  1. MRI

  2. Ultrasound

  3. Nerve conduction studies (NCS)

  4. Xray

Answer: (C) Nerve conduction studies (NCS)

Question 168:

Which of the following findings most strongly supports a diagnosis of primary CNS vasculitis?

  1. Sudden-onset focal neurological deficits with a normal MRI

  2. Multifocal cerebral infarcts of varying ages with negative systemic vasculitis workup

  3. Isolated posterior circulation stroke with atrial fibrillation

  4. Symmetric periventricular white matter hyperintensities without infarction

Answer: (B) Multifocal cerebral infarcts of varying ages with negative systemic vasculitis workup

Question 169:

Which of the following features is most characteristic of vascular dementia compared to Alzheimer’s disease?

  1. Early episodic memory impairment

  2. Stepwise cognitive decline following cerebrovascular events

  3. Visual hallucinations

  4. Rapidly progressive aphasia

Answer: (B) Stepwise cognitive decline following cerebrovascular events

Question 170:

Which of the following is considered the gold standard for confirming the diagnosis of vasculitic neuropathy?

  1. Electromyography

  2. MRI of peripheral nerves

  3. Nerve biopsy

  4. Blood tests

Answer: (C) Nerve biopsy is the gold standard, demonstrating vessel wall inflammation

Question 171:

Which of the following findings is most characteristic of benign paroxysmal positional vertigo (BPPV)?

  1. Continuous vertigo with hearing loss

  2. Episodic vertigo triggered by head position changes

  3. Vertigo with focal neurological deficits

  4. Vertigo associated with visual aura and photophobia

Answer: (B) Episodic vertigo triggered by head position changes

Question 172:

Which artery is most commonly implicated in Wallenberg Syndrome?

  1. Basilar artery

  2. Anterior inferior cerebellar artery

  3. Posterior inferior cerebellar artery

  4. Superior cerebellar artery

Answer: (C) Posterior inferior cerebellar artery

Question 173:

Which of the following is not part of the classic triad of Wernicke’s encephalopathy?

  1. Confusion

  2. Ataxia

  3. Ophthalmoplegia

  4. Hyperreflexia

Answer: (D) Hyperreflexia

Question 174:

Which of the following clinical features is least likely to be associated with West Nile Encephalitis?

  1. Fever and altered mental status

  2. Neck stiffness and photophobia

  3. Acute flaccid paralysis

  4. Erythematous maculopapular rash

Answer: (D) Erythematous maculopapular rash — Rash is uncommon in

Question 175:

Which of the following findings is most specific for Wilson’s disease?

  1. Elevated serum ferritin

  2. Low serum ceruloplasmin with Kayser-Fleischer rings

  3. Hyperammonemia and elevated INR

  4. Increased serum alpha-fetoprotein

Answer: (B) Low serum ceruloplasmin with Kayser-Fleischer rings

Question 176:

Which of the following biochemical findings is characteristic of X-linked adrenoleukodystrophy?

  1. Decreased plasmalogen synthesis

  2. Elevated very long-chain fatty acids due to peroxisomal β-oxidation defect

  3. Elevated lysosomal enzyme activity

  4. Reduced branched-chain amino acid levels

Answer: (B) X-linked adrenoleukodystrophy results from defective transport of VLCFAs