Q.1 Which of the following is the most common cause of subarachnoid hemorrhage?
Hypertensive crisis
Trauma
Ruptured berry aneurysm
Arteriovenous malformation
Explanation - The most common cause of spontaneous subarachnoid hemorrhage is rupture of a berry aneurysm, usually in the circle of Willis.
Correct answer is: Ruptured berry aneurysm
Q.2 A patient presents with sudden-onset severe headache described as 'the worst headache of my life.' Which condition should be suspected first?
Migraine
Cluster headache
Subarachnoid hemorrhage
Tension headache
Explanation - A thunderclap headache or 'worst headache of life' is characteristic of subarachnoid hemorrhage.
Correct answer is: Subarachnoid hemorrhage
Q.3 In status epilepticus, what is the first-line pharmacological treatment?
Phenytoin
Lorazepam
Valproate
Phenobarbital
Explanation - Benzodiazepines such as lorazepam are first-line agents for status epilepticus due to rapid onset of action.
Correct answer is: Lorazepam
Q.4 Which clinical sign is most suggestive of raised intracranial pressure?
Bradycardia
Hypertension
Papilledema
All of the above
Explanation - Cushing’s triad of hypertension, bradycardia, and irregular breathing, along with papilledema, suggest raised ICP.
Correct answer is: All of the above
Q.5 A Glasgow Coma Scale (GCS) score of 8 or less indicates:
Mild head injury
Moderate head injury
Severe head injury
Normal consciousness
Explanation - GCS ≤ 8 defines severe traumatic brain injury, requiring airway protection and close monitoring.
Correct answer is: Severe head injury
Q.6 What is the immediate priority in the management of suspected spinal cord injury?
Airway stabilization
Pain relief
Neurological examination
CT scan
Explanation - Airway and breathing take priority, but neck immobilization must be maintained to prevent further injury.
Correct answer is: Airway stabilization
Q.7 Which of the following is an indication for mannitol use in neurological emergencies?
Cerebral edema
Seizure
Spinal cord transection
Meningitis
Explanation - Mannitol is an osmotic diuretic that reduces intracranial pressure by drawing fluid out of brain tissue.
Correct answer is: Cerebral edema
Q.8 The classic triad of meningitis includes fever, headache, and:
Seizures
Neck stiffness
Altered vision
Vomiting
Explanation - Fever, headache, and neck stiffness are the classic triad of meningitis, though not always all present.
Correct answer is: Neck stiffness
Q.9 Which artery is most commonly involved in an ischemic stroke?
Middle cerebral artery
Anterior cerebral artery
Basilar artery
Posterior cerebral artery
Explanation - The middle cerebral artery is most commonly affected, leading to contralateral hemiparesis and aphasia if dominant hemisphere is involved.
Correct answer is: Middle cerebral artery
Q.10 What is the most appropriate imaging for acute stroke diagnosis?
MRI brain
CT brain without contrast
CT brain with contrast
PET scan
Explanation - A non-contrast CT is the initial imaging to rule out hemorrhage before thrombolysis.
Correct answer is: CT brain without contrast
Q.11 In acute ischemic stroke, thrombolytic therapy with tPA should ideally be given within:
1 hour
3 hours
4.5 hours
6 hours
Explanation - tPA is most effective within 4.5 hours of symptom onset in eligible patients.
Correct answer is: 4.5 hours
Q.12 Which sign is typical of epidural hematoma?
Lucid interval
Neck rigidity
Meningism
Cranial nerve palsy
Explanation - Epidural hematoma classically presents with initial loss of consciousness, followed by a lucid interval, then deterioration.
Correct answer is: Lucid interval
Q.13 What is the hallmark symptom of cluster headache?
Photophobia
Unilateral severe orbital pain
Aura
Bilateral pressure headache
Explanation - Cluster headache causes excruciating unilateral orbital pain, often with lacrimation and nasal congestion.
Correct answer is: Unilateral severe orbital pain
Q.14 Which electrolyte imbalance is most likely to precipitate seizures?
Hyponatremia
Hyperkalemia
Hypercalcemia
Hypochloremia
Explanation - Hyponatremia lowers seizure threshold and can cause cerebral edema leading to seizures.
Correct answer is: Hyponatremia
Q.15 Cerebral herniation most commonly occurs due to:
Trauma
Infection
Mass effect from hematoma or tumor
Migraine
Explanation - Space-occupying lesions increase intracranial pressure and may lead to herniation syndromes.
Correct answer is: Mass effect from hematoma or tumor
Q.16 Which of the following is NOT part of the Glasgow Coma Scale?
Eye opening
Verbal response
Motor response
Pupil size
Explanation - The GCS assesses eye, verbal, and motor responses. Pupil size is assessed separately in neurological exams.
Correct answer is: Pupil size
Q.17 What is the gold standard investigation for cerebral venous sinus thrombosis?
Non-contrast CT
CT venography
MRI with MR venography
Carotid Doppler
Explanation - MR venography is the most sensitive tool for detecting cerebral venous sinus thrombosis.
Correct answer is: MRI with MR venography
Q.18 Kernig’s and Brudzinski’s signs are tested in suspected cases of:
Stroke
Meningitis
Migraine
Seizure
Explanation - Both signs are classic physical findings in meningitis indicating meningeal irritation.
Correct answer is: Meningitis
Q.19 Which of the following is the first step in managing a patient with suspected stroke?
Start aspirin immediately
Obtain urgent neuroimaging
Begin thrombolysis
Start anticoagulation
Explanation - Imaging is essential to differentiate between ischemic and hemorrhagic stroke before initiating treatment.
Correct answer is: Obtain urgent neuroimaging
Q.20 Which condition is associated with a 'locked-in syndrome' presentation?
Brainstem stroke
Temporal lobe epilepsy
Frontal lobe tumor
Spinal cord injury
Explanation - Locked-in syndrome results from ventral pontine stroke, leaving patients conscious but unable to move except for eye movements.
Correct answer is: Brainstem stroke
Q.21 In Guillain-Barré syndrome, the typical pattern of weakness is:
Proximal to distal
Distal to proximal
Random distribution
Cranial nerves only
Explanation - Guillain-Barré typically causes ascending symmetrical weakness starting from the lower limbs.
Correct answer is: Distal to proximal
Q.22 Which of the following is the most feared complication of bacterial meningitis?
Hydrocephalus
Brain abscess
Septic shock
Cerebral herniation
Explanation - Increased intracranial pressure can rapidly progress to cerebral herniation, which is often fatal.
Correct answer is: Cerebral herniation
Q.23 What is the commonest cause of intracerebral hemorrhage?
Trauma
Hypertension
Amyloid angiopathy
Anticoagulant use
Explanation - Chronic hypertension leads to rupture of small penetrating arteries, causing intracerebral hemorrhage.
Correct answer is: Hypertension
Q.24 A patient with head trauma develops progressive drowsiness and unequal pupils. The most likely diagnosis is:
Concussion
Diffuse axonal injury
Epidural hematoma
Cerebral concussion
Explanation - Expanding epidural hematoma causes raised ICP and compression of oculomotor nerve leading to anisocoria.
Correct answer is: Epidural hematoma
Q.25 What is the drug of choice for absence seizures?
Carbamazepine
Phenytoin
Ethosuximide
Phenobarbital
Explanation - Ethosuximide is specifically effective in absence seizures due to its action on T-type calcium channels.
Correct answer is: Ethosuximide