Differential Diagnosis (DDx) by Signs and Symptoms—Primarily Intracranial

Question 1

What is the most common cause of syncope?
● A. Reflex-mediated such as vasovagal or Valsalva/stress-induced
● B. Cardiac valvular etiology or arrhythmia
● C. Orthostatic due to autonomic dysregulation, dehydration, or polypharmacy
● D. Cerebrovascular due to stroke
● E. Seizure

Answer 1

A. Reflex-mediated such as vasovagal or Valsalva/stress-induced

Question 2

Most of transient ischemic attack (TIA) resolve within how long?
● A. < 5 minutes
● B. < 10 minutes
● C. < 20 minutes
● D. < 30 minutes
● E. < 40 minutes

Answer 2

C. < 20 minutes

Question 3

Wide base gait is defined as gait with feet spread of how much?
● A. > 1 to 2 inch apart
● B. > 2 to 4 inch apart
● C. > 4 to 6 inch apart
● D. > 6 to 8 inch apart
● E. > 8 to 10 inch apart

Answer 3

B. > 2 to 4 inch apart

Question 4

A patient presented with abdominal cramps, dry mouth, and diarrhea followed by symmetrical cranial nerve palsies, diplopia, ptosis, loss of accommodation, and pupillary light reflex and descending weakness. Sensory disturbances are absent. Sensorium is clear. What is the most likely diagnosis?
● A. Graves’ disease
● B. Myasthenia gravis
● C. Giant cell arteritis
● D. Botulism
● E. Pseudotumor cerebri

Answer 4

D. Botulism

Question 5

All of the following are causes of facial diplegia except?
● A. Mobius syndrome
● B. Guillain Barre syndrome
● C. Lyme disease
● D. Lhermitte Duclos syndrome
● E. Sarcoidosis

Answer 5

D. Lhermitte Duclos syndrome

Question 6

A 30-year-old patient presented with binocular vision loss after head trauma. All of the following are causes of binocular vision loss except?
● A. Amaurosis fugax
● B. Bilateral PCA flow impairment
● C. Bilateral occipital lobe injury
● D. Raised ICP
● E. Epileptic blindness

Answer 6

A. Amaurosis fugax

Question 7

Exophthalmos is defined as anterior displacement of globe by how much?
● A. > 14 mm
● B. > 16 mm
● C. > 18 mm
● D. > 20 mm
● E. > 22 mm

Answer 7

C. > 18 mm

Question 8

What is the most common cause of unilateral proptosis?
● A. Orbital tumor
● B. Infection (cellulitis)
● C. Hemorrhage
● D. Thyroid disease
● E. Cavernous sinus occlusion

Answer 8

D. Thyroid disease

Question 9

Which of the following investigations is not helpful for diagnosis (nonsensitive, nonspecific) of pulsatile tinnitus?
● A. MRI
● B. MRV
● C. Carotid USG
● D. Angiogram
● E. None of the above

Answer 9

C. Carotid USG

Question 10

How frequently is treatment required for arachnoid cyst?
● A. 10%
● B. 20%
● C. 30%
● D. 40%
● E. 50%

Answer 10

C. 30%

Question 11

Syncope is defined as one or more episodes of brief loss of consciousness with prompt recovery. Which of the following are the etiologies of syncope?
● A. Cerebrovascular (subarachnoid hemorrhage, intracerebral hemorrhage, brainstem infarction, pituitary apoplexy, vertebrobasilar insufficiency, rarely with migraine)
● B. Cardiovascular (carotid sinus syncope, vasopressor syncope, cardiac standstill, orthostatic hypotension)
● C. Infections (meningitis, encephalitis)
● D. Metabolic hypoglycemia
● E. All of the above

Answer 11

E. All of the above

Question 12

Following are the causes of transient neurologic deficit except?
● A. Transient ischemic attack
● B. Migraine
● C. Spinocerebellar degeneration
● D. Seizures
● E. TIA like syndrome (tumor TIA)

Answer 12

C. Spinocerebellar degeneration

Question 13

Wide based gait is a gait with feet spread more than 2 to 4 inches apart. Which of the following are included in the differentials of this symptom?
● A. Idiopathic normal pressure hydrocephalus
● B. Cerebellar ataxia
● C. Sensorimotor peripheral neuropathy
● D. Vestibular ataxia
● E. Myelopathy
● F. All of the above

Answer 13

F. All of the above

Question 14

Following are the causes of diplopia except?
● A. Cranial nerve palsy of any one or a combination of cranial nerves 3, 4, and 6
● B. Intraorbital mass compressing extraocular muscles
● C. Grave’s disease
● D. Myasthenia gravis
● E. Friderichsen syndrome
● F. Giant cell arteritis

Answer 14

E. Friderichsen syndrome

Question 15

Following are included in the most probable cause of gradual onset of anosmia except?
● A. Allergic rhinitis and sinus disease
● B. Intracranial neoplasms
● C. Head trauma
● D. Nasal polyps
● E. Intracranial neoplasms like olfactory groove meningioma

Answer 15

C. Head trauma

Question 16

Marble bone disease is a group of genetic disorders of defective osteoclastic resorption of bone resulting in increased bone density, which may be transmitted either as autosomal dominant or recessive. What is the other name of this disease?
● A. Paget’s disease
● B. Marfan syndrome
● C. Osteopetrosis
● D. Osteoporosis
● E. None of the above

Answer 16

C. Osteopetrosis

Question 17

All of the following are included in the differentials of binocular blindness except?
● A. Bilateral posterior cerebral artery flow impairment
● B. Amaurosis fugax due to giant cell arteritis or TIAs
● C. Bilateral vitreous hemorrhage
● D. Trauma with bilateral occipital lobe injury
● E. Posterior ischemic optic neuropathy usually in the setting of shock

Answer 17

B. Amaurosis fugax due to giant cell arteritis or TIAs

Question 18

Exophthalmos is abnormal protrusion of eyeball. It can be pulsatile or nonpulsatile. All of the following are included in nonpulsatile exophthalmos except?
● A. Intraorbital tumors like optic glioma, optic sheath neuroma, lymphoma or Graves disease or enlargement of periorbital fat
● B. Carotid cavernous fistula or transmitted intracranial pulsations due to defect in orbital roof or vascular tumors
● C. Inflammatory or hemorrhage or third nerve palsy
● D. Cavernous sinus occlusion
● E. Pseudo exophthalmos

Answer 18

B. Carotid cavernous fistula or transmitted intracranial pulsations due to defect in orbital roof or vascular tumors

Question 19

Ptosis is drooping of upper eyelid. Ptosis can be pupil sparing or not pupil sparing. Etiologies of pupil sparing ptosis includes the following except?
● A. Congenital
● B. Traumatic injury to eyelid or traumatic roof fracture
● C. Neurogenic involving third nerve palsy due to compression from tumors or pituitary apoplexy
● D. Myogenic ptosis due to botulism toxin or myasthenia gravis
● E. None of the above

Answer 19

C. Neurogenic involving third nerve palsy due to compression from tumors or pituitary apoplexy

Question 20

Following are the causes of macrocephaly with ventricular enlargement except?
● A. Hydranencephaly
● B. Constitutional ventriculomegaly
● C. External hydrocephalus
● D. Hydrocephalus ex vacuo
● E. Obstructive hydrocephalus

Answer 20

C. External hydrocephalus