made mcqs according to the importance of topic based on previous mcqs and uqs data of past uhs neuro medicine at least 200

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UHS MBBS Final Year neurology past MCQs important topics Pakistan 2019 2020 2021 2022 2023

Based on UHS Final Year Medicine past papers pattern, here are 210 high-yield Neurology MCQs ranked by topic frequency and importance. Topics are ordered: Stroke > Meningitis/Encephalitis > Epilepsy > Parkinson's > MS > Headache > Peripheral neuropathy > Neuromuscular junction > Raised ICP/Coma > Misc.

UHS FINAL YEAR MBBS - NEUROLOGY MCQs (210 Questions)

Based on UHS Past MCQ & UQ Pattern - Medicine Paper

SECTION A: STROKE & CEREBROVASCULAR DISEASE (Most Repeated - ~35 MCQs)

Q1. A 65-year-old hypertensive male presents with sudden onset left-sided hemiplegia. CT head shows a hyperdense lesion in the right middle cerebral artery territory. The most likely diagnosis is:

A. Ischemic stroke
B. Intracerebral hemorrhage
C. Subdural hematoma
D. Epidural hematoma
E. Brain abscess

Q2. A patient presents 2 hours after acute ischemic stroke. BP is 160/90 mmHg. CT head shows no hemorrhage. The drug of choice is:

A. Aspirin
B. Warfarin
C. IV rtPA (alteplase)
D. Heparin infusion
E. Clopidogrel

Q3. The therapeutic window for IV thrombolysis in acute ischemic stroke is:

A. 1 hour
B. 3-4.5 hours
C. 6 hours
D. 9 hours
E. 12 hours

Q4. A 70-year-old patient has a TIA. What is the most appropriate immediate management?

A. Aspirin 75 mg daily
B. Aspirin 300 mg + Clopidogrel 75 mg for 21 days
C. Warfarin
D. IV heparin
E. Statins only

Q5. Which artery occlusion causes contralateral hemiplegia, hemianesthesia, and homonymous hemianopia (the "three H's")?

A. Anterior cerebral artery
B. Middle cerebral artery
C. Posterior cerebral artery
D. Basilar artery
E. Anterior communicating artery

Q6. Anterior cerebral artery occlusion causes:

A. Contralateral arm and face weakness
B. Contralateral leg weakness with urinary incontinence
C. Homonymous hemianopia
D. Dysphagia and vertigo
E. Contralateral hemianesthesia only

Q7. A patient has sudden onset of vertigo, dysphagia, ipsilateral Horner syndrome, and contralateral loss of pain and temperature. Which artery is occluded?

A. PICA (posterior inferior cerebellar artery)
B. AICA
C. Basilar artery
D. Middle cerebral artery
E. Vertebral artery

Q8. The above clinical picture is called:

A. Weber syndrome
B. Lateral medullary syndrome (Wallenberg)
C. Locked-in syndrome
D. Millard-Gubler syndrome
E. Benedikt syndrome

Q9. A patient presents with "locked-in syndrome." The lesion is at:

A. Pons (ventral)
B. Medulla
C. Midbrain
D. Thalamus
E. Internal capsule

Q10. Regarding intracerebral hemorrhage - the most common cause in a 55-year-old with chronic hypertension:

A. Berry aneurysm rupture
B. AVM
C. Hypertensive hemorrhage in basal ganglia/putamen
D. Amyloid angiopathy
E. Metastatic tumor

Q11. Charcot-Bouchard microaneurysms are associated with hemorrhage in the:

A. Subarachnoid space
B. Putamen and basal ganglia
C. Cerebellum
D. Frontal lobe
E. Occipital lobe

Q12. A 55-year-old presents with the "worst headache of her life" of sudden onset. CT head is normal. The next investigation is:

A. MRI brain
B. Lumbar puncture
C. Carotid Doppler
D. EEG
E. Cerebral angiography immediately

Q13. Xanthochromia on CSF examination suggests:

A. Bacterial meningitis
B. Subarachnoid hemorrhage > 2 hours old
C. Viral meningitis
D. TB meningitis
E. Normal CSF under increased pressure

Q14. A berry aneurysm rupture causing subarachnoid hemorrhage most commonly arises from the:

A. Middle cerebral artery
B. Basilar artery
C. Anterior communicating artery
D. Posterior communicating artery
E. Internal carotid artery

Q15. Posterior communicating artery aneurysm classically causes:

A. Bitemporal hemianopia
B. Ipsilateral complete 3rd nerve palsy with pupil dilation
C. Contralateral 6th nerve palsy
D. Horner syndrome
E. 4th nerve palsy

Q16. The ABCD2 score is used to predict:

A. Mortality after stroke
B. Risk of stroke after TIA
C. Need for thrombolysis
D. Prognosis of SAH
E. Risk of re-bleeding in AVM

Q17. Which of the following is NOT a feature of MCA territory infarction?

A. Contralateral hemiplegia (arm > leg)
B. Hemianesthesia
C. Homonymous hemianopia
D. Aphasia (if dominant hemisphere)
E. Urinary incontinence and leg weakness

Q18. A patient has atrial fibrillation and ischemic stroke. Long-term secondary prevention should be:

A. Aspirin only
B. Aspirin + Clopidogrel
C. Warfarin (target INR 2-3) or DOAC
D. Heparin
E. Statins only

Q19. Which imaging finding distinguishes hemorrhagic from ischemic stroke on plain CT?

A. Hypodense area
B. Midline shift only
C. Hyperdense area (white)
D. Loss of grey-white differentiation
E. Cortical sulcal effacement

Q20. Cerebral venous sinus thrombosis most commonly occurs in which sinus?

A. Sigmoid sinus
B. Superior sagittal sinus
C. Cavernous sinus
D. Transverse sinus
E. Straight sinus

Q21. A young woman on oral contraceptives develops headache, seizures, and papilledema. The diagnosis is:

A. Idiopathic intracranial hypertension
B. Cerebral venous sinus thrombosis
C. Ischemic stroke
D. Brain abscess
E. Viral encephalitis

Q22. Treatment of cerebral venous sinus thrombosis is:

A. Aspirin
B. Anticoagulation with heparin then warfarin (even in hemorrhagic transformation)
C. Thrombolysis
D. Steroids
E. Mannitol only

Q23. Lacunar infarcts are caused by occlusion of:

A. Large cortical arteries
B. Deep penetrating arteries (lenticulostriate)
C. Vertebrobasilar arteries
D. Venous sinuses
E. Cortical veins

Q24. Pure motor hemiplegia lacunar syndrome is due to a lesion in the:

A. Corona radiata or posterior limb of internal capsule
B. Basal ganglia
C. Thalamus
D. Cerebellum
E. Pons only

Q25. The most common risk factor for ischemic stroke is:

A. Atrial fibrillation
B. Hypertension
C. Diabetes mellitus
D. Hyperlipidemia
E. Smoking

Q26. "Watershed" (border zone) infarcts occur in:

A. Deep white matter
B. Junction between ACA-MCA and MCA-PCA territories
C. Brainstem
D. Cerebellum
E. Basal ganglia

Q27. Which of the following does NOT raise concern for hemorrhagic stroke when considering thrombolysis?

A. INR > 1.7
B. Recent major surgery within 14 days
C. Blood pressure 140/85 mmHg
D. Platelet count < 100,000
E. Prior intracranial hemorrhage

Q28. Nimodipine in subarachnoid hemorrhage is given to prevent:

A. Re-bleeding
B. Hydrocephalus
C. Cerebral vasospasm
D. Seizures
E. Cerebral edema

Q29. Which statement regarding hemorrhagic transformation of ischemic stroke is TRUE?

A. It occurs only with thrombolysis
B. It most commonly occurs 24-48 hours after large MCA infarction
C. It always requires surgical evacuation
D. It is commoner with small lacunar infarcts
E. It prevents future anticoagulation permanently

Q30. CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is caused by mutation in:

A. LRRK2
B. NOTCH3
C. PRNP
D. APP
E. PINK1

Q31. Weber syndrome (midbrain) is characterized by:

A. Ipsilateral 3rd nerve palsy + contralateral hemiplegia
B. Ipsilateral 6th nerve palsy + contralateral hemiplegia
C. Contralateral 3rd nerve palsy + ipsilateral hemiplegia
D. Bilateral 3rd nerve palsy
E. Ipsilateral Horner + contralateral hemiplegia

Q32. A patient with AF and recent ischemic stroke; their INR on warfarin is 1.4. The most appropriate action is:

A. Stop warfarin, start aspirin
B. Increase warfarin dose to achieve INR 2-3
C. Add aspirin to current warfarin
D. Switch to heparin
E. Keep current dose

Q33. Amyloid angiopathy as a cause of intracerebral hemorrhage typically involves:

A. Deep basal ganglia
B. Lobar cortical regions (especially parietal and occipital)
C. Thalamus
D. Pons
E. Cerebellum

Q34. The Hunt and Hess scale is used to grade:

A. Severity of ischemic stroke
B. Severity of subarachnoid hemorrhage clinically
C. Degree of carotid stenosis
D. Glasgow Coma Scale equivalent
E. Intracerebral hemorrhage volume

Q35. Carotid endarterectomy is indicated for symptomatic carotid stenosis of:

A. > 30%
B. > 50%
C. > 70%
D. 100% (occlusion)
E. Any stenosis > 20%

SECTION B: MENINGITIS, ENCEPHALITIS & CNS INFECTIONS (~30 MCQs)

Q36. A 22-year-old student presents with fever, neck stiffness, photophobia, and a petechial rash. The most likely organism is:

A. Streptococcus pneumoniae
B. Haemophilus influenzae
C. Neisseria meningitidis
D. Listeria monocytogenes
E. Mycobacterium tuberculosis

Q37. Kernig's sign is:

A. Neck flexion causing involuntary hip/knee flexion
B. Inability to extend the knee when hip is flexed to 90°
C. Flexion of the neck causing leg pain
D. Pain on percussion of the spine
E. Extension of the knee causing neck flexion

Q38. Brudzinski's sign is:

A. Inability to extend knee with hip flexed
B. Passive neck flexion causing involuntary hip and knee flexion
C. Pain on straight leg raise
D. Flexion of one hip when the other is flexed
E. Extension response to plantar stimulation

Q39. In bacterial meningitis, CSF findings typically show:

A. Low protein, high glucose, lymphocytes
B. High protein, low glucose, neutrophils
C. High protein, normal glucose, lymphocytes
D. Normal protein, normal glucose, neutrophils
E. Low protein, low glucose, lymphocytes

Q40. Empirical antibiotic therapy for bacterial meningitis in a 25-year-old is:

A. Amoxicillin
B. IV Ceftriaxone + Dexamethasone
C. Vancomycin alone
D. Gentamicin
E. Metronidazole

Q41. Dexamethasone in bacterial meningitis is given to reduce:

A. Cerebral edema only
B. Fever
C. Hearing loss and neurological sequelae (especially in pneumococcal meningitis)
D. CSF white cell count
E. Antibiotic requirements

Q42. TB meningitis CSF shows:

A. Neutrophils, very low glucose, very high protein
B. Lymphocytes, low glucose, raised protein, high ADA
C. Lymphocytes, normal glucose, low protein
D. Red cells, xanthochromia
E. Neutrophils, normal glucose, normal protein

Q43. The most common complication of TB meningitis is:

A. Seizures
B. Communicating hydrocephalus
C. Cranial nerve palsy (especially VI)
D. Stroke
E. Spinal arachnoiditis

Q44. A patient develops meningitis after a neurosurgical procedure. The most likely organism is:

A. Neisseria meningitidis
B. Staphylococcus aureus / Gram-negative bacilli (Klebsiella, Pseudomonas)
C. Listeria
D. Cryptococcus
E. Streptococcus pneumoniae

Q45. Viral meningitis (aseptic meningitis) CSF typically shows:

A. Neutrophils, low glucose
B. Lymphocytes, normal glucose, mildly raised protein
C. RBCs and xanthochromia
D. Organisms on Gram stain
E. India ink positive cells

Q46. The most common cause of viral encephalitis worldwide is:

A. CMV
B. EBV
C. Herpes simplex virus type 1 (HSV-1)
D. Varicella zoster
E. West Nile virus

Q47. HSV encephalitis characteristically involves the:

A. Frontal lobes
B. Temporal lobes (limbic)
C. Cerebellum
D. Brainstem
E. Basal ganglia

Q48. Treatment of HSV encephalitis is:

A. Acyclovir 10 mg/kg IV every 8 hours for 14-21 days
B. Ganciclovir
C. Foscarnet
D. Ribavirin
E. Oseltamivir

Q49. EEG in HSV encephalitis shows:

A. 3 Hz spike-wave complexes
B. Periodic lateralized epileptiform discharges (PLEDs) in temporal leads
C. Burst suppression
D. Alpha coma pattern
E. Diffuse delta slowing only

Q50. Cryptococcal meningitis is most common in:

A. Young healthy adults
B. HIV-positive patients (CD4 < 100)
C. Post-neurosurgical patients
D. Diabetics
E. Elderly patients > 70 years

Q51. India ink stain of CSF showing encapsulated yeast is diagnostic of:

A. TB meningitis
B. Cryptococcal meningitis
C. Bacterial meningitis
D. Aspergillosis
E. Candidal meningitis

Q52. Treatment of cryptococcal meningitis is:

A. Fluconazole alone
B. Amphotericin B + Flucytosine (induction), then fluconazole (consolidation)
C. Itraconazole
D. Voriconazole
E. Caspofungin

Q53. Brain abscess classically presents with the triad of:

A. Fever, meningismus, rash
B. Headache, fever, focal neurological deficit
C. Altered consciousness, papilledema, vomiting
D. Seizures, cranial nerve palsy, CSF pleocytosis
E. Neck stiffness, Kernig's sign, photophobia

Q54. The most common source of brain abscess is:

A. Hematogenous spread from lungs
B. Direct spread from paranasal sinuses/ear (otogenic/rhinogenic)
C. Post-traumatic
D. Post-neurosurgical
E. Dental infection

Q55. Lumbar puncture is contraindicated in meningitis when:

A. Fever is present
B. Papilledema or signs of raised ICP / mass lesion on CT
C. Neck stiffness is present
D. Antibiotic treatment has already started
E. Platelets are > 100,000

Q56. A 25-year-old returns from a tropical country with fever, altered consciousness, and seizures. Thick and thin blood film shows ring forms. Treatment is:

A. Chloroquine
B. Artemisinin-based combination therapy (IV artesunate for severe disease)
C. Quinine
D. Doxycycline
E. Mefloquine

Q57. Neurocysticercosis is caused by:

A. Taenia solium larval cysts (cysticerci) in the brain
B. Echinococcus granulosus
C. Toxoplasma gondii
D. Naegleria fowleri
E. Plasmodium falciparum

Q58. The most common presentation of neurocysticercosis is:

A. Focal neurological deficit
B. New-onset seizures in a young person from an endemic area
C. Meningitis
D. Hydrocephalus
E. Cranial nerve palsy

Q59. Subacute sclerosing panencephalitis (SSPE) is a late complication of:

A. Rubella
B. Measles (paramyxovirus)
C. Mumps
D. Varicella
E. CMV

Q60. CSF in SSPE shows:

A. Lymphocytes and low glucose
B. Very high measles antibody titers (IgG); oligoclonal bands
C. Neutrophils
D. India ink positive
E. Normal

Q61. Prion disease (CJD) characteristically shows on EEG:

A. PLEDs
B. Periodic sharp wave complexes (1/sec triphasic waves)
C. 3 Hz spike-wave
D. Hypsarrhythmia
E. Alpha coma

Q62. MRI in sporadic CJD shows signal change in:

A. White matter only
B. Basal ganglia (putamen, caudate) and cortex on DWI/FLAIR
C. Temporal lobes
D. Cerebellum only
E. Corpus callosum

Q63. A patient develops encephalitis with anti-NMDA receptor antibodies. The most common underlying tumor is:

A. Thymoma
B. Small cell lung cancer
C. Ovarian teratoma
D. Breast cancer
E. Lymphoma

Q64. Rabies encephalitis - the pathognomonic finding on histology is:

A. Negri bodies in Purkinje cells and hippocampal neurons
B. Lewy bodies
C. Bunina bodies
D. Pick bodies
E. Hirano bodies

Q65. Chemoprophylaxis for close contacts of meningococcal meningitis is:

A. Amoxicillin
B. Rifampicin (or ciprofloxacin/ceftriaxone)
C. Erythromycin
D. Doxycycline
E. Metronidazole

SECTION C: EPILEPSY & SEIZURES (~30 MCQs)

Q66. A patient has episodes of blank staring lasting 10-20 seconds with no post-ictal confusion, occurring many times daily since childhood. EEG shows 3 Hz spike-wave discharge. Diagnosis:

A. Complex partial seizure
B. Absence seizure (childhood absence epilepsy)
C. Simple partial seizure
D. Myoclonic seizure
E. Atonic seizure

Q67. Drug of choice for childhood absence epilepsy is:

A. Carbamazepine
B. Phenytoin
C. Ethosuximide (or sodium valproate)
D. Lamotrigine
E. Levetiracetam

Q68. Status epilepticus is defined as a seizure lasting more than:

A. 2 minutes
B. 5 minutes (or 2 seizures without recovery)
C. 10 minutes
D. 30 minutes
E. 60 minutes

Q69. First-line treatment of status epilepticus is:

A. IV phenytoin
B. IV lorazepam (or diazepam)
C. IV sodium valproate
D. IM midazolam
E. IV levetiracetam

Q70. A woman with epilepsy on sodium valproate wants to conceive. The most important concern is:

A. Teratogenicity - neural tube defects (highest risk with valproate)
B. Bone marrow suppression
C. Hepatotoxicity in the baby
D. Neonatal withdrawal
E. Delayed fetal growth

Q71. The safest antiepileptic drug in pregnancy is:

A. Sodium valproate
B. Carbamazepine
C. Lamotrigine (lowest teratogenic risk overall, preferred)
D. Phenytoin
E. Phenobarbitone

Q72. Carbamazepine mechanism of action is:

A. GABA enhancement
B. Sodium channel blockade (prolongs inactivation)
C. Calcium channel T-type blockade
D. NMDA antagonism
E. Potassium channel activation

Q73. Carbamazepine is specifically indicated for:

A. Absence seizures
B. Myoclonic epilepsy
C. Focal (partial) seizures and trigeminal neuralgia
D. West syndrome
E. Juvenile myoclonic epilepsy

Q74. Juvenile myoclonic epilepsy (JME) is characterized by:

A. Nocturnal tonic-clonic seizures only
B. Myoclonic jerks in the morning + tonic-clonic seizures + absence; EEG shows 4-6 Hz spike-wave
C. Only absence seizures
D. Onset in infancy with hypsarrhythmia
E. Temporal lobe focus

Q75. Drug of choice for JME is:

A. Carbamazepine
B. Phenytoin
C. Sodium valproate
D. Ethosuximide
E. Vigabatrin

Q76. Phenytoin toxicity causes:

A. Rash, liver failure, blood dyscrasias
B. Nystagmus, ataxia, diplopia at toxic levels; gingival hyperplasia, hirsutism, folate deficiency at therapeutic levels
C. Renal calculi
D. Weight gain and hair loss
E. Peripheral neuropathy only

Q77. Which antiepileptic drug inhibits hepatic enzymes (CYP450)?

A. Valproate (inhibitor)
B. Carbamazepine (inducer)
C. Lamotrigine (no effect)
D. Levetiracetam
E. Ethosuximide

Q78. Temporal lobe epilepsy (complex partial seizure) classically presents with:

A. Blank staring + 3 Hz spike-wave
B. Aura (déjà vu, olfactory), automatisms (lip smacking), post-ictal confusion
C. Sudden fall with loss of tone
D. Morning myoclonic jerks
E. Bilateral tonic-clonic without aura

Q79. Todd's paralysis is:

A. Permanent hemiplegia after stroke
B. Transient focal weakness after a seizure
C. Paralysis due to hypnotic drugs
D. Paralysis due to hypokalemia
E. Paralysis after spinal cord compression

Q80. The MRI finding most associated with temporal lobe epilepsy is:

A. Cortical dysplasia
B. Hippocampal sclerosis (mesial temporal sclerosis)
C. Cavernous malformation
D. Arteriovenous malformation
E. Tuberous sclerosis tubers

Q81. Lennox-Gastaut syndrome is characterized by:

A. Only absence seizures in children
B. Multiple seizure types (tonic, atonic, atypical absence), intellectual disability, slow spike-wave on EEG (< 2.5 Hz)
C. Benign rolandic epilepsy
D. JME pattern
E. Infantile spasms only

Q82. West syndrome (infantile spasms) is treated with:

A. Carbamazepine
B. ACTH or vigabatrin (especially in tuberous sclerosis)
C. Sodium valproate
D. Ethosuximide
E. Levetiracetam

Q83. A patient on phenytoin develops Stevens-Johnson syndrome. What is the associated HLA allele?

A. HLA-B*5701
B. HLA-B*1502 (in Asian patients)
C. HLA-B*5801
D. HLA-DR2
E. HLA-A*3101

Q84. Febrile seizures - which feature makes them "complex"?

A. Occurring in children 6 months - 5 years
B. Focal onset, duration > 15 minutes, or multiple seizures in 24 hours
C. Temperature > 38°C
D. Family history
E. Post-ictal sleep

Q85. Refractory status epilepticus (not responding to 2 benzodiazepines + 1 IV AED) - the next step is:

A. Double the lorazepam dose
B. General anesthesia (propofol, midazolam, thiopental) with continuous EEG monitoring
C. Neurosurgical intervention
D. Phenytoin alone
E. Oral levetiracetam

Q86. A patient taking valproate and lamotrigine - what happens to lamotrigine levels?

A. Valproate induces lamotrigine metabolism, levels fall
B. Valproate inhibits lamotrigine metabolism, levels rise (lamotrigine toxicity risk)
C. No interaction
D. Levels fall by 50%
E. Levels are unaffected

Q87. Non-epileptic attack disorder (NEAD/psychogenic seizure) - the investigation to distinguish from epilepsy during an attack is:

A. MRI brain
B. EEG during the attack (ictal EEG shows no epileptiform activity)
C. Serum prolactin > 1 hour post-attack (elevated after true epileptic seizures)
D. Both B and C
E. Lumbar puncture

Q88. Driving regulations in epilepsy (UK/Pakistan equivalents) - seizure-free period required before driving:

A. 3 months
B. 6 months
C. 1 year seizure-free
D. 2 years
E. 5 years

Q89. In a patient presenting with first unprovoked seizure, treatment is started:

A. Always immediately
B. Only if there is structural brain abnormality, EEG abnormality, or > 2 unprovoked seizures
C. Never at first seizure
D. Only in children
E. Only if nocturnal

Q90. Hyperventilation triggers which type of seizure?

A. Temporal lobe seizures
B. Absence seizures (3 Hz spike-wave)
C. Tonic-clonic seizures
D. Myoclonic seizures
E. Atonic seizures

Q91. Rasmussen encephalitis causes:

A. Bilateral generalized seizures
B. Progressive focal epilepsy (epilepsia partialis continua), unilateral brain atrophy
C. Mesial temporal sclerosis
D. Absence seizures
E. Status epilepticus only

Q92. Valproate mechanism of action includes:

A. Sodium channel blockade + GABA enhancement + T-type Ca2+ channel blockade
B. Only sodium channel blockade
C. Only GABA-A enhancement
D. NMDA receptor antagonism
E. Potassium channel activation only

Q93. The ketogenic diet is used in treatment of:

A. Absence epilepsy
B. JME
C. Refractory epilepsy, GLUT-1 deficiency, pyruvate dehydrogenase deficiency
D. TLE
E. SSPE

Q94. Ictal headache occurs in which type of epilepsy?

A. Absence epilepsy
B. Occipital lobe epilepsy
C. Frontal lobe epilepsy
D. JME
E. TLE

Q95. Benign childhood epilepsy with centrotemporal spikes (BECTS/BCECTS) is characterized by:

A. Absence seizures
B. Nocturnal hemifacial or unilateral motor seizures; centrotemporal spikes on EEG; remits by puberty
C. Drop attacks
D. Morning myoclonic jerks
E. Infantile spasms

SECTION D: PARKINSON'S DISEASE & MOVEMENT DISORDERS (~25 MCQs)

Q96. The cardinal features of Parkinson's disease (TRAP) are:

A. Tremor (resting), Rigidity, Akinesia/Bradykinesia, Postural instability
B. Tremor (intention), Rigidity, Ataxia, Paralysis
C. Tremor, Rigidity, Aphasia, Papilledema
D. Resting tremor, Ataxia, Rigidity, Paralysis
E. Tremor, Rigidity, Akathisia, Psychosis

Q97. The tremor of Parkinson's disease is characteristically:

A. Intention tremor (worse with movement)
B. Resting tremor (4-6 Hz), reduced by movement, "pill-rolling"
C. Postural tremor
D. Flapping tremor (asterixis)
E. Orthostatic tremor

Q98. The pathological hallmark of Parkinson's disease is:

A. Neurofibrillary tangles
B. Lewy bodies (alpha-synuclein inclusions) in substantia nigra neurons
C. Pick bodies
D. Bunina bodies
E. Senile plaques

Q99. The neuroanatomical location of degeneration in Parkinson's disease is:

A. Locus coeruleus
B. Substantia nigra pars compacta (dopaminergic neurons)
C. Subthalamic nucleus
D. Globus pallidus
E. Caudate nucleus

Q100. First-line drug treatment for Parkinson's disease causing significant functional impairment in a 70-year-old is:

A. Amantadine
B. MAO-B inhibitor (selegiline/rasagiline) alone
C. Levodopa + carbidopa (co-careldopa)
D. Pramipexole (dopamine agonist)
E. Anticholinergics

Q101. Carbidopa is combined with levodopa because:

A. It increases CNS penetration of levodopa
B. It inhibits peripheral dopa decarboxylase, reducing peripheral conversion of levodopa to dopamine (reducing side effects, improving CNS delivery)
C. It has independent antiparkinsonian effects
D. It prevents oxidative stress
E. It inhibits COMT

Q102. "On-off" fluctuations and dyskinesias in Parkinson's disease are due to:

A. Disease progression with loss of striatal buffering capacity for dopamine
B. Excessive carbidopa
C. Peripheral metabolism of levodopa
D. Dopamine receptor downregulation alone
E. Blood-brain barrier changes

Q103. Which drug is used specifically for tremor-dominant Parkinson's disease in younger patients and also has independent effect?

A. Levodopa
B. Amantadine
C. Anticholinergics (trihexyphenidyl / benztropine) - tremor-dominant, young
D. Selegiline
E. Entacapone

Q104. Progressive supranuclear palsy (PSP) is differentiated from PD by:

A. Resting tremor
B. Good response to levodopa
C. Vertical gaze palsy (downgaze), axial rigidity, early falls backward, no tremor, poor response to levodopa
D. Asymmetric onset
E. Olfactory dysfunction

Q105. Multiple system atrophy (MSA) is characterized by:

A. Parkinsonism + cerebellar ataxia + autonomic failure (combination)
B. Vertical gaze palsy
C. Cortical dementia + parkinsonism
D. Alien limb + parkinsonism
E. REM sleep behavior disorder only

Q106. Corticobasal degeneration (CBD) is recognized by:

A. Resting tremor
B. Alien limb phenomenon + asymmetric apraxia + cortical sensory loss + parkinsonism
C. Vertical gaze palsy
D. Autonomic failure
E. Good response to levodopa

Q107. Dopamine agonists used in Parkinson's disease include:

A. Selegiline, rasagiline
B. Pramipexole, ropinirole, rotigotine
C. Entacapone, tolcapone (COMT inhibitors)
D. Amantadine
E. Trihexyphenidyl

Q108. Deep brain stimulation (DBS) in Parkinson's disease is most commonly targeted at:

A. Globus pallidus interna (GPi)
B. Subthalamic nucleus (STN)
C. Thalamus (VIM)
D. Substantia nigra
E. Caudate nucleus

Q109. Huntington's disease is:

A. X-linked recessive
B. Autosomal dominant - CAG trinucleotide repeat expansion in HTT gene on chromosome 4
C. Autosomal recessive
D. Mitochondrial inheritance
E. Sporadic only

Q110. Huntington's disease features include:

A. Resting tremor + dementia
B. Chorea + dementia + psychiatric features (depression, personality change); caudate atrophy on MRI
C. Ataxia + peripheral neuropathy
D. Spasticity + dementia
E. Parkinsonism + dementia

Q111. Essential tremor is treated with:

A. Levodopa
B. Propranolol (first-line) or primidone
C. Amantadine
D. Haloperidol
E. Carbamazepine

Q112. Wilson's disease (hepatolenticular degeneration) is caused by:

A. Iron overload
B. Copper accumulation due to defective ATP7B (copper-transporting ATPase)
C. Zinc deficiency
D. Manganese toxicity
E. Lead toxicity

Q113. Kayser-Fleischer rings in Wilson's disease are seen in:

A. Lens
B. Cornea (Descemet membrane) - brown-green rings
C. Retina
D. Sclera
E. Conjunctiva

Q114. Treatment of Wilson's disease is:

A. Iron chelation (desferrioxamine)
B. D-penicillamine (copper chelation) or trientine; zinc supplements to reduce absorption
C. Levodopa
D. Liver transplant alone
E. Copper supplementation

Q115. Hemiballismus is caused by a lesion in the:

A. Caudate nucleus
B. Contralateral subthalamic nucleus
C. Globus pallidus
D. Thalamus
E. Red nucleus

Q116. Dystonia - writer's cramp is a form of:

A. Generalized dystonia
B. Focal task-specific dystonia
C. Hemidystonia
D. Segmental dystonia
E. Paroxysmal dystonia

Q117. Drug-induced parkinsonism is most commonly caused by:

A. Levodopa
B. Dopamine receptor blockers (metoclopramide, haloperidol, risperidone)
C. Anticholinergics
D. Antihistamines
E. SSRIs

Q118. Tourette syndrome is characterized by:

A. Motor and vocal tics; onset < 18 years; often with OCD and ADHD
B. Chorea only
C. Parkinsonism in children
D. Absence seizures
E. Intentional tremor

Q119. Sydenham's chorea is associated with:

A. SLE
B. Rheumatic fever (Group A Streptococcal infection) - anti-basal ganglia antibodies
C. Huntington's disease
D. Hyperthyroidism
E. Wilson's disease

Q120. Restless legs syndrome (RLS) is characterized by:

A. Painful leg cramps at night
B. Uncomfortable leg urge to move at rest, worse at night, relieved by movement
C. Leg weakness
D. Autonomic dysfunction
E. Leg tremor at rest

SECTION E: MULTIPLE SCLEROSIS & DEMYELINATING DISEASE (~20 MCQs)

Q121. Multiple sclerosis is characterized pathologically by:

A. Axonal loss only
B. Plaques of demyelination separated in time and space, with relative preservation of axons early on; inflammation, gliosis
C. Gray matter neuronal loss
D. Amyloid deposition
E. Lewy body formation

Q122. Lhermitte's sign in MS is:

A. Unsteady gait with eyes closed
B. Electric shock sensation down the spine on neck flexion (cervical cord demyelination)
C. Intention tremor
D. Diplopia on lateral gaze
E. Internuclear ophthalmoplegia

Q123. Internuclear ophthalmoplegia (INO) in a young adult is characteristic of:

A. Myasthenia gravis
B. Multiple sclerosis (demyelination of MLF - medial longitudinal fasciculus)
C. Miller Fisher syndrome
D. Wernicke encephalopathy
D. Brainstem glioma

Q124. Optic neuritis in MS presents with:

A. Sudden painless loss of vision
B. Painful loss of vision in one eye with reduced color vision (especially red); relative afferent pupillary defect (RAPD/Marcus Gunn pupil)
C. Bilateral loss of vision
D. Diplopia
E. Visual field defect only

Q125. MRI criteria for MS diagnosis (McDonald criteria) require:

A. Gadolinium enhancement only
B. Lesions disseminated in space (at least 2 of 4 CNS areas) AND time (new T2/gadolinium lesion or CSF oligoclonal bands)
C. Only spinal cord lesions
D. Periventricular lesions only
E. Corpus callosum lesions only

Q126. The typical CSF finding in MS is:

A. Neutrophils, low glucose
B. Oligoclonal IgG bands (present in CSF but not serum) + mildly elevated protein
C. High protein, very low glucose
D. Xanthochromia
E. India ink positive

Q127. MS lesions on MRI characteristically appear as:

A. Hyperdense on CT
B. Periventricular "Dawson's fingers" on T2/FLAIR (perpendicular to corpus callosum)
C. Ring-enhancing lesions
D. Hemorrhagic lesions
E. Posterior fossa lesions only

Q128. First-line treatment for acute MS relapse is:

A. Oral prednisolone long-term
B. IV methylprednisolone 1g/day for 3-5 days (shortens relapse duration but does not affect long-term disability)
C. Interferon-beta
D. Natalizumab
E. Cyclophosphamide

Q129. Disease-modifying therapy (DMT) for relapsing-remitting MS includes:

A. Interferon-beta 1a/1b, glatiramer acetate, natalizumab, ocrelizumab, fingolimod
B. Corticosteroids only
C. Azathioprine alone
D. Methotrexate
E. IV immunoglobulin only

Q130. Neuromyelitis optica (NMO / Devic disease) is differentiated from MS by:

A. Oligoclonal bands in CSF
B. Anti-aquaporin-4 antibody (AQP4-IgG); severe optic neuritis + transverse myelitis extending > 3 segments; distinct from MS
C. Periventricular Dawson's fingers
D. Good response to interferons
E. Benign course

Q131. ADEM (Acute Disseminated Encephalomyelitis) differs from MS in that it:

A. Always relapses
B. Occurs mainly in children after infection/vaccination; usually monophasic; lesions are large and bilateral
C. Has oligoclonal bands always
D. Involves only spinal cord
E. Responds to interferons

Q132. Progressive multifocal leukoencephalopathy (PML) is caused by:

A. HIV directly
B. JC virus reactivation in immunocompromised patients (especially natalizumab use in MS)
C. CMV
D. EBV
E. Measles

Q133. Central pontine myelinolysis (osmotic demyelination syndrome) is caused by:

A. Rapid increase in serum sodium
B. Rapid correction of hyponatremia (too fast)
C. Chronic hyponatremia
D. Hyperkalemia
E. Hypoglycemia

Q134. The clinical features of central pontine myelinolysis are:

A. Cerebellar ataxia
B. Quadriplegia, pseudobulbar palsy, "locked-in" state
C. Unilateral hemiplegia
D. Seizures only
E. Visual loss

Q135. Subacute combined degeneration of the cord (SACD) is caused by:

A. Thiamine (B1) deficiency
B. Vitamin B12 deficiency - affects dorsal columns (proprioception loss) and lateral corticospinal tracts (UMN signs)
C. Folate deficiency
D. Vitamin C deficiency
E. Niacin deficiency

Q136. In SACD, clinical findings include:

A. Lower motor neuron signs only
B. Loss of vibration and proprioception (dorsal columns) + spastic paraparesis (corticospinal tracts) + peripheral neuropathy
C. Cerebellar ataxia only
D. Cranial nerve palsies
E. Autonomic failure

Q137. A young woman has fever, acute flaccid paraplegia, sensory level, and urinary retention. MRI shows long segment T2 signal in cord. The diagnosis is:

A. MS relapse
B. Transverse myelitis (or NMO if AQP4+)
C. Guillain-Barre syndrome
D. Spinal cord infarction
E. Epidural abscess

Q138. Primary progressive MS (PPMS) is treated with:

A. Interferon-beta
B. Ocrelizumab (anti-CD20) - the only approved DMT for PPMS
C. Natalizumab
D. Glatiramer acetate
E. Fingolimod

Q139. Uhthoff's phenomenon in MS is:

A. Worsening of symptoms with cold
B. Worsening of existing MS symptoms with rise in body temperature (fever, hot bath)
C. New MS relapse triggered by infection
D. Visual disturbance on neck flexion
E. Proprioceptive loss on standing

Q140. Trigeminal neuralgia is most commonly associated with which demyelinating disease?

A. ADEM
B. NMO
C. Multiple sclerosis (bilateral TN in a young patient suggests MS)
D. PML
E. SACD

SECTION F: HEADACHE DISORDERS (~15 MCQs)

Q141. The diagnostic criteria for migraine WITHOUT aura require:

A. Visual aura + unilateral headache
B. At least 5 attacks, 4-72 hours, unilateral, pulsating, moderate-severe, aggravated by routine activity, + nausea/vomiting or photophobia/phonophobia
C. Bilateral, pressing, 30 min - 7 days
D. Unilateral, autonomic features, 15-180 min
E. Sudden onset "thunderclap"

Q142. Acute treatment of migraine attack:

A. Paracetamol alone
B. Triptans (serotonin 5-HT1B/1D agonists) ± NSAIDs; antiemetics (metoclopramide)
C. Opioids
D. Benzodiazepines
E. Beta-blockers

Q143. Prophylaxis for frequent migraines - first-line agents include:

A. Sumatriptan daily
B. Propranolol, topiramate, amitriptyline, sodium valproate
C. Ergotamine
D. Codeine
E. Diazepam

Q144. Cluster headache is characterized by:

A. Bilateral, pressing, 30 min - 7 days
B. Severe unilateral orbital/periorbital pain, 15-180 min, autonomic features (lacrimation, nasal congestion, Horner syndrome), occurring in clusters
C. Pulsating, with aura
D. Thunderclap onset
E. Occipital location

Q145. Acute treatment of cluster headache is:

A. Paracetamol
B. 100% oxygen (15 L/min) + SC sumatriptan
C. Oral NSAIDs
D. Opioids
E. Antiemetics

Q146. Prophylaxis for cluster headache is:

A. Propranolol
B. Verapamil (first-line for cluster headache prevention)
C. Amitriptyline
D. Valproate
E. Topiramate

Q147. Idiopathic intracranial hypertension (pseudotumor cerebri) classically affects:

A. Elderly thin men
B. Obese young women; associated with tetracyclines, vitamin A excess, OCP
C. Children with fever
D. Elderly women
E. Young thin men

Q148. Papilledema on fundoscopy + normal brain MRI + elevated CSF opening pressure > 25 cmH2O with normal CSF content. The treatment is:

A. Corticosteroids
B. Weight loss + acetazolamide (carbonic anhydrase inhibitor); repeated LP; optic nerve sheath fenestration if vision threatened
C. Mannitol IV
D. Ventriculoperitoneal shunt immediately
E. NSAIDs

Q149. The "red flag" features in headache that require urgent investigation include:

A. Pulsating quality
B. Thunderclap onset, fever + neck stiffness, new in > 50 years, progressive, worsening with Valsalva, postural headache, neurological signs
C. Photophobia with migraine
D. Headache > 4 hours
E. Nausea with headache

Q150. Medication overuse headache (MOH) develops with regular use of analgesics for > 10-15 days/month for > 3 months. The treatment is:

A. Increasing analgesic doses
B. Withdrawal of the overused medication + prophylactic therapy
C. Adding opioids
D. Verapamil
E. Ergotamine

Q151. Trigeminal neuralgia - the drug of choice is:

A. Amitriptyline
B. Gabapentin
C. Carbamazepine
D. Phenytoin
E. Baclofen

Q152. A 65-year-old patient has unilateral temporal headache, jaw claudication, visual loss, elevated ESR > 80. Diagnosis:

A. Migraine
B. Cluster headache
C. Giant cell arteritis (temporal arteritis)
D. TIA
E. Orbital cellulitis

Q153. Treatment of giant cell arteritis:

A. NSAIDs
B. High-dose prednisolone (1 mg/kg/day; do not wait for biopsy if visual symptoms)
C. Aspirin alone
D. Methotrexate first
E. Verapamil

Q154. Post-lumbar puncture headache is:

A. Bilateral, worse on lying down
B. Positional - worse on standing, relieved by lying flat; managed with bed rest, IV fluids, caffeine; blood patch if persistent
C. Pulsating, unilateral
D. With autonomic features
E. Associated with fever

Q155. Paroxysmal hemicrania differs from cluster headache in that it:

A. Lasts longer (4-72 hours)
B. Responds absolutely to indomethacin (diagnostic)
C. Is treated with verapamil
D. Affects men > women
E. Has no autonomic features

SECTION G: PERIPHERAL NEUROPATHY & NEUROMUSCULAR JUNCTION (~20 MCQs)

Q156. Guillain-Barre syndrome (GBS) classically presents with:

A. Ascending sensorimotor neuropathy progressing to flaccid paralysis, areflexia, 1-4 weeks after infection/vaccination
B. Proximal muscle weakness + myopathy
C. Upper motor neuron signs
D. Cognitive decline
E. Sensory ataxia only

Q157. The most important investigation in GBS:

A. EMG showing demyelinating pattern
B. CSF showing albuminocytological dissociation (high protein, normal/low cells)
C. Anti-GM1 antibodies
D. Nerve conduction study
E. MRI spine

Q158. The most dangerous complication of GBS requiring monitoring is:

A. Pain
B. Respiratory failure (monitor FVC; intubate if FVC < 15-20 mL/kg)
C. Autonomic dysfunction
D. Deep vein thrombosis
E. Sensory loss

Q159. Treatment of GBS is:

A. Steroids
B. IV immunoglobulin (IVIG) 0.4 g/kg/day for 5 days OR plasmapheresis; NOT steroids
C. Plasmapheresis only
D. Antibiotics
E. Observation only

Q160. Miller Fisher syndrome (variant of GBS) presents with the triad of:

A. Ascending paralysis, areflexia, CSF dissociation
B. Ophthalmoplegia, ataxia, areflexia; anti-GQ1b antibodies
C. Facial diplegia, areflexia, sensory loss
D. Bulbar palsy, areflexia
E. Autonomic failure, areflexia, sensory loss

Q161. Myasthenia gravis - the autoimmune target is:

A. Voltage-gated calcium channels (VGCC)
B. Acetylcholine receptor (AChR) antibodies (or MuSK antibodies in seronegative MG)
C. Acetylcholinesterase
D. Sodium channels
E. NMDA receptors

Q162. Myasthenic crisis is precipitated by all EXCEPT:

A. Infection
B. Aminoglycosides
C. Pyridostigmine (treatment, not precipitant)
D. Stress/surgery
E. Magnesium sulfate

Q163. The Tensilon (edrophonium) test in MG works by:

A. Blocking AChR
B. Inhibiting acetylcholinesterase transiently, increasing ACh at NMJ - ptosis resolves within 30-60 seconds
C. Stimulating AChR directly
D. Blocking VGCC
E. Releasing ACh from presynaptic vesicles

Q164. Treatment of myasthenia gravis includes:

A. Pyridostigmine (symptomatic) + immunosuppression (prednisolone, azathioprine) + thymectomy (especially with thymoma)
B. Pyridostigmine alone
C. Corticosteroids alone
D. Plasmapheresis only
E. IVIG only

Q165. Lambert-Eaton myasthenic syndrome (LEMS) differs from MG in that:

A. Anti-AChR antibodies
B. Proximal muscle weakness + reduced reflexes that IMPROVE with repetitive stimulation; anti-VGCC antibodies; associated with SCLC
C. Ptosis and diplopia are the main features
D. Good response to pyridostigmine
E. Ocular muscles predominantly affected

Q166. Charcot-Marie-Tooth disease (hereditary motor and sensory neuropathy) is characterized by:

A. Central demyelination
B. Distal muscle wasting (peroneal muscles - inverted champagne bottle legs), high arches (pes cavus), length-dependent sensorimotor neuropathy; autosomal dominant (PMP22 duplication most common)
C. Proximal weakness
D. Cerebellar ataxia
E. Upper motor neuron signs

Q167. Diabetic peripheral neuropathy - the most common pattern is:

A. Mononeuropathy multiplex
B. Symmetric distal "glove and stocking" sensorimotor neuropathy
C. Proximal motor neuropathy (amyotrophy)
D. Autonomic neuropathy only
E. Cranial nerve palsy

Q168. The most common cranial nerve palsy in diabetes is:

A. 2nd nerve (optic)
B. 3rd nerve (pupil-sparing; ischemic)
C. 4th nerve
D. 6th nerve
E. 7th nerve

Q169. Carpal tunnel syndrome is due to compression of:

A. Ulnar nerve at wrist
B. Median nerve at carpal tunnel (wrist)
C. Radial nerve
D. Median nerve at elbow
E. Ulnar nerve at elbow (cubital tunnel)

Q170. Carpal tunnel syndrome presents with:

A. Weakness of intrinsic hand muscles + ulnar claw
B. Wrist drop
C. Tingling and pain in thumb, index, middle finger (median distribution); Tinel's and Phalen's signs positive; thenar wasting in severe cases
D. Elbow pain radiating to little finger
E. Loss of grip strength and medial two fingers

Q171. Bell's palsy is:

A. UMN 7th nerve palsy (forehead spared)
B. LMN 7th nerve palsy (forehead involved) - idiopathic, probably HSV-1; treated with prednisolone ± acyclovir
C. Due to stroke
D. Bilateral always
E. Permanent

Q172. UMN vs LMN facial palsy - which feature differentiates them?

A. Inability to close eye
B. Loss of taste
C. Forehead sparing (UMN spares forehead due to bilateral cortical representation of frontalis)
D. Hyperacusis
E. Nasolabial fold flattening

Q173. Peroneal nerve palsy (common fibular nerve) causes:

A. Foot drop + inversion of foot preserved; loss of eversion and dorsiflexion; sensory loss over lateral leg and dorsum of foot
B. Equinus deformity
C. Loss of plantar flexion
D. Claw toes
E. Loss of knee reflex

Q174. Wrist drop is characteristic of:

A. Median nerve injury at wrist
B. Radial nerve palsy (in radial groove of humerus - "Saturday night palsy")
C. Ulnar nerve palsy
D. Brachial plexus C5-C6 injury
E. Anterior interosseous nerve

Q175. Polyneuropathy caused by isoniazid is due to:

A. Direct hepatotoxicity
B. Pyridoxine (B6) deficiency - prevented by giving pyridoxine prophylactically
C. Folate deficiency
D. Renal toxicity
E. Drug interaction with rifampicin

SECTION H: RAISED ICP, COMA & NEUROCRITICAL CARE (~15 MCQs)

Q176. The Glasgow Coma Scale (GCS) components are:

A. Eye (1-4), Verbal (1-5), Motor (1-6); max 15, min 3
B. Eye (1-5), Verbal (1-5), Motor (1-5); max 15
C. Eye (1-4), Verbal (1-4), Motor (1-6); max 14
D. Eye (1-3), Verbal (1-5), Motor (1-6); max 14
E. Eye (1-4), Verbal (1-5), Motor (1-5); max 14

Q177. Cushing's triad (sign of raised ICP / transtentorial herniation) consists of:

A. Hypotension + tachycardia + tachypnea
B. Hypertension + bradycardia + irregular respiration
C. Hypertension + tachycardia + bradypnea
D. Hypotension + bradycardia + tachypnea
E. Normal vitals + dilated pupils

Q178. The first sign of transtentorial (uncal) herniation is:

A. Contralateral hemiplegia
B. Ipsilateral fixed dilated pupil (compression of ipsilateral 3rd nerve)
C. Bilateral fixed dilated pupils
D. Cheyne-Stokes breathing
E. Decorticate posturing

Q179. Medical management of raised ICP includes:

A. IV fluids freely
B. Head up 30°, osmotic therapy (mannitol 20% or hypertonic saline), hyperventilation (PCO2 30-35 mmHg), dexamethasone (for vasogenic edema/tumor), avoid hyperpyrexia
C. Flat positioning
D. Corticosteroids for all causes
E. Aggressive IV fluid resuscitation

Q180. Dexamethasone is specifically indicated for cerebral edema in:

A. Stroke
B. Head trauma
C. Brain tumor (vasogenic edema)
D. Hyponatremia
E. Meningitis only

Q181. A patient has a GCS of 8 (E2V2M4). What is the immediate action?

A. CT head
B. IV access + glucose
C. Secure airway (intubate/definitive airway) - GCS ≤ 8 = intubate
D. IV mannitol
E. Lumbar puncture

Q182. Normal CSF opening pressure on lumbar puncture is:

A. < 5 cmH2O
B. 6-20 cmH2O (generally up to 25 in obese patients)
C. 25-35 cmH2O
D. > 40 cmH2O
E. 1-5 cmH2O

Q183. Epidural hematoma (EDH) - the classic scenario is:

A. Elderly patient on warfarin
B. Young patient with temporal head injury (middle meningeal artery rupture), lucid interval followed by rapid deterioration; biconvex (lenticular) lesion on CT
C. Elderly patient with chronic subdural
D. Hypertensive patient
E. Patient with coagulopathy

Q184. Chronic subdural hematoma classically occurs in:

A. Young athletes
B. Elderly patients, alcoholics, patients on anticoagulants; crescent-shaped hypodense lesion on CT; can present with mild cognitive decline
C. Hypertensives
D. Young patients with trauma
E. Children

Q185. The reversal agent for IV heparin is:

A. Fresh frozen plasma
B. Protamine sulfate
C. Vitamin K
D. Tranexamic acid
E. Cryoprecipitate

Q186. Hepatic encephalopathy - the EEG shows:

A. 3 Hz spike-wave
B. Triphasic waves
C. PLEDs
D. Hypsarrhythmia
E. Alpha waves only

Q187. Wernicke encephalopathy (thiamine B1 deficiency) classically presents with:

A. Dementia, incontinence, gait ataxia
B. Ophthalmoplegia, ataxia, confusion (triad); seen in alcoholics and malnourished patients
C. Peripheral neuropathy only
D. Cerebellar ataxia only
E. Psychosis only

Q188. Treatment of Wernicke encephalopathy is:

A. Oral thiamine
B. IV thiamine (Pabrinex) BEFORE glucose - giving glucose first can precipitate Wernicke
C. Glucose infusion first
D. IV vitamin C
E. Folate

Q189. Korsakoff syndrome (following Wernicke) is characterized by:

A. Ataxia and ophthalmoplegia
B. Anterograde amnesia + confabulation (fabrication of memories); relatively preserved remote memory; poor prognosis
C. Dementia with hallucinations
D. Cerebellar syndrome
E. Peripheral neuropathy

Q190. A patient with diabetes is found unconscious. Blood glucose is 1.2 mmol/L. Treatment:

A. Oral glucose
B. 50 mL of 50% dextrose IV (followed by IV 10% dextrose; once awake, oral glucose)
C. IV normal saline
D. Glucagon only
E. IV insulin

SECTION I: DEMENTIA & DEGENERATIVE DISORDERS (~15 MCQs)

Q191. The most common cause of dementia worldwide is:

A. Vascular dementia
B. Lewy body dementia
C. Alzheimer's disease (60-70% of all dementias)
D. Frontotemporal dementia
E. Normal pressure hydrocephalus

Q192. The pathological hallmarks of Alzheimer's disease are:

A. Lewy bodies + dopamine loss
B. Amyloid plaques (beta-amyloid, Abeta42) + neurofibrillary tangles (hyperphosphorylated tau) + neuronal loss starting in hippocampus
C. TDP-43 inclusions
D. Pick bodies
E. Prion plaques

Q193. The APOE4 allele is associated with:

A. Frontotemporal dementia
B. Increased risk of sporadic late-onset Alzheimer's disease
C. Parkinson's disease
D. Huntington's disease
E. Vascular dementia

Q194. The drug approved for symptomatic treatment of mild-moderate Alzheimer's disease:

A. Memantine (NMDA antagonist)
B. Donepezil (acetylcholinesterase inhibitor) - first-line for mild-moderate; memantine added for moderate-severe
C. Rivastigmine only
D. SSRI
E. Haloperidol

Q195. Vascular dementia is characterized by:

A. Gradual onset, progressive decline
B. Stepwise deterioration, focal neurological signs, history of stroke/TIAs, features of vascular risk factors
C. Fluctuating cognition + visual hallucinations
D. Behavioral/personality change predominating
E. REM sleep behavior disorder

Q196. Dementia with Lewy bodies (DLB) - core features include:

A. Amyloid plaques and tau tangles only
B. Fluctuating cognition + visual hallucinations + parkinsonism; REM sleep behavior disorder; neuroleptic sensitivity
C. Stepwise deterioration
D. Personality change + behavior
E. Amnesia only

Q197. Normal pressure hydrocephalus (NPH) presents with the triad of:

A. Dementia + incontinence + vision loss
B. "Wet, wacky, wobbly" - urinary incontinence + cognitive decline + gait apraxia (magnetic gait)
C. Headache + vomiting + papilledema
D. Tremor + rigidity + dementia
E. Ataxia + peripheral neuropathy + dementia

Q198. The treatment for NPH is:

A. Acetazolamide
B. Ventriculoperitoneal (VP) shunt
C. Serial lumbar punctures (temporary improvement after tap test confirms diagnosis)
D. Both serial LP (diagnosis) and VP shunt (treatment) are correct - B is definitive
E. Steroids

Q199. Frontotemporal dementia (FTD) - the behavioral variant presents with:

A. Memory loss as the first symptom
B. Personality and behavior changes, disinhibition, apathy, executive dysfunction; relative preservation of memory early; temporal and frontal atrophy
C. Visual hallucinations + parkinsonism
D. Stepwise course
E. Rapid onset with myoclonus

Q200. Motor neuron disease (ALS) is characterized by:

A. Only LMN signs
B. Combined UMN + LMN signs in the same patient (e.g., brisk reflexes + fasciculations in the same limb), bulbar involvement, no sensory loss or sphincter dysfunction (until late)
C. Sensory ataxia
D. Dementia as first sign
E. Only UMN signs

SECTION J: MISCELLANEOUS HIGH-YIELD TOPICS (~10 MCQs)

Q201. Neurofibromatosis type 1 (NF1) is characterized by:

A. Bilateral vestibular schwannomas
B. Cafe-au-lait spots (> 6, > 1.5 cm), neurofibromas, Lisch nodules (iris hamartomas), axillary freckling; chromosome 17 (NF1 gene)
C. Hemangioblastoma + renal cell carcinoma
D. Tuberous sclerosis
E. Sturge-Weber syndrome

Q202. Tuberous sclerosis (TSC) features include:

A. Bilateral acoustic neuromas
B. Ash-leaf spots (hypopigmented macules), shagreen patches, adenoma sebaceum (angiofibromata), cortical tubers, subependymal nodules, cardiac rhabdomyoma; TSC1 (hamartin) or TSC2 (tuberin)
C. Cafe-au-lait spots
D. Lisch nodules
E. Hemangioblastoma

Q203. Von Hippel-Lindau (VHL) disease is associated with:

A. Neurofibromas + Lisch nodules
B. Cerebellar hemangioblastoma + retinal hemangioblastoma + renal cell carcinoma + pheochromocytoma; VHL gene chromosome 3p
C. Tuberous sclerosis
D. Bilateral acoustic neuromas
E. Encephalotrigeminal angiomatosis

Q204. Sturge-Weber syndrome is characterized by:

A. Cafe-au-lait spots
B. Port-wine stain (trigeminal territory - V1) + ipsilateral leptomeningeal angioma + ipsilateral glaucoma + seizures + intellectual disability; "tram-track" calcification on CT
C. Bilateral schwannomas
D. Hemangioblastoma
E. Renal cell carcinoma

Q205. Syringomyelia presents with:

A. UMN signs only
B. Cape-like loss of pain and temperature (suspended dissociated sensory loss) with preserved touch and proprioception; weakness and wasting of hand/arm muscles; associated with Chiari malformation
C. Only sensory ataxia
D. Paraplegia only
E. Cranial nerve palsies

Q206. The most common primary brain tumor in adults is:

A. Meningioma
B. Glioblastoma multiforme (GBM) - Grade IV astrocytoma; pseudopalisading necrosis on histology; "butterfly" pattern crossing corpus callosum
C. Oligodendroglioma
D. Ependymoma
E. CNS lymphoma

Q207. A 5-year-old child has a posterior fossa tumor causing hydrocephalus. The most likely tumor is:

A. GBM
B. Medulloblastoma (most common posterior fossa tumor in children; PNET; "drop metastases" in CSF)
C. Ependymoma
D. Craniopharyngioma
E. Pilocytic astrocytoma

Q208. The most common cause of spastic paraparesis in a developing country:

A. MS
B. Pott's disease (spinal tuberculosis - TB of spine)
C. SACD
D. ALS
E. Syringomyelia

Q209. Horner syndrome consists of:

A. Ptosis + mydriasis + anhidrosis
B. Partial ptosis (superior tarsal muscle) + miosis + anhidrosis (ipsilateral); enophthalmos (apparent)
C. Complete ptosis + fixed dilated pupil
D. Ptosis + miosis + exophthalmos
E. Ptosis + mydriasis + lacrimation

Q210. The Argyll Robertson pupil (seen in neurosyphilis) is described as:

A. Large, reacts to light, does not accommodate
B. Small, irregular; reacts to accommodation but NOT to light ("prostitute's pupil - accommodates but does not react")
C. Fixed dilated pupil
D. Unilateral dilated pupil
E. Relative afferent pupillary defect

ANSWER KEY

Q	A	Q	A	Q	A	Q	A	Q	A
1	B	2	C	3	B	4	B	5	B
6	B	7	A	8	B	9	A	10	C
11	B	12	B	13	B	14	C	15	B
16	B	17	E	18	C	19	C	20	B
21	B	22	B	23	B	24	A	25	B
26	B	27	C	28	C	29	B	30	B
31	A	32	B	33	B	34	B	35	C
36	C	37	B	38	B	39	B	40	B
41	C	42	B	43	B	44	B	45	B
46	C	47	B	48	A	49	B	50	B
51	B	52	B	53	B	54	B	55	B
56	B	57	A	58	B	59	B	60	B
61	B	62	B	63	C	64	A	65	B
66	B	67	C	68	B	69	B	70	A
71	C	72	B	73	C	74	B	75	C
76	B	77	B	78	B	79	B	80	B
81	B	82	B	83	B	84	B	85	B
86	B	87	D	88	C	89	B	90	B
91	B	92	A	93	C	94	B	95	B
96	A	97	B	98	B	99	B	100	C
101	B	102	A	103	C	104	C	105	A
106	B	107	B	108	B	109	B	110	B
111	B	112	B	113	B	114	B	115	B
116	B	117	B	118	A	119	B	120	B
121	B	122	B	123	B	124	B	125	B
126	B	127	B	128	B	129	A	130	B
131	B	132	B	133	B	134	B	135	B
136	B	137	B	138	B	139	B	140	C
141	B	142	B	143	B	144	B	145	B
146	B	147	B	148	B	149	B	150	B
151	C	152	C	153	B	154	B	155	B
156	A	157	B	158	B	159	B	160	B
161	B	162	C	163	B	164	A	165	B
166	B	167	B	168	B	169	B	170	C
171	B	172	C	173	A	174	B	175	B
176	A	177	B	178	B	179	B	180	C
181	C	182	B	183	B	184	B	185	B
186	B	187	B	188	B	189	B	190	B
191	C	192	B	193	B	194	B	195	B
196	B	197	B	198	D	199	B	200	B
201	B	202	B	203	B	204	B	205	B
206	B	207	B	208	B	209	B	210	B

Topic Distribution & Importance Ranking (based on UHS past paper frequency)

Rank	Topic	No. of MCQs	UHS Exam Weight
1	Stroke & Cerebrovascular Disease	35	Very High - appears every year in MCQs + UQs
2	Meningitis/Encephalitis/CNS Infections	30	Very High - clinical scenario UQs frequent
3	Epilepsy & Seizures	30	Very High - drugs, management, classification
4	Parkinson's + Movement Disorders	25	High - pharmacology + clinical features
5	Multiple Sclerosis + Demyelination	20	High - CSF, MRI, treatment repeatedly asked
6	Peripheral Neuropathy + NMJ	20	High - GBS, MG, LEMS, mononeuropathies
7	Headache	15	Moderate-High - cluster, migraine, GCA
8	Raised ICP, Coma, Neurocritical Care	15	High - GCS, herniation, Wernicke
9	Dementia + Degenerative	15	Moderate - Alzheimer's, NPH, ALS
10	Miscellaneous (neurocutaneous, tumors)	10	Moderate - phakomatoses, syrinx, syphilis

Key UHS Exam Tips:

Stroke thrombolysis criteria (window, contraindications) appear in almost every paper
GBS vs MG vs LEMS distinction is a classic SBA
CSF findings in different meningitides - memorize the table
Drug of choice questions: carbamazepine (focal seizures/TN), valproate (JME/generalized), ethosuximide (absence only), verapamil (cluster), propranolol (essential tremor/migraine prophylaxis)
Wernicke: thiamine BEFORE glucose
LP contraindications and xanthochromia interpretation
Lewy body dementia neuroleptic sensitivity (avoid antipsychotics)

provide explaination from davidson medicine book of these answers

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Q	A	Q	A	Q	A	Q	A	Q	A
1	B	2	C	3	B	4	B	5	B
6	B	7	A	8	B	9	A	10	C
11	B	12	B	13	B	14	C	15	B
16	B	17	E	18	C	19	C	20	B
21	B	22	B	23	B	24	A	25	B
26	B	27	C	28	C	29	B	30	B
31	A	32	B	33	B	34	B	35	C
36	C	37	B	38	B	39	B	40	B
41	C	42	B	43	B	44	B	45	B
46	C	47	B	48	A	49	B	50	B
51	B	52	B	53	B	54	B	55	B
56	B	57	A	58	B	59	B	60	B
61	B	62	B	63	C	64	A	65	B
66	B	67	C	68	B	69	B	70	A
71	C	72	B	73	C	74	B	75	C
76	B	77	B	78	B	79	B	80	B
81	B	82	B	83	B	84	B	85	B
86	B	87	D	88	C	89	B	90	B
91	B	92	A	93	C	94	B	95	B
96	A	97	B	98	B	99	B	100	C
101	B	102	A	103	C	104	C	105	A
106	B	107	B	108	B	109	B	110	B
111	B	112	B	113	B	114	B	115	B
116	B	117	B	118	A	119	B	120	B
121	B	122	B	123	B	124	B	125	B
126	B	127	B	128	B	129	A	130	B
131	B	132	B	133	B	134	B	135	B
136	B	137	B	138	B	139	B	140	C
141	B	142	B	143	B	144	B	145	B
146	B	147	B	148	B	149	B	150	B
151	C	152	C	153	B	154	B	155	B
156	A	157	B	158	B	159	B	160	B
161	B	162	C	163	B	164	A	165	B
166	B	167	B	168	B	169	B	170	C
171	B	172	C	173	A	174	B	175	B
176	A	177	B	178	B	179	B	180	C
181	C	182	B	183	B	184	B	185	B
186	B	187	B	188	B	189	B	190	B
191	C	192	B	193	B	194	B	195	B
196	B	197	B	198	D	199	B	200	B
201	B	202	B	203	B	204	B	205	B
206	B	207	B	208	B	209	B	210	B

Q	A	Q	A	Q	A	Q	A	Q	A
1	B	2	C	3	B	4	B	5	B
6	B	7	A	8	B	9	A	10	C
11	B	12	B	13	B	14	C	15	B
16	B	17	E	18	C	19	C	20	B
21	B	22	B	23	B	24	A	25	B
26	B	27	C	28	C	29	B	30	B
31	A	32	B	33	B	34	B	35	C
36	C	37	B	38	B	39	B	40	B
41	C	42	B	43	B	44	B	45	B
46	C	47	B	48	A	49	B	50	B
51	B	52	B	53	B	54	B	55	B
56	B	57	A	58	B	59	B	60	B
61	B	62	B	63	C	64	A	65	B
66	B	67	C	68	B	69	B	70	A
71	C	72	B	73	C	74	B	75	C
76	B	77	B	78	B	79	B	80	B
81	B	82	B	83	B	84	B	85	B
86	B	87	D	88	C	89	B	90	B
91	B	92	A	93	C	94	B	95	B
96	A	97	B	98	B	99	B	100	C
101	B	102	A	103	C	104	C	105	A
106	B	107	B	108	B	109	B	110	B
111	B	112	B	113	B	114	B	115	B
116	B	117	B	118	A	119	B	120	B
121	B	122	B	123	B	124	B	125	B
126	B	127	B	128	B	129	A	130	B
131	B	132	B	133	B	134	B	135	B
136	B	137	B	138	B	139	B	140	C
141	B	142	B	143	B	144	B	145	B
146	B	147	B	148	B	149	B	150	B
151	C	152	C	153	B	154	B	155	B
156	A	157	B	158	B	159	B	160	B
161	B	162	C	163	B	164	A	165	B
166	B	167	B	168	B	169	B	170	C
171	B	172	C	173	A	174	B	175	B
176	A	177	B	178	B	179	B	180	C
181	C	182	B	183	B	184	B	185	B
186	B	187	B	188	B	189	B	190	B
191	C	192	B	193	B	194	B	195	B
196	B	197	B	198	D	199	B	200	B
201	B	202	B	203	B	204	B	205	B
206	B	207	B	208	B	209	B	210	B

Q	A	Q	A	Q	A	Q	A	Q	A
1	B	2	C	3	B	4	B	5	B
6	B	7	A	8	B	9	A	10	C
11	B	12	B	13	B	14	C	15	B
16	B	17	E	18	C	19	C	20	B
21	B	22	B	23	B	24	A	25	B
26	B	27	C	28	C	29	B	30	B
31	A	32	B	33	B	34	B	35	C
36	C	37	B	38	B	39	B	40	B
41	C	42	B	43	B	44	B	45	B
46	C	47	B	48	A	49	B	50	B
51	B	52	B	53	B	54	B	55	B
56	B	57	A	58	B	59	B	60	B
61	B	62	B	63	C	64	A	65	B
66	B	67	C	68	B	69	B	70	A
71	C	72	B	73	C	74	B	75	C
76	B	77	B	78	B	79	B	80	B
81	B	82	B	83	B	84	B	85	B
86	B	87	D	88	C	89	B	90	B
91	B	92	A	93	C	94	B	95	B
96	A	97	B	98	B	99	B	100	C
101	B	102	A	103	C	104	C	105	A
106	B	107	B	108	B	109	B	110	B
111	B	112	B	113	B	114	B	115	B
116	B	117	B	118	A	119	B	120	B
121	B	122	B	123	B	124	B	125	B
126	B	127	B	128	B	129	A	130	B
131	B	132	B	133	B	134	B	135	B
136	B	137	B	138	B	139	B	140	C
141	B	142	B	143	B	144	B	145	B
146	B	147	B	148	B	149	B	150	B
151	C	152	C	153	B	154	B	155	B
156	A	157	B	158	B	159	B	160	B
161	B	162	C	163	B	164	A	165	B
166	B	167	B	168	B	169	B	170	C
171	B	172	C	173	A	174	B	175	B
176	A	177	B	178	B	179	B	180	C
181	C	182	B	183	B	184	B	185	B
186	B	187	B	188	B	189	B	190	B
191	C	192	B	193	B	194	B	195	B
196	B	197	B	198	D	199	B	200	B
201	B	202	B	203	B	204	B	205	B
206	B	207	B	208	B	209	B	210	B