NEUROLOGY

1. A 23yearold man presents with visual loss in the right eye, 8. A 19 year old girl presents at the antenatal clinic. She is
diagnosed as optic neuritis. Which one of the following approximately six weeks pregnant and the pregnancy was
statements would be seen in an afferent pupillary defect? unplanned. She has a two year history of grand mal epilepsy
a. accommodation response is unaffected for which she takes carbamazepine. She has had no fits for
approximately six months. She wants to continue with her
b. hypersensitive response to pilocarpine in the affected eye pregnancy if it is safe to do so. She is worried about her
c. irregular pupil of the affected eye anticonvulsant therapy and the effects on the baby and
d. pupil of affected eye larger than the unaffected eye enquireshow she should be managed?
e. pupil of affected eye smaller than the unaffected eye a. Advise termination due to drug teratogenicity
b. Continue with carbamazepine
2. A 75yearold man presents with 12 months history of cognitive
c. Stop carbamazepine until the second trimester
impairment, parkinsonism, intermittent confusion and
generalised myoclonus. He was started on 62.5 tds of sinemet. d. Switch therapy to phenytoin
In the following 2 months he was started experiencing visual e. Switch therapy to sodium valproate
hallucinations. The most likely diagnosis is:
a. Idiopathic Parkinson’s disease 9. A female patient aged 30 has a 5 years history of difficulty
getting upstairs and out of a low chair and mild upper
b. Alzheimer’s disease limb weakness but no pain. There is no family history. She
c. Diffuse Lewy body disease presented with severe type 2 respiratory failure. EMG showed
d. Multiple system atrophy evidence of myopathy. The most likely diagnosis is:
e. Progressive supranuclear palsy a. Polymyositis
b. Inclusion body myositis
3. Which visual field defect is most likely to occur with multiple
c. Acid Maltase Deficiency
sclerosis?
d. MillerFisher Syndrome
a. bitemporal hemianopia
e. LambertEaton Myasthenic Syndrome
b. central scotoma
c. homonymous hemianopia 10. A 75 yearold woman with acute monocular visual loss.
d. increased blind spot Fundoscopy reveals a swollen pale optic disc in the affected
eye. What is the mose likely diagnosis?
e. tunnel vision
a. Central retinal vein occlusion.
4. Which is true of herpes simplex encephalitis? b. Closed angle glaucoma.
a. brain MRI is characteristically normal c. Giant cell arteritis.
b. fits are uncommon d. Optic neuritis.
c. genital herpes is usually present e. Raised intracranial pressure.
d. temporal lobe involvement is common
11. A 45yearold man presents with an insidious onset of binocular
e. viral identification using polymerase chain reaction on CSF
horizontal diplopia and left sided facial pain. On examination
is nonspecific
ha has a left abducens nerve palsy and numbness over the
5. Which of the following investigations best supports a maxillary division of the left trigeminal nerve. The most likely
diagnosis of new variant CJD: anatomical site of his neurological lesion is:
a. CSF analysis a. Cavernous sinus
b. CT brain b. Petrous apex
c. EEG c. Superior orbital fissure
d. EMG d. Cerebellopontine angle
e. MRI brain e. Midbrain

6. Which of the following is a recognised cause of a phrenic 12. An adloescent boy presents with unexplained neurological
nerve palsy? illness.Which one of the following would suggest substance
abuse?
a. Aortic aneurysm
a. A history of low selfesteem.
b. Dermoid
b. A history of social isolation.
c. Ganglioneuroma
c. Deposits around the mouth.
d. Pericardial cyst
d. A history of family conflict.
e. Sarcoidosis
e. A history of attention deficit disorder.
7. A 33 year old epileptic female presents with visual problems.
Examination reveals a constriction of visual fields to 13. A 45yearold woman noticed tinnitus in her left ear which
confrontation. Which of the following may be responsible for progressed over some weeks to hearing loss in that ear. On
her visual deterioration? physical examination she is found to have a marked decrease
in hearing on the left, with Rinne test indicating air conduction
a. Vigabatrin better than bone conduction. The other cranial nerves I VII
b. Lamotrigine and IX XII are intact. A brain MRI scan revealed a solitary,
c. Gabapentin fairly discreet, 3 cm mass located in the region of the left
cerebellopontine angle. Which of the following statements is
d. Phenytoin
most appropriate to tell the patient regarding these findings?
e. Sodium Valproate
 1250 a. A test for HIV1 is likely to be positive a. Isotretinoin
b. Other family members should undergo MR imaging of the b. Ampicillin
brain c. Topical tetracycline
c. Remissions and exacerbations are likely to occur in coming d. Dianette
years
e. Erythromycin
d. The lesion can be resected with a good prognosis
e. You are unlikely to survive for more than a year 20. Which of the following is true of human neurons?
a. myelin sheaths extend across the nodes of Ranvier.
14. A 22yearold man suffers a deep laceration to the forearm
b. unmyelinated fibres have faster conduction.
resulting in transection of the median nerve. Following
this injury, the nerve will undergo which of the following c. sodium ion influx occurs during the action potential.
pathological processes? d. the action potential increases with increased stimulation.
a. Chronic inflammation e. increased extracellular calcium leads to increased neuronal
b. Coagulative necrosis excitability.
c. Fibrinoid necrosis
MCQ's

21. A 34 year old male presents with backpain and weakness.

d. Segmental demyelination Which of the following would support a diagnosis of
e. Wallerian degeneration prolapsed intervertebral disc?
a. bilateral symmetrical nerve involvement
15. Which of the following features is characteristic of myasthenia
b. Loss of sensation over the left outer upper thigh
gravis?
c. no evidence of nerve compression
a. Diplopia
d. pain which is worse on resting
b. Equal sex incidence
e. pain which is unremitting in character
c. Fasciculation
d. Lid lag 22. The anticonvulsant Levetiracetecam
e. Loss of pupillary reflexes a. Is used as monotherapy for the treatment of generalised
convulsions
16. A 25yearold woman presents with a severe migraine. Which of
b. Acts via the GABA receptor
the following is not a recognised feature of migraine?
c. Is associated with induction of hepatic cytochrome p450
a. Some symptoms improved by tricyclic antidepressants
enzymes
b. Third nerve palsy
d. Is well absorbed via the oral route
c. External opthalmoplegia
e. Is associated with increased plasma concentrations of
d. bilateral fortification spectra sodium valproate
e. precipitation by oral contraceptives
23. Following factors decrease large intestinal motility:
17. A 48yearold female patient develops an acute, severe and a. Parasympathetic activity
isolated right C6 radiculopathy affecting both the motor and
b. Anticholinergic agents
sensory roots. She is examined in an EMG clinic 3 weeks after
the onset of symptoms. Which of the following statements is c. Gastric Distension
true? d. CCKPZ
a. Absent sensory nerve potentials would be expected on e. Laxatives.
examination of the thumb and index finger on the right.
b. A repeat examination 12 months later is likely to reveal 24. A 72 year old female presents with general slowness.
rapidly recruited low amplitude short duration motor units Examination reveals a tremor of the hands. What frequency of
in the clinically involved muscle on EMG. tremor would you suspect in Parkinson’s disease?
c. Fibrillation potentials would be expected in the right a. 1 Hz
brachioradialis and abductor pollicus brevis. b. 2 Hz
d. Triceps tendon jerk is likely to be depressed or absent. c. 5 Hz
e. Voluntary motor unit activity may be absent in the right d. 8 Hz
biceps. e. 10 Hz
18. A 15 year old boy presents with tremor of both hands. Over the 25. Which statement is true regarding Gabapentin?
previous months he has eveloped a mild dysarthria. He has
a history of behavioural problems, of a depressive/psychotic a. is a potent hepatic enzyme inducer
nature. The most likely diagnosis is: b. side effects typically include visual field defects with
a. Alzheimer’s disease longterm use
b. Huntington’s disease c. therapy is best monitored through measuring plasma
concentrations
c. Neuroacanthocytosis
d. is of particular value as monotherapy in absence attacks
d. variant CreutzfeldtJakob disease (petit mal)
e. Wilson’s disease e. requires dose adjustment in renal disease
19. A 24 year old female presents with vague frontal headaches 26. A 62yearold man presented with difficult walking. He had
and visual disturbance. She has a past history of acne for a past history of diabetes mellitus and cervicalspondylosis,
which she is receiving treatment. Examination reveals her which had required surgical decompression eight years
to be obese with a blood pressure of 110/70 mmHg. There is previously. He drank 40 units of alcohol weekly. On
absence of the central retinal vein pulsation on fundoscopic examination there was fasciculation, wasting and weakness
examination. Which of the following drugs account for these in the left deltoid and biceps, with weakness in the shoulder
findings?
 girdle muscles bilaterally. There was fasciculation in the c. there is a characteristic EEG 1251
glutei and quadriceps bilaterally, weakness of hip flexion and d. Clostridiumspecific intravenous immunoglobulin is of no
foot dorsiflexion, brisk reflexes in upper and lower limbs, and benefit once spasm has started
extensor plantar responses. There was no sensory impairment.
e. cephalic tetanus causes severe dysphagia
What is the diagnosis?
a. alcoholic myopathy 33. A68yearold man presents with progressive visual impairment.
b. diabetic amyotrophy On examination there is an incongruous homonymous
hemianopia. The most likely anatomical site of the
c. motor neurone disease
neurological lesion is at:
d. recurrent cervical cord compression
a. optic nerve
e. syringomyelia
b. optic tract
27. Which of the following is least likely to cause choreiform c. chiasma
movements? d. optic radiation
a. polyarteritis nodosa e. occipital lobe

NEUROLOGY
b. polycythaemia rubra vera
34. A 21 year old female with epilepsy is well controlled on sodium
c. Rheumatic fever
valproate 600mg bd and had been taking oral contraceptives
d. systemic lupus erythematosus for three years. She presented to her general practitioner 12
e. thyrotoxicosis weeks pregnant. Which of the following is correct?
a. An alternative anticonvulsant should be used in place of
28. A 24yearold man presents with a five month history of low sodium valproate
back pain, radiating to his buttocks, and back stiffness worse
in the morning and worse after periods of inactivity. Which of b. Interaction of sodium valproate with the oral contraceptive
the following signs is the mostlikely to be present? increased the risk of pregnancy
a. exaggerated lumbar lordosis c. The dose of sodium valproate should be increased
b. positive femoral stretch test d. There is an increased risk of a neural tube defect in her fetus
c. positive Trendelenburg test e. She is at increased risk of anaemia in pregnancy
d. restricted straight leg raising 35. A 40yearold man has had decreased mentation with confusion
e. sacroiliac joint tenderness as well as increasing incoordination and loss of movement in
his right arm over the past 6 weeks. An MRI scan shows 0.5 to 1.5
29. A previously well 27yearold woman presents with a history of cm lesions in cerebral hemispheres in white matter and at the
transient ischaemic attack affecting her right side and speech. greywhite junction that suggest demyelination. A stereotatic
She had returned to the United Kingdom from a holiday in biopsy is performed, and immunohistochemical staining of
New Zealand two days previously. On examination there was the tissue reveals JC papovavirus in oligodendrocytes. Which
nothing abnormal to find. An ECG, chest Xray, CT brain scan of the following laboratory test findings is most likely to be
and routine haematology and biochemistry were all normal. associated with these findings?
What is the most likely underlying abnormality? a. CD4 lymphocyte count of 90/microliter
a. atrial myxoma b. Haemoglobin A1c of 9.8%
b. carotid artery stenosis c. HDL cholesterol of 0.7 mmol/L
c. embolus from paroxysmal atrial fibrillation d. Oligoclonal bands in CSF
d. patent foramen ovale e. Serum sodium of 110 mmol/L
e. subarachnoid haemorrhage
36. A 60yearold man presents with an episode of memory loss.
30. Which of the following factors is the most likely to account for Three days earlier he had become confused. His wife led him
this problem? into the house he apparently sat down at her request, and had
a. altered volume of distribution a cup of tea. He then wandered around the house, confused,
but remained conscious and able to have some conversation
b. delayed gastric emptying
with his wife, though continuing to ask similar questions
c. first pass metabolism repeatedly. After three hours, he abruptly returned to normal
d. hepatic enzyme induction and had no recollection of the events. What is the most likely
e. reduced gut blood flow diagnosis?
a. alcohol related amnesia
31. A 25yearold female presents with 2 days history of b. chronic subdural haematoma
diplopia and unsteadiness. 2 weeks ago she suffered an
upper respiratory tract infection. On examination there is c. complex partial status epilepticus
complete opthalmoplegia, areflexia and gait ataxia. Which d. hysterical fugue state
of the following blood tests is the most likely to confirm the e. transient global amnesia
underlying diagnosis?
a. Acetylcholine receptors antibodies 37. A 65yearold man presents with 4 months history of
swallowing difficulties (worse with liquids than solids). He
b. Anti GM1 antibodies
also complains of nasal regurgitation, coughing and choking
c. Anti GQib antibodies episodes during meals and slight dysarthria. He lost 1 stone
d. Anti Hu antibodies over the last 8 weeks. Which of the following investigations is
e. Anti purkinje cell antibodies the most appropriate for this case?
a. Gastroscopy
32. Which of the following is true of tetanus? b. Barium swallow
a. failure to culture Clostridium tetani from the wound would c. CXR
make the diagnosis doubtful
b. infection confers lifelong immunity
 1252 d. Tumour markers c. confabulation
e. Acetyl choline receptors antibodies d. loss of personal identity
e. normal perception
38. A complete unilateral facial hemiparesis may be caused by
which of the following? 46. A lesion of the occipital lobe causes:
a. An intracranial tumour a. Acalculia
b. Birth injury b. Astereogenesis
c. Cerebellar atrophy c. Constructional apraxia
d. Myasthenia gravis d. Cortical blindness
e. Phenothiazine toxicity e. Visuospatial neglect
39. Regarding pseudotumours cerebri (benign hypercranial 47. A 17yearoldman has been diagnosed with schizophrenia 4
hypertension) which is true? weeks ago. He was started on haloperidol. Two weeks later
a. A mildly increased CSF cell count is typical. he was found confused and drowsy. On examination he was
b. May be caused by prolonged steriod therapy. pyrexial (40.7 C), rigid with blood pressure of 200/100. Which
MCQ's

of the following treatment will you initiate?

c. Is occasionally associated with focal neurological signs.
a. phenytoin
d. Frequently presents with ataxia.
b. diazepam
e. Is distinguished from hydrocephalus by the absence of
suture separation. c. cefuroxime
d. acyclovir
40. Which of the following associations is correct? e. dantrolene
a. Renal transplantation and NonHodgkin’s lymphoma
b. Hepatitis B and aplastic anaemia 48. A 50 yearold male epileptic presents with paraesthesia of
hands and feet. He also has unsteadiness when walking. On
c. Turner’s syndrome and acute myeloid leukaemia examination he has Dupytren’s contracture in his left hand, a
d. Basophilia and chronic myeloid leukaemia peripheral sensory neuropathy and palpable lymph nodes in
e. Crohn’s disease and TB his neck and axillae. Which of the following drugs is the most
likely cause of these features?
41. A demyelinating polyneuropathy is typically caused by: a. Carbamazepine.
a. Diabetes b. Clonazepam
b. Excessive alcohol c. Lamotrigine.
c. Hereditary motorsensory neuropathy d. Phenytoin.
d. Renal failure e. Sodium valproate.
e. Vitamin B12 deficiency
49. An 80yearold woman has a three month history of progressive
42. Causes of dilated pupils include: numbness and unsteadiness of her gait. On examination, there
a. Argyll Robertson pupil is a mild spastic paraparesis, with brisk knee reflexes, ankle
reflexes are present with reinforcement, extensor plantars,
b. Ethylene glycol poisoning sensory loss in the legs with a sensory level at T10, impaired
c. Myotonic dystrophy joint position sense in the toes, and loss of vibration sense
d. Organophosphate poisoning below the iliac crests.
e. Pontine haemorrhage Investigations were as follows:
43. Which ONE of the following would be expected in a third Haemoglobin 12.0 g/dl
nerve palsy?
a. Enophthalmos MCV 99 fl
b. Constricted pupil
What is the most likely diagnosis?
c. Convergent strabismus
a. anterior spinal artery occlusion
d. Increased lacrimation
b. dorsal meningioma
e. Unreactive pupil to light
c. multiple sclerosis
44. A 20yearold female presents with acute onset of left foot d. subacute combined degeneration of the cord
drop. Examination reveals weakness of ankle dorsiflexion and e. tabes dorsalis
eversion. There is a small area of sensory loss in the first web
space. Reflexes were all present and plantars flexor. Which of 50. A 16 year old girl presented with a three week history of
the following nerves is likely to be involved? headache and horizontal diplopia on far right lateral gaze.
a. Tibial nerve On two separate occasions she noted dimmed vision whilst
bending forwards. Over the last year she had gained 12
b. Common peroneal nerve
kilograms in weight. On examination, her weight was 95
c. Sciatic nerve kg, and height 162cms. Neurological examination revealed
d. Femoral nerve bilateral papilloedema and a partial right sixth cranial nerve
e. Inferior gluteal nerve palsy. What is the most likely diagnosis?
a. Benign intracranial hypertension.
45. Which of the following is a characteristic feature of transient b. Multiple sclerosis.
global amnesia?
c. Pituitary tumour
a. abnormal behaviour
d. Superior sagittal vein thrombosis.
b. apraxia
e. Thyroid eye disease.
51. Which of the following clinical manifestations suggests sodium 144 mmol/l 1253
Guillain Barré Syndrome?
potassium 3.9
a. Weakness beginning in the arms
b. Asymmetrical involvement of distal muscles urea 10.4
c. Bulbar involvement in about 50% of cases
creatinine 120
d. Brisk tendon reflexes
e. Normal CSF protein glucose 8

52. In herpes simplex encephalitis which of the following dip stick urine blood ++, protein +
statements is correct?
a. brain MRI is characteristically normal What is the most important immediate investigation?
b. temporal lobe involvement is common a. Chest Xray
c. fits are uncommon b. MSU

NEUROLOGY
d. cold sores or genital herpes are usually present c. prostate specific antigen
e. viral identification by PCR on cerebrospinal fluid is d. serum calcium
nonspecific e. serum protein electrophoresis

53. A 25 yearold lady recently diagnosed with rheumatoid 58. A 25yearold old woman presents with 2 hrs of a unilateral
arthritis. She has developed weakness, double vision and temporal headache increasing in severity. The Pain is of a
tiredness. Examination reveals bilateral weakness of eye throbbing character and is exacerbated by light. There are no
abduction, bilateral ptosis, slightly reduced proximal motor abnormal signs on examination. What is the diagnosis?
power in the limbs, normal reflexes and sensation. What is the a. Acute Subarachnoid haemorrhage.
diagnosis?
b. Cluster headache.
a. Chronic progressive external opthalmoplegia.
c. Intracranial Tumour.
b. GuillainBarre syndrome.
d. Migraine.
c. Multiple sclerosis.
e. Tension headaches.
d. Myasthenia gravis.
e. Polymyositis 59. 50yearold old man is admitted to hospital unconsious, and
smelling of alcohol. One hour after admission,he becomes
54. A 63 year old male is admitted with acute onset unsteadiness suddenly sweaty with a regular tachycardia of 110 bpm and a
of gait, dizziness and dysphagia. Examination revealed a BP of 100/50. What is thediagnosis?
rightsided Horner’s syndrome, nystagmus, loss of pain and a. Alcohol withdrawal.
temperature sensation on the left side of the trunk and in
b. Hepatic encephalopathy.
the left arm and leg, and gait ataxia. What is the most likely
diagnosis? c. Hypoglycaemia.
a. leaking posterior communicating artery aneurysm d. Subdural haematoma.
b. left sided acoustic neuroma e. Wernicke’s encephalopathy.
c. posterior inferior cerebellar artery occlusion
60. A 70yearold man presents with weight loss, lower limb
d. right sided pontine infarct weakness and dry mouth. He has been a heavy smoker. On
e. spontaneous left sided cerebellar haemorrhage examination, he looks cachectic; he has proximal lower limb
weakness, areflexia (reflexes normalise with repetitive muscle
55. Which of the following features are not compatible with the contraction). There is no wasting or fasciculations. Sensory
diagnosis of motor neuron disease? examination is normal. Which of the following blood test is
a. Dementia the most likely to confirm the diagnosis?
b. Dysphagia a. Acetylcholine receptors
c. Muscle cramps b. Voltage gated calcium channels antibodies
d. Neck weakness c. Anti GM1 antibody
e. Optic atrophy d. Antinuclear antibody
e. Anti Ro/La antibodies
56. A 35yearold man has wrist drop of his right hand. Examination
reveals a small area of sensory loss on the dorsum of the hand. 61. 54 year old female is admitted with progressive weakness
Which of the following nerves is likely to be involved? following a trivial flulike illness. Which of the following
a. Median nerve would exclude GuillainBarre Syndrome as the diagnosis?
b. Ulnar nerve a. Autonomic dysfunction
c. Long thoracic nerve b. Elevated protein on CSF examination
d. Radial nerve c. Evidence of muscle wasting
e. T1 nerve root d. Ophthalmoplegia
e. Sensory level below D1
57. A 92yearold man was admitted in a confused state. He has a
history of immobility due to severe lower back pain. He had 62. An 18 year old man presented with a history of a sudden onset
been losing weight for three months and had complains of of a frontal headache and photophobia. He had neck stiffness
weakness, urinary frequency, thirst, poor urinary stream and and a temperature of 38°C. Which one of the following findings
constipation. Lumbar spine Xrays show severe osteopenia and would suggest a diagnosis of subarachnoid haemorrhage
collapse of the body of the vertebra at L3. Investigations show: rather than bacterial meningitis?
a. a blood neutrophil leucocytosis
haemoglobin 9.6 g/dl
b. a family history of polycystic renal disease
 1254 c. a fluctuating conscious level b. A family history of major psychiatric illness
d. a history of diabetes mellitus c. Impaired short term memory
e. a history of opiate abuse d. No previous history of psychiatric illness
e. Clouding of conciousness
63. A 45yearold man has a history of progressive weakness for
5 weeks. He had particular difficulty getting out of the bath. 70. A 27 yearold male presents with 3 months of difficulty
On examination there was severe truncal and proximal limb walking. Examination reveals motor weakness of left leg
weakness, without wasting or fasciculation. Tendon reflexes, in a pyramidal distribution with increase in tone. Impaired
plantar and sensation were all normal. The vital capacity was pinprick sensation of right leg extending into the groin. What
1.8L. What is the most likely diagnosis? is the cause of these signs?
a. cervical myelitis a. A central cauda equina lesion.
b. GuillainBarre syndrome b. A cervical spinal cord lesion.
c. polio c. A foramen magnum lesion.
d. polymyositis d. A left sided thoracic spinal cord lesion.
e. syringiobulbia e. Bilateral cerebral hemisphere lesions.
MCQ's

64. Which is true regarding cerebral palsy? 71. Which of the following relate to Dopadecarboxylase
a. The incidence is 2 per 100 live births. inhibitors?
b. Visual impairement occurs in 50%. a. enhance the effect of levodopa on the substantia nigra
c. Hearing loss is present in 5%. b. reduce the extracerebral complications of Ldopa therapy
d. Epilepsy is present in 40%. c. have anticholinergic activity
e. Learning impairment is present in 30%. d. should not be given in combination with dopamine agonists
e. prevent Ldopa associated dyskinesias
65. A right carotid artery stenosis could not account for:
a. Contralateral hemiplegia 72. Which of the following associations of muscles and nerve
b. Contralateral hemisensory loss supply are NOT true:
c. Drop attacks a. Triceps and C7
d. Dysphasia b. Deltoid and C5
e. Right amaurosis fugax c. Gastroenemius and S1
d. Quadriceps and L3
66. Which of the following statements about the spinal cord is e. Long flexors of fingers and C6
true?
a. A lesion of the left side of the spinal cord at C5 causes 73. Which of the following would be expected following distal
pyramidal weakness of the right leg occlusion of the posterior cerebral artery?
b. Centrally placed spinal cord lesions affect joint position a. cerebellar ataxia
sense before other modalities of sensation b. contralateral hemiplegia
c. Conus medullaris lesions characteristically cause mixed c. dysarthria
upper and lower motor neurone signs in the legs
d. homonymous hemianopia
d. The spinal cord ends at the lower border of the L3 vertebra
e. palatal palsy
e. The spinothalamic tracts are supplied principally by the
anterior spinal artery 74. A young teenager presents with fever and headache. He has
received oral Amoxycillin for 3 days. Which of the following
67. A 50yearold man presented with 18 months history of CSF findings would exclude a partially treated meningitis?
parasthesiae of his feet and hands. On examination there is
a. Negative gram stain
numbness of glove and stocking distribution with generalised
hyporeflexia. Nerve conduction studiesrevealed demyelinative b. A CSF glucose of 45% of blood glucose
sensory polyneuropathy. Which of the following conditions is c. A white cell count of 50
the most likely diagnosis?
d. A negative CSF culture
a. Alcohol abuse
e. Negative Kernig’s Sign
b. Diabetes
c. Chronic inflammatory demyelinating polyneuropathy 75. A 52 year old man has a slurring of his speech. Examination
reveals bilateral partial ptosis and frontal balding, and
d. Vasculitis
difficulty releasing his grip after shaking hands. What is the
e. Vitamin B12 deficiency most likely diagnosis?
a. myasthenia gravis
68. Which of the following would be the result of a spinal lesion
at the level of C8? b. EatonLambert syndrome
a. a reduced brachioradialis reflex c. Myotonia dystrophica
b. inability to abduct the shoulder d. Duchenne muscular dystrophy
c. loss of sensation over the lateral aspect of the arm e. Myotonia congenita
d. winging of the scapula
76. A 43yearold woman develops a progressive, ascending motor
e. weakness of finger flexion weakness over several days. She is hospitalized and requires
intubation with mechanical ventilation. She is afebrile. A
69. Psychiatric illness rather than an organic brain disorder is lumbar puncture is performed with normal opening pressure
suggested by: and yields clear, colorless CSF with normal glucose, increased
a. Onset for the first time at the age of 55 years protein, and cell count of 5/microliter, all lymphocytes.
She gradually recovers over the next month. Which of the
 following conditions most likely preceded the onset of her d. occipital lobe 1255
illness? e. internal capsule
a. Ketoacidosis
83. A 21 year old man recovered from the immediate effects of a
b. Staphylococcus aureus septicemia
head injury sustained in a motor cycle accident three months
c. Systemic lupus erythematosus previously. Which one of the following is the most likely
d. Viral pneumonia delayed consequence of severe traumatic brain injury?
e. Vitamin B12 deficiency a. Episodic hypersomnia
b. Multiple obsessional symptoms
77. A 19yearold woman presents to the clinic having had 5
blackouts over the last year, all while she is standing up. She c. Outbursts of aggressive behaviour
gets warnings of blurred vision, nausea, feeling hot. She had d. Pathological jealousy
been witnessed twice to have jerking of all limbs while she e. Persistent anxiety
is unconscious. The attacks last 3060 seconds. She recovers
quickly after the attacks. She has never bitten her tongue or 84. A patient presented with a quadrantic hemianopia. Which

NEUROLOGY
sustained any injuries. Physical examination and an ECG of the following conditions is most likeley to cause such a
are normal. Her grandmother and sister suffer from epilepsy. presentation?
Which of the following investigations is the most appropriate?
a. a lesion of the occipital cortex
a. EEG
b. a lesion of the optic chiasma
b. 24 hour ECG recording
c. bilateral diabetic retinopathy
c. CT brain
d. chloroquine poisoning
d. ECHO
e. tobacco amblyopia
e. Tilt table test
85. A 22 year old female presents with a month history of episodic,
78. A 36 yearold man has a 3 month history of pain in feet and brief visual loss affecting the right eye. Over the last one year
lower legs. He was diagnosed as having diabetes at age 14 and she had gained a considerable amount of weight. Examination
treated with insulin. He is a cannabis smoker and drinks 30 reveals a BMI of 35, with bilateral optic disc swelling, worse
units of alcohol per week. On examination he has impaired on the right and small retinal haemorrhages on the right. What
pain and temperature sensation in feet and lower legs, normal is the most likely diagnosis?
joint position and vibration sense. His reflexes are normal.
a. benign intracranial hypertension
What is the diagnosis?
b. Craniopharyngioma
a. Alcoholic polyneuropathy.
c. Graves’ Ophthalmopathy
b. Chronic inflammatory demyelinating polyneuropathy
(CIDP) d. Optic neuritis
c. Diabetic polyneuropathy. e. sagittal sinus thrombosis
d. Syringomyelia. 86. Frontal lobe brain damage is associated with:
e. Vitamin B12 deficiency. a. astereognosis
79. A lesion of the parietal lobe causes: b. auditory agnosia
a. Bitemporal hemianopia c. dressing apraxia
b. Homonymous inferior quadrantanopia d. focal epileptic fits
c. Perseveration e. perseveration
d. Primitive reflexes 87. Chronic subdural haematoma in a 75yearold man is NOT
e. Wernike’s (receptive) aphasia associated with the presence of:
a. hemiparesis
80. The following are recognized features of Pancoast’s tumour
except: b. internuclear ophthalmoplegia
a. ipsilateral Horner’s syndrome c. impaired cognitive function
b. wasting of the dorsal interossei d. fluctuating level of consciousness
c. pain in the arm radiating to the fourth and fifth fingers e. bilateral papilloedema
d. erosion of the first rib 88. A broadbased ataxic gait occurs characteristically with:
e. weakness of abduction at the shoulder a. proximal myopathy
81. Causes of a small pupil include: b. basal ganglia lesion
a. Carbon Monoxide Poisoning c. rightsided cerebral infarction
b. Ethylene Glycol Poisoning d. phenytoin toxicity
c. Holme’s Adie pupil e. cerebellar vermis lesion
d. Pontine haemorrhage 89. Which ONE of the following is associated with Parkinsonian
e. Third Nerve Palsy features?
a. Chronic carbon dioxide retention
82. A 70yearold female patient presents with 2 months history
of apathy, withdrawal, urinary and faecal incontinence and b. Kernicterus
anosmia. The most likely anatomical site of the neurological c. Lead poisoning
lesion is at the: d. Mercury poisoning
a. frontal lobe e. Wilson’s disease
b. parietal lobe
c. temporal lobe 90. A 30yearold female presents to the eye clinic with an acute
 1256 history of pain and blurring in the right eye. Examination 95. A 60yearold woman presents with a 24 hours history of
reveals a visual acuity of 6/36 in the right eye but 6/6 in the headache and vomiting. She has been on steroids for temporal
left eye, a central scotoma in the right eye, with a right swollen arteritis for the last 3 years. Examination demonstrates pyrexia,
optic disc. What is the most likely diagnosis? neck stiffness, photophobia, dysarthria, nystagmus and ataxia.
a. Compression of the optic nerve CSF shows neutrophilic pleocytosis, low glucose, elevated
protein. What is the most likely diagnosis?
b. Cavernous sinus thrombosis
a. Carcinomatosis meningitis
c. Glaucoma
b. Cryptococcal meningitis
d. Optic neuritis
c. Listeria meningitis
e. Retinal vein occlusion
d. Meningococcal meningitis
91. A 47yearold man presents with memory impairment e. Tuberculus meningitis
worsening over 9 months. He has jerking movements of his
limbs and biphasic highamplitude sharp waves on EEG. 96. In which of the following is mental retardation an expected
Which diagnosis is most likely? finding?
a. Alzheimer’s disease a. Alkaptonuria
MCQ's

b. CreutzfeldJakob disease b. Cystinuria

c. Multiinfarct dementia c. Glycogen storage disease
d. Normal Pressure Hydrocephalus d. Lactose intolerance
e. Pick’s disease e. Maple syrup urine disease

92. A 72yearold woman has a five year history of worsening 97. Which of the following is correct regarding Herpes simplex
mental functioning with trouble remembering things. She has encephalitis?
no problems with movement. She is noted on an MRI scan of a. shows a peak incidence in the Autumn
the brain to have symmetrically increased size of the lateral
ventricles along with cerebral cortical atrophy in a mainly b. is associated with a polymorphonuclear pleocytosis in the
frontal and parietal distribution. A lumbar puncture reveals a CSF
normal opening pressure, and analysis of the clear, colorless c. produces a diffuse, evenly distributed inflammation of
cerebrospinal fluid reveals a glucose and protein which cerebral tissues
are in normal ranges. Cell count on the CSF shows 3 WBCs d. produces a typical EEG pattern with lateralised periodic
(all lymphocytes) and 1 RBC. A fundoscopic examination discharges at 2 Hz
is normal. Which of the following findings is most likely
e. should be treated with acyclovir as soon as the diagnosis is
associated with her underlying disease process?
confirmed by urgent CSF viral antibody titres
a. Increased numbers of Lewy bodies
b. Loss of Betz cells 98. A 73yearold man presents with an abrupt onset of double
vision and left leg weakness. Examination shows weakness
c. Loss of gamma aminobutyric acid (GABA)
of abduction of the right eye, rightsided facial weakness
d. Perivascular mononuclear inflammation affecting upper and lower parts of the face. He also has a left
e. Presence of the e4 allele of apolipoprotein E hemiparesis. Where is the lesion?
a. left frontal lobe
93. A 60yearold man was brought to casualty after a fall in his
bathroom. Seen immediately by his family, he was already b. left lateral medulla
picking himself up from the floor and said he was not c. right corpus striatum
injured. His wife felt that he was transiently dazed. On d. right midbrain
examination, he was alert, and no abnormalities were noted.
e. right pons
His past medical history included a history of hypertension
for which he was taking bendrofluazide 2.5 mg daily. He was 99. Which of the following statements regarding hiccup is true?
discharged without any further intervention. Two weeks later
his wife brings the patient to see you because the dazed state a. Is caused by a tonic relaxation of the diaphragm.
has returned. Examination reveals a temperature of 36.7C, a b. May be caused by local irritation to the vagus nerve.
pulse rate of 84 bpm regular, a blood pressure of 152/94 mm c. Can reliably be treated with theophylline.
Hg. On questioning he is slightly slowed, being disoriented
d. May be caused by a posterior fossa tumour.
to time with some deficit in recent memory. The patient moves
slowly, but power is normal. Neurologic examination shows e. May be caused by a foreign body in the nose.
slight hyperactivity of the tendon reflexes on the right with
unclear plantar responses because of bilateral withdrawal. 100. In considering the management of convulsions select the
Which of the following would you request? correct statement from the list below.
a. 24hour ambulatory electrocardiogram a. If the fit lasts longer than 5 minutes, then PR diazepam
should be given.
b. CSF analysis
b. Phenobarbitone is a useful therapy in school age children.
c. CT of the head
c. Paraldehyde is best given intramuscularly.
d. Electromyography and nerve conduction testing
d. Hypoglycaemia should always be considered.
e. EEG
e. When associated with fever, antibiotics should always be
94. Which of the following forms of encephalitis is caused by a given to cover the possibility of meningitis.
neuroimmunological response?
101. The action of noradrenaline released at sympathetic nerve
a. Herpes simplex
endings is terminated by
b. Measles
a. enzymatic decarboxylation
c. HIV infection
b. enzymatic inactivation by catecholOmethyl transferase
d. Enteral viruses
c. reuptake of noradrenaline by the axonal terminals
e. Cytomegalovirus
 d. oxidative deamination by monoamine oxidase a. Optic neuritis 1257
e. Removal by the circulating blood b. Nonarteritic ischaemic optic neuropathy
c. Arteritic ischaemic optic neuropathy
102. A 65 yearold woman with 12 hour history of unsteady gait,
sudden onset associated with vomiting and headache. d. Acute angleclosure glaucoma
Following this she had increasing drowsiness. What is the e. Compressive optic neuropathy
diagnosis?
108. A 67yearold man has drunk 8 units of alcohol a day for most
a. Acute subdural haemorrhage
of his adult life. He has worsening symptoms of poor memory,
b. Cerebellar haemorrhage. a widebased gait and urinary incontinence for ten months.
c. Frontal subdural empyema What is the most likely diagnosis?
d. Herpes simplex encephalitis. a. HIV encephalitis
e. Pituitary apoplexy. b. meningovascular syphilis
c. normal pressure hydrocephalus
103. A 18yearold female presents with a 3 days history of progressive

NEUROLOGY
weakness and numbness of her legs, urinary retention and d. syringomyelia
back pain 2 weeks following an upper respiratory infection. e. WernickeKorsakoff syndrome
On examination there is spastic paraparesis, sensory level up
to T5, extensor plantars. Examination of cranial nerves and 109. A 40 year old male is diagnosed with Dystrophia myotonica.
upper limbs is normal. MRI of the spine is normal. The most Which one of the following features would be expected in this
likely diagnosis is: patient?
a. Multiple sclerosis a. Autosomal recessive inheritance
b. Anterior spinal artery occlusion b. Cataracts
c. Postinfectious transverse myelitis c. Fasiculations would predominate
d. Thoracic disc prolapse d. Progressive external ophthalmoplegia
e. Guillain Barre syndrome e. Preserved tendon reflexes despite muscle wasting

104. A 40yearold man with a long history of alcohol abuse is 110. A 40yearold man presents with 2 years history of intermittent
admitted with a subacute illness, comprising headache, strictly unilateral headaches. The pain is excruciating severe.
fever, meningism and ataxia. MRI brain showed patchy high It is located around the orbital region. The headache usually
signal abnormality of the brain stem. CSF analysis showed lasts 4560 minutes. It usually appears early hours in the
polymphonuclear pleocytosis and low glucose. He had failed morning. There is associated ptosis and lacrimation on the
to improve after 3 days of intravenous cefotaxime treatment. side of the headache. The most likely diagnosis is:
The most likely diagnosis of the meningitis is: a. Cluster headaches
a. Mycobacterium tuberculosis b. Migraine
b. Cryptococcus neoformans c. Tension type headache
c. Nocardia asteroides d. Giant cell arteritis
d. Staphyloccus aureus e. Trigeminal neuralgia
e. Listeria monocytogenes
111. A 50 year old female presents with a 4 month history of
105. A 27yearold man presents with a two years history of progressive distal sensory loss and weakness. On examination
intermittent tingling sensation involving his left side. It starts positive neurological findings include moderate proximal and
in his fingers and spreads in 1020 seconds to affect the whole distal weakness of arms and legs, glove and stocking sensory
arm and leg on the same side. The attacks only last for one loss and areflexia. Planter responses were mute. The following
minute. The most likely diagnosis is: conditions could give a similar picture:
a. Migraine with aura a. GuillianBarre syndrome
b. Transient ischaemic attacks b. Chronic inflammatory demyelinating neuropathy(CIDP)
c. Somatosensory seizures c. Cervical spondylosis
d. Hyperventilation d. Hereditary motor and sensory neuropathy(HMSN)
e. Multiple sclerosis e. Myasthenia Gravis

106. A 24yearold man presents with a headache that has been 112. Which one of the following would support a diagnosis of
present for nine months. He has headache almost every day, subacute combined degeneration of the cord rather than
mainly frontal, sometimes with nausea. Current medication multiple sclerosis?
includes paracetamol, brufen and codeine with only a. absent ankle jerks
transient relief of symptoms. He has a history of depression.
b. autonomic symptoms
Examination was normal. What is the most likely diagnosis?
c. cerebellar signs
a. analgesic misuse headache
d. extensor plantars
b. cluster headache
e. visual problems
c. frontal brain tumour
d. headache due to depression 113. A 65yearold woman has a one month history of malaise, weight
e. migraine loss, right sided pain around the eye and headaches. She has
also noticed intermittent diplopia. Five years previously she
107. A 60yearold man awakens with painless loss of vision of his had a mastectomy for carcinoma of the breast. On examination,
left eye. Three years earlier he had suffered a similar episode temperature was 37.5°C, there was tenderness of the scalp on
involving the right eye. Visual loss in that eye has been the right forehead and temple, and some minor weakness of
stationary. He does not complain of any systemic symptoms. abduction of the right eye. ESR 55 mm/hour. What is the most
What is the most likely diagnosis? likely diagnosis?
 1258 a. thyroid eye disease of Diabetes Mellitus. Examination reveals a central scotoma.
b. frontal sinusitis What is the diagnosis?
c. giant cell arteritis a. Central retinal artery occlusion.
d. meningeal metastastatic disease b. Diabetic retinopathy.
e. posterior communicating artery aneurysm c. Optic neuritis.
d. Pituitary tumour.
114. A sixty year old male presents with a six month history e. Migraine.
of a gradually increasing burning sensation in his feet.
Examination revealed normal cranial nerves and higher 121. A 72yearold lady has 4 months of memory loss, urinary
mental function. Normal bulk, tone, power, light touch and incontinence and falls. On examination she has mild memory
pinprick sensation, coordination and reflexes in upper and loss and a broadbased, slow gait. Muscle tone is normal
lower limbs. The clinical findings are consistent with and both plantar reflexes are downgoing. What is the likely
a. Large fibre sensory neuropathy diagnosis?
b. Small fibre sensory neuropathy a. Alzheimer’s disease
c. Diabetic Amyotrophy b. Frontal lobe dementia
MCQ's

d. Motor neurone disease c. Mulitinfarct dementia

e. Sjogrens syndrome d. Normalpressure hydrocephalus
e. Parkinson’s disease
115. Which of the following anatomical considerations is correct:
a. optic chiasm lesions characteristically produce a bitemporal 122. Baclofen
hemianopia a. acts directly on skeletal muscle
b. central scotoma occurs early in papilloedema b. causes rhabdomyolysis
c. in cortical blindness pupillary reactions are abnormal c. reduces cerebral but not spinal spasticity
d. optic tract lesions produce an ipsilateral homonymous d. cause hallucinations when withdrawn
hemianopia
e. reduce Ca2+ release from sarcoplasmic reticulum
e. opticokinetic nystagmus is found with bilateral infarction of
the parietooccipital lobes 123. A 26yearold previously healthy woman has the sudden onset
of mental confusion. She has a seizure and is brought to the
116. A 62 year old male is noted to have a broadbased ataxic gait. hospital. Her vital signs show blood pressure 100/60 mm Hg,
This is characteristic of which of the following? temperature 37 C., pulse 89, and respirations 22. A lumbar
a. A basal ganglia lesion puncture reveals a normal opening pressure, and clear,
b. Cerebellar vermis lesion colorless cerebrospinal fluid is obtained with 1 RBC and 20
WBC’s (all lymphocytes), with normal glucose and protein.
c. Osteomalacia An MRI scan reveals swelling of the right temporal lobe with
d. phenytoin toxicity hemorrhagic areas. Which of the following infectious agents
e. Rightsided cerebral infarction is the most likely cause for these findings?
a. Haemophilus influenzae
117. A lesion of the facial nerve in the internal auditory meatus
b. Herpes simplex virus
will NOT affect
c. Influenza virus
a. taste
d. Mycobacterium tuberculosis
b. sweating over the cheek
e. Neisseria meningitidis
c. lacrimation
d. hearing 124. Which of the following statements regarding central pontine
e. blinking myelinolysis is correct?
a. Consciousness is preserved characteristically.
118. Which of the following is a form of generalised seizure?
b. MR imaging shows diagnostic features in the majority of
a. Aversive seizures patients.
b. Epilepsia partialis continua c. The cause has been linked to overrapid correction of
c. Automatisms hyponatraemic states.
d. Lennox Gastaut Syndrome d. The condition is confined to malnourished alcoholic
e. Benign rolandic epilepsy patients.
e. The pathological changes are confined to the pons.
119. A 21yearold female presented with a sudden onset of left sided
head and neck pain. 24 hours later she presents with sudden 125. A 48 year old man presented with a two week history of
onset of right hemiparesis, facial weakness and homonymous recurrent severe rightsided. Periorbital headache, frequently
hemianopia and left horner’s syndrome. A CT brain showed a nocturnal and occurring at least once daily, usually lasting
left middle cerebral artery territory infarction. The most likely an hour. He had noticed lacrimation from the right eye and
diagnosis is: blockage of the right nostril during the headache. At the time
a. Cardiac embolism of the examination he was free from headache and there were
no abnormal physical signs. Which of the following is the
b. Migraine most likely diagnosis?
c. Left Carotid artery dissection a. cluster headache
d. Antiphospholipid syndrome b. intracranial aneurysm
e. Systemic vasculitis c. orbital pseudotumour
120. A 25 yearold man presents with 24 hours blurred vision in d. right maxillary sinusitis
left eye and mild frontal headache. He has a 10 year history e. trigeminal neuralgia
126. Which of the following is a true of myasthenia gravis? 132. Which of the following may cause a downbeat nystagmus? 1259
a. there is a strong association with antinoradrenergic receptor a. Chiari type I malformation
antibodies b. Unilateral medial longitudinal fasciculus lesion
b. neurotransmitter released at the motor end plate is greatly c. Central cerebellar lesion
reduced
d. Wernicke’s encephalopathy
c. repetitive stimulation of a motor nerve produces a reduction
e. Aqueduct stenosis
in the amplitude of the 5th response compared with the 1st
in 98% of cases (electrodecremental test)
133. A 35 year old female presents with headaches. Examination
d. electrical recordings of single motor unit activity commonly reveals papilloedema. Which of the following would make
reveal variation in the latency of the various mucle fibre the diagnosis of benign intracranial hypertension unlikely?
responses (jitter)
a. Absence of retinal venous pulsations
e. subjective improvement in muscle strength following
b. Bilateral upgoing plantar responses
edrophonium is diagnostic of the condition
c. Normal ventricles on CT or MRI scan

NEUROLOGY
127. A 55yearold man has progressive weakness of his hands d. Reduced visual acuity
over a period of 1 year. Examination reveals wasting of the
e. VIth cranial nerve palsy
muscles of the hands and forearms and fasciculation. There
is hyperreflexia of his lower limbs and upgoing plantars. 134. A teenage girl presents with GuillainBarre syndrome. Her
Sensation is normal. Which of the following is the most likely weakness continues to worsen after admission to hospital.
diagnosis? Which of the following should be used to monitor her?
a. Alzheimer’s disease a. arterial blood gases
b. Motor Neurone Disease b. chest expansion size
c. Multiple Cerebral Infarcts c. FEV1/FVC ratio
d. Multiple Sclerosis d. PEFR
e. Syringolmyelia e. vital capacity
128. A 25yearold female presented with 6 months history of 135. A 60 year old man has Parkinson’s disease. He is started on
depression, irritability and painful sensory symptoms in her treatment with Ldopa and dopa decarboxylase inhibitor
legs. Over the last 4 weeks she presents a broad base ataxic therapy. However he continues to have troublesome tremor.
gait. An MRI brain showed bilateral posterior thalamic nuclei Which of the following drugs would be most likely to help?
(pulvinar region) high signals. The most likely diagnosis is:
a. Amantadine.
a. Sporadic CJD
b. Benzexol.
b. New variant CJD
c. Propranolol
c. Wilson disease
d. Ropinirole
d. Multiple system atrophy
e. Selegiline
e. Herpes simplex encephalitis
136. Which of the following would be expected features of a LEFT
129. A 70yearold woman presented with episodic impairment Posterior cerebral artery occlusion :
of consciousness. Which of the following is the most likely
cause? a. a right homonymous hemianopia
a. Alzheimer type dementia b. internuclear ophthalmoplegia
b. chronic subdural haematoma c. Wernicke’s aphasia
c. CreutzfeldtJacob disease d. pure aphasia (i.e. without alexia)
d. depressive stupor e. decerebrate state
e. normal pressure hydrocephalus 137. A 70yearold woman has a history of dyspnoea and palpitations
for six months. An ECG at that time showed atrial fibrillation.
130. A lesion of the Frontal lobe causes: She was given digoxin, diuretics and aspirin. She now
a. Apraxia presents with two shortlived episodes of altered sensation in
b. Broca’s (expressive) aphasia the left face, left arm and leg. There is poor coordination of the
left hand. ECHO was normal as was a CT head scan. What is
c. Cortical blindness
the most appropriate next step in management?
d. Homonymous hemianopia
a. anticoagulation
e. Visuospatial neglect
b. carotid endarterectomy
131. A 65yearold man has a monotonous, slurred speech. He c. clopidogrel
has an expressionless face and a festinant gait. There is d. corticosteroid treatment
also impairment of vertical gaze. What is the most likely
e. no action
underlying aetiology?
a. ShyDrager syndrome 138. A patient presented with a quadrantic hemianopia. Which
b. idiopathic of the following conditions is most likeley to cause such a
presentation?
c. cerebrovascular disease
a. a lesion of the occipital cortex
d. Wilson’s disease
b. a lesion of the optic chiasma
e. SteeleRichardsonOlszewski syndrome
c. bilateral diabetic retinopathy
d. chloroquine poisoning
e. tobacco amblyopia
 1260 139. A 57yearold man develops deep venous thrombosis during 145. Which of the following clinical manifestations suggests
a hospitalization for prostatectomy. He exhibits decreased Guillain Barré Syndrome?
mental status with right hemiplegia, and a CT scan of the a. Weakness beginning in the arms
head suggests an acute cerebral infarction in the distribution
b. Asymmetrical involvement of distal muscles
of the left middle cerebral artery. A chest Xray reveals cardiac
enlargement and prominence of the main pulmonary arteries c. Bulbar involvement in about 50% of cases
that suggests pulmonary hypertension. His serum troponin I d. Brisk tendon reflexes
is <0.4 ng/mL. Which of the following lesions is most likely to
e. Normal CSF protein
be present on echocardiography?
a. Coarctation of the aorta 146. A complete unilateral facial hemiparesis may be caused by
b. Dextrocardia which of the following?
c. Pulmonary stenosis a. An intracranial tumour
d. Tetralogy of Fallot b. Birth injury
e. Ventricular septal defect c. Cerebellar atrophy
d. Myasthenia gravis
MCQ's

140. A 55yearold woman has had worsening shortness of breath

e. Phenothiazine toxicity
for several years. She now has to sleep sitting up on two
pillows. She has difficulty swallowing. There is no history 147. A 65yearold male presents with bilateral leg pain. There is
of chest pain. She is afebrile. Recently, she suffered a stroke no relevant past medical history, and no excess alcohol use.
with left hemiparesis. A chest Xray reveals a nearnormal left Both knee reflexes are reduced. Fasting glucose is 6.5 mmol/L.
ventricular size with a prominent left atrial border. Which of Which is the next most likely investigation to confirm the
the following conditions is most likely to account for these diagnosis?
findings?
a. B12 and folate
a. Aortic coarctation
b. Chest Xray
b. Cardiomyopathy
c. CSF examination
c. Essential hypertension
d. MRI spine
d. Left renal artery stenosis
e. Oral glucose tolerance test
e. Mitral valve stenosis
148. A 45yearold man presents with headaches and low libido. He
141. A 63 year old male is admitted with acute onset unsteadiness is found to be hypopituitary. The CT scan shows a pituitary
of gait, dizziness and dysphagia. Examination revealed a tumour with suprasellar extension. Which of the following
rightsided Horner’s syndrome, nystagmus, loss of pain and structures is likely to be compressed?
temperature sensation on the left side of the trunk and in
the left arm and leg, and gait ataxia. What is the most likely a. Abducens nerve
diagnosis? b. Hypothalamus
a. leaking posterior communicating artery aneurysm c. Occulomotor nerve
b. left sided acoustic neuroma d. 3rd Ventricle
c. posterior inferior cerebellar artery occlusion e. Optic nerve
d. right sided pontine infarct
149. A 66-year-old woman complains of stiffness and weakness
e. spontaneous left sided cerebellar haemorrhage climbing stairs. She has a history of hypertension and diet-
controlled type 2 diabetes. On examination, there is mild
142. Which of the following would be expected following distal upper arm weakness, hip flexion is 4−/5 bilaterally, with
occlusion of the posterior cerebral artery? bilateral wasting and flickers of fasciculations in the right
a. cerebellar ataxia quadriceps. Knee extension is 4/5. Dorsiflexion and plantar
b. contralateral hemiplegia flexion are strong. Brisk knee and ankle reflexes are elicited,
as well as a positive Hoffman’s and Babinski’s sign. Sensory
c. dysarthria
examination and cranial nerves are normal. Her BM is 8.9, her
d. homonymous hemianopia pulse is regular and her blood pressure is 178/97. What is the
e. palatal palsy most likely diagnosis?
a. Myasthenia gravis
143. Which of the following would be expected features of a LEFT
b. Diabetic neuropathy
Posterior cerebral artery occlusion :
c. Myositis
a. a right homonymous hemianopia
d. Motor neurone disease
b. internuclear ophthalmoplegia
e. Multiple sclerosis (MS)
c. Wernicke’s aphasia
d. pure aphasia (i.e. without alexia) 150. A 23-year-old man is stabbed in the neck. Once stabilized, his
e. decerebrate state MRI shows a right hemisection of the cord at C6. What is the
expected result of this injury?
144. Regarding pseudotumours cerebri (benign hypercranial a. Paralysed diaphragm
hypertension) which is true?
b. Absent sensation to temperature in the left hand
a. A mildly increased CSF cell count is typical.
c. Paralysis of the left hand
b. May be caused by prolonged steriod therapy.
d. Absent sensation to light touch in the left hand
c. Is occasionally associated with focal neurological signs.
e. Brisk right biceps reflex
d. Frequently presents with ataxia.
e. Is distinguished from hydrocephalus by the absence of 151. A 23-year-old woman complains that her right leg has become
suture separation. progressively stiff and clumsy over the last couple of weeks.
She is worried as she has not been able to go to work for the
 last 4 days. On examination, tone is increased and there is a the floor and his arms and legs jerked. After waking, he was 1261
catch at the knee. She has six beats of clonus and an upgoing shaken but was ‘back to normal’ a few minutes after the event.
plantar. Power is reduced to 3-4/5 in the right leg flexors. There His medication includes aspirin, atenolol and frusemide.
is no sensory involvement and the rest of the neurological What is the most likely diagnosis?
exam is normal other than a pale disc on opthalmoscopy. On a. Vasovagal syncope
further questioning, she admits that she has had two episodes
of blurred vision in her right eye in the last two years. Each b. Orthostatic hypotension
lasted a couple of weeks from which she fully recovered. What c. Cardiogenic syncope
is the most appropriate initial treatment? d. Transient ischaemic attack (TIA)
a. A non-steroidal anti-inflammatory drug (NSAID) e. Seizure
b. Interferon-beta
157. A 41-year-old man complains of terrible headache. It started
c. Bed rest
an hour ago, without warning, while stressed at work. It affects
d. Methotrexate the right side of his head. He scores it ‘11/10’ in severity. When
e. A course of oral steroids asked, he agrees that light does bother him a little. He had

NEUROLOGY
a similar episode six months ago, experiencing very similar
152. A 78 year old right-handed male collapses and is brought into headaches over 2 weeks which resolved spontaneously. On
accident and emergency. He seems to follow clear one-step observation, he looks quite distressed and prefers to pace up
commands but he gets very frustrated as he cannot answer and down, unable to sit still. What is the diagnosis?
questions. He is unable to lift his right hand or leg. He has a. Subarachnoid haemorrhage
an irregularly irregular pulse and his blood pressure is 149/87.
He takes only aspirin and frusemide. What is the most likely b. Tension headache
diagnosis? c. Intracerebralhaemorrhage
a. Left cortical infarct d. Migraine
b. Right internal capsule infarct e. Cluster headache
c. Left cortical haemorrhage
158. A 49-year-old man complains of sudden onset, painless
d. Left internal capsule haemorrhage unilateral visual loss lasting about a minute. He describes
e. Brainstem haemorrhage ‘a black curtain coming down’. His blood pressure is 158/90,
heart rate 73 bpm. There is an audible bruit on auscultation of
153. A 19-year-old woman collapses at a concert and is witnessed his neck. His past medical history is insignificant other than
to have a tonic-clonic seizure lasting 2 minutes. When the deep vein thrombosis of his right leg ten years ago. The most
paramedics arrive and ask her questions, she mumbles but likely diagnosis is:
no-one can understand what she is saying. Only when the a. Retinal vein thrombosis
paramedic applies pressure to her nailbed does she open her
eyes and reach out with her other hand to rub her nail and b. Retinal artery occlusion
then push him away. What is her Glasgow Coma Scale (GCS)? c. Amaurosisfugax
a. 12 d. Optic neuritis
b. 11 e. Acute angle glaucoma
c. 10
159. A 77-year-old woman is admitted to hospital with a urinary
d. 9 tract infection. She receives antibiotics and seems to be
e. 8 responding well. On the fourth day she is eating her lunch
when she suddenly drops her fork. She calls for the nurse who
154. A 79-year-old man is admitted with left hemiparesis. CT notices the left side of her face is drooping. What is the best
reveals a middle cerebral artery infarct. What is his most next course of action?
significant risk factor for stroke? a. CT head
a. Hypertension b. Thrombolysis
b. Smoking c. MRI head
c. Family history d. Aspirin
d. Diabetes e. Place nil by mouth
e. Cholesterol
160. A 71-year-old right-handed male is brought in by ambulance
155. A 42-year-old woman presents with ataxia. Gadolinium- at 17:50 having suffered a collapse. His wife came home to
enhanced MRI reveals multiple subcortical white matter find him on the floor unable to move his right arm or leg and
lesions as well as enhancing lesions in the cerrebellum and unable to speak. Her call to the ambulance was logged at 17:30.
spinal cord. She is diagnosed with MS. Two months later He has a past medical history of well-controlled hypertension,
she develops optic neuritis. What feature is associated with a ischaemic heart disease and atrial fibrillation for which he is
milder disease course? on warfarin. He had a hernia repair three months ago and his
a. Her age of 42 brother had a ‘bleed in the brain’ at the age of 67. What is the
absolute contraindication to thrombolysis in this male?
b. Her initial presentation of ataxia
a. Family history of haemorrhagic stroke
c. Her female gender
b. History of recent surgery
d. The interval between the two episodes of two months
c. Time of onset
e. Her MRI scan appearance
d. Current haemorrhagic stroke
156. A 71-year-old man with atrial fibrillation is seen in clinic e. Warfarin treatment
following an episode of syncope. He describes getting a poor
night’s sleep and, as he got out of bed in the morning, feeling 161. A 69-year-old man presents to clinic with a six-month history
dizzy for a couple of seconds before the lights dimmed around of progressive lower back pain which radiates down to his
him. He was woken a couple of seconds later by his wife who buttock. He found the pain was exacerbated while taking his
had witnessed the event. She says he went pale and fell to daily morning walk and noticed that it eased going uphill but
 1262 worsened downhill. He stopped his daily walks as a result but she has not stopped fitting. What is the most appropriate
and he now walks only slowly to the shops when he needs to, management?
taking breaks to sit down and ease the pain. He has a history a. Lorazepam
of hypertension, diabetes and prostatic hyperplasia. What is
the diagnosis? b. Phenobarbital

a. Peripheral vascular disease c. Intubation

b. Osteoporotic fracture d. Call ITU

c. Spinal stenosis e. Phenytoin loading

d. Sciatica 166. A 72-year-old man with known epilepsy and hypertension

e. Metastatic bone disease is admitted with pneumonia. His drug history includes
aspirin, phenytoin, bendroflumethiazide and amlodipine. His
162. A 31-year-old woman presents to accident and emergency heart rate is 67, blood pressure 170/93, sats 96 per cent on 2
with progressive difficulty walking associated with lower L of oxygen. Neurological examination is normal. His doctor
back pain. A few days ago she was tripping over things, now requests blood tests including phenytoin level. What is the
she has difficulty climbing stairs. She describes tingling and correct indication for this test?
MCQ's

numbness in both hands which moved up to her elbows, she a. Routine check
is unable to write. On examination, cranial nerves are intact
but there is absent sensation to vibration and pin prick in her b. Ensure levels are not toxic
upper limbs to the elbow and lower limbs to the hip. Power c. Confirm patient compliance
is 3/5 in the ankles and 4−/5 at the hip with absent reflexes d. Ensure therapeutic level reached
and mute plantars. Her blood pressure is 124/85, pulse 68 and
e. Reassure the patient
sats 98 per cent on air. She has a past medical history of type
I diabetes and recently recovered from an episode of food 167. A 23-year-old woman is seen in clinic for recurrent funny
poisoning a month or two ago. What is the diagnosis? turns. She is not aware of them, but her family and friends
a. MS have noticed them. They say she looks around blankly, then
b. Guillain–Barré syndrome (GBS) starts picking at her clothes and sometimes yawns, then she
comes back after a minute. She can get drowsy after these
c. Myasthenia gravis
episodes. What seizure type does this patient describe?
d. Diabetic neuropathy
a. Absence
e. Infective neuropathy
b. Tonic clonic
163. A left-handed 79-year-old man presents with a troublesome c. Simple partial
resting tremor of his left hand. The tremor is evident in his d. Complex partial
writing. He has also noticed his writing is smaller than it used
e. Generalized
to be. He complains he has difficulty turning in bed to get
comfortable and his wife complains that he sometimes kicks 168. You are asked to perform a lower limb peripheral neurological
her in the middle of the night. When he gets out of bed in the examination ona 45-year-old diabetic male. The patient has
morning he feels a little woozy, but this resolves after a while. normal tone, 5/5 power, normalplantars and proprioception.
On examination, he blinks about three times a minute and his However, you notice that the patient does not respondto any
face does not show much emotion. Glabelar tap is positive. He sensory stimulus on the medial side of the right lower leg.
has a slow, shuffling gait. He has difficulty stopping, starting Which dermatomeis affected?
and turning. He holds his feet slightly apart to steady himself.
When you pull him backwards, he is unable to right himself a. L1
and stumbles back. Which of the signs and symptoms is not b. L2
commonly associated with parkinsonism? c. L3
a. Postural instability d. L4
b. Rapid eye movement (REM) sleep disturbance e. L5
c. Hypomimia
169. On examination, a patient has 5/5 power in all muscle groups
d. Broad-based gait
of his upper limbs, 0/5 power in all the muscle groups of his
e. Autonomic instability lower limbs. Cranial nerves are intact. Where is the lesion?
164. A 33-year-old woman attends her six-month follow-up a. Muscle
appointment for headache. They are migrainous in nature b. Neuromuscular junction
but whereas she used to have them every few months, over c. Peripheral nerves
the last three months she has experienced a chronic daily
d. Spinal cord
headache which varies in location and can be anywhere from
3–7/10 severity. Her last migraine with aura was two months e. Brain
ago. She takes co-codamolqds and ibuprofen tds. What is the
best medical management? 170. On examination, a patient has 5/5 power in his upper limbs,
0/5 power in his lowerlimbs. Further examination reveals a
a. Stop all medication
sensory level at the umbilicus. Cranial nervesare intact. Where
b. Start paracetamol is the lesion?
c. Start sumatriptan a. C4
d. Start propranolol b. T4
e. Continue current medication c. T10
d. L1
165. A 17-year-old girl is brought into accident and emergency with
generalized tonicclonic seizure. Her mother had found her e. L
fitting in her bedroom about 20 minutes ago. The ambulance
crew handover state that her sats are 96 per cent on 15 L of 171. A patient is unable to move his right arm or leg. When asked
oxygen and they have given her two doses of rectal diazepam to smile, the left sideof his mouth droops. Where is the lesion?
 a. Left motor cortex a. Chvostek’s 1263
b. Right motor cortex b. Glabellar
c. Left brainstem c. Hoffman’s
d. Right brainstem d. Tinel’s
e. Cervical spine e. Babinksi’s

172. A light is shone into a patient’s right eye and it constricts. 178. A 69-year-old man is taken to his GP by his concerned wife.
When moved to the lefteye, the left eye constricts. When She complains that hehas not been himself for the last year.
moved back to the right eye, the right eye dilates. What is the He has slowly become withdrawn and stoppedworking
diagnosis? on his hobbies. Now she is concerned that he often forgets
a. Afferent lesion to brush histeeth. She has noticed he sometimes struggles
to find the right word and this has gradually become more
b. Efferent lesion noticeable over the last couple of months. She presentedtoday
c. Relative afferent lesion because she was surprised to come home to find him naked
and urinating inthe living room last week. He has a history of

NEUROLOGY
d. Relative efferent lesion
hypertension and is an ex-smoker. The most likely diagnosis
e. Normal
is:
173. A 55-year-old woman complains of double vision. She finds a. Depression
that she is more tiredthan usual and has difficulty climbing b. Frontotemporal dementia
stairs, especially when they are very long.She has difficulty
c. Alzheimer’s disease
getting items off high shelves at work and lately even
brushingher hair is a problem. During the consultation, her d. Vascular dementia
voice fades away duringconversation. Reflexes are present and e. Lewy Body disease
equal throughout. Which sign or symptomis most indicative
of myasthenia gravis? 179. Which of the following is not a cause of absent ankle jerks and
a. Proximal weakness up-going plantars?
b. Normal reflexes a. Freidreich’s ataxia
c. Diplopia b. B12 deficiency
d. Fatigability c. MS
e. Bulbar symptoms d. Cord compression
e. Motor neurone disease
174. A 55-year-old woman complains of double vision. She finds
that she is tired all thetime and has difficulty climbing stairs. 180. A patient has difficulty walking. His gait is unsteady. He
She has difficulty getting items off highshelves at work. seems to have difficultyraising his right leg and swings it
Reflexes are absent but elicited after exercise. Shoulder round in an arc as he walks. He holds his rightarm and wrist
abductionis initially 4−5 but on repeated testing is 4-5. What flexed. What type of gait does this patient exhibit?
pathology is associated with this female’s diagnosis? a. Hemiplegic
a. Thyrotoxicosis b. Scissoring
b. Peptic ulcer c. High stepping
c. Diabetes d. Spastic
d. Stroke e. Stomping
e. Lung cancer
181. A patient is admitted with a stroke. On examination of her
175. On observation, a patient has a left facial droop. On closer visual fields, she isunable to see in the right lower quadrant of
examination hisnasolabial fold is flattened. When asked to her field. Where is the lesion?
smile, the left corner of his mouthdroops. He is unable to a. Optic chiasm
keep his cheeks puffed out. Eye closure is only slightlyweaker
b. Left parietal lobe
compared to the right and his forehead wrinkles when he is
asked to lookup high. What is the diagnosis? c. Right temporal lobe
a. Right middle cerebral artery stroke d. Right optic radiation
b. Parotid gland tumour e. Left optic nerve
c. Left internal capsule stroke
182. A 43-year-old woman presents with dizziness to accident and
d. Bell’s palsy emergency. It startedsuddenly this morning, she awoke with
e. Cerebellar pontine angle tumour a headache and the dizziness started whenshe sat up in bed.
She describes the room spinning for a couple of minutes. It
176. A female presents with diplopia. On closer examination, settlesif she keeps still, but returns on movement. There is no
when asked to look right,her left eye stays in the midline tinnitus or deafness, but some nausea and no vomiting. The
but her right eye moves right and starts jerking. What is the most likely diagnosis is:
diagnosis? a. Brainstem stroke
a. Myasthenia gravis (MG) b. Benign paroxysmal positional vertigo
b. Vertigo c. Ménière’s disease
c. Cerebellar syndrome d. Vestibular neuronitis
d. MS e. Migraine
e. Peripheral neuropathy
183. A 40-year-old woman seen in clinic has multiple fleshy nodules
177. A neurologist is examining a patient. She takes the patient’s and several lightbrown, round macules with a smooth border
middle finger and flicksthe distal phalanx, her thumb contracts on her back, arms and legs. There arealso freckles under her
in response. What sign has been elicited? arms. What is the underlying disorder?
 1264 a. Neurofibromatosis type I keep her balance. What is the diagnosis?
b. Neurofibromatosis type II a. Diabetes
c. Tuberous sclerosis b. Cerebellar problem
d. Hereditary haemorrhagictelangectasia c. Alcohol abuse
e. Sturge–Weber syndrome d. Proprioceptive problem
e. Visual problem
184. A 19-year-old man is admitted with a GCS of 12. He was doing
push ups when hecomplained of a sudden-onset, severe 189. A 29-year-old man is brought to the emergency department
headache and collapsed. What would youexpect on his CT? in a comatose state a few hours after complaining of sudden
a. Convex haematoma onset of excruciating headache. Neurologic examination
b. Midline shift reveals dilated pupils poorly responsive to light. A CT scan of
the head without contrast demonstrates hyperdensity within
c. Crescent-shaped haematoma the suprasellar cistern, while MRI is unremarkable. Lumbar
d. Blood along the sulci and fissures puncture shows hemorrhagic cerebrospinal fluid. Which of
e. Intraventricular blood the following is the most likely diagnosis? 
MCQ's

a. Amyloid angiopathy-related hemorrhage 

185. A 60-year-old man presents with visual problems and
b. Cavernous sinus thrombosis 
dizziness. The dizzinessstarted suddenly, he sees the room
spinning around and he has noticed he keepsbumping into c. Hemorrhagic infarction
things on his right. His blood pressure is 159/91, heart rate 72. d. Pituitary apoplexy
Onexamination, there is nystagmus and dysdiadochokinesia. e. Ruptured berry aneurysm
Where is his stroke?
a. Temporal lobe 190. A 55-year-old woman complains of double vision. She is
b. Left parietal lobe tired all the time and has difficulty climbing stairs. She has
difficulty getting items off shelves. Reflexes are absent but
c. Right parietal lobe elicited after exercise. Initial shoulder abduction is 4/5 but on
d. Anterior circulation repeated testing is 4 +/5. What is the pathology associated with
e. Posterior circulation this female’s diagnosis?
a. Thyrotoxicosis
186. A 45-year-old man presents with a 5-day history of progressive
b. Myasthenia Gravis
tingling andnumbness of his hands and feet. He insists that
he has never had this problembefore and that he was perfectly c. Diabetes
fine a week ago. Over the last 2 days he has hadsome difficulty d. Stroke
walking but mostly he complains about difficulty rolling e. Lung cancer
upcigarettes. On examination, there is mild symmetrical distal
weakness, mild gaitataxia and dysdiadochokinesia. He smokes 191. The worst score in Glasgow Coma Scale (GCS) representing
30 cigarettes a day and drinks 1–2bottles of wine. He has a “none” in all three categories assessed is
family history of hypertension and his 63-year-old motherhas
type 2 diabetes, whom over the last year has complained of a. Fifteen
numbness andburning in her feet. He self-discharges. A week b. Zero
later, his symptoms have peaked. Hedisplays moderate distal c. Three
weakness and numbness to his knees, after which he turns a
d. None
corner and his symptoms start to slowly resolve. What is the
diagnosis? 192. Nerve fiber most susceptible to hypoxia is-
a. Miller Fisher syndrome a. A
b. Alcoholic neuropathy b. C
c. Chronic idiopathic demyelinating polyneuropathy c. B
d. Charcot Marie Tooth disease d. D
e. GBS
193. Earliest cranial never to be involved in Acoustic Neuroma:
187. A 28-year-old junior doctor has been complaining of a. 5 th
a headache for the last 24hours. It started gradually,
intensifying slowly and involving the entire cranium,but b. 7th
over the last couple of hours she has noticed that turning c. 6 th
her head isuncomfortable. She feels generally unwell and d. 8 th
prefers to lie in a dark room. Herboyfriend has noticed that
she seems irritable. On examination, she exhibitsphotophobia 194. Deep peronial nerve supplies all of the following except
and there is neck stiffness. There is no papilloedema. Close
a. Tibialis anterior
examinationof her skin reveals no rashes. Kernig’s sign is
negative. A lumbar puncture (LP) reveals low protein, normal b. Extensor Hallusislongus
glucose and lymphocytosis. What is the diagnosis? c. Extensor digitorumlongus
a. Viral meningitis d. Peroneus brevis
b. Migraine
195. Which of the following structures enter through the greater
c. Aseptic meningitis sciatic notch and leave through the lessor notch
d. Bacterial meningitis a. Obturator nerve
e. TB meningitis b. Pudendal artery
188. A 36-year-old woman presents to clinic with neurological c. Femoral vessels
symptoms. Onexamination, she is able to stand with her feet d. Lesser sciatic nerve
together. Upon closing her eyes,however, she is unable to
 1265
Neurology - Answers
1. a 40. b 79. b 118. d 157. e

2. c 41. c 80. e 119. c 158. c

3. b 42. b 81. d 120. c 159. e

4. d 43. e 82. a 121. d 160. c

5. e 44. b 83. e 122. d 161. c

6. a 45. e 84. a 123. b 162. b

NEUROLOGY
7. a 46. d 85. a 124. c 163. d

8. b 47. e 86. e 125. a 164. a

9. c 48. d 87. b 126. d 165. e

10. c 49. b 88. d 127. b 166. c

11. b 50. a 89. e 128. b 167. d

12. c 51. c 90. d 129. b 168. d

13. d 52. b 91. b 130. b 169. d

14. e 53. d 92. e 131. e 170. c

15. a 54. c 93. c 132. a 171. c

16. c 55. e 94. b 133. b 172. c

17. a 56. d 95. c 134. e 173. d

18. e 57. d 96. e 135. b 174. e

19. d 58. d 97. d 136. a 175. a

20. c 59. c 98. e 137. a 176. d

21. b 60. b 99. d 138. a 177. c

22. d 61. e 100. d 139. e 178. b

23. b 62. b 101. c 140. e 179. c

24. c 63. d 102. b 141. c 180. a

25. e 64. d 103. c 142. d 181. b

26. c 65. c 104. e 143. a 182. b

27. a 66. e 105. c 144. b 183. a

28. e 67. c 106. a 145. c 184. d

29. d 68. e 107. b 146. b 185. e

30. b 69. b 108. c 147. e 186. e

31. c 70. d 109. b 148. e 187. a

32. e 71. b 110. a 149. d 188. d

33. b 72. e 111. b 150. b 189. e

34. d 73. d 112. a 151. e 190. e

35. a 74. c 113. c 152. a 191. c

36. e 75. c 114. b 153. d 192. c

37. e 76. d 115. a 154. a 193. d

38. b 77. e 116. d 155. c 194. d

39. b 78. c 117. b 156. b 195. a