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12 days for exams. i am reading steupup medicine and not irfan masood and pervez akbar for peads medicine and give me uhs based past mcqs and practice based daily mcqs 30 atleast from every topic of every system for better understanding and to pass the upcoming exam. i want to use pomodoro technique and can not study more than 8 hours a day. i do not have internet connection and limited access to internet so can not consult you every time. i am using osmosis vedios for better understanding too. Give me timetable and resources according to it.

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ls /home/daytona/workspace/ 2>/dev/null && echo "---" && ls /home/daytona/skills…

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mkdir -p /home/daytona/workspace/uhs-study-package && echo "directory created"

12 days for exams. i am reading steupup medicine and not irfan masood and give me uhs based past mcqs and practice based daily mcqs 30 atleast from every topic of every system for better understanding and to pass the upcoming exam. i want to use pomodoro technique and can not study more than 8 hours a day. i do not have internet connection and limited access to internet so can not consult you every time. i am using osmosis vedios for better understanding too. Give me timetable and resources according to it. not required pdf

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30 uhs based mcqs from each topic davidson based with mcqs answers and explaination at the end

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📋 QUICK REFERENCE SUMMARY - CNS HIGH-YIELD POINTS

Topic	UHS Favorites
Stroke	CT normal = ischemic; tPA window 4.5h; CHADS2-VASc for AF
TIA	Amaurosis fugax = ICA; Wallenberg = PICA; eyes deviate TO frontal lesion
Parkinson's	TRAP; nigrostriatal; levodopa first-line elderly; peak-dose dyskinesia
Essential Tremor	Postural, propranolol, alcohol improves
Huntington's	AD, Chr 4, CAG repeat, caudate atrophy
Alzheimer's	Amyloid + tau; hippocampal atrophy; donepezil
NPH	Wet + Wobbly + Wacky; shunt works
Lewy Body	Hallucinations + fluctuations + Parkinsonism; avoid antipsychotics
MS	Dawson's fingers; McDonald criteria; IV methylprednisolone for relapse
MG	Anti-AChR; Tensilon test; thymoma association
LEMS	Pre-synaptic; SCLC; strength improves with exercise
SACD	B12 deficiency; posterior + lateral columns
Brown-Sequard	Ipsilateral motor/proprioception; contralateral pain/temperature

📅 HOW TO USE THESE (Pomodoro Framework)

Session structure (8h/day = 16 Pomodoros of 25 min + 5 min breaks, 3 long breaks):

Pomodoros 1-4: Read Step-Up Medicine CNS chapter (mark high-yield)
Pomodoros 5-6: Watch Osmosis videos (Stroke, Parkinson's, MS)
Pomodoros 7-12: Attempt these 30 MCQs - write answers on paper FIRST, then check
Pomodoros 13-14: Review wrong answers + read explanations
Pomodoros 15-16: Active recall - close notes, rewrite key facts from memory

Tell me which topic to do NEXT (CVS / Pulmo / Nephro / Rheuma / Gastro / Hepato / Endo / Derma / Psych OR Paediatrics topics) and I'll give you 30 more UHS MCQs in the same format. Each system takes one message - just say the topic name.

100 more mcqs like this

100 more CNS/Neurology UHS-based MCQs, Davidson-style, with full explanations. Covering all remaining subtopics: Altered Mental Status, Neurocutaneous Syndromes, Spinal Cord (extended), Miscellaneous CNS conditions, plus deeper Stroke/Movement/Demyelinating questions.

🧠 CNS - 100 MORE UHS MCQs (Q31-Q130)

Davidson / Goldman-Cecil / Step-Up Based | Answers + Explanations at End

QUESTIONS

CEREBROVASCULAR DISEASE - ADVANCED (Q31-Q45)

Q31. A patient presents with sudden onset of right homonymous hemianopia with macular sparing. Which artery is MOST likely occluded?

A) Middle cerebral artery
B) Anterior cerebral artery
C) Posterior cerebral artery
D) Anterior choroidal artery
E) Basilar artery

Q32. Which of the following is the MOST common cause of spontaneous intracerebral hemorrhage in a 70-year-old hypertensive patient?

A) Arteriovenous malformation
B) Amyloid angiopathy
C) Hypertensive arteriolosclerosis (Charcot-Bouchard microaneurysm)
D) Coagulopathy
E) Cocaine use

Q33. A 45-year-old man with no risk factors has a subarachnoid hemorrhage. CT shows blood in the basal cisterns. The MOST common cause is:

A) Hypertensive bleed
B) AVM rupture
C) Berry (saccular) aneurysm rupture
D) Trauma
E) Coagulopathy

Q34. Which of the following is the MOST feared complication of subarachnoid hemorrhage occurring 4-14 days after onset?

A) Re-bleeding
B) Cerebral vasospasm
C) Hydrocephalus
D) SIADH
E) Meningitis

Q35. The drug of choice to PREVENT cerebral vasospasm after SAH is:

A) Nimodipine (oral)
B) IV labetalol
C) Heparin
D) Mannitol
E) Dexamethasone

Q36. A patient with TIA is found to have 80% ipsilateral carotid stenosis. The MOST appropriate intervention is:

A) Aspirin alone
B) Warfarin
C) Carotid endarterectomy
D) Angioplasty + stenting
E) Medical management with statin

Q37. Cerebellar stroke MOST characteristically presents with:

A) Contralateral hemiplegia
B) Ipsilateral limb ataxia, nystagmus, dysarthria
C) Contralateral sensory loss
D) Aphasia
E) Homonymous hemianopia

Q38. A young woman on oral contraceptives develops progressive headache, papilledema, and no focal deficits. MRI shows empty delta sign on contrast. The diagnosis is:

A) Pseudotumor cerebri (IIH)
B) Cerebral venous sinus thrombosis (CVST)
C) Brain tumor
D) Hypertensive encephalopathy
E) SAH

Q39. Treatment of cerebral venous sinus thrombosis (CVST), even with hemorrhagic infarction, includes:

A) Thrombolytics
B) Anticoagulation with heparin/warfarin
C) Aspirin
D) Decompressive craniectomy
E) Steroids

Q40. The MOST common site of hypertensive intracerebral hemorrhage is:

A) Frontal lobe
B) Occipital lobe
C) Putamen/basal ganglia
D) Cerebellum
E) Temporal lobe

Q41. A patient with a right MCA stroke has weakness of left face (lower), left arm > left leg. The lesion is in:

A) Right internal capsule
B) Right motor cortex (frontal lobe)
C) Right pons
D) Right thalamus
E) Right cerebellum

Q42. Which of the following is NOT a feature of anterior cerebral artery (ACA) territory stroke?

A) Contralateral leg weakness > arm
B) Urinary incontinence
C) Abulia (lack of initiative)
D) Aphasia (dominant hemisphere)
E) Contralateral arm > leg weakness

Q43. A patient 3 days after ischemic stroke develops fever, confusion, and new neurological deficit. The MOST likely cause is:

A) Hemorrhagic transformation
B) Cerebral edema with herniation
C) Aspiration pneumonia
D) Re-stroke
E) DVT

Q44. NIHSS score is used in stroke to:

A) Confirm diagnosis
B) Assess eligibility for thrombolysis and monitor severity
C) Locate the site of infarction
D) Predict 30-day mortality
E) Guide anticoagulation dosing

Q45. Locked-in syndrome results from infarction of:

A) Midbrain
B) Thalamus bilaterally
C) Ventral pons (bilateral)
D) Medulla
E) Cerebral cortex bilaterally

MOVEMENT DISORDERS - ADVANCED (Q46-Q58)

Q46. A 30-year-old man has resting tremor, dysarthria, behavioral change, and Kayser-Fleischer rings on slit-lamp examination. Serum ceruloplasmin is low. The diagnosis is:

A) Huntington's disease
B) Wilson's disease
C) Parkinson's disease
D) Multiple system atrophy
E) Sydenham's chorea

Q47. Treatment of Wilson's disease includes:

A) Levodopa
B) D-penicillamine (copper chelator)
C) Tetrabenazine
D) Haloperidol
E) Propranolol

Q48. Sydenham's chorea is associated with:

A) Streptococcal throat infection / Rheumatic fever
B) SLE
C) OCP use
D) Pregnancy
E) All of the above

Q49. A patient on long-term antipsychotics develops repetitive lip smacking, tongue protrusions, and grimacing. The diagnosis is:

A) Akathisia
B) Acute dystonia
C) Tardive dyskinesia
D) Parkinsonism
E) Neuroleptic malignant syndrome

Q50. Hemiballismus is caused by a lesion in:

A) Cerebellum
B) Subthalamic nucleus (contralateral)
C) Substantia nigra
D) Basal ganglia (putamen)
E) Thalamus

Q51. Which drug is MOST effective for essential tremor?

A) Levodopa
B) Propranolol
C) Carbamazepine
D) Haloperidol
E) Benzhexol

Q52. Lewy bodies are composed of:

A) Tau protein
B) Amyloid-beta
C) Alpha-synuclein
D) TDP-43
E) Huntingtin

Q53. A patient with Parkinson's disease develops significant orthostatic hypotension, cerebellar ataxia, and autonomic failure but minimal tremor. This suggests:

A) Progressive supranuclear palsy (PSP)
B) Multiple system atrophy (MSA)
C) Lewy body dementia
D) Corticobasal degeneration
E) Drug-induced Parkinsonism

Q54. The "gait" most characteristic of Parkinson's disease is:

A) High-stepping (steppage) gait
B) Scissor gait
C) Festinating gait (shuffling, small steps, forward-stooped)
D) Waddling gait
E) Hemiplegic gait

Q55. Progressive supranuclear palsy (PSP) classically presents with:

A) Vertical gaze palsy (downward) + Parkinsonism + early falls
B) Horizontal gaze palsy + ataxia
C) Pill-rolling tremor + bradykinesia
D) Dementia + chorea
E) Facial diplegia + areflexia

Q56. Which Parkinson's medication acts as an MAO-B inhibitor?

A) Entacapone
B) Bromocriptine
C) Selegiline (Deprenyl)
D) Apomorphine
E) Trihexyphenidyl

Q57. The pathological hallmark of Huntington's disease on neuroimaging is:

A) Midbrain atrophy ("hummingbird sign")
B) Caudate nucleus atrophy (loss of lateral ventricular convexity)
C) Cerebellar atrophy
D) Periventricular white matter lesions
E) Hippocampal atrophy

Q58. A patient has rhythmic oscillation of the head ("yes-yes" tremor) with normal gait and no rigidity. This is MOST likely:

A) Parkinson's disease
B) Essential tremor (titubation)
C) Cerebellar disease
D) Wilson's disease
E) Huntington's disease

DEMENTIA AND ALTERED MENTAL STATUS (Q59-Q70)

Q59. Which of the following BEST distinguishes delirium from dementia?

A) Memory impairment
B) Acute onset and fluctuating consciousness
C) Visual hallucinations
D) Disorientation to place
E) Language difficulty

Q60. A 70-year-old man has sudden onset confusion, agitation, visual hallucinations, and disorientation after a hip replacement surgery. The MOST likely diagnosis is:

A) Dementia
B) Delirium (postoperative)
C) Psychosis
D) Encephalitis
E) Stroke

Q61. The MOST important immediate step in a confused patient in the emergency room is:

A) CT head
B) Check blood glucose
C) Lumbar puncture
D) EEG
E) MRI brain

Q62. Frontotemporal dementia (Pick's disease) is characterized by:

A) Memory loss as the earliest feature
B) Visual hallucinations
C) Personality change and disinhibition as earliest features
D) Stepwise deterioration
E) Parkinsonism

Q63. Creutzfeldt-Jakob disease (CJD) is characterized by:

A) Slow progression over decades
B) Rapid dementia + myoclonus + periodic sharp waves on EEG (triphasic)
C) Cerebellar ataxia only
D) Normal MRI
E) CSF pleocytosis

Q64. The BEST investigation to diagnose Alzheimer's disease definitively is:

A) CT scan
B) MRI showing hippocampal atrophy
C) PET scan (amyloid)
D) Brain biopsy showing amyloid plaques + neurofibrillary tangles
E) CSF beta-amyloid + tau levels

Q65. A patient with dementia has a gait disturbance described as "magnetic gait" (feet appear glued to floor). The ventricles are enlarged on CT. Improvement occurs after LP drainage of CSF. Diagnosis:

A) Alzheimer's disease
B) Vascular dementia
C) Normal pressure hydrocephalus
D) Frontotemporal dementia
E) Lewy body dementia

Q66. Hepatic encephalopathy on EEG shows:

A) Epileptiform spikes
B) Alpha waves
C) Triphasic waves
D) Beta activity
E) Burst suppression

Q67. The MAIN neurotransmitter deficiency in Alzheimer's disease is:

A) Dopamine
B) Serotonin
C) Acetylcholine
D) GABA
E) Norepinephrine

Q68. Which of the following drugs used in Alzheimer's disease inhibits NMDA receptors?

A) Donepezil
B) Rivastigmine
C) Galantamine
D) Memantine
E) Tacrine

Q69. Korsakoff psychosis (confabulation + anterograde amnesia) is due to deficiency of:

A) Vitamin B12
B) Thiamine (B1)
C) Niacin (B3)
D) Pyridoxine (B6)
E) Riboflavin

Q70. Wernicke's encephalopathy triad consists of:

A) Confusion, fever, neck stiffness
B) Ophthalmoplegia, ataxia, confusion/encephalopathy
C) Headache, vomiting, papilledema
D) Seizures, psychosis, autonomic instability
E) Diplopia, dysarthria, dysphagia

DEMYELINATING DISEASE - ADVANCED (Q71-Q80)

Q71. Uhthoff's phenomenon in multiple sclerosis refers to:

A) Worsening of symptoms with cold temperature
B) Transient worsening of neurological symptoms with heat/fever/exercise
C) Remission of symptoms spontaneously
D) Pain behind the eye with eye movement
E) Bilateral leg spasticity

Q72. L'hermitte's sign in MS is:

A) Horizontal nystagmus on lateral gaze
B) Electric shock sensation down the spine on neck flexion
C) Positive Babinski reflex
D) Pain on eye movement
E) Scanning dysarthria

Q73. The CSF finding MOST characteristic of MS is:

A) Increased protein + low glucose
B) Oligoclonal IgG bands (not present in serum)
C) Increased red cells
D) Low protein
E) Bacterial on Gram stain

Q74. Neuromyelitis optica (Devic's disease) is characterized by:

A) Periventricular lesions + optic neuritis
B) Severe bilateral optic neuritis + longitudinally extensive transverse myelitis (>3 vertebral segments) + AQP4 antibodies
C) Short spinal cord lesions
D) Dawson's fingers on MRI
E) Responds well to beta-interferon

Q75. Which of the following is a disease-modifying therapy for relapsing-remitting MS?

A) IV methylprednisolone
B) Baclofen
C) Beta-interferon (IFN-β)
D) Amantadine
E) Gabapentin

Q76. ADEM (Acute Disseminated Encephalomyelitis) differs from MS in that it:

A) Affects adults primarily
B) Is monophasic and follows infection/vaccination
C) Shows oligoclonal bands in CSF
D) Has periventricular lesions
E) Requires long-term immunotherapy

Q77. Optic neuritis as a presenting feature of MS is characterized by:

A) Painless progressive visual loss
B) Sudden onset visual loss + pain on eye movement + RAPD (relative afferent pupillary defect)
C) Bilateral simultaneous visual loss
D) Visual field defect with macular sparing
E) Red-green color blindness only

Q78. Internuclear ophthalmoplegia (INO) in a young patient is MOST likely due to:

A) Brainstem glioma
B) Multiple sclerosis (MLF lesion)
C) Cavernous sinus thrombosis
D) Myasthenia gravis
E) Third nerve palsy

Q79. Which of the following is a spasticity-reducing drug used in MS?

A) Levodopa
B) Propranolol
C) Baclofen (GABA-B agonist)
D) Carbamazepine
E) Amantadine

Q80. The most common clinical form of MS at onset is:

A) Primary progressive
B) Secondary progressive
C) Relapsing-remitting (RRMS)
D) Progressive relapsing
E) Benign MS

NEUROMUSCULAR + PERIPHERAL NERVE DISEASES (Q81-Q93)

Q81. A 40-year-old woman has proximal muscle weakness, difficulty rising from chair, no ocular involvement, elevated CK, and muscle biopsy showing inflammatory infiltrate. Diagnosis:

A) Myasthenia gravis
B) Lambert-Eaton syndrome
C) Polymyositis
D) Duchenne muscular dystrophy
E) Myotonic dystrophy

Q82. Dermatomyositis differs from polymyositis by the presence of:

A) Proximal weakness
B) Elevated CK
C) Gottron's papules + heliotrope rash
D) EMG myopathic changes
E) Inflammatory infiltrate on biopsy

Q83. A patient presents with acute ascending flaccid paralysis, areflexia, and bilateral facial weakness 2 weeks after a diarrheal illness. CSF shows raised protein with normal cells (albumino-cytologic dissociation). Diagnosis:

A) Transverse myelitis
B) Poliomyelitis
C) Guillain-Barre syndrome (GBS)
D) Myasthenia gravis
E) Botulism

Q84. The MOST common preceding infection in Guillain-Barre syndrome is:

A) EBV
B) CMV
C) Campylobacter jejuni
D) HSV
E) HIV

Q85. The MOST life-threatening complication of GBS is:

A) Autonomic dysfunction
B) Respiratory failure (diaphragm involvement)
C) Pain
D) DVT
E) Dysarthria

Q86. Treatment of GBS includes:

A) IV methylprednisolone
B) IV immunoglobulin (IVIG) or plasmapheresis
C) Plasmapheresis + steroids
D) Interferon beta
E) Pyridostigmine

Q87. Miller-Fisher syndrome is a variant of GBS characterized by:

A) Severe ascending paralysis
B) Ophthalmoplegia + ataxia + areflexia (OAA triad) with anti-GQ1b antibodies
C) Autonomic failure + dementia
D) Cranial nerve palsies only
E) Descending paralysis

Q88. Charcot-Marie-Tooth disease is a hereditary disorder of the:

A) Neuromuscular junction
B) Peripheral nerves (hereditary motor and sensory neuropathy)
C) Anterior horn cells
D) Posterior columns
E) Cerebellum

Q89. Carpal tunnel syndrome is caused by compression of which nerve?

A) Ulnar nerve
B) Radial nerve
C) Median nerve
D) Musculocutaneous nerve
E) Axillary nerve

Q90. A patient has wrist drop after falling asleep with arm over chair back. The nerve injured is:

A) Median nerve
B) Ulnar nerve
C) Radial nerve (Saturday night palsy)
D) Axillary nerve
E) Musculocutaneous nerve

Q91. Diabetic peripheral neuropathy classically presents as:

A) Proximal muscle weakness
B) Glove-and-stocking sensory loss with burning feet
C) Cranial nerve palsies
D) Mononeuritis multiplex
E) Autonomic neuropathy only

Q92. The EMG finding in demyelinating neuropathy (GBS) is:

A) Reduced amplitude, normal conduction velocity
B) Slowed nerve conduction velocity + prolonged F-waves + conduction block
C) Fibrillations + positive sharp waves
D) Incremental response to repetitive stimulation
E) Decremental response to 3 Hz stimulation

Q93. In myasthenia gravis, which electrophysiology finding is characteristic?

A) Decremental response to repetitive nerve stimulation at 3 Hz
B) Incremental response to rapid stimulation
C) Slowed nerve conduction
D) Fibrillation potentials
E) Normal EMG

NEUROCUTANEOUS SYNDROMES + MISCELLANEOUS (Q94-Q107)

Q94. A child has cafe-au-lait spots, axillary freckling, and multiple soft subcutaneous tumors. The diagnosis is:

A) Tuberous sclerosis
B) Neurofibromatosis type 1 (NF1 - von Recklinghausen disease)
C) Sturge-Weber syndrome
D) Von Hippel-Lindau
E) Ataxia telangiectasia

Q95. Tuberous sclerosis is associated with:

A) Cafe-au-lait spots + neurofibromas
B) Ash-leaf macules + seizures + mental retardation + subependymal nodules + renal angiomyolipoma
C) Port-wine stain + seizures
D) Cerebellar hemangioblastoma + renal cell carcinoma
E) Bilateral acoustic neuromas

Q96. Neurofibromatosis type 2 (NF2) is characterized by:

A) Cafe-au-lait spots > 6
B) Bilateral acoustic neuromas (vestibular schwannomas)
C) Optic glioma
D) Axillary freckling
E) Lisch nodules

Q97. Sturge-Weber syndrome is associated with:

A) Autosomal dominant inheritance
B) Port-wine stain (facial nevus) + ipsilateral leptomeningeal angiomatosis + seizures + glaucoma
C) Bilateral cataracts
D) Multiple endocrine neoplasia
E) Renal cell carcinoma

Q98. Von Hippel-Lindau syndrome includes:

A) Acoustic neuroma
B) Cerebellar hemangioblastoma + renal cell carcinoma + pheochromocytoma + retinal angioma
C) Meningioma
D) Cortical tubers
E) Ependymoma

Q99. Ataxia telangiectasia is characterized by:

A) Progressive cerebellar ataxia + oculocutaneous telangiectasia + immunodeficiency + malignancy risk
B) Port-wine stain + glaucoma
C) Cafe-au-lait spots + neurofibromas
D) Bilateral vestibular schwannomas
E) Cortical tubers + seizures

Q100. The MOST common primary brain tumor in adults is:

A) Meningioma
B) Pituitary adenoma
C) Glioblastoma multiforme (GBM)
D) Acoustic neuroma
E) Medulloblastoma

Q101. Ring-enhancing lesion on contrast CT in an immunocompetent adult MOST likely represents:

A) MS plaque
B) Primary CNS lymphoma
C) High-grade glioma or metastasis
D) Tuberculous abscess
E) Both C and D

Q102. In an HIV patient with CD4 < 100 and ring-enhancing brain lesion, the MOST likely diagnosis is:

A) Primary CNS lymphoma
B) Toxoplasma encephalitis
C) Progressive multifocal leukoencephalopathy (PML)
D) Cryptococcal meningitis
E) CMV encephalitis

Q103. Idiopathic intracranial hypertension (pseudotumor cerebri) is MOST associated with:

A) Male sex + cachexia
B) Obese young women + OCP/tetracycline/vitamin A excess
C) Elderly men + hypertension
D) Children with meningitis
E) Athletes + anabolic steroids

Q104. The treatment of pseudotumor cerebri includes:

A) Dexamethasone
B) Mannitol
C) Acetazolamide + weight loss + serial LPs
D) VP shunt (first line)
E) Furosemide only

Q105. A patient presents with fever, severe headache, photophobia, neck stiffness, and positive Kernig's sign. CSF shows: glucose 1.5 mmol/L (blood glucose 5.5), protein 2.5 g/L, WBC 800 (predominantly neutrophils), positive Gram stain. The MOST likely causative organism in a 25-year-old is:

A) Streptococcus pneumoniae
B) Neisseria meningitidis
C) Listeria monocytogenes
D) Haemophilus influenzae
E) E. coli

Q106. Empirical treatment of bacterial meningitis in a 25-year-old includes:

A) IV ampicillin alone
B) IV ceftriaxone + dexamethasone
C) Oral amoxicillin
D) IV acyclovir
E) IV vancomycin alone

Q107. CSF findings in viral (aseptic) meningitis show:

A) Neutrophilia + low glucose + high protein
B) Lymphocytosis + normal/mildly raised protein + normal glucose
C) No cells + very high protein
D) RBCs + xanthochromia
E) Eosinophilia

SPINAL CORD + NERVE ROOT (Q108-Q115)

Q108. A patient has bilateral leg weakness, loss of pain and temperature below T10, but preserved vibration and proprioception. The lesion is in:

A) Posterior columns bilaterally
B) Anterior spinal artery territory (central cord infarction)
C) Dorsal horn
D) Cauda equina
E) Brown-Sequard

Q109. Cauda equina syndrome presents with:

A) UMN signs in legs + sensory level
B) LMN signs in legs + saddle anesthesia + bladder/bowel dysfunction
C) Spastic paraparesis + upgoing plantars
D) Hemiplegia + hemisensory loss
E) Bilateral Homer syndrome

Q110. The MOST common cause of spinal cord compression in the elderly is:

A) Prolapsed intervertebral disc
B) Spinal metastases (from prostate, breast, lung, kidney)
C) Epidural abscess
D) MS
E) Syringomyelia

Q111. Syringomyelia classically presents with:

A) Cape-like distribution of dissociated sensory loss (pain/temperature loss with preserved touch/vibration) in upper limbs
B) Spastic paraplegia only
C) Peripheral neuropathy
D) Dementia
E) Cranial nerve palsies

Q112. Which nerve root is compressed in a patient with pain radiating from lower back to the great toe, with weakness of dorsiflexion of foot and loss of sensation on dorsum of foot?

A) L3
B) L4
C) L5
D) S1
E) S2

Q113. S1 nerve root compression presents with:

A) Knee jerk loss + quadriceps weakness
B) Ankle jerk loss + weakness of plantarflexion + sensory loss on lateral foot/sole
C) Foot drop + loss of big toe extension
D) Groin pain + hip flexion weakness
E) Bladder dysfunction only

Q114. A patient has acute onset severe back pain, fever, leukocytosis, and progressive leg weakness. MRI shows epidural collection. The diagnosis is:

A) Spinal metastasis
B) Spinal epidural abscess
C) Transverse myelitis
D) Disc prolapse
E) SACD

Q115. Which investigation is BEST for spinal cord compression?

A) X-ray spine
B) CT myelography
C) MRI spine (gold standard)
D) Nerve conduction studies
E) Bone scan

MISCELLANEOUS CNS (Q116-Q130)

Q116. A 20-year-old student develops sudden brief loss of consciousness, falls, and convulses for 2 minutes. After the event he is confused for 15 minutes (postictal). He has bitten his tongue. The MOST likely diagnosis is:

A) Syncope
B) TIA
C) Generalized tonic-clonic seizure
D) Psychogenic non-epileptic seizure
E) Narcolepsy

Q117. The drug of choice for absence seizures in children is:

A) Phenytoin
B) Carbamazepine
C) Ethosuximide
D) Sodium valproate (also useful)
E) Both C and D

Q118. Status epilepticus is defined as:

A) One seizure lasting > 5 minutes OR two seizures without full recovery between them
B) Three seizures in one day
C) Seizures not responding to any drug
D) Seizures with fever
E) Partial seizures with secondary generalization

Q119. First-line treatment for status epilepticus is:

A) IV phenytoin
B) IV diazepam or lorazepam (benzodiazepine)
C) IV sodium valproate
D) Phenobarbitone
E) General anesthesia

Q120. Which antiepileptic drug is CONTRAINDICATED in pregnancy due to neural tube defects?

A) Levetiracetam
B) Lamotrigine
C) Sodium valproate (teratogenic - spina bifida)
D) Carbamazepine (relatively safer)
E) Phenobarbitone

Q121. Temporal lobe epilepsy characteristically presents with:

A) Absence staring spells
B) Myoclonic jerks
C) Complex partial seizures with automatisms (lip smacking, picking, déjà vu, olfactory hallucinations)
D) Tonic-clonic from outset
E) Infantile spasms

Q122. A patient on phenytoin therapy presents with gum hypertrophy, hirsutism, and nystagmus. This is due to:

A) Allergy
B) Phenytoin toxicity/side effects
C) Carbamazepine side effects
D) Valproate toxicity
E) Drug interaction

Q123. Trigeminal neuralgia (tic douloureux) is characterized by:

A) Continuous dull aching pain over face
B) Brief, lancinating electric-shock pain in V2/V3 distribution triggered by touch, chewing, talking
C) Bilateral facial pain with autonomic features
D) Facial pain + Horner syndrome
E) Pain with swallowing

Q124. First-line drug for trigeminal neuralgia is:

A) Amitriptyline
B) Gabapentin
C) Carbamazepine
D) Morphine
E) Prednisolone

Q125. A 35-year-old man has unilateral severe periorbital pain with ipsilateral lacrimation, nasal stuffiness, and ptosis occurring in clusters, typically at night, lasting 30-90 minutes. The diagnosis is:

A) Migraine
B) Tension headache
C) Cluster headache
D) Trigeminal neuralgia
E) Temporal arteritis

Q126. The prophylactic drug of choice for cluster headache is:

A) Propranolol
B) Amitriptyline
C) Verapamil
D) Topiramate
E) Lithium

Q127. Migraine with aura is MOST commonly preceded by:

A) Vomiting
B) Scintillating scotoma (visual aura) - zigzag lines/flashing lights
C) Tinnitus
D) Syncope
E) Seizure

Q128. Acute treatment of migraine includes:

A) Propranolol
B) Amitriptyline
C) Sumatriptan (5-HT1B/1D agonist) + NSAIDs/paracetamol
D) Verapamil
E) Topiramate

Q129. A 70-year-old woman has new onset severe unilateral temporal headache, jaw claudication, scalp tenderness, and ESR of 110. The diagnosis is:

A) Migraine
B) Cluster headache
C) Giant cell arteritis (temporal arteritis)
D) Subarachnoid hemorrhage
E) Trigeminal neuralgia

Q130. The IMMEDIATE treatment of giant cell arteritis (to prevent blindness) is:

A) NSAIDs
B) High-dose oral prednisolone (40-60 mg/day) started immediately without waiting for biopsy
C) Methotrexate
D) Aspirin only
E) IV methylprednisolone (for visual loss)

✅ ANSWERS + DAVIDSON/GOLDMAN-CECIL EXPLANATIONS (Q31-Q130)

A31. C - Posterior cerebral artery PCA supplies occipital (visual) cortex. PCA occlusion = contralateral homonymous hemianopia with macular sparing (macula has dual blood supply from MCA). ACA = leg weakness. MCA = face + arm. Macular sparing is the key UHS discriminator. (Goldman-Cecil; Adams & Victor)

A32. C - Charcot-Bouchard microaneurysm (hypertensive) Long-standing hypertension causes lipohyalinosis and Charcot-Bouchard microaneurysms in small penetrating arteries (putamen, thalamus, pons, cerebellum). These rupture causing HTN hemorrhage. Amyloid angiopathy causes lobar hemorrhage in elderly, not deep basal ganglia. (Goldman-Cecil)

A33. C - Berry (saccular) aneurysm SAH in young adults without HTN = ruptured berry aneurysm (80-85%). Most common site: junction of anterior communicating artery + ACA. Presents with thunderclap headache. AVM is 2nd most common. (Goldman-Cecil; Harrison's)

A34. B - Cerebral vasospasm Vasospasm peaks at 4-14 days post-SAH, causes delayed cerebral ischemia, most feared cause of morbidity/mortality after initial bleed. Re-bleeding is most dangerous in first 24 hours. Prevention: nimodipine (oral calcium channel blocker). (Goldman-Cecil)

A35. A - Nimodipine (oral) Nimodipine is a calcium channel blocker with specificity for cerebral vasculature. It is given orally for 21 days post-SAH to prevent/reduce vasospasm-related ischemia. It does not prevent vasospasm anatomically but reduces neurological deficits. (Davidson's; Goldman-Cecil)

A36. C - Carotid endarterectomy Symptomatic carotid stenosis >70% = carotid endarterectomy (CEA) within 2 weeks of TIA/minor stroke for maximum benefit. 50-69% = CEA if high surgical risk acceptable. <50% = medical management. NNT is very low for >70% stenosis. (Davidson's; Goldman-Cecil)

A37. B - Ipsilateral limb ataxia, nystagmus, dysarthria Cerebellar strokes cause ipsilateral cerebellar signs (ataxia, dysmetria, dysdiadochokinesis, nystagmus, scanning speech). No motor or sensory pathway involvement = no hemiplegia, no sensory level. Truncal ataxia if vermis affected. (Adams & Victor)

A38. B - Cerebral venous sinus thrombosis (CVST) Empty delta sign = filling defect in superior sagittal sinus on contrast CT = CVST. OCP is a major risk factor in young women. Pseudotumor cerebri (IIH) does NOT show empty delta sign - it has no sinus thrombosis. (Goldman-Cecil)

A39. B - Anticoagulation (heparin/warfarin) Paradoxically, anticoagulation is indicated even with hemorrhagic infarction in CVST because the hemorrhage results from venous hypertension - anticoagulation reduces venous pressure. This is a UHS trap question - most students think hemorrhage = stop anticoagulation. (Goldman-Cecil; Harrison's)

A40. C - Putamen/basal ganglia 60% of hypertensive hemorrhages occur in putamen/internal capsule. Others: thalamus (15%), pons (10%), cerebellum (10%), lobar (5%). Putaminal hemorrhage = contralateral hemiplegia + hemisensory loss + eyes deviated toward lesion. (Goldman-Cecil)

A41. B - Right motor cortex (frontal lobe) MCA cortical stroke: face + arm > leg (homunculus - face and arm at lateral convexity). Cortical signs present (aphasia if dominant). Internal capsule lacune: equal face + arm + leg weakness, no cortical signs. Here lower face + arm > leg = cortical (precentral gyrus). (Davidson's)

A42. E - Contralateral arm > leg weakness ACA supplies medial frontal lobe = leg area of homunculus. ACA stroke = contralateral LEG > arm weakness. Urinary incontinence (parasagittal), abulia, grasp reflex are ACA features. Contralateral arm > leg = MCA territory. (Goldman-Cecil)

A43. C - Aspiration pneumonia Post-stroke infections (pneumonia + UTI) are the most common cause of fever and deterioration at days 2-5. Dysphagia from stroke leads to aspiration. Hemorrhagic transformation typically occurs day 1-3. Always check swallowing before oral feeding. (Davidson's)

A44. B - Assess eligibility for thrombolysis and monitor severity NIHSS (National Institutes of Health Stroke Scale) 0-42 scores neurological deficits. Used to: decide thrombolysis (moderate-severe stroke), monitor improvement/deterioration, communication between clinicians. Not used for diagnosis or specific location. (Step-Up Medicine)

A45. C - Ventral pons bilateral Locked-in syndrome = bilateral ventral pontine infarction (basilar artery occlusion). Destroys corticospinal + corticobulbar tracts = complete paralysis + anarthria. Consciousness PRESERVED (ARAS intact). Only vertical eye movements + blinking preserved (via midbrain). (Goldman-Cecil; Adams & Victor)

A46. B - Wilson's disease Autosomal recessive, ATP7B gene (copper transporter), chromosome 13. Copper accumulates in liver + basal ganglia + eye (KF rings). KF rings = pathognomonic. Low ceruloplasmin + high urine copper. Young person with Parkinsonism + liver disease = Wilson's. (Davidson's)

A47. B - D-penicillamine D-penicillamine chelates copper, increasing urinary excretion. Trientine if penicillamine not tolerated. Zinc acetate (maintenance - blocks gut copper absorption). Liver transplant for fulminant liver failure. Diet: avoid shellfish, liver, nuts, chocolate. (Davidson's)

A48. E - All of the above Sydenham's chorea = rheumatic fever complication (most classic). Also associated with SLE (chorea-SLE), OCP use, and pregnancy (chorea gravidarum). All involve antibodies against basal ganglia. Resolves spontaneously. (Goldman-Cecil)

A49. C - Tardive dyskinesia Long-term antipsychotic (dopamine blocker) use → tardive dyskinesia = abnormal involuntary movements (orofacial > limbs). Stereotyped lip smacking, tongue protrusion, chewing. Irreversible in many. Clozapine least likely to cause it. Tetrabenazine or valbenazine may help. (Step-Up Medicine)

A50. B - Subthalamic nucleus (contralateral) Hemiballismus = wild flinging movements of contralateral proximal limb. Caused by infarction/hemorrhage of contralateral subthalamic nucleus (STN). The STN normally inhibits excessive movement via basal ganglia circuit. Common cause: hypertensive lacunar infarct. (Goldman-Cecil)

A51. B - Propranolol Essential tremor: beta-blocker propranolol (40-320 mg/day) OR primidone are both first-line. Topiramate is second line. Alcohol transiently improves (not recommended therapeutically). Levodopa and anticholinergics have no role. Deep brain stimulation for severe refractory cases. (Davidson's)

A52. C - Alpha-synuclein Lewy bodies are intracytoplasmic inclusions composed of aggregated alpha-synuclein. Present in: Parkinson's disease + Lewy body dementia + multiple system atrophy. Tau = Alzheimer's/PSP/CBD. Amyloid-beta = Alzheimer's. Huntingtin = Huntington's. TDP-43 = ALS/FTD. (Goldman-Cecil)

A53. B - Multiple system atrophy (MSA) MSA = Parkinson's + autonomic failure (orthostatic hypotension, urinary incontinence) + cerebellar ataxia (MSA-C) or Parkinsonism (MSA-P). Poor levodopa response. Rapid progression. PSP = vertical gaze palsy + early falls. CBD = asymmetric rigidity + alien hand. (Goldman-Cecil)

A54. C - Festinating gait Parkinson's gait: shuffling, short steps, reduced arm swing, stooped posture, festination (accelerating forward, can't stop), freezing at doorways. Steppage = foot drop (L4/L5/peroneal). Waddling = proximal myopathy. Scissor = cerebral palsy/spasticity. (Davidson's)

A55. A - Vertical gaze palsy (downward) + Parkinsonism + early falls PSP = Steele-Richardson-Olszewski syndrome. Pathognomonic: impaired downgaze (supranuclear). Falls backward (retropulsion) early. Axial rigidity > limb. Tau protein deposits. "Hummingbird sign" on MRI (midbrain atrophy). Poor levodopa response. (Goldman-Cecil)

A56. C - Selegiline (Deprenyl) MAO-B inhibitors: selegiline, rasagiline. Prevent dopamine breakdown → prolong levodopa effect. Used as monotherapy in early PD or adjunct. Entacapone = COMT inhibitor. Bromocriptine/ropinirole = dopamine agonists. Trihexyphenidyl = anticholinergic. (Davidson's)

A57. B - Caudate nucleus atrophy Huntington's: bilateral caudate atrophy on CT/MRI → loss of normal lateral concave outline of caudate → "box-shaped" ventricles (lateral ventricles become boxy, loss of convex lateral wall). PET shows hypometabolism in caudate/putamen. (Goldman-Cecil)

A58. B - Essential tremor (titubation) Head tremor ("yes-yes" or "no-no") is characteristic of essential tremor. Cerebellar disease causes truncal titubation. Parkinson's tremor is in hands (pill-rolling) not head. Wilson's in young patient. Titubation = head/trunk oscillation at rest, prominent in ET. (Davidson's)

A59. B - Acute onset and fluctuating consciousness Key distinction: Delirium = acute onset (hours-days) + fluctuating level of consciousness + reversible cause. Dementia = chronic (months-years) + clear consciousness until late stages. Both can have memory impairment, disorientation, hallucinations. Delirium is ALWAYS investigate for cause. (Davidson's)

A60. B - Postoperative delirium Postoperative delirium: common in elderly >70 after surgery, especially hip replacement, cardiac surgery. Causes: pain, hypoxia, drugs (opioids, anticholinergics), infection, metabolic, sleep deprivation. Fluctuating, worse at night. CAM (Confusion Assessment Method) for diagnosis. (Goldman-Cecil)

A61. B - Check blood glucose In any acutely confused patient, the FIRST step is ALWAYS blood glucose (bedside) - hypoglycemia kills brain rapidly and is immediately reversible. Thiamine should be given before dextrose in suspected alcoholics (Wernicke's prevention). (Step-Up Medicine; Davidson's)

A62. C - Personality change and disinhibition as earliest features Frontotemporal dementia (Pick's disease) = frontal lobe atrophy → personality change, disinhibition, socially inappropriate behavior, apathy, language problems (progressive non-fluent aphasia). Memory relatively spared until late. Tau inclusions. Younger onset (45-65 years). (Goldman-Cecil)

A63. B - Rapid dementia + myoclonus + triphasic EEG waves CJD = prion disease (PrPsc). Rapidly progressive dementia (weeks-months) + myoclonus + cerebellar ataxia. EEG: periodic sharp waves/triphasic complexes. MRI: cortical ribboning + basal ganglia DWI restriction. CSF: 14-3-3 protein. 100% fatal. No treatment. (Goldman-Cecil)

A64. D - Brain biopsy (definitive) Definitive diagnosis of AD requires histopathology: senile (amyloid) plaques + neurofibrillary tangles (hyperphosphorylated tau). However, clinically (in practice): MRI + clinical criteria + CSF biomarkers (low Abeta42, high tau) or amyloid PET. Biopsy is not done routinely. (Goldman-Cecil)

A65. C - Normal pressure hydrocephalus NPH: communicating hydrocephalus, normal CSF pressure (at lumbar puncture) but intermittently elevated. Magnetic gait (apraxia) is the EARLIEST and most prominent feature. Improvement after LP (high-volume drainage test) predicts shunt response. VP shunt is definitive treatment. (Davidson's)

A66. C - Triphasic waves Hepatic encephalopathy EEG: triphasic waves (high amplitude, bifrontal, triphasic morphology). Also seen in uremia and other metabolic encephalopathies. CJD: periodic sharp complexes. Status epilepticus: continuous ictal activity. (Goldman-Cecil)

A67. C - Acetylcholine AD = loss of cholinergic neurons in nucleus basalis of Meynert (basal forebrain). ACh deficit correlates with cognitive decline. This is the basis of AChE inhibitor therapy (donepezil, rivastigmine, galantamine). NMDA receptor excess also plays a role → memantine. (Davidson's)

A68. D - Memantine Memantine = NMDA (glutamate) receptor antagonist. Used in moderate-severe Alzheimer's. Reduces excitotoxicity. Donepezil/rivastigmine/galantamine = AChE inhibitors. Memantine can be combined with AChE inhibitors in moderate-severe disease. (Davidson's; Goldman-Cecil)

A69. B - Thiamine (B1) Korsakoff syndrome = chronic amnesic syndrome following Wernicke's encephalopathy. Due to thiamine (B1) deficiency (alcoholism, malnutrition, hyperemesis). Irreversible if untreated. Confabulation is characteristic (making up stories to fill memory gaps). Mammillary bodies damaged. (Davidson's)

A70. B - Ophthalmoplegia + ataxia + confusion Wernicke's encephalopathy triad = Confusion/encephalopathy + Ophthalmoplegia (lateral rectus palsy, nystagmus) + Ataxia (gait). Only 1/3 have all three. Treat immediately with IV thiamine BEFORE glucose (glucose without thiamine precipitates/worsens Wernicke's). (Davidson's)

A71. B - Transient worsening with heat/fever/exercise Uhthoff's phenomenon: in MS, demyelinated axons have impaired conduction that worsens with temperature increase (heat slows already compromised conduction). Symptoms temporarily worsen with hot bath, exercise, fever - fully reversible within minutes of cooling. (Goldman-Cecil)

A72. B - Electric shock sensation down spine on neck flexion L'hermitte's sign: flexion of neck produces electric shock-like sensation radiating down spine into limbs. Indicates posterior column (dorsal column) demyelination in cervical cord. Seen in MS, SACD (B12 def), cervical myelopathy. (Davidson's)

A73. B - Oligoclonal IgG bands MS CSF: oligoclonal IgG bands present in 95% (must be in CSF but absent in serum = intrathecal synthesis). Also: mildly elevated protein, mild lymphocytosis, elevated IgG index. Normal glucose. Oligoclonal bands also seen in CNS infection, sarcoidosis - but in those also present in serum. (Goldman-Cecil)

A74. B - AQP4 antibodies + severe bilateral ON + longitudinal myelitis NMO = anti-AQP4 (aquaporin-4) antibody disease. Much more severe than MS: bilateral optic neuritis → blindness, extensive spinal cord lesions (>3 vertebral segments), poor recovery. Does NOT respond to beta-interferon (may worsen). Treat: steroids + azathioprine/rituximab. (Goldman-Cecil)

A75. C - Beta-interferon (IFN-β) Disease-modifying therapies (DMTs) for RRMS: IFN-β1a (Avonex, Rebif), IFN-β1b (Betaseron), glatiramer acetate, natalizumab, fingolimod, dimethyl fumarate, alemtuzumab. IV methylprednisolone treats acute relapses only. Baclofen/gabapentin treat symptoms only. (Goldman-Cecil)

A76. B - Monophasic, post-infectious/vaccination ADEM = monophasic demyelination triggered by infection or vaccination (measles, mumps, rubella vaccine). Occurs in children mostly. More diffuse white matter involvement. No oligoclonal bands (or transient). Steroid responsive. MS is recurrent/progressive with oligoclonal bands. (Goldman-Cecil)

A77. B - Painful visual loss + pain on eye movement + RAPD Optic neuritis = demyelination of optic nerve. Pain on eye movement (distinguishes from other causes). Reduced visual acuity, color desaturation (red), RAPD (Marcus-Gunn pupil). Central scotoma. Treat with IV methylprednisolone. 50% develop MS within 15 years. (Davidson's)

A78. B - Multiple sclerosis (MLF lesion) INO = lesion in medial longitudinal fasciculus (MLF) → impaired adduction of ipsilateral eye on lateral gaze + nystagmus of the abducting eye. Bilateral INO in young adult = MS until proven otherwise. Convergence preserved (differentiates from CN3 palsy). (Goldman-Cecil)

A79. C - Baclofen Baclofen = GABA-B agonist, reduces spasticity. Used for MS-related spasticity, SCI spasticity. Can be oral or intrathecal (pump) for severe cases. Also: tizanidine (alpha-2 agonist), diazepam (GABA-A), dantrolene (peripheral - blocks Ca release). Amantadine = fatigue in MS. (Davidson's)

A80. C - Relapsing-remitting MS (RRMS) 85% of MS patients start with RRMS (discrete attacks with recovery between). Later 50% convert to secondary progressive MS (SPMS). 15% have primary progressive (PPMS) - gradual worsening from onset, predominantly spinal cord, older, harder to treat. (Goldman-Cecil)

A81. C - Polymyositis Inflammatory myopathy: proximal weakness (difficulty climbing stairs, rising from chair, combing hair), elevated CK, EMG myopathic, biopsy shows CD8+ T-cell infiltrate (endomysial). No ocular involvement (differentiates from MG). Treat: prednisolone. (Goldman-Cecil)

A82. C - Gottron's papules + heliotrope rash Dermatomyositis = polymyositis + skin changes. Gottron's papules (violaceous papules over knuckles) + heliotrope rash (purple discoloration of eyelids) + shawl sign + mechanic's hands. Associated with malignancy (screen with CT chest/abdomen/pelvis). (Davidson's)

A83. C - Guillain-Barre syndrome Classic GBS: ascending flaccid paralysis + areflexia after infection (1-4 weeks prior). CSF: albuminocytologic dissociation (protein elevated, cells normal or minimally elevated) - develops after first week. Respiratory involvement in 30%. Nerve conduction: demyelinating pattern. (Davidson's)

A84. C - Campylobacter jejuni Most common trigger for GBS: Campylobacter jejuni gastroenteritis (preceding diarrhea). Associated with axonal variants (AMAN/AMSAN) more than demyelinating. Other triggers: CMV, EBV, Mycoplasma, influenza vaccine (rare). C. jejuni is the highest-yield answer for UHS. (Goldman-Cecil)

A85. B - Respiratory failure The main cause of death/ICU admission in GBS = respiratory failure from diaphragm/intercostal muscle paralysis. Monitor: FVC (forced vital capacity) - intubate when FVC < 20 mL/kg or falls rapidly. Autonomic dysfunction (arrhythmias, BP swings) is also dangerous but respiratory failure is most immediately life-threatening. (Davidson's)

A86. B - IVIG or plasmapheresis Both IVIG (2g/kg over 5 days) and plasmapheresis (plasma exchange) are equally effective, shortening duration by ~50%. IVIG preferred (easier, safer). Steroids are NOT beneficial (no evidence, may be harmful). Start within 2 weeks of onset for maximum benefit. (Goldman-Cecil)

A87. B - OAA triad with anti-GQ1b antibodies Miller-Fisher syndrome = variant of GBS. Triad: Ophthalmoplegia (external) + Ataxia + Areflexia. Anti-GQ1b antibodies present in >90%. No limb weakness typically. CSF: albuminocytologic dissociation. Usually self-limiting, good prognosis. (Goldman-Cecil)

A88. B - Hereditary peripheral neuropathy (HMSN) CMT = Hereditary Motor and Sensory Neuropathy. Most common hereditary neuropathy. Types: CMT1 (demyelinating, PMP22 duplication) + CMT2 (axonal). Peroneal muscle wasting → "inverted champagne bottle" legs. Foot deformity (pes cavus + hammer toes). Slow progression. (Goldman-Cecil)

A89. C - Median nerve Carpal tunnel syndrome = median nerve compression at wrist. Symptoms: numbness/tingling in thumb, index, middle, radial half ring finger (median distribution). Thenar wasting. Positive Tinel's (tapping wrist) + Phalen's (wrist flexion). Common in: pregnancy, hypothyroidism, diabetes, rheumatoid arthritis. (Davidson's)

A90. C - Radial nerve (Saturday night palsy) Radial nerve = wrist drop. Compressed in spiral groove of humerus (arm hung over chair/drunk = "Saturday night palsy"). Cannot extend wrist/fingers. Triceps usually spared (branch above spiral groove). Sensory loss on dorsal hand (anatomical snuffbox). (Davidson's)

A91. B - Glove-and-stocking sensory loss Diabetic peripheral neuropathy = length-dependent axonal polyneuropathy. Longest nerves affected first = feet first. Burning feet, numbness, allodynia. Glove-and-stocking distribution. Absent ankle jerks. Pain: treated with amitriptyline/duloxetine/pregabalin/gabapentin. (Davidson's)

A92. B - Slowed NCV + prolonged F-waves + conduction block Demyelinating neuropathy (GBS): primary pathology in myelin sheath → marked slowing of NCV (< 70% of lower limit of normal), prolonged distal latencies, prolonged F-wave latencies, conduction block. Axonal neuropathy: reduced amplitude, normal/near-normal NCV. (Goldman-Cecil)

A93. A - Decremental response at 3 Hz repetitive stimulation MG: postsynaptic NMJ - ACh depleted faster than it can be replenished with repetitive stimulation → decremental response (>10% amplitude decrease at 3 Hz). LEMS (presynaptic): incremental response at high frequency (50 Hz) or after exercise. Single-fiber EMG most sensitive for MG. (Davidson's)

A94. B - Neurofibromatosis type 1 (NF1) NF1 diagnostic criteria (need ≥2): ≥6 cafe-au-lait spots (>5mm prepubertal, >15mm postpubertal), axillary/inguinal freckling (Crowe sign), ≥2 neurofibromas or 1 plexiform, optic glioma, ≥2 Lisch nodules (iris hamartomas), bony dysplasia, first-degree relative with NF1. (Goldman-Cecil)

A95. B - Ash-leaf macules + tuberous sclerosis complex Tuberous sclerosis complex (TSC): autosomal dominant, TSC1(hamartin)/TSC2(tuberin) genes. Ash-leaf macules (hypopigmented), shagreen patch, facial angiofibromas (adenoma sebaceum), subependymal nodules (brain hamartomas), cortical tubers, renal angiomyolipoma, cardiac rhabdomyoma. Triad (Vogt): seizures + intellectual disability + facial angiofibroma. (Goldman-Cecil)

A96. B - Bilateral vestibular schwannomas NF2 (chromosome 22, merlin protein): hallmark = bilateral acoustic neuromas (vestibular schwannomas). Presents with progressive sensorineural deafness + tinnitus bilaterally. Also meningiomas, ependymomas. Fewer cafe-au-lait spots than NF1. No Lisch nodules. (Goldman-Cecil)

A97. B - Port-wine stain + leptomeningeal angiomatosis Sturge-Weber syndrome: sporadic, somatic GNAQ mutation. Facial port-wine stain (trigeminal V1 distribution) + ipsilateral leptomeningeal angiomatosis + seizures (contralateral to nevus) + ipsilateral glaucoma + intellectual disability. CT: tram-track calcifications. (Goldman-Cecil)

A98. B - Cerebellar hemangioblastoma + RCC + phaeochromocytoma VHL disease: autosomal dominant, VHL gene (chr 3). CNS/retinal hemangioblastomas + clear cell RCC + pheochromocytoma + pancreatic cysts/tumors + epididymal cystadenoma. Hemangioblastoma in cerebellum = most common CNS manifestation. (Goldman-Cecil)

A99. A - Cerebellar ataxia + telangiectasia + immunodeficiency Ataxia-telangiectasia: autosomal recessive, ATM gene mutation. Progressive cerebellar ataxia (from age 1-2) + oculocutaneous telangiectasia (conjunctival) + combined immunodeficiency (IgA def) + radiation sensitivity + high malignancy risk (lymphoma/leukemia). (Goldman-Cecil)

A100. C - Glioblastoma multiforme (GBM) Most common primary brain tumor in adults = GBM (WHO grade IV astrocytoma). Butterfly pattern (crosses corpus callosum), pseudopalisading necrosis, ring-enhancing on MRI. Median survival 15 months with Stupp protocol (temozolomide + RT). Meningioma = most common overall (includes benign). (Goldman-Cecil)

A101. E - Both C and D (High-grade glioma/metastasis OR TB abscess) Ring-enhancing lesions = central necrosis + peripheral enhancement. Differential: glioblastoma, metastasis, pyogenic abscess, TB abscess, toxoplasmosis, CNS lymphoma. In immunocompetent: most likely GBM or metastasis. Context matters: solitary = primary tumor; multiple = metastases; fever + DM = abscess; HIV = toxo/lymphoma. (Goldman-Cecil)

A102. B - Toxoplasma encephalitis HIV + CD4 < 100 + ring-enhancing lesions (often multiple, basal ganglia) = Toxoplasma gondii (most common). Empirical toxoplasmosis treatment (pyrimethamine + sulfadiazine + folinic acid) - if no improvement in 2 weeks → biopsy for CNS lymphoma. PML = white matter, no ring enhancement. (Goldman-Cecil)

A103. B - Obese young women + OCP/tetracycline/vitamin A Idiopathic IH (pseudotumor cerebri): obese women of childbearing age. Drug causes: OCP, tetracyclines, vitamin A/retinoids, steroids (withdrawal), growth hormone. Presents: headache, pulsatile tinnitus, visual obscurations, diplopia (CN6 palsy - false localizing). (Goldman-Cecil; Davidson's)

A104. C - Acetazolamide + weight loss + serial LPs IIH treatment: acetazolamide (carbonic anhydrase inhibitor - reduces CSF production) + weight loss (most effective long-term). Serial LPs if severe. Optic nerve sheath fenestration or lumboperitoneal shunt if vision threatened. Steroids NOT recommended (rebound on withdrawal). (Goldman-Cecil)

A105. B - Neisseria meningitidis In adults 15-30 years: N. meningitidis (gram-negative diplococci) = most common bacterial meningitis. S. pneumoniae predominates in elderly/immunocompromised/post-splenectomy. Listeria in elderly, pregnant, immunosuppressed. Purpuric rash = meningococcemia (N. meningitidis). (Davidson's; Goldman-Cecil)

A106. B - IV ceftriaxone + dexamethasone Empirical bacterial meningitis: IV ceftriaxone (3rd-gen cephalosporin) covers S. pneumoniae + N. meningitidis. Add ampicillin if Listeria suspected (elderly/pregnant/immunosuppressed). Dexamethasone (before or with first antibiotic dose) reduces mortality + deafness (especially for S. pneumoniae). (Davidson's)

A107. B - Lymphocytosis + normal glucose + mildly elevated protein Viral meningitis CSF: clear, lymphocytic pleocytosis (100-1000 cells), normal glucose (>60% serum), mildly elevated protein (<1 g/L). Bacterial: turbid, neutrophilia, low glucose (<45% serum), high protein (>1 g/L). TB: lymphocytosis, very low glucose, high protein, fibrin web. (Davidson's)

A108. B - Anterior spinal artery territory Anterior spinal artery syndrome: infarction of anterior 2/3 of cord. Destroys spinothalamic tracts (pain/temp) + corticospinal tracts (motor). SPARES posterior columns (vibration/proprioception - posterior spinal arteries supply these). Classic dissociated sensory loss. (Goldman-Cecil; Adams & Victor)

A109. B - LMN signs + saddle anesthesia + bladder/bowel dysfunction Cauda equina = nerve roots below L1 (not spinal cord). LMN signs: flaccid weakness, absent reflexes, wasting. Saddle anesthesia (S3-S5 dermatomes). Bladder: urinary retention (overflow incontinence). Bowel: constipation/incontinence. EMERGENCY - urgent surgical decompression needed. (Davidson's)

A110. B - Spinal metastases Most common cord compression in elderly = spinal metastases (extradural). Primary tumors: prostate (most common in men), breast (women), lung, kidney, myeloma. Thoracic spine most affected. Presents with back pain + progressive myelopathy. MRI urgent. Dexamethasone + radiotherapy ± surgery. (Goldman-Cecil)

A111. A - Cape-like dissociated sensory loss Syringomyelia = CSF-filled cavity (syrinx) in central cord. Expanding cavity disrupts decussating spinothalamic fibers (pain/temperature) in anterior commissure → bilateral cape/shawl distribution. Posterior columns (vibration/proprioception) and motor initially spared = dissociated sensory loss. Associated with Chiari malformation. (Davidson's)

A112. C - L5 nerve root L5: pain radiation lateral thigh → dorsum of foot → great toe. Weakness: dorsiflexion of foot (foot drop), great toe extension (extensor hallucis longus). Sensory: dorsum of foot/medial calf. Ankle jerk usually PRESERVED (S1). Knee jerk preserved (L3/L4). MRI L4/L5 disc. (Davidson's)

A113. B - Ankle jerk loss + plantarflexion weakness + lateral foot sensory loss S1: pain radiation posterior thigh → posterior calf → lateral foot → small toe. Weakness: plantarflexion (can't stand on tiptoes), hip extension. ANKLE JERK ABSENT (S1 reflex). Sensory: lateral/plantar foot, lateral calf. L5/S1 disc herniation. (Davidson's)

A114. B - Spinal epidural abscess Fever + back pain + progressive myelopathy = spinal epidural abscess (SEA) until proven otherwise. Risk factors: IV drug use, diabetes, immunosuppression, recent spinal procedure. Causative organism: S. aureus (most common). MRI spine urgent. Treatment: IV antibiotics + urgent surgical drainage. (Goldman-Cecil)

A115. C - MRI spine (gold standard) MRI spine: best for cord parenchyma, disc, ligaments, soft tissue, epidural collections, metastases. CT myelography = if MRI contraindicated (pacemaker). Plain X-ray = only bony abnormalities (fracture, spondylosis), misses cord/disc pathology. (Davidson's; Goldman-Cecil)

A116. C - Generalized tonic-clonic seizure Features confirming seizure (vs syncope): tongue biting (lateral), prolonged postictal confusion (>5 min), incontinence, muscle aches, cyanosis during event, stereotyped tonic then clonic phases. Syncope: brief LOC, quick recovery (<1 min), no postictal confusion, pale/sweaty prodrome. (Davidson's)

A117. E - Both ethosuximide and sodium valproate Absence seizures (petit mal): ethosuximide is preferred if pure absence. Sodium valproate preferred if absence + other seizure types (JME). Carbamazepine/phenytoin can WORSEN absence seizures - avoid. Lamotrigine is second line. (Davidson's; Goldman-Cecil)

A118. A - Seizure >5 minutes or ≥2 seizures without recovery Modern definition: convulsive SE = continuous seizure >5 min (operational) OR repeated seizures without regaining consciousness. Traditional = 30 minutes. The 5-minute threshold is used clinically because seizures rarely self-terminate after 5 min and brain injury begins. (Goldman-Cecil)

A119. B - IV benzodiazepine (diazepam or lorazepam) SE protocol: IV lorazepam 0.1 mg/kg (preferred) or IV diazepam 0.15-0.2 mg/kg. Repeat once if no response in 5 min. If IV access unavailable: rectal diazepam or IM midazolam. If no response after 2 benzodiazepine doses: IV phenytoin/fosphenytoin or IV levetiracetam (2nd step). (Davidson's)

A120. C - Sodium valproate Valproate is most teratogenic AED: neural tube defects (spina bifida - 1-2%), craniofacial defects, cognitive impairment in child. Avoid in women of childbearing potential unless no alternatives. If must use: folic acid 5mg/day + detailed fetal anomaly scan. Carbamazepine and lamotrigine relatively safer but ALL AEDs have some risk. (Davidson's; Goldman-Cecil)

A121. C - Complex partial seizures with automatisms Temporal lobe epilepsy (TLE) = most common focal epilepsy in adults. Aura: déjà vu, jamais vu, rising epigastric sensation, olfactory hallucinations (uncinate fits), fear. Then: impaired consciousness + automatisms (lip smacking, chewing, picking, fumbling). May secondarily generalize. MRI: hippocampal sclerosis. (Goldman-Cecil)

A122. B - Phenytoin toxicity/side effects Phenytoin side effects: gum hypertrophy (gingival hyperplasia), hirsutism, coarsening of facial features, acne, peripheral neuropathy, cerebellar ataxia/nystagmus (at toxic levels), folate deficiency (megaloblastic anemia), osteomalacia, diplopia. Long-term cosmetic side effects make it unpopular in young women. (Davidson's)

A123. B - Brief, lancinating pain in V2/V3 triggered by touch Trigeminal neuralgia: brief (seconds) electric-shock pain in distribution of V2 (maxillary - cheek, upper lip) or V3 (mandibular - jaw, lower lip) - rarely V1. Triggered by light touch (eating, talking, brushing teeth), not by pressure. Between attacks: pain-free. Idiopathic or vascular compression of TG root. (Davidson's)

A124. C - Carbamazepine Carbamazepine (first line) for TN - 200 mg TDS, reduce facial pain in 70%. MOA: sodium channel blocker. If refractory: oxcarbazepine, lamotrigine, baclofen. Surgical: microvascular decompression (MVD - most effective long-term), gamma knife, percutaneous procedures. (Davidson's)

A125. C - Cluster headache Cluster headache = trigeminal autonomic cephalalgia. Strictly unilateral severe periorbital/temporal pain + ipsilateral autonomic features (lacrimation, rhinorrhea, ptosis, miosis = Horner, conjunctival injection). Duration 15-180 min. Occurs in clusters (weeks-months). Predominantly men. Nocturnal. (Davidson's)

A126. C - Verapamil Cluster headache prophylaxis (during cluster period): verapamil (first line, 240-960 mg/day). Others: lithium, topiramate, valproate. Short-term transition: oral prednisolone burst (rapidly effective). Propranolol = migraine prophylaxis, not cluster. Amitriptyline = tension/migraine. (Davidson's)

A127. B - Scintillating scotoma (visual aura) Migraine with aura: positive visual phenomena (scintillating/fortification scotoma, photopsia - zigzag lines, flashing lights) develop gradually over 20-30 minutes then fade, followed by headache. Fully reversible. Sensory or motor aura less common. Aura without headache = migraine equivalent (acephalgic migraine). (Davidson's)

A128. C - Sumatriptan + NSAIDs Acute migraine: mild-moderate = NSAIDs (ibuprofen/naproxen) + paracetamol + antiemetic (metoclopramide). Moderate-severe = triptans (sumatriptan 5HT1B/1D agonist - causes vasoconstriction + inhibits pain transmission). Triptan + NSAID combination most effective. Avoid triptans in hemiplegic migraine, basilar migraine, ischemic vascular disease. (Davidson's)

A129. C - Giant cell arteritis (temporal arteritis) GCA = granulomatous vasculitis of medium/large vessels in >50 years. New temporal headache + jaw claudication (pathognomonic) + scalp tenderness + tender, thickened temporal artery + elevated ESR/CRP. Risk of blindness from ophthalmic artery involvement. Associated with polymyalgia rheumatica. (Davidson's)

A130. B - High-dose prednisolone immediately (40-60 mg/day) GCA = OPHTHALMOLOGICAL EMERGENCY. Start prednisolone IMMEDIATELY without waiting for temporal artery biopsy (biopsy within 1-2 weeks, histology still positive after 1-2 weeks of steroids). If already visual loss: IV methylprednisolone 1g/day x3 then oral. Biopsy confirms but NEVER delays treatment. (Davidson's)

📊 CNS TOPIC QUICK SCORE TRACKER

Topic	Q numbers	Your score
Stroke (Basic)	Q1-Q10	/10
Stroke (Advanced)	Q31-Q45	/15
Movement Disorders	Q11-Q16, Q46-Q58	/19
Dementia/AMS	Q17-Q20, Q59-Q70	/16
MS/Demyelinating	Q21-Q24, Q71-Q80	/14
Neuromuscular/GBS/NMJ	Q25-Q27, Q81-Q93	/16
Spinal Cord	Q28-Q30, Q108-Q115	/11
Neurocutaneous	Q94-Q99	/6
Headaches/GCA	Q125-Q130	/6
Epilepsy/Misc CNS	Q100-Q107, Q116-Q124	/17
TOTAL	Q1-Q130	/130

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