NEURO MCQS

1. Which of the following features suggest cerebral hemorrhage rather than ischaemia?
a. Old age
b. Headache
c. High density area on non-contrast CT brain
d. Hemiplegia
e. Acute onset

2. A 24 year lady who gave birth a week ago presented with severe headache with neck
pain. She was not febrile; BP was normal and had bilateral papilloedema. The most
important diagnosis to consider is:
a. Severe migraine attack
b. Acute meningitis
c. Benign intracranial hypertension
d. Late onset eclampsia
e. Cerebral dural sinus thrombosis

3. A 24 year old woman presented to ER with a generalized tonic-clonic seizure. No prior

history of a seizure disorder. The patient continues to be in tonic-clonic state. Her pulse is
118/min, with a blood pressure of 138/64 mm Hg and a normal temperature. The patient
appears cyanotic, and she is intubated. She weighs 60 kg. The patient is given 3 mg of
lorazepam intravenously but continues to have seizures. The medical resident physician
orders the nurse to give another 3 mg of lorazepam, which has no effect. The patient
continues to have seizures.

What is next step in management?

a. Lumbar puncture
b. Intravenous antibiotics
c. Additional doses of lorazepam until the seizures stop
d. Intravenous phenytoin
e. Intravenous Phenobarbital

4. You examine a 78 year old right-handed man who is dysphasic and hemiplegic following a
stroke.
Which one of the following clinical signs would you expect to find?
a. Left extensor plantar
b. Left sided hemiplegia
c. Right homonymous hemianopia
d. Right lower motor neurone VIIth nerve palsy
e. left upper motor neurone VII th nerve palsy
5. A 36 year old lady presents with a two-week history of increasing headache which is
worse at night and in the early morning. Then she become increasingly drowsy with an
evolving left-sided hemiparesis. Her headache causes her to vomit and on occasions she
has had involuntary movements of the left arm and leg and possibly of the face as well.
What is the next step in her management?
a. Request CT / MRI brain with contrast
b. Start intravenous antibiotics
c. Give a loading dose of intravenous phenytoin
d. Do lumbar puncture
e. Relieve her headache with analgesics

6. Aphasia is most likely to occur with what type of stroke?

a. Lacunar
b. Right cortical hemisphere
c. Left cortical hemisphere
d. Brain stem
e. Bilateral occipital lobe

7. A 70 year old lady is brought into the ER by her worried neighbours, who report her not
being her usual self. On examination she looks unwell, is confused and complains of a
headache. She is pyrexial, does not tolerate examination of papillary reflexes and flexion
of the neck causes hip flexion.
What is the most appropriate empirical treatment for this patient?
a. Gentamicin
b. Rifampicin
c. Metronidazole
d. Ciprofloxacin
e. Ceftriaxone
8. The following is a cause of Autoimmune Encephalitis:
a. Acute Disseminated Encephalitis (ADEM)
b. Hashimoto's Encephalitis
c. Rasmussen's Encephalitis
d. NMDA-Receptor Antibody Encephalitis (N-methyl D-aspartate)
e. All the above
9. The following is true for Herpes Simplex encephalitis (HSV):
a. HSV-2 causes encephalitis in adult
b. HSV-1: is responsible for neonatal encephalitis
c. mortality in untreated patients is 100 percent
d. It involves mainly the occipital lobes of the brain
e. Is treated with Parentral Aciclovir
10. A 75 years old man presents with 12 hours history left sided weakness and difficulty in
speech. He was well when he went to bed the night before, and woke up in the morning
unable to move his left side. Physical examination confirmed profound left sided
weakness of upper and lower limbs and loss of speech. His pulse was irregular and BP
140/80.
Which of the following next step is most appropriate?
a. His BP should be tightly controlled below 140/80
b. If gag reflex present should be allowed free oral intake
c. Should be fully anticoagulated as soon as possible for maximum benifit
d. Should be thrombolysed
e. Should have a brain scan (CT/MRI) within next 24 hours

11. Two weeks following an upper repiratory tract infection, a 25 year old girl presents with
tingling and weakness in the lower limbs which progressed over a day to involve the
upper limbs. Physical examination confirmed profound muscle weakness and absent
tendon reflexes. Sensations were intact.
Which of the following next step is most appropriate?
a. A tensilon (edrophonium) test
b. A brain CT to exclude stroke disease
c. Brain and spinal MRI to look for plaques of demyelination
d. Observation in HDU/ITU and monitoring of FVC (forced vital capacity)
e. Muscle biopsy

12. A 35-year-old man presents to the ER complaining of sudden onset headache. He has no
previous history of headaches. He has vomited twice with the pain but has no other
symptoms. Physical examination is normal. The admitting doctor considered the
possibility of Subarachnoid haemorrhage (SAH)
Which of the following statements are true?
a. SAH is unlikely in absence of neurological signs
b. It is safe to send him home with regular anagesia
c. A normal lumbar puncture soon after presentation excludes SAH
d. Steroids improve outcome following SAH
e. Nimodipine may be useful in the treatment of SAH
13. A 75 years old man presents with slowly progressive rigidity, shaking, slowness of
movement and difficulty with walking. Physical examination confirmed a course
asymmetric tremor of the hands, rigidity and shuffling gait.
Which of the following statements is correct?
a. The most common aetiology of this syndrome is idiopathic
b. The main pathological characteristic is cell death in the cerebellum
c. Neurofibrillary tangles and senile plaques are characteristic features
d. Diagnosis is confirmed by MRI brain scan
e. Dianosis is confirmed by CSF analysis

14. In a patient with bacterial meningitis the best empirical treatment is:
a) Crystalline penicillin
b) Amoxicillin
c) Chloramphenicol
d) Ceftriaxone
e) Co-trimoxazole

15. 51) A 40- year- old man presented with numbness and tingling sensations in his feet for
the last 2 months. Examination revealed brisk knee reflexes, absent ankle reflexes &
positive Romberg's sign. The most likely diagnosis is:
a) Spinal cord compression
b) Syringomyelia
c) subacute combined degeneration of the cord
d) Freidrechs ataxia
e) Pott's disease of the spine

16. A 25 year old female presented to outpatient department with unilateral drooping of the
upper eyelid, squint & preserved pupillary light reflex .The most likely diagnosis is:
a) Myasthenia Graves
b) Trochlear nerve palsy
c) Abducens nerve palsy
d) Oculomotor nerve palsy
e) Horner syndrome
17. ) Motor neuron disease (MND):
a) Is a chronic demyelinating disease.
b) Is a disease of young females
c) Progression is slower and prognosis better in patients with bulbar-onset disease
d) Brain imaging confirms the diagnosis
e) Sensory nerves and the autonomic nervous system are generally not affected
18. A 50- year- old diabetic, alcoholic male presented with progressive confusion and
headache over the last two weeks. The most useful investigation is:
a) HIV serology
b) MRI brain
c) Drug screening
d) Blood sugar
e) blood film for malaria

19. An adult male patient presented with symptoms and signs of multiple sclerosis, his family
asked about the prognosis. Good prognosis is indicated by:
a) Cerebellar ataxia
b) Optic neuritis
c) Late presentation
d) Progressive paraparesis
e) Significant intellectual defect

20. A 21 year old male patient presented with acute urinary retention followed 24 hours later
by numbness, then weakness of both lower and upper limbs that was complete in three
days. The most likely diagnosis is:
a) Pott’s disease of the spine
b) Syringomyelia
c) Transverse myelitis
d) Anterior spinal artery syndrome
e) Brain stem infraction

21. A patient is diagnosed as epileptic, is well controlled with ethosuxamide. The most likely
type of this epilepsy is:
a) Partial epilepsy
b) Secondary generalized epilepsy
c) Akinetic epilepsy
d) Psychomotor epilepsy
e) Petit mal (Absence seizures)
22. ) A 42-year-old woman presented to the emergency department complaining of the
"worst headache of her life." It began abruptly and has persisted for 60 minutes
accompanied with nausea and fatigability. On physical examination, her blood pressure is
240/130 mm Hg, and pulse is 62/min. She has neck rigidity but no localizing neurologic
signs. Which of the following is the most appropriate NEXT STEP IN MANAGEMENT?
a) Control blood pressure with intravenous nicardipine
b) Observe general condition and BP every 2 hours
c) Refer to neurosurgery
d) Obtain a CT brain scan without contrast
e) Perform a lumbar puncture

23. A 30 year old female presented with acute right sided hemiplegia, her work up showed
left capsular infarct & asymptomatic mitral stenosis with completely irregular pulse of 98/
min. the most appropriate treatment to prevent further embolization is:
a) Anti platelets
b) Anti coagulant therapy
c) Dexamethasone
d) Thrombolytic therapy
e) Digoxin

24. An 18 year old female presented with bilateral ptosis and tiredness towards the evening.
Muscle tone and reflexes were normal but she had proximal muscle weakness. The
diagnosis is supported by:
a) Edrophonium test
b) CSF analysis
c) CT brain scan
d) MRI cervical spine
e) Thyroid function test

25. A 40- year- old man presented with numbness and tingling sensations in his feet for the
last 2 months. Examination revealed brisk knee reflexes, absent ankle reflexes & positive
Romberg's sign. The most likely diagnosis is:
f) Spinal cord compression.
g) Syringomyelia.
h) subacute combined degeneration of the cord
i) Freidrechs ataxia
j) Pott's disease of the spine.
26. A 25 year old female presented to outpatient department with unilateral drooping of the
upper eyelid, squint & preserved pupillary light reflex .The most likely diagnosis is:
a. Myasthenia Graves.
b. Trochlear nerve palsy.
c. Abducens nerve palsy.
d. Oculomotor nerve palsy.
e. Horner syndrome
27. A 50- year- old diabetic, alcoholic male presented with progressive confusion and
headache over the last two weeks. The most useful investigation is:
a. HIV serology.
b. MRI brain.
c. Drug screening.
d. Blood sugar.
e. blood film for malaria

28. Motor neuron disease (MND) :

a. Is a chronic demyelinating disease.
b. Is a disease of young females
c. Familial and sporadic cases appear similar clinically
d. Brain imaging confirms the diagnosis
e. Riluzole offers radical treatment

29. An adult male patient presented with symptoms and signs of multiple sclerosis, his family
asked about the prognosis. Good prognosis is indicated by:
a. Cerebellar ataxia
b. Optic neuritis
c. Late presentation
d. Progressive paraparesis
e. Significant intellectual defect

30. A 21 year old male patient presented with acute urinary retention followed 24 hours later
by numbness, then weakness of both lower and upper limbs that was complete in three
days. The most likely diagnosis is:
a. Pott’s disease of the spine
b. Syringomyelia
c. Transverse myelitis
d. Anterior spinal artery syndrome
e. Brain stem infraction
31. A patient is diagnosed as epileptic, is well controlled with ethosuxamide. The most likely
type of this epilepsy is:
a. Partial epilepsy
b. Secondary generalized epilepsy
c. Akinetic epilepsy
d. Psychomotor epilepsy
e. Petit mal (Absence seizures)

32. A 42-year-old woman presented to the emergency department complaining of the "worst
headache of her life." It began abruptly and has persisted for 60 minutes accompanied
with nausea and fatigability. On physical examination, her blood pressure is 240/130 mm
Hg, and pulse is 62/min. She has neck rigidity but no localizing neurologic signs. Which of
the following is the most appropriate NEXT STEP IN MANAGEMENT?

a) Control blood pressure with intravenous nicardipine

b) Observe general condition and BP every 2 hours
c) Refer to neurosurgery
d) Obtain a CT brain scan without contrast
e) Perform a lumbar puncture

33. A 30 year old female presented with acute right sided hemiplegia, her work up showed
left capsular infarct & asymptomatic mitral stenosis with completely irregular pulse of 98/
min. the most appropriate treatment to prevent further embolization is:
a. Anti platelets
b. Anti coagulant therapy
c. Dexamethasone
d. Thrombolytic therapy
e. Digoxin

34. An 18 year old female presented with bilateral ptosis and tiredness towards the evening.
Muscle tone and reflexes were normal but she had proximal muscle weakness. The
diagnosis is supported by:
a. Edrophonium test
b. CSF analysis
c. CT brain scan
d. MRI cervical spine
e. Thyroid function test
35. A 73 year-old woman has a stroke resulting in mild left hemiparesis and left neglect.
The lesion is most likely located at:-

a) Right cerebellar peduncle

b) Left frontal lobe
c) Right parietal lobe
d) Right thalamus
e) Left internal capsule

36. A 50-year-old man complained of double vision when reading a newspaper 1 week
following a minor head injury. On examination, he had double vision maximal on looking
down and to the left. The peripheral (outer) image came from the right eye.
The most likely muscle affected is:-
a. left inferior oblique
b. left superior oblique
c. right inferior oblique
d. right inferior rectus
e. right superior oblique

37. A 75-year-old woman complained of weakness of her left leg. Forty-eight hours previously
she had been given a spinal anaesthetic for a left total-hip replacement. The operation
note and anaesthetic chart suggested no untoward events during the operation.
On examination, neurological signs were confined to the left leg. There was severe weakness
of flexion of the knee, dorsiflexion, plantar flexion, inversion and eversion of the ankle,
extension of the great toe and flexion and extension of the toes. The knee jerk was normal
but the ankle jerk was absent. There was diminished sensation to pinprick over the calf, the
sole and dorsum of the foot extending up the anterolateral aspect of the shin to just below
the tibial tuberosity.
the most likely diagnosis is:-
a) common peroneal nerve lesion
b) diabetic amyotrophy
c) L5/S1 disc prolapsed
d) sciatic nerve lesion
e) spinal extradural haematoma
38. A 26-year-old woman presented with three headaches over a 7-month period. Each
episode was characterized by severe right-sided headache lasting 12 hours, preceded by
teichopsia and associated with mild nausea.
The most appropriate initial treatment is:
a) Cafergot R
b) ibuprofen at the onset of the next attack
c) pizotifen prophylaxis
d) propranolol prophylaxis
e) sumatriptan at the onset of the next attack

39. A 76-year-old man developed unsteadiness when trying to walk, 2 weeks after undergoing
right hemicolectomy for carcinoma. His postoperative course had been complicated by
severe Gram-negative sepsis for which he had required assisted ventilation and treatment
with broad-spectrum antibiotics. At one stage, trough gentamicin concentration had been
in the toxic range.
On examination, He was able to stand independently, but swayed. He had a broad-based gait
and could not tandem walk. Romberg’s test was negative.
The most likely diagnosis is:-
a) acute alcohol withdrawal
b) cerebellar stroke
c) gentamicin toxicity
d) paraneoplastic cerebellar degeneration
e) subacute combined degeneration of the cord

40. A 45-year-old man presented with a 4-day history of fever, headache and neck stiffness.
On examination, he was pyrexial (39•C). His Glasgow coma score was 15. Kernig’s sign was
positive. There were no focal neurological signs.
Investigations:
Cerebrospinal fluid:
opening pressure 240 mmHg ;total protein 1.2 g/L ; glucose 1.2 mmol/L ;cell count 150/cumm
(05) ;lymphocyte count 10% (60.70) ;neutrophil count 150 (none)
Gram stain: showed Gram-positive diplococci
The most likely causative agent is:
a) Escherichia coli
b) Haemophilus influenza
c) Listeria monocytogenes
d) Neisseria meningitides
e) Streptococcus pneumonia
41. A 20 years university female student suffers with recurrent attacks of headaches
associated with blurring of vision, occasional nausea and rare vomiting. She is normal in
between attacks. Which of the following is NOT a feature of migraine:
a) Transient right hemianopia
b) Convulsions
c) Photophobia
d) Numbness on both hands
e) Tiredness

42. A 62 years gentleman developed sudden weakness on the right arm and leg. Known
diabetic and hypertensive. The following are expected physical signs :
a) Expressive dysphasia
b) Nystagmus
c) Decrease sensations on the left
d) Facial deviation to the right
e) Extensor plantar response on the left foot
43. A 24 years bus driver was found unconscious on the floor of his house. He was
Previously fit. The least appropriate urgent investigations is:
a) Random blood sugar level
b) Blood film for malaria
c) MRI scan of the brain
d) Liver functions test
e) Serum electrolytes

44. 32 years old housewife developed fever, joints aches, severe headache and a skin rash.
The following are suitable immediate therapies:
a) Intravenous ceftriaxone 2 grams
b) Intravenous dexamethazone 4 mg
c) Intravenous amoxicillin 1 gm if she is pregnant
d) Adequate rehydration
e) Intravenous loading with phenytoin prophylactically
45. A 35-year-old woman developed bilateral optic neuritis with partial recovery. MRI of
brain was normal. One year later, she developed paraparesis and incontinence. She was
given intravenous methylprednisolone followed by oral prednisolone, but continued to
deteriorate. Investigations showed:
ESR 7 mm/1st hr, antinuclear antibodies negative. MRI scan of spine: high-signal lesion
from C6 to T10. Cerebrospinal fluid: white cell count 12/ cu mm , negative oligoclonal
bands. What is the most likely diagnosis?

a) Acute disseminated encephalomyelitis

b) Multiple sclerosis
c) Sjogren's syndrome
d) Systemic lupus erythematosus
e) Neuromyelitis optica

46. A 25-yr- old female presented with 3 weeks history of bulbar palsy following a 2-months
history of fluctuating bilateral ptosis & diplopia . The most specific test for her likely
diagnosis is:
a) Elevated serum ACh-receptor binding antibodies
b) Repetitive nerve stimulation test
c) Positive edrophonium test
d) Measurement of jitter by single fibre electromyography
e) Reduced amplitude of the compound motor action potential

47. A 72-year-old man presents with 3 intermittent episodes of left sided weakness involving
his arm, face and leg over the last 2 months. Each episode lasts about 20 to 30
minutes. He is hypertensive on medication (nifedipine) which he takes 3 times a day. He
smokes 10 cigarettes a day. In the past he has suffered ischaemic heart disease and
angina and has pains in his calves when he walks about quarter of a mile which goes
when he rests. What is the most likely cause for his weakness?

a) TIA in the territory of the right Middle Cerebral Artery

b) Partial seizures
c) Minor ischemic strokes
d) Metastatic deposits
e) Demylinating lesions
48. A 24-year-old man presents with a sudden onset headache in the night and on getting up
finds that he has developed a complete ptosis on the left. On examination he has a
complete ptosis on the left and the eye lies down and out with a fixed dilated pupil. What
is the most likely cause of this presentation?
a) Left complete third nerve palsy due to cerebral aneurysm
b) brain stem infarct
c) subarachnoid haemorrhage
d) ischaemic left third nerve palsy
e) myasthenia gravis

49. A 65 year old lady was seen in the outpatient clinic with a 2 weeks history of severe left
sided headache. She has increasing pain over her shoulders and lost weight recently. No
focal neurological signs were detected. Her ESR was 122 mm/ Hr.
The most likely diagnosis is:
a) Tuberculous meningitis
b) Temporal arteritis (giant cell arteritis)
c) Intracerebral haemorrhage
d) Glioblastoma multiforme
e) Brain abscess

50. A 28 years old gentleman was on treatment for pulmonary tuberculosis for 6 weeks
complained of increasing burning sensation and pain on his feet. This likely due to:
a) Large fibre neuropathy caused by streptomycin
b) Arthritis due to ethambutol
c) Isoniazid induced peripheral neuritis
d) Skin involvement with pyrazinamide
e) Rifampicin induced tendinitis

51. The following is not a feature of Guillain-Barre Syndrome:

a) Ascending progressive weakness
b) Severe back pain
c) Autonomic disturbances
d) Loss of tendon reflexes
e) Detection of a sensory level on the trunk
52. A 24 year lady who gave birth a week ago presented with severe headache with neck
pain. She was not febrile; BP was normal and had bilateral papilloedema. The most
important diagnosis to consider is:
a) Severe migraine attack
b) Acute meningitis
c) Cerebral dural sinus thrombosis
d) Benign intracranial hypertension
e) Late onset eclampsia

53. The following is the most easily preventable cause of stroke:

a) Rheumatic heart disease
b) Hypertension
c) Cardiac arrhythmias
d) Dissection of the carotid and vertebral arteries
e) Antiphospholipid syndrome

54. Interferon Beta is useful in the treatment of:

a) Guillain- Barre syndrome
b) Myasthenia gravis
c) Relapsing remitting multiple sclerosis
d) Motor neurone disease
e) Parkinsons disease

55. 69) 33 years male with no significant past medical history was brought to the ER with
fever, confusion and mild cough for 2 days. T 39.2; HR 106; BP 116/86
Heart, Lung and abdomen were unremarkable. CNS showed positive neck stiffness and mild
confusion. The rest of neurological exam was normal including the optic discs. What is the
next step at this point?
a) Immediate LP
b) Brain CT scan
c) Immediate Broad spectrum antibiotics
d) Immediate MRI
e) EEG
56. Typical finding in central spinal cord in the thoracic segment will cause :
a. Saddle anesthesia
b. Loss of vibration sense below lesion
c. Suspended sensory lesion
d. Incontinence of bowel and stool
e. Pyramidal weakness below the lesion

57. In strict Conus medullaris lesion the following are typical :

a. Severe back pain
b. Absent ankle and patellar reflex
c. Late and mild in continence of the urine
d. Normal anal wink reflex
e. Saddle anesthesia

58. 35 yrs old has developed progressive weakness in the hand over a week . There is some
associated numbness and tingling in the hand and feet . She complain of breathing
difficulty . She had Several episodes of diarrheal disease two weeks ago . On examination
there is slurring of speech . Her reflexes are absent .what is the next step to assess the
severity of the disease?
a. MRI
b. LP
c. Vital capacity
d. EMG
e. Anti- Ach Abs

59. 30 yr old man presents with a 6 months hx. of recurrent episodes of altered behavior .
During these episodes he developed a motionless stare with associated lip smacking ,
grimacing , chewing movements , scratching or gesturing . His partner describe him as
labile emotion . He may get sudden outbursts of aggression or agitation .which the is the
dx :
a. Transient global amnesia
b. Frontal lobe epilepsy
c. Temporal lobe epilepsy
d. Parietal lobe lesion
e. Migraine

60. 55 yrs old pt. present with an 8 month hx. of progressive difficulty in swallowing and
dysarthria . He has lost 6 kg in Wt . On examination he has tongue fasciculation and brisk
jaw reflex what is the Dx ?
a. ALS
b. MS
c. SACD
d. Senile dementia
e. GBS
61. 35 yr old teacher has a right sided headache and blurring of her vision in the rt eye , she
has previously had an episode of optic neuritis 3 yrs ago . O/E : Rt afferent pupillary defect
, and pale optic desk . What is most likely Dx ?
a. MS
b. Cerebral lymphoma
c. ADEM
d. Lyme disease
e. Sarcoidosis

62. 56 years old lady present with a two week history of increasing headache which is worsen
at night and the early morning , then she became increasingly drowsy with evolving left
hemiparesis , her headache cause her to vomit and she had involuntary movements of the
left arm and leg and of the face as well . What is the most initial investigation
a. Skull x-ray
b. CT scan
c. EEG
d. LP
e. Serology

63. Which of the followings is a cause of small pupil?

a. Carbon monoxide poisoning.
b. Ethylene glycol poisoning.
c. Holmes Aide pupil.
d. Pontine haemorrhage.
e. Third nerve palsy,

64. Brachial plexopathy secondary to birth injury:

a) In Erb’s waiter’s tip position is uncommon
b) Claw hand is common in upper plexopathy
c) Klumpke’s is associated with Horner’s syndrome
d) C5,C6 cervical root lesion is common in Klumpke’s
e) The sympathetic chain is commonly affected

65. Which of the following is the target of multiple sclerosis attack?

a) The neurotransmitter balance in the CNS.
b) The oligodendrocytes of the CNS.
c) The cerebral hemispheres.
d) The cerebellum.
e) The posterior columns of the spinal cord.
66. Which of the following statements regarding beginning and stopping antiepileptic therapy
(AE) is true?
a) AE therapy can be discontinued safely after a seizure-free interval of 1 year
b) every patient who has a seizure should start taking AE therapy
c) AE medication should be started with a combination of 2 or more drugs
d) the decision to stop AE medication should be guarded by the result of EEG
e) none of the above

67. The following is the most common neurological disorder worldwide:

a- Epilepsy
b- Multiple sclerosis
c- Myasthenia gravis
d- Stroke
e- Bell’s palsy.

68. The following primary brain tumor is most likely responsible for a new-onset seizure in a
68-yr-old gentleman:
a- Meningioma
b- Ependymoma
c- Pituitary adenoma
d- Schwanoma
e- glioblastoma

69. Which of the following muscular dystrophies (MD) affects males & is carried by females?
a) Myotonic MD
b) facioscapulohumeral MD
c) Becker’s MD
d) limb girdle MD
e) occulopharyngeal MD

70. A 60 years old man presenting with right sided weakness and confusion. His Blood
pressure is 165/100.
a) First step in the management:
b) Should be given antihypertensive drugs immediately to lower the blood pressure.
c) Send for a CT scan immediately
d) Assess, insert an IV line, a urinary catheter and then send for scanning.
e) Start Aspirin 100mg
71. A 20 years old female presented with bilateral ptosis and fatigue more marked towards
the evening`. Which of the following tests would be least helpful in her case:
(a) Acetylecholine receptor antibodies
(b) Striated muscle antibodies
(c) CT scan of the thorax
(d) Electromyography
(e) CT scan of the brain

72. Which of the following muscles is involved in carpal tunnel syndrome?

a) Dorsal interossei
b) Medial two lumbricals
c) Opponens
d) Plamar interossei
e) Extensor pollicis longus

73. Which of the following is not a risk factor for cerebrovascular accidents?
a) Increased body mass index
b) Lack of exercise
c) High blood pressure
d) Increased high density lipoprotein
e) Smoking

74. Muscle fasciculation is a characteristic feature of

a) Motor neuron disease
b) Huntington chorea
c) Muscular dystrophy
d) Friedrech’s ataxia
e) Syringomyelia

75. Bilateral lower motor neurone lesion of the facial nerve occurs with
a) Parotid tumors
b) Sarcoidosis
c) Cerebellopontine angle tumors
d) Internal capsule lesion
e) Tetanus
76. Skeletal muscle pain occurs in
a) Dermatomyositis
b) Muscular dystrophy
c) Poliomyelitis
d) Muscle phosphorylase deficiency
e) Parkinson’s disease

77. Petit mal epilepsy

(a) Has a characteristic EEG pattern
(b) Is best treated with phenytoin
(c) Is not associated with automatism
(d) Is always secondary
(e) Is almost always observed at adolescence

78. What investigation is most relevant in a young patient who presented with recurrent
transient ischemic attacks in the form of left hemiparesis with left UMN type facial
paresis:
a) Carotid Doppler ultrasound.
b) Cerebral angiography.
c) Electrocardiography (ECG).
d) Electro-Encephalography (EEG).
e) CT scan

79. In a patient with unilateral ptosis, dilated pupil & squint. The most likely diagnosis is:
a) myasthenia gravis
b) abducent nerve palsy
c) oculomotor nerve palsy
d) Horner’s syndrome
e) trochlear nerve palsy

80. The single most important test for a stable patient, with suspected stroke presenting to
the emergency department is:
a) lumbar puncture
b) lateral skull X-ray
c) brain MRI
d) CT brain scan
e) Doppler ultrasound for the carotids
81. Regarding Parkinson’s disease:
a) it is an autosomal recessive disorder
b) it is a form of hyperkinetic movement disorder
c) it is characterized by rigidity & tremors
d) it is a demnyelinating disease
e) the treatment of choice is steroids

82. In Parkinson’s disease the following facts are correct:

a. It caries a poor prognosis
b. Constitutes one half of all cases of parkinsonian disorders
c. Haloperidol is the treatment of choice
d. The onset is classically in childhood
e. Pill rolling tremor is characteristic

83. Regarding anti-epileptic (AE) THERAPY:

a) Can be discontinued after a seizure-free interval of one year
b) Patients with single seizure have to start taking AE
c) Is to be started with a combination of two drugs or more
d) The decision to stop AE is guarded with the results of EEG
e) Compliance is better with polypharmacy

84. Guillain Barre Syndrome is characterized by:

a) generalized areflexia
b) hypertonia involving all 4 limbs
c) presence of sensory level
d) persistent retention of urine
e) up going plantar response

85. Two non identical twins- male and female- are likely to have a genetic disorder if they
have the following except:
a. Difficulties walking with increasing spasticity with normal upper limbs
b. Unsteady gait with slurred speech and up going plantar responses
c. Progressive wasting of shoulder and hip muscles with normal sensations
d. Hypopigmented anaesthetic skin patches with thicken nerves
e. Pes cavus with lost sensations to the level of the knees
86. Skeletal muscle pain occurs in:
a) dermatomyositis
b) muscular dystrophy
c) Poliomyelitis
d) muscle phosphorylase deficiency
e) Parkinson’s disease

87. A 27-year-old man presents to the Emergency Department with 2 day history of severe
headache and pyrexia (38.2ºC). A CT scan is reported as follows: CT: Brain Petechial
haemorrhages in the temporal and inferior frontal lobes. No mass effect. Brain
parenchyma otherwise normal What is the most likely diagnosis?
a. Brain abscess
b. Meningococcal meningitis
c. Cerebral malaria
d. Herpes simplex encephalitis
e. New variant CJD

88. A 29-year-old man presents complaining of visual disturbance. Examination reveals a right
superior homonymous quadrantanopia. Where is the lesion most likely to be?
A - Optic chiasm
B - Left temporal lobe
C - Right temporal lobe
D - Left optic nerve
E - Left parietal lobe

89. A 64-year-old man with a history of Parkinson's disease is reviewed in clinic and a decision
has been made to start him on cabergoline. Which one of the following adverse
effects is most strongly associated with this drug?
A - Optic neuritis
B - Transient rise in liver function tests
C - Pulmonary fibrosis
D - Renal failure
E – Thrombocytopenia
90. A 76-year-old man is admitted with a right hemiparesis. He first noticed weakness on his
right side around six hours ago. A CT scan shows an ischaemic stroke and aspirin 300mg is
commenced. terms of further management in the acute phase, which one of the
following values should not be corrected?
A - BP 210/110
B - Blood glucose 11.2 mmol/l
C - Oxygen saturation 93%
D - Temp 38.3ºC
E - Blood glucose 3.5 mmol/l

91. A 44-year-old woman presents with pain in her right hand and forearm which has been
getting worse for the past few weeks. There is no history of trauma. The pain is
concentrated around the thumb and index finger and is often worse at night. Shaking her
hand seems to provide some relief. On examination there is weakness of the abductor
pollicis brevis and reduced sensation to fine touch at the index finger. What is the most
likely diagnosis?
A - C6 entrapment neuropathy
B - Thoracic outlet syndrome
C - Carpal tunnel syndrome
D - Cervical rib
E - Pancoast's tumour

92. A 56-year-old woman presents with facial asymmetry. Whilst brushing her teeth this
morning she noted that the right hand corner of her mouth was drooping. She is generally
well but noted some pain behind her right ear yesterday and says her right eye is
becoming dry. On examination she has a complete paralysis of the facial nerve on the
right side, extending from the forehead to the mouth. Ear, nose and throat examination is
normal. Clinical examination of the peripheral nervous system is normal. What is the
most likely diagnosis?
A - Ramsey-Hunt syndrome
B - Bell's palsy
C - Stroke
D - Multiple sclerosis
E - Parotid tumour
93. A 30-year-old male is admitted with headache, photophobia and neck stiffness.His
temperature is 39.0°C, pulse rate 120 beats/min and he has no skin rash or focal neurological
signs. His Glasgow coma scale is 15/15. A CT scan shows no contraindication to lumbar
puncture. CSF is obtained and Gram stain shows Gram-positive cocci.
a. Intravenous penicillin is the drug of choice
b. streptococcus pneumonia is the likely organism
c. prophylaxis is recommended for close contacts
d. Intravenous acyclovir is needed
e. Antibiotic treatment is given for 6 weeks

94. Uncrossed right-sided Hemiparesis is...

a) limbs weakness on ipsilateral side of the body with contralateral LMN facial weakness.
b) Limbs weakness on ipsilateral side of the body with contralateral UMN facial weakness
c) Limbs weakness that moves from one side of the body to the other
d) Limbs weakness on ipsilateral side of the body with ipsilateral UMN facial weakness
e) Limbs weakness on ipsilateral side of the body with ipsilateral LMN facial weakness

95. A 24-year-old woman is being evaluated in the emergency room for occasional, self-
resolving headaches. During examination, the patient has a generalized tonic-clonic
seizure. According to her family, the patient has no prior history of a seizure disorder. The
patient continues to be in tonic-clonic state. Her pulse is 118/min, with a blood pressure
of 138/64 mm Hg and a normal temperature. The patient appears cyanotic, and she is
intubated. She weighs 60 kg. The patient is given 3 mg of lorazepam intravenously but
continues to have seizures. The medical resident physician orders the nurse to give
another 3 mg of lorazepam, which has no effect. The patient continues to have seizures.

What is next step in management?

A) Lumbar puncture
B) Antibiotics
C) Additional doses of lorazepam until the seizures stop
D) Intravenous phenytoin
E) Intravenous phenobarbital
92. A 29-year-old man is brought to the emergency department in a comatose state a few
hours after complaining of sudden onset of excruciating headache. Neurologic examination
reveals dilated pupils poorly responsive to light. A CT scan of the head without contrast
demonstrates hyperdensity within the suprasellar cistern, while MRI is unremarkable.
Lumbar puncture shows hemorrhagic cerebrospinal fluid.Which of the following is the most
likely diagnosis?

a) Amyloid angiopathy-related hemorrhage

b) Cavernous sinus thrombosis
c) Hemorrhagic infarction
d) Pituitary apoplexy
e) Ruptured berry aneurysm
96. You examine a 78 year old right-handed man who is dysphasic and hemiplegic because he
has suffered from a stroke.
Which one of the following clinical signs would you expect to find?
a. Left extensor plantar
b. Left sided hemiplegia
c. Right homonymous hemianopia
d. Right lower motor neurone VIIth nerve palsy
e. left upper motor neurone VII nerve palsy,

97. A 36-year-old lady presents with a two-week history of increasing headache which is
worse at night and in the early morning. Then she become increasingly drowsy with an
evolving left-sided hemiparesis. Her headache causes her to vomit and on occasions she
has had involuntary movements of the left arm and leg and possibly of the face as well.
What is the next step in management ?
a. do CT / MRI brain with contrast
b. Start intravenous antibiotics
c. give a loading dose of intravenous phenytoin
d. do lumbar puncture
e. relieve her headache with analgesics

98. Aphasia is most likely to occur with what type of stroke?

a. Lacunar
b. Right cortical hemisphere c.
c. Left cortical hemisphere
d. Brain stem
e. Bilateral occipital lobe
99. Which of the following statements best describe fluent aphasia?
a. Complete loss of speech and language
b. Nonsense words or sound substitution errors occur
c. Poorly articulated and effortful speech
d. Normal understanding of the speech of others but impaired repetition of phrases
e. Disorientation with respect to time and inability to follow demonstrations of motor
acts

100. In assessment of the visual field:

a) Finger counting can be used
b) Perimetry is the best method
c) Tunnel vision indicates that the patient sees far objects
d) Bitemporal hemiansopia is a feature of retro orbital lesions
e) Optic radiation damage causes bi-nasal hemianospia

101. A characteristic sign of lower motor neuron lesion is:

a) Fibrillation
b) Minimal muscle wasting
c) Reflexes are obtainable only after reinforcement
d) Clonus
e) Hypotonia

102. Hypotonia & areflexia are a feature of:

a) Myasethenia gravis
b) Epilepsy
c) Motor neuron disease
d) Guillain-Barre syndrome
e) Cord compression

103. The following is the most easily preventable cause of stroke:

f) Rheumatic heart disease
g) Hypertension
h) Cardiac arrhythmias
i) Dissection of the carotid and vertebral arteries
j) Antiphospholipid syndrome
104. A true statement regarding facial nerve palsy:
a) Is of lower motor neuron lesion if the lower half of the face is affected
b) Eye closes normally if the facial nerve nucleus is affected
c) The patient can blow the cheeks normally
d) Is of upper motor neuron lesion if there is ipsilateral hemiplegia
e) It is of upper motor lesion if there is contra lateral hemiplegia

105. Ina patient suspected of hemiplegia, the best telling single test of his status is:
a) Inspection of the limb
b) Assessment of muscle tone
c) Examination of muscle power
d) Eliciting tendon reflexes
e) Assessment of sensations

106. Brisk tendon reflexes, is a feature of:

a) Hypothyroidism
b) Diabetic neuropathy
c) Myopathy
d) Leprosy
e) Spastic parplegia

107. A 50- year- old diabetic, alcoholic male presented with progressive confusion and
headache over the last two weeks. The most useful investigation is:
a. HIV serology.
b. MRI brain.
c. Drug screening.
d. Blood sugar.
e. Blood film for malaria

108. An adult male patient presented with symptoms and signs of multiple sclerosis, his
family asked about the prognosis. Good prognosis is indicated by:
f) Cerebellar ataxia
g) Significant intellectual defect
h) Late presentation
i) Progressive paraparesis
j) Optic neuritis
109. A 21 year old male patient presented with acute urinary retention followed 24 hours
later by numbness, then weakness of both lower and upper limbs that was complete in
three days. The most likely diagnosis is:
f) Pott’s disease of the spine
g) Syringomyelia
h) Transverse myelitis
i) Anterior spinal artery syndrome
j) Brain stem infraction

110. A patient is diagnosed as epileptic, is well controlled with ethosuxamide. The most
likely type of this epilepsy is:
f) Partial epilepsy
g) Secondary generalized epilepsy
h) Akinetic epilepsy
i) Psychomotor epilepsy
j) Petit mal (Absence seizures)