The best ever bcqs of medicine

1. Nervous system BCQs
By
Sajid Ali Talpur

2. 1. A 42 years old comes to your clinic and you notice that he is taking accelerated and
narrowed steps. On further observation you notice that he has mask like expressionless
face. He is most likely suffering from:
a) Cerebellar disease
b) Ataxia telangiectasia
c) Alzheimer’s disease
d) Psycosis
e) Parkinson’s disease
Ans. E
2. A 30 years old woman complains of loss of pain, temperature and vibration sensation. On
examination, babinski’s sign and optic neuritis are positive. The patient is most likely
suffering from:
a) Intracerebral hemorrhage
b) Stroke
c) Multiple sclerosis
d) Multiple myeloma
e) Transverse myelitis
Ans. C
3. The most common cause of cerebral infarction is:
a) Embolism
b) Vasculitis
c) Thromoboembolic disease
d) Lacunar infarcts
e) Endocarditis
Ans. C
4. The best initial test in patients with srtoke is:
a) Non contrast C.T scan
b) MRI
c) X ray skull
d) CSF fluid analysis
e) Angiography
Ans. A

3. 5. All of the following features are associated with LMN except:
a) Fasciculations
b) Decreased reflexes
c) Clasp knife spasticity
d) Decreased tone
e) Babinski’s sign negative
Ans. C
6. The most accurate test for gullain barre syndrome is:
a) MRI
b) CT scan
c) EEG
d) Lumber puncture
e) Electromyography
Ans. E
7. A 50 years old known hypertensive now presents with vomiting and headache to which he
describes as the worst headache of his life. The most probable diagnosis is:
a) Extradural hemorrhage
b) Subdural hemorrhage
c) Subarachnoid hemorrhage
d) Intracerebral hemorrhage
e) Cluster headache
Ans. C
8. Locked in syndrome occurs due to the compromised blood flow in:
a) Vertebral artery
b) Cerebellar artery
c) Anterior cerebral artery
d) Middle cerebral artery
e) Basilar artery
Ans. E
9. The most accurate test for detecting ischemia is:
a) Non contrast C.T scan
b) MRI
c) Duplex ultrasound
d) CT angiography
e) ECG and Echo
Ans. B

4. 10. The hyponatremia after subarachnoid hemorrhage should be treated with:
a) Normal saline
b) Isotonic saline
c) Both a & b
d) Ringer’s lactate
e) Water restriction
Ans. E
11. The drug of choice in case of Trigeminal Neuralgia is:
a) Carbamazepine
b) Steroids
c) NSAIDs
d) Gabapentin
e) both b & c
Ans. A
12. Basal ganglia lacunar stroke is characterized by:
a) Pure hemiplegia
b) Pure hemianesthesia
c) Both a & b
d) Ataxic hemiparesis
e) A.O.T
Ans. E
13. it is not the feature of blockage of anterior cerebral artery:
a) contralateral weakness
b) urinary incontinence
c) face is also affected
d) confusion and behavioral disturbances
e) N.O.T
Ans. C
14. All of the following drugs cause fetal congenital abnormalities except:
a) Carbamazepine
b) Ethosuximide
c) Gabapentin
d) Lamotrigine
e) Phenytoin
Ans. C

5. 15. The most common risk factor for intracerebral hemorrhage is:
a) Anticoagulant therapy
b) Thrombolytic therapy
c) AV malformation
d) Cocaine
e) Hypertension
Ans. E
16. The most common cause of acute pyogenic meningitis in neonates is:
a) Streptococcus pneumonia
b) E.Coli
c) Group B streptococci
d) Nisseria meningitides
e) Both b & c
Ans. E
17. When focal neurologic deficit lasts ˂ 24 hours it is called:
a) Stroke
b) Transient ischemic attack
c) Completed stroke
d) Stroke in evolution
e) N.O.T
Ans. B
18. The most common cause of subarachnoid hemorrhage is:
a) Hematologic disturbances
b) Traumatic hematoma
c) Vascular malformations
d) Berry (Saccular) aneurysms
e) Tumors
Ans. D
19. The most common site of berry aneurysms is:
a) Anterior cerebral artery
b) Middle cerebral artery
c) Posterior cerebral artery
d) Junction of ACA with anterior communicating artery
e) Posterior communicating artery
Ans. D

6. 20. The best initial test for subarachnoid hemorrhage is:
a) Xray skull
b) Non contrast C.T scan
c) MRI
d) Duplex ultrasound
e) Lumber puncture
Ans. B
21. In the management of intracerebral hemorrhage the goal should be to keep Systolic BP
˂_____ ?
a) 120 mm/Hg
b) 130 mm/Hg
c) 140 mm/Hg
d) 150 mm/Hg
e) 110 mm/Hg
Ans. C
22. The investigation of choice for subarachnoid hemorrhage is:
a) Xray skull
b) Non contrast C.T scan
c) MRI
d) Duplex ultrasound
e) Lumber puncture
Ans. E
23. All are the finding CSF of patients with subarachnoid hemorrhage except:
a) Raised proteins
b) Raised RBC
c) Raised glucose
d) Raised pressure
e) Normal WBC
Ans. C
24. The recurrence rate of the seizures after 1st seizure is:
a) 25 %
b) 40 %
c) 50 %
d) 70 %
e) 90 %
Ans. D

7. 25. It prevents seizures:
a) Acetylcholine
b) GABA
c) Glutamine
d) Aspartate
e) A.O.T
Ans. B
26. It is not a feature of simple partial seizures:
a) Automatism
b) No loss of consciousness
c) It may be motor, sensory or autonomic
d) Example includes Jacksonian seizure
e) N.O.T
Ans. A
27. In case of partial seizures best initial therapy is with:
a) Phenobarbital
b) Gabapentin
c) Carbamazepine
d) Valproic acid
e) A.O.T
Ans. C
28. Absence seizure always starts in:
a) Children
b) Adolescents
c) Adults
d) Old patients
e) A.O.T
Ans. A
29. Regarding absence seizures:
a) It is simple partial seizure
b) No loss of consciousness
c) Loss of postural tone
d) EEG shows 3 per second spike and wave activity
e) A.O.T
Ans. D

8. 30. It 20 years old patient presents with seizure. These are characterized by rhythmic
contractions alternating with relaxation of all muscle groups and is associated with tongue
biting and urinary incontinence. The type of seizures is:
a) Jacksonian seizure
b) Complex partial seizure
c) Tonic phase of Grand-Mal seizures
d) Clonic phase of Grand-Mal seizures
e) Myoclonic seizure
Ans. D
31. Broca’s aphasia and Wernicke’s aphasia occur due to the disturbance in the blood flow
through:
a) Anterior cerebral artery
b) Middle cerebral artery
c) Middle meningeal artery
d) Posterior cerebral artery
e) BVertebra cerebral circulation
Ans. B
32. The following condition is associated with antibodies formation against water channel
aquaporin 4.
a) Neuromyelitis optica
b) Intranuclear ophthalmoplegia
c) Optic neuritis
d) Multiple myeloma
e) Normal pressure hydrocephalus
Ans. A
33. It is called status epilepticus when seizures or series of seizures lasts more than ______
without patient regaining awareness between attacks.
a) 10 min
b) 20 min
c) 30 min
d) 40 min
e) One hour
Ans. C

9. 34. It does not meet the guidelines for starting antiepileptic drugs:
a) Start with atleast two first line drugs
b) Start at a low dose
c) Use minimum number of doses per day
d) Both a & b
e) Both b & c
Ans. A
35. Hair loss, menstrual irregularities and PCOS are the side effects of:
a) Carbamazepine
b) Ethosuximide
c) Sodium valproate
d) Lamotrigine
e) Phenytoin
Ans. C
36. The preferred 1st line agent in absence seizures is:
a) Carbamazepine
b) Ethosuximide
c) Sodium valproate
d) Lamotrigine
e) Phenytoin
Ans. B
37. Gum hypertrophy, osteomalacia and folate deficiency are the side effects of:
a) Carbamazepine
b) Ethosuximide
c) Sodium valproate
d) Lamotrigine
e) Phenytoin
Ans. E
38. The risk of fetal complications is higher if anti epileptic drugs are given
a) During 1st trimester
b) During 2nd trimester
c) During 3rd trimester
d) During birth
e) A.O.T
Ans. A

10. 39. All of the following are features of tension headache except:
a) The pain aggravates as days goes on
b) The pain is generalized and constant
c) It is the most common type of headache
d) Pain is associated with aura
e) The pain is felt as tight, band like or pressure
Ans. D
40. All of the following are features of migraine except:
a) Throbbing headache
b) Classic migraine is without aura
c) Triptans are used in severe attacks
d) Oral contraceptives may trigger the attack
e) N.O.T
Ans. B
41. All of the following are true about narcolepsy except:
a) It mainly occurs in old age
b) The patient tends to fall while eating or walking
c) Hypnagogic hallucination occurs as the patient falls asleep
d) Hypopompic hallucination occurs as the patient awakens
e) Both c & d
Ans. A
42. The most common presentation in multiple sclerosis is:
a) Bilateral trigeminal neuralgia
b) Optic neuritis
c) Scanning speech
d) Intranuclear ophthalmoplegia
e) Nystagmus
Ans. B
43. All are included in charcot’s triad except:
a) Scanning speech
b) Optic neuritis
c) Intranuclear ophthalmoplegia
d) Nystagmus
e) Both c & d
Ans. B

11. 44. All of the following CSF findings are associated with Multiple sclerosis except:
a) Increased CSF leukocytosis
b) Increased CSF protein
c) Increased myelin basic protein
d) Increased CSF glucose
e) CSF protein ˂ 100
Ans. D
45. The most sensitive for the diagnosis of Multiple myeloma is:
a) Lumber puncture
b) MRI with gadolinium
c) Non contrast CT scan
d) EEG
e) CBC,ESR
Ans. B
46. The investigation of choice for transverse myelitis is:
a) Lumber puncture
b) MRI
c) Non contrast CT scan
d) EEG
e) CBC & ESR
Ans. B
47. Most common cause of death in case of Alzheimer’s disease is:
a) Aspiration pneumonia
b) Intracerebral hemorrhage
c) Stroke
d) Seizure disorders
e) Tumors
Ans. A
48. All are true about Pick’s disease except:
a) It involves only frontal lobe
b) There is asymmetrical lobar atrophy
c) Pick bodies are inclusion bodies of tau protein
d) Associated with dementia
e) N.O.T
Ans. A

12. 49. Classic triad of dementia, gait apraxia and urinary incontinence is found in:
a) Picks disease
b) Normal pressure hydrocephalus
c) Creutzfeldt-Jackob disease
d) Alzheimer’s disease
e) Parkinson’s disease
Ans. B
50. Lewy bodies are foundi in:
a) Picks disease
b) Normal pressure hydrocephalus
c) Creutzfeldt-Jackob disease
d) Alzheimer’s disease
e) Parkinson’s disease
Ans. E
51. All of the following are features of amyotrophic lateral sclerosis except:
a) Hyper reflexia
b) Spasticity
c) Positive babinski’s sign
d) Fasciculation
e) N.O.T
Ans. E
52. All of the following are features of Friedreich’s Ataxia except:
a) Onset is in first decade of life
b) Deep tendon reflexes are exaggerated
c) Hypertrophic cardiomyopathy
d) Dysarthria
e) N.O.T
Ans. B
53. The best initial test for acute pyogenic meningitis is:
a) Blood culture
b) Lumber puncture
c) CT scan
d) MRI
e) X-ray
Ans. B

13. 54. A 40 years old man complains of slowness of movement, impaired balance on turning,
postural instability and resting tremors. He is most likely suffering from:
a) Picks disease
b) Ataxia telangiectasia
c) Creutzfeldt-Jackob disease
d) Cerebellar disease
e) Parkinson’s disease
Ans. E
55. The most common cause of acute pyogenic meningitis overall is:
a) Streptococcus pneumonia
b) E.Coli
c) Group B streptococci
d) Nisseria meningitides
e) Listeria monocytogenes
Ans. A
56. Intravenous tissue plasminogen activator is contraindicated in all of the following conditions
except:
a) When given within 3 hours of ischemic stroke symptoms
b) Within 3 months of head trauma
c) Within 3 months of MI
d) Within 7 days of lumber puncture
e) N.O.T
Ans. A
57. A 4 years old boy presents with the signs of meningism. CSF examination shows increased
pressure, cloudy appearance, increased no of mononuclear cells, decreased glucose and
markedly increased protein. The type of meningitis most likely he is suffering from is :
a) Bacterial
b) Viral
c) Fungal
d) Tuberculous
e) Both a & d
Ans. D

14. 58. Subcutaneous injections of sumitriptan along with 100% oxygen are mainly used as abortive
therapy in case of?
a) Tension headache
b) Cluster headache
c) Migraine
d) Pseudotumor cerebri
e) Trigeminal neuralgia
Ans. B
59. The most common complication of acute pyogenic meningitis is:
a) Deafness
b) Hyponatremia
c) Cereberal edema
d) Ventriculitis
e) Subdural empyema
Ans. A
60. The most common cause of viral encephalitis is:
a) Herpes simplex virus
b) Cytomegalovirus
c) Arbovirus
d) Varicella zoster virus
e) Enterovirus
Ans. A
61. The most accurate test for HSV encephalitis is:
a) MRI
b) CT scan
c) EEG
d) Lumber puncture
e) PCR of CSF
Ans. E
62. Brain abscess most commonly involves:
a) Frontal lobe
b) Parietal lobe
c) Temporal lobe
d) Occipital lobe
e) Both a & b
Ans. A

15. 63. The best initial test for brain abscess is:
a) MRI
b) CT scan
c) EEG
d) Lumber puncture
e) PCR of CSF
Ans. B
64. The most common cause of Guillain Barre syndrome:
a) Cytomegalovirus
b) Ebstein barr virus
c) Campylobacter jejuni
d) Mycoplasma pneumonia
e) E.Coli
Ans. C
65. All of the following are features of guillain barre syndrome except:
a) Loss of deep tendon reflexes
b) Respiratory weakness
c) Bulbar palsy
d) Descending paralysis
e) Ataxia
Ans. D
66. The most common site for syringomylia is:
a) Cervical spine
b) Thoracic spine
c) Lumber spine
d) Sacral region
e) Ventricles
Ans. A
67. Wernicke Korsakoff disease is caused by the deficiency of:
a) Alcohol
b) Vitamin A
c) Vitamin B12
d) Thiamine
e) Riboflavin
Ans. D

16. 68. The most accurate test for spinal cord compression is:
a) MRI spine
b) CT scan
c) Electromyography
d) Lumber puncture
e) X-ray
Ans. A
69. A 30 years old man presents with recent changes in mood, suicidal tendency, dementia and
chorea. He is most likely suffering from:
a) Parkinson’s disease
b) Huntigton’s disease
c) Alzheimer’s disease
d) Psycosis
e) Depression
Ans. B
70. A 25 years old woman presents with ptosis, she also complains of weakness which
aggravates with activity as the day progresses. On examination deep tendon reflexes and
papillary response are normal. She is most likely suffering from:
a) Guillain Barre syndrome
b) Myasthenia gravis
c) Lumber disc hearniation
d) Spinal cord compression
e) 3rd nerve palsy
Ans. B
Note: Please notify me the mistake if I have done any.