General Practitioner - Neurology MCQs

Female patient with fatigue, muscle weakness, paresthesia in the lower limbs and unsteady gait, next
step?

Folate level

Vitamin B12 level (Correct Answer)

Ferritin level

In brainstem damage:

Absent spontaneous eye movement

Increase PaCO2 (Correct Answer)

Unequal pupils

Presence of motor movement

What is the most reversible risk factor for stroke?

DM

HTN (Correct Answer)

obesity

Dyslipidemia

Which of the following found to reduce the risk of post herapeutic neuralgia?

Corticosteroids only

Corticosteroids + valacyclovi (Correct Answer)

Valacyclovir only

Cardiac syncope:
 Gradual onset

Fast recovery (Correct Answer)

Neurological sequence after

An 18 years old male who was involved in an RTA had fracture of the base of the skull. O/E he had loss of

sensation of the anterior 2/3 of the tongue & deviation of the angle of the mouth. Which of the
following

nerves is affected?

I (Olfactory)

III (Occulomotor)

V (Trigeminal) (Correct Answer)

IV (Abducens)

VII (Facial)

A 35 years old patient, she is on phenytoin since she was 29 due to partial epilipsy she didn’t have any
attack

since. She want to stop taking the drug due to facial hair growth:

It is reasonable to stop it now (Correct Answer)

Stop it after 6 months

Stop after 10 years

Don’t stop it

Patient 22 years old with unilateral headache attacks:

Cluster headache

Migraine (Correct Answer)

 Tension headache

Which of the following is true about migraine:

Aura occur after the headache

Each attack lasts about 4 hours

It is unilateral pounding headache (Correct Answer)

A middle age man presented with severe headache after lifting heavy object. His BP was high. He was
fully

conscious. Examination was otherwise normal. The most likely diagnosis is:

Subarachnoid hemorrhage (Correct Answer)

Central HTN

Tension headache

Migraine

Intracerebral hemorrhage

Patient has neck stiffness, headache and petechial rash. Lumber puncture showed a high pressure , what

would be the cause?

group B strep

Neisseria meningitides (Correct Answer)

m.tubecrlosis

staphylococcus aures

The most common cause of non traumatic subarachnoid hemorrhage is:

Middle meningeal artery hemorrhage

 Bridging vein hemorrhage

Rupture of previously present aneurysm (Correct Answer)

The most common cause of non traumatic subarachnoid hemorrhage is:

Middle meningeal artery hemorrhage

Bridging vein hemorrhage

Rupture of previously present aneurysm (Correct Answer)

Which is not true in emergency management of stroke?

Give IVF to avoid D5 50% 􀃆 Hyperglycemia can increase the severity of ischemic injury
whereas hypoglycemia can mimic a stroke

Give diazepam in convulsions

Anticonvulsants not needed in if seizures (Correct Answer)

Anticonvulsants not needed in if seizures

Treat elevated blood pressure 􀃆Treat if SBP>220 or DBP>120 or MAP>130

A 26 year old female complaining of headache more severe in the early morning mainly bitemporal, her
past

medical history is unremarkable. She gave history of OCP use for 1 year. Ophthalmoscope examination
showed

papilledema but there are no other neurological findings. The most probable diagnosis is:

Optic neuritis

Benign intracranial hypertension (Correct Answer)

Encephalitis

Meningitis

Intracranial abscess

A 27 years old male with tonic colonic seizures in the ER, 20 mg Diazepam was given and the convulsion
did not

stop. What will be given?

Diazepam till dose of 40 mg (Correct Answer)

Phenytoin

Phenobarbitone

Definition of status epilepticus:

Generalized tonic clonic seizure more than 15 minutes

Seizure more than 30 minutes without regains consciousness in between (Correct Answer)

Absence seizure for more than 15 minutes

25 years old student presented to your office complaining of sudden & severe headache for 4 hours.
History

revealed mild headache attacks during the last 5 hours. On examination: agitated & restless. The
diagnosis is:

Severe migraine attack (Correct Answer)

Cluster headache

Subarachnoid hemorrhage

Hypertensive encephalopathy

encephalitis

all of the following precipitate seizure except:

hypourecemia (Correct Answer)

Hypokalemia

hypophosphatemia
 hypocalcemia

hypoglycemia

A 25 years old patient presented with headache, avoidance of light & resist flexion of neck, next step is:

EEG

C-spine X-ray

Phonation

Non of the above (Correct Answer)

Which of the following side effect is not associated with phenytoin?

Hirsutism

Macrocytic anemia

Asteomalasia

Ataxia

Osteoporosis (Correct Answer)

Pain near eye prescribed by tingling and paresthesia occur many times a week in the same time, also
there is

nasal congestion and eye lid edema, what is the diagnosis?

Cluster headache (Correct Answer)

Migraine with aura

Tension headache

Withdrawal headache

Girl with band like headache increase with stress and periorbital, twice a week, what is the diagnosis?

Tension headache (Correct Answer)

 Tension headache

clusterPatient presented with nausea, vomiting, nystagmus, tinnitus and inability to walk unless
he concentrates well

on a target object. His Cerebeller function is intact, what is the diagnosis?

Benign positional vertigo

Meniere’s disease

Vestibular neuritis (Correct Answer)

80 years old male patient, come with some behavioral abnormalities, annoying, (he mentioned some

dysinhibitory effect symptoms), most postulated lobe to be involved:

Frontal (Correct Answer)

Parietal

Occipital

Temporal.

The commonest initial manifestation of increased ICP in patient after head trauma is

Change in level of consciousness (Correct Answer)

Ipsilateral pupillary dilatation

Contralateral pupillary dilatation

Hemiparesis

One of following true regarding systolic hypertension :

In elderly it’s more dangerous than diastolic hypertension (Correct Answer)

Occur usually due to mitral regurge

Defined as systolic, above 140 and diastolic above 100 “combined systolic and diastolicâ€
Typical picture of oculomotor nerve palsy: stroke with loss of smell, which lobe is affected?

Frontal

Parital

Occipital

Temporal (Correct Answer)

Man is brought to the ER after having seizure for more than 30 min the most initial drug you will start
with:

IV lorazepam (Correct Answer)

IV phenobarbital

IV phynetoin

Middle aged patient with ataxia, multiple skin pigmentation and decrease hearing, one of the family
members

has the same condition?

Malignant melanoma

Neurofibromatosis “ most likelyâ€ (Correct Answer)

hemochromatosis

measles

nevi

19 years old after bike accident, he can't bring the spoon in front of himself to eat, lesion is in:

Temporal lobe

Cerebellum (Correct Answer)

Parietal lobe
 Occipital lobe

Young girl experienced crampy abdominal pain & proximal muscular weakness but normal reflexes after

receiving septra (trimethoprim sulfamethoxazole) :

Functional myositis

Polymyositis

Guillianbarre syndrome

Neuritis (Correct Answer)

Sciatica increased incidence of :

Lumbar lordosis

Paresthesia (Correct Answer)

Female patient presented with migraine headache which is pulsatile, unilateral, increase with activity.
Doesn't

want to take medication. Which of the following is appropriate?

Bio feedback (Correct Answer)

TCA

BB

Diabetic patient was presented by spastic tongue, Dysarthria and spontaneous crying what is the most
likely

diagnosis?

Parkinson.

Bulbar palsy.

Pseudobulbar (Correct Answer)

 Myasthenia gravis.

Patient with ischemic stroke present after 6 hours, the best treatment is:

ASA (Correct Answer)

Tissue plasminogen activator “TPAâ€

Clopidogril

Clopidogril

Other ant

Old male with neck stiffness, numbness and paresthesia in the little finger and ring finger and positive
raised

hand test, diagnosis is:

Thoracic outlet syndrome (Correct Answer)

Impingement syndrome

Ulnar artery thrombosis

Ulnar artery thrombosisicoagulant

Prophylaxis for meningitis treatment of contact:

Cemitidine

Rifampicin (Correct Answer)

Old male with symptoms suggesting Parkinsonism such as difficulty walking, resting tremors and rigidity
in

addition to hypotension. Then he asks about what is the most common presenting symptom of this
disease

Rigidity

Tremors (Correct Answer)

 Unsteady Gait

Hypotension

Which of the following is a side effect of bupropion , a drug used to help smoking cessation:

Arrhythmia

Xerostomia

Headache

Seizure (Correct Answer)

Most effective treatment of cluster headache:

Ergotamine nebulizer

S/C Sumatriptan

100% O2 (Correct Answer)

IV Verapamil

Old patient with HTN and migraine treatment:

B blockers (Correct Answer)

B blockers

Ca blockers

Young adult Sickle cell patients are commonly affected with

dementia

Multiple cerebral infarcts (Correct Answer)

70 years old with progressive dementia, no personality changes and neurological examination was
normal but

there is visual deficit, on brain CT shower cortex atrophy and ventricular dilatations, what is the
diagnosis?

Multi micro infract dementia

Alzheimer dementia (Correct Answer)

parkinsonism dementia

70 years old with progressive dementia, on brain microscopy amyloid plaques and neurofibrillary tangles
are

clearly visible also Plaques are seen, what is the diagnosis?

lewy dementia

Parkisonism

Alzheimer (Correct Answer)

87 years old who brought by his daughter, she said he is forgettable, doing mess thing in room , do not

maintain attention , neurological examination and the investigation are normal, what is the diagnosis?

Alzheimer disease (Correct Answer)

Multi-Infarct Dementia
73 year patient complain of progressive loses of memory with decrease in cognition function. C.T reveal

enlarge ventricle and cortical atrophy, what is the diagnosis?

Alzheimer (Correct Answer)

multi infarct dementia

multiple sclerosis

Female patient developed sudden loss of vision (both eyes) while she was walking down the street, also

complaining of numbness and tingling in her feet ,there is discrepancy between the complaint and the
finding,

on examination reflexes and ankle jerks preserved,there is decrease in the sensation and weakness in
the

lower muscles not going with the anatomy, what is your action?

Call ophthalmologist

Call neurologist

Call neurologist

Reassure her and ask her about the stressors! (Correct Answer)

Female patient complaining of severe migraine that affecting her work, she mentioned that she was
improved

in her last pregnancy, to prevent that:

Biofeedback

Propranolol (Correct Answer)

6 months boy with fever you should give antipyretic to decrease risk of:

Febrile convulsion (Correct Answer)

Epilepsy

Max dose of ibuprofen for adult is :

800

1600

3000

3200 (Correct Answer)

65 year male presented with 10 days history of hemiplagia, CT shows: infarction, he has HTN. He is on
lisonipril

& thiazide, 2 years back he had gastric ulcer. tratment that you should add :
 continue same meds

Aspirin 325

aspirin 81

warfarin

Dipyridamole (Antiplatlet agent) (Correct Answer)

Indication for CT brain for dementia, all true except:-

Younger than 60 years old (Correct Answer)

After head trauma

Progressive dementia over 3 years

Investigation of Multiple Sclerosis include all except:

Visual evoked potential

LP

MRI

CT (Correct Answer)

Young man come with headache he is describing that this headache is the worst headache in his life
what of

the following will be less helpful?

Young man come with headache he is describing that this headache is the worst headache in his
life what of the following will be less helpful?

Young man come with headache he is describing that this headache is the worst headache in his
life what of the following will be less helpful?

Skull x ray (Correct Answer)

LP
All of the fallowing are criteria of subarachnoid hemorrhage EXCEPT:

Paraplegia (Correct Answer)

confusion

nuchal Rigidity

Due to berry aneurysm rupture

Acute severe headache

The best treatment for the previous case is :

Benzodiazepines

Phenothiazine

monoamine oxidase inhibitor

selective serotonin reuptake inhibitor

supportive psychotherapy (Correct Answer)

After infarction, the patient become disinhibited, angrier & restless, The area responsible which is
affected:

Premotor area

Temporal area

Temporal area (Correct Answer)

26 years old female present with 6 month history of bilateral temporal headache increased in morning &

history of OCP last for 1 year, on examination BP 120/80 & papilledema, what is the diagnosis?

Encephalitis

Meningitis

Optic nuritis
 Benign intracranial hypertension (Correct Answer)

Intracerbral abscesses

60 years old male complain of decreased libido, decreased ejaculation , FBS= 6.5 mmol , increased
prolactin ,

normal FSH & LH , do next step:

Testosterone level

DM

NL FBG

CT of the head (Correct Answer)

Side effects of Levodopa :

Dyskinesia (Correct Answer)

Speech

Fatal hepatic toxicity

Patient present with generalized seizures not known case before of any seizure , no pervious history like
that,

The most important thing to do now is:

EEG. After that

Laboratory test in ER (Correct Answer)

Lactating mother newly diagnosed with epilepsy, taking for it phenobarbital your advice is:

Discontinue breastfeeding immediately

Breast feed baby after 8 hours of the medication

Continue breastfeeding as tolerated (Correct Answer)

Sciatica:

Never associated with sensory loss

Don’t cause pain with leg elevation

Causes increased lumbar lordosis

Maybe associated with calf muscle weakness (Correct Answer)

Old male with stroke, after 9 days he loss left eye vision, what are the affect structure?

Frontal lobe

Partial

Occipital (Correct Answer)

Temporal

Male old patient has signs & symptoms of facial palsy (LMNL), which of the following correct about it?

Almost most of the cases start to improve in 2nd week (Correct Answer)

it need treatment by antibiotic and anti viral

contraindicated to give corticosteroid

usually about 25 % of the cases has permanent affection

Patient known of epilepsy on phenytoin, presented with history of abdominal pain, bilateral axillary
lymph

node enlargement, what is the most like diagnosis?

Hodgkin's lymphoma

Reaction to drug (Correct Answer)

TB

Old age patient presented with neck stiffness, cervical arthritis, paresthesia on palm and medial 2/3
fingers,

the proper investigation:

CT cervical spine

CT cervical spine

PT

Decompression of median nerve (carpal tunnel) (Correct Answer)

Diaphoresis and hyperreflexia, what is the diagnosis?

Neuroleptic malignant syndrome (Correct Answer)

Imatinib toxicity

odansetron toxicity

Young suddenly develops ear pain, facial dropping, what to do?

mostly will resolve spontaneously (Correct Answer)

25% will have permanent paralysis

No role of steroid

Man with high fever, Petechial rash and CSF decrease glucose, he has:

Neisseria meningitis (Correct Answer)

N gonorrhea

H influenza

Romberg sign lesion in :

Dorsal column (Correct Answer)

 cerebellum

visual cortex

In aseptic meningitis, in the initial 24 hours what will happen?

Decrease protein

Increase glucose

Lymphocytes (Correct Answer)

Eosinophils

Something

50 years old female have DM well controlled on metformin, now c\o diplopia RT side eye lis ptosis and
loss of

adduction of the eyes and up word and out word gaze !! reacting pupil no loss of visual field:

Faisal palsy

Oculomotor palsy of the right side (Correct Answer)

Myasthenia gravies

increase IgG in CSF:

Multiple sclerosis (Correct Answer)

Duchene dystrophy