Previous year question on temporal lobe based on neet pg, usmle, plab and fmge or mci screening exams

All of the following are MRI features of Mesial temporal sclerosis, except:
A: Atrophy of fornix
B: Atrophy of hippocampus
C: Blurring of Grey white matter junction of ipsilateral temporal lobe
D: None of the above
Correct Ans:D
Explanation
Classic imaging findings in Mesial temporal sclerosis are hippocampal atrophy, increased T2
signal and loss or distortion of adjacent white matter.
Secondary MRI findings include (ipsilateral to side of MTS)
? Temporal horn dilatation
? Loss of hippocampal internal architecture
? Atrophy of temporal afferent and efferent pathways
? Decreased hippocampal signal on T1 weighted images
? Poor parahippocampal grey white matter differentiation
? Narrowed collateral white matter in adjacent para hippocampal gyrus
Ref: Brain Imaging Case Review Series By Arora, Page 152; Atlas of Epilepsies By C. P.
Panayiotopoulos, Page 795; Pediatric Epilepsy: Diagnosis and Therapy By John M. Pellock,
3rd Edition, Page 43
Sample Previous Year Question on Temporal Lobe based on previous Year
Questions of NEET PG, USMLE,PLAB,FMGE (MCI Screening). Please visit
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A patient presented with short lasting episodic behavioural changes which include agitation
and dream like state with thrashing movements of his limbs. He does not recall these
episodes and has no apparent precipitating factor. Which of the following is the most likely
diagnosis?
A: Panic episodes
B:
Schizophreni
a
C: Temporal lobe epilepsy

D: Dissociative disorder
Correct Ans:C
Explanation
The patient in the question has most likely suffered an attack of temporal lobe epilepsy. The
loss of consciousness need not always be present but it is associated with loss of memory
for the episode. In temporal lobe seizure, the patient usually experiences auras or warning
signs, epigastric discomfort, olfactory hallucination, sensation of deja vu. A dream like state
is often a feature of TLE. There may be loss of consciousness abnormal movement of mouth,
and rarely abnormal movement of body. Frontal lobe epilepsy is also associated with
episodes of agitation known as ‘intermittent explosive disorder’.
Ref: Clinical Neuroanatomy By Stephen G. Waxman, 26th Edition, Chapter 19
Gustatory hallucinations are most commonly associated with:
A: Temporal lobe epilepsy
B:
Grand mal
epilepsy
C: Anxiety disorders
D: Tobacco dependence
Correct Ans:A
Explanation
Gustatory hallucinations are most commonly associated with temporal lobe lesions,
especially uncinate gyrus seizures. Patients report experiencing bitter, sweet, salty,
tobacco-like, metallic or indescribable strange tastes. They are found in 4% of seizure
patients with temporal lobe foci.
Ref: Clinical neuropsychology 4th Ed By Kenneth M.Heilman, Page 488.

B:
Grand mal
epilepsy
Correct Ans:A
Explanation
Mesial temporal lobe epilepsy is the epilepsy most commonly associated with gustatory
hallucinations. This syndrome produces seizures with visual, auditory, gustatory and
visceral hallucinations.
Ictal gustatory hallucinations are the experience of a taste due to a focal seizure in the
absence of an environmental stimulus of the sensation. Common gustatory hallucinations
includes metallic, rusty, bitter, and salty tastes.
Ref: Atlas of Epilepsies, Volume 3 edited by S.R. Benbadis page 451.
B:
Grand mal
epilepsy
Correct Ans:A
Explanation
Gustatory hallucinations are most commonly associated with temporal lobe lesions,
especially uncinate gyrus seizures. Patients report experiencing bitter, sweet, salty,
tobacco-like, metallic or indescribable strange tastes. They are found in 4% of seizure
patients with temporal lobe foci.
Ref: Clinical neuropsychology 4th Ed By Kenneth M.Heilman, Page 488.

A 60 year old man presents to a physician because of difficulty in reading and coming down
stairs, which he attributes to an inability to "look down." Physical examination reveals that
the patient looks around by moving his head rather than his eyes and also shows a
distinctive axial rigidity of neck, trunk, and proximal limb muscles. He shows poverty of
movement and dysarthric speech. Mentally, the patient responds very slowly but has better
memory and intellect than are initially apparent. Which of the following pathologic findings
of the brain would most likely be present?
A: Depigmentation of the substantia nigra and locus ceruleus
B: Diffuse cortical atrophy with relative sparing of primary motor and sensory areas
C: Selective frontal and temporal lobe atrophy
D: Widespread neuronal loss and gliosis in subcortical sites
Correct Ans:D
Explanation
The disease is progressive supranuclear palsy, a degenerative disorder characterized by
ophthalmoplegia, pseudobulbar palsy, axial dystonia, and bradykinesia. The presentation
described in the question is typical. The pathologic changes consist of widespread neuronal
loss and gliosis in subcortical sites with sparing of the cerebral and cerebellar cortices.
Pigmented neurons in the substantia nigra (pars compacta) and locus ceruleus selectively
degenerate in Parkinson's disease.
In Alzheimer's disease, there is diffuse cortical atrophy, especially over the
association cortex of frontal, temporal, and parietal lobes, with relative sparing of primary
sensory and motor areas.Selective frontal and temporal lobe atrophy is characteristic of
Pick's disease.
Ref: Wyatt C., Butterworth IV J.F., Moos P.J., Mackey D.C., Brown T.G. (2008). Chapter 11.
Neuropathology. In C. Wyatt, J.F. Butterworth IV, P.J. Moos, D.C. Mackey, T.G. Brown
(Eds),Pathology: The Big Picture.
All of the following are pathologic features of brain in AIDS, EXCEPT:
A: Perivascular giant cell invasion
B:
Microglial
nodules
C: Vasculitis
D: Temporal lobe infarction
Correct Ans:C
Explanation
Pathologic features of brain in AIDS includes:
Gross:

 Encephalitis: frontal /temporal cortical atrophy
Histology:
Meningitis with mild lymphocytic infiltrates and scanty perivascular inflammation
Features of giant cell (HIV) encephalitis are:
 Presence of microglial nodules
 Pericapillary aggregates of multinucleated giant cells having generous or
scanty neoplasm
 Perivascular lymphocytic cuffing
 In leukoencephalopathy: there is diffuse diffuse demyelination and
infiltration of macrophages and multinucleated giant cells.
Ref: Neuropathology,A Volume in the High Yield Pathology Series (Expert Consult ...
edited by Anthony T. Yachnis page 235.
A 9 year old boy with Fallot's tetralogy, had high grade fever followed by focal seizure 2
days prior to hospital admission. His blood counts were increased and predominantly
polymorphs. CT scan of the head showed a focal lesion suggestive of an abscess. Where
would be the commonest location of brain abscess in this patient?
A: Cerebellum
B:
Thalamu
s
C: Temporal lobe
D: Parietal lobe
Correct Ans:D
Explanation
Cyanotic congenital heart diseases like TOF are a significant
risk factor for brain abscess. The mortality associated with
the condition is very high. Focal ischemia in the brain,
particularly the parietal lobe is the cause.
Otogenic : Temporal lobe and cerebellum ; Paranasal sinuses : Frontal Lobe. Intracranial
abscesses can originate from infection of contiguous structures (eg, otitis media, dental
infection, mastoiditis, sinusitis) secondary to hematogenous spread from a remote site
(especially in patients with cyanotic congenital heart disease), after skull trauma or
surgery, and, rarely, following meningitis. In at least 15% of cases, no source can be
identified.

An adolescent is brought to the emergency department following an episode of myoclonic
jerks at morning after waking up. His consciousness was not impaired. His EEG shows
generalized 3-4 Hz spike and slow wave complexes. Most probable diagnosis is?
A: Generalized tonic clonic seizure
B: Absent seizure
C: Temporal lobe epilepsy
D: Juvenile myoclonic epilepsy
Correct Ans:D
Explanation
Juvenile myoclonic epilepsy is a subtype of idiopathic generalized epilepsy with onset
usually between 8 and 20 years of age. Myoclonic jerks, especially in the morning, are of
variable intensity ranging from simple twitching (“flying saucer syndrome”) to
falls; consciousness is not impaired in it. It is precipitated by alcohol and sleep deprivation.
Patients will have normal intelligence. The typical interictal EEG abnormality consists of a
generalized 4- to 6-Hz spike or polyspike and slow-wave discharges lasting 1-20 seconds.
Usually, 1-3 spikes precede each slow wave.
Also know:
 In Generalized tonic clonic seizure EEG shows a normal background with
generalized epileptiform discharges such as spike or polyspike wave
complexes at 2.5 to 4 Hz.
 During absence seizures there is an abrupt onset of bilaterally
synchronous and symmetrical 3 Hz spike-wave discharge, irrespective of
whether typical absences are simple or complex.
 Ictal recordings from patients with typical temporal lobe epilepsy usually
exhibit 5-7 Hz, rhythmic, sharp theta activity, maximal in the sphenoidal
and the basal temporal electrodes on the side of seizure origin.
Ref: A-Z of Neurological Practice: A Guide to Clinical Neurology By Andrew J. Larner,
Alasdair J Coles, Neil J. Scolding, Roger A Barker, 2011, Page 368 ; Clinical
Electroencephalography by Misra,2005, Page 188
Which of the following sites is not involved in a posterior cerebral artery infarct?

A:
Midbrai
n
B: Thalamus
C: Temporal lobe
D: Anterior Cortex
Correct Ans:D
Explanation
The cortical branches of posterior cerebral artery supplies the inferolateral surface of the temporal
lobe and the lateral and medial surfaces of the occipital lobe (visual cortex). The central branches
supply the deep masses of gray matter within the cerebral hemisphere and midbrain.
The anterior cortex is supplied by the anterior and middle cerebral arteries.
Ref: Snell’s Clinical Anatomy 7th Edition, Page 814
The area of the brain resistant to Neurofibrillary tangles of Alzheimer's disease is:
A: Visual association areas
B:
Entorhinal
cortex
C: Temporal lobe
D: Lateral geniculate body
Correct Ans:D
Explanation
Lateral geniculate body of the thalamus is resistant to the neurofibrillary tangles of
Alzheimer’s disease. So lateral geniculate body is the single best answer of choice.
Ref: Harrisons Principles of Internal Medicine, 16th Edition, Pages 2398-2401.

The most characteristic EEG finding in complex partial (psychomotor) seizures is:
A: Spikes over the temporal lobes
B:
Diffuse
Slowing
C: Generalized Spike and wave pattern
D: Multifocal spikes
Correct Ans:A
Explanation
Partial complex seizures (psychomotor seizures or temporal lobe seizures) are
characterized clinically by automatisms – repetitive complex but purposeless and
inappropriate motor activities. There may or may not be changes in the consciousness and
responsiveness. There may be bizarre behavior, strange feelings, confusion, and fear. The
most common electroencephalographic finding is spike waves over the temporal lobes.
Ref: Greenberg D.A., Aminoff M.J., Simon R.P. (2012). Chapter 12. Seizures & Syncope. In
D.A. Greenberg, M.J. Aminoff, R.P. Simon (Eds), Clinical Neurology, 8e.
The most characteristic EEG finding in complex partial (psychomotor) seizures is:
A: Spikes over the temporal lobes
B:
Diffuse
Slowing
C: Generalized Spike and wave pattern
D: Multifocal spikes
Correct Ans:A
Explanation
Partial complex seizures (psychomotor seizures or temporal lobe seizures) are
characterized clinically by automatisms – repetitive complex but purposeless and
inappropriate motor activities. There may or may not be changes in the consciousness and
responsiveness. There may be bizarre behavior, strange feelings, confusion, and fear. The
most common electroencephalographic finding is spike waves over the temporal lobes.
Ref: Greenberg D.A., Aminoff M.J., Simon R.P. (2012). Chapter 12. Seizures & Syncope. In
D.A. Greenberg, M.J. Aminoff, R.P. Simon (Eds), Clinical Neurology, 8e.

A leukemia patient who has undergone multiple courses of chemotherapy develops herpes
simplex encephalitis. Which of the following would you expect a CT scan of the patient's
brain to show?
A: Generalized volume loss
B: Volume loss selectively in the basal ganglia
C: Volume loss selectively in the brainstem
D: Volume loss selectively in the temporal and frontal lobes
Correct Ans:D
Explanation
Herpes simplex can cause a necrotizing, hemorrhagic acute encephalitis that may rapidly
produce death. The encephalitis characteristically involves the lower portions of the
cerebral cortex, notably the temporal lobes and the base of the frontal lobes, possibly
because the infection spreads from the oropharynx.
Ref: Ropper A.H., Samuels M.A. (2009). Chapter 33. Viral Infections of the Nervous System,
Chronic Meningitis, and Prion Diseases. In A.H. Ropper, M.A. Samuels (Eds), Adams and
Victor's Principles of Neurology, 9e.
Blunt injury to the eye can lead to hyphaema, detachment (due to haemarrhage), dislocation of lens,
damage to macula, damage to drainage angle of the eye, orbital fracture or cataract as a late effect.
Out of all the options given vitreous detachment is the best suited.
Ref: BC of eyes: Volume 1 - Page 31.
A:
Frontal lobe
tumors
B: Craniopharyngioma
C: Pitutary tumor
D: Temporal lobe tumor
Correct Ans:D
Explanation

Among the options given, temporal lobe tumor compress the inferior retinal fibers resulting
in the visual field defect called superior quadrantopia (pie in the sky). If a pituitary
adenoma compress the optic chiasma from below, initially it result in upper bitemporal
quadrantopsia followed by bitemporal hemianopsia. Craniopharyngioma compress optic
chiasma from above, and initially result in lower bitemporal quadrantopsia followed by
bitemporal hemianopsia
Careful testing of the visual fields in a patient complaining of difficulty reading
demonstrates a central scotoma involving one visual field. This defect is most likely due to a
lesion involving which of the following structures?
A: Macula
B: Optic chiasm
C: Optic radiations in the parietal lobe
D: Optic radiations in the temporal lobe
Correct Ans:A
Explanation
The probable location of lesions producing visual defects is a favorite topic for examiners
(and is also well worth knowing if you have occasion to work up such a patient). Here is a
list that may help you sort through these problems:
Central scotoma ~ macula
Ipsilateral blindness ~ optic nerve
Bitemporal hemianopia ~ optic chiasm
Homonymous hemianopia ~ optic tract
Upper homonymous quadrantanopia ~ temporal optic radiations
Lower homonymous quadrantanopia ~ parietal optic radiations
Also, cortical lesions produce defects similar to those of the optic radiations, but may spare
the macula.
Ref: Sterns G.K., Faye E.E. (2011). Chapter 24. Low Vision. In P. Riordan-Eva, E.T.
Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e.

Careful testing of the visual fields in a patient complaining of difficulty reading
demonstrates a central scotoma involving one visual field. This defect is MOST likely due to
a lesion involving which of the following structures?
A: Macula
B: Optic chiasm
C: Optic radiations in the parietal lobe
D: Optic radiations in the temporal lobe
Correct Ans:A
Explanation
Here is a list that may help you sort through these problems:
Central scotoma ~ macula
Ipsilateral blindness ~ optic nerve
Bitemporal hemianopia ~ optic chiasm
Homonymous hemianopia ~ optic tract
Upper homonymous quadrantanopia ~ temporal optic radiations
Lower homonymous quadrantanopia ~ parietal optic radiations
Also, cortical lesions produce defects similar to those of the optic radiations, but may spare
the macula.
Ref: Sterns G.K., Faye E.E. (2011). Chapter 24. Low Vision. In P. Riordan-Eva, E.T.
Cunningham, Jr. (Eds), Vaughan & Asbury's General Ophthalmology, 18e.

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Previous year question on temporal lobe based on neet pg, usmle, plab and fmge or mci screening exams