Neurology Practice Questions

Q: All are characteristic features of cerebral palsy except

Erb's palsy. ***Erb's palsy*** - **Erb's palsy** is a form of brachial plexus palsy, characterized by injury to the **upper brachial plexus** (C5-C6 nerve roots), typically occurring during birth. - It results in a characteristic **"waiter's tip" position** of the arm and is a distinct peripheral nerve injury, not a characteristic feature of **cerebral palsy**, which is a central neurological disorder. *Hypotonia* - While many forms of cerebral palsy present with **spasticity**, some individuals, particularly those with **ataxic cerebral palsy** or specific types of dyskinetic cerebral palsy, can exhibit **hypotonia** (low muscle tone). - Hypotonia can also be an early manifestation before the development of more prominent hypertonia or spasticity, making it an associated feature. *Epilepsy* - **Epilepsy** and seizure disorders are common co-morbidities seen in children with **cerebral palsy**, particularly in those with severe brain damage or certain types of CP. - The underlying brain injury that causes cerebral palsy can also disrupt normal electrical activity in the brain, leading to seizures. *Spasticity* - **Spasticity** is the most common motor type of **cerebral palsy**, affecting approximately 80% of individuals. - It is characterized by **increased muscle tone** and **hyperreflexia**, resulting in stiff, tight muscles and exaggerated reflexes, due to damage to the motor cortex or pyramidal tracts.

Q: Which of the following is NOT true regarding rheumatic chorea in children?

Within 8-12 weeks of disease. ***Within 8-12 weeks of disease*** - Rheumatic chorea, or **Sydenham's chorea**, typically manifests several weeks to months (often 1-6 months) after the initial **Group A Streptococcus (GAS)** infection. - It is not usually limited to an 8-12 week timeframe from the onset of the entire rheumatic fever disease process but rather represents a delayed manifestation. *Chorea disappears during sleep* - This is a true characteristic of Sydenham's chorea and other forms of chorea; the involuntary movements **cease during sleep**. - This cessation during sleep helps differentiate chorea from other movement disorders like some forms of **myoclonus** or tics, which may persist. *Remits spontaneously* - Sydenham's chorea is generally **self-limited**, with symptoms often resolving spontaneously over weeks to months, although resolution can take up to a year or more. - While it may recur in some cases, the natural course is one of **spontaneous remission**. *Rapid jerky movements of distal extremities* - Sydenham's chorea is characterized by **involuntary, abrupt, purposeless, and rapid jerky movements**, which are often more prominent in the distal extremities and face. - These movements can involve any part of the body, leading to difficulties with coordination, gait, and fine motor tasks.

Q: Which of the following is the most common neurocutaneous syndrome?

Neurofibromatosis. ***Neurofibromatosis*** - **Neurofibromatosis type 1 (NF1)**, also known as von Recklinghausen disease, is the most common of all neurocutaneous syndromes, affecting about 1 in 3,000 live births. - It is characterized by **café-au-lait spots**, **axillary/groin freckling**, **neurofibromas**, **Lisch nodules**, and optic pathway gliomas. *Sturge Weber syndrome* - This syndrome is characterized by a **port-wine stain (facial angioma)**, leptomeningeal angioma, and glaucoma; it is less common than neurofibromatosis. - It is a **sporadic disorder** and does not show an inherited pattern like neurofibromatosis. *Von Hippel Lindau disease* - This is a rare, **autosomal dominant** inherited disorder characterized by various tumors such as **hemangioblastomas** in the cerebellum, retina, and spinal cord, as well as renal cysts and pheochromocytomas. - Its prevalence is significantly lower than neurofibromatosis. *Tuberous sclerosis* - This is an **autosomal dominant** disorder marked by the growth of **benign tumors** in the brain, heart, kidneys, skin, and other organs, such as **facial angiofibromas** and **epilepsy**. - While significant, its incidence is approximately 1 in 6,000 to 1 in 10,000 live births, making it less common than neurofibromatosis.

Q: Initial drug of choice in a child with status epilepticus:

Lorazepam. ***Lorazepam*** - **Lorazepam** is a benzodiazepine that rapidly crosses the blood-brain barrier and has a longer duration of action compared to other benzodiazepines, making it highly effective for acute seizure termination in children with **status epilepticus**. - Its rapid onset and sustained anticonvulsant effect reduce the risk of ongoing neuronal damage and provide a window for administering longer-acting antiepileptic drugs. *Phenobarbitone* - **Phenobarbitone** is a potent anticonvulsant but has a slower onset of action and a higher risk of **respiratory depression** and sedation compared to lorazepam. - It is typically considered a second-line or third-line agent in status epilepticus, after benzodiazepines have failed. *Phenytoin* - **Phenytoin** is a classic antiepileptic drug, but it has a slower onset of action when administered intravenously and carries risks of **cardiac arrhythmias** and **hypotension** with rapid infusion. - It's generally used as a second-line agent to maintain seizure control after the initial termination of status epilepticus with a benzodiazepine. *Valproate* - **Valproate** can be effective in status epilepticus, especially for generalized seizures, but its intravenous formulation also has a slower onset of action than lorazepam. - While it's a good broad-spectrum antiepileptic, it is not the **first-line choice** for immediate seizure termination due to its slower pharmacokinetics in acute settings.

Q: What is the typical age of occurrence of febrile seizures in children?

6 months - 60 months. ***6 months - 60 months*** - Febrile seizures typically occur in children between **6 months and 5 years** of age (60 months). - This age range reflects the period of brain development where children are most susceptible to seizures triggered by **fever**. *5 months - 60 months* - While it's close, the lower limit of **5 months** is generally considered outside the typical range for **simple febrile seizures**. - Seizures occurring at this younger age might warrant further investigation to rule out other causes. *1 year - 50 months* - This option narrows the typical range too much, excluding the important period between **6 months and 1 year** and also not fully encompassing up to **5 years** (60 months). - The peak incidence of febrile seizures is often observed between **12 and 18 months**, but the overall range is broader. *1 year - 5 years* - This option is equivalent to 1 year - 60 months, but it misses the critical age range between **6 months and 1 year**, where a significant number of **febrile seizures** occur. - The definition explicitly includes children starting from **6 months of age**.

Q: Most common acute complication of meningitis in children is –

Seizures. ***Seizures*** - **Seizures** are a common acute complication of meningitis in children, often occurring due to brain irritation and inflammation. - They can be the presenting symptom or develop during the course of the illness, and are particularly prevalent in **bacterial meningitis**. *Hydrocephalus* - **Hydrocephalus** can be a complication of meningitis due to obstruction of cerebrospinal fluid (CSF) flow or impaired absorption, but it is less frequent than seizures. - It usually represents a more chronic or late complication rather than an immediate and common one. *Hearing loss* - **Hearing loss**, especially sensorineural, is a well-recognized and serious complication of bacterial meningitis in children, but it is generally less common than seizures. - It can be permanent and often results from damage to the cochlea or auditory nerve. *Mitral regurgitation* - **Mitral regurgitation** is a heart valve disorder and is **not a typical complication of meningitis**. - Meningitis primarily affects the central nervous system and does not directly lead to valvular heart disease.

Q: A 2-year-old boy has been doing well despite his diagnosis of tetralogy of Fallot. He presented to an outside ER a few days ago with a complaint of an acute febrile illness for which he was started on a "pink, bubble-gum tasting antibiotic." His mother reports that for the past 12 hours or so he has been holding his head saying it hurts and he is less active than normal. On your examination, he seems to have a severe headache, nystagmus, and ataxia. Which of the following would be the most appropriate first test to order?

CT or MRI of the brain. ***CT or MRI of the brain*** - The patient's history of **tetralogy of Fallot** puts him at increased risk for a **brain abscess** due to right-to-left shunting, bypassing pulmonary filtration of bacteria. - New onset of severe headache, nystagmus, and ataxia in this context strongly suggests an **intracranial mass lesion**, making immediate imaging crucial. *Lumbar puncture* - Performing a **lumbar puncture** in the presence of signs of elevated intracranial pressure (severe headache, nystagmus, ataxia) or suspicion of a mass lesion (brain abscess) is **contraindicated** due to the risk of herniation. - While it can diagnose meningitis, the clinical picture with focal neurological signs makes a mass lesion a higher concern that needs to be ruled out first. *Urine drug screen* - The patient's symptoms (severe headache, nystagmus, ataxia) are not typical for drug intoxication in a 2-year-old, especially given the history of a recent febrile illness and a congenital heart defect. - There is no clinical indication for drug use in this young child, and this test would not address the serious neurological symptoms. *Blood culture* - While a blood culture might be useful to identify a systemic infection, it will not directly explain or diagnose the acute focal neurological deficits such as nystagmus and ataxia, and the severe headache. - Given the high suspicion of an intracranial lesion with risk of herniation, obtaining imaging is a higher priority than waiting for blood culture results, which would take time.

Q: Pyknolepsy is seen in

Absence seizures. ***Absence seizures*** - **Pyknolepsy** is a form of **childhood absence epilepsy** characterized by frequent, brief absence seizures (dozens to hundreds per day) [1]. - These seizures typically begin between ages 3 and 8 years and often resolve in adolescence [1]. *Narcolepsy* - Narcolepsy is a chronic neurological condition characterized by overwhelming daytime **sleepiness** and sudden attacks of sleep. - It involves symptoms like **cataplexy**, sleep paralysis, and vivid dreams, not brief episodes of impaired consciousness. *Lennox-Gastaut syndrome* - This is a severe form of epilepsy that begins in childhood, characterized by multiple seizure types, **intellectual disability**, and a specific EEG pattern (**slow spike-and-wave**). - It involves tonic, atonic, and atypical absence seizures but is a more severe and intractable syndrome than typical pyknolepsy. *Adrenoleukodystrophy* - Adrenoleukodystrophy is a rare, **X-linked genetic disorder** that affects the brain, spinal cord, and adrenal glands due to the accumulation of very long-chain fatty acids. - It leads to neurological dysfunction, including seizures, but it is a progressive neurodegenerative disease, not a specific seizure type like pyknolepsy [2].

Q: Management of typical febrile seizures includes all except:

Prophylactic phenobarbitone. ***Prophylactic phenobarbitone*** - **Continuous prophylactic anticonvulsant therapy** with phenobarbitone is **definitively NOT recommended** for typical (simple) febrile seizures - The risks of chronic anticonvulsant use—including **sedation, cognitive impairment, and behavioral problems**—significantly outweigh any potential benefits - Evidence shows prophylactic phenobarbital does **not prevent future epilepsy** and has insufficient benefit in preventing recurrent febrile seizures - This is the **correct answer** as it is explicitly excluded from management guidelines *Intermittent diazepam* - While **not routinely recommended** for typical febrile seizures, intermittent rectal or buccal diazepam may be discussed as a *potential option* for specific situations (frequent recurrences, parental anxiety, prolonged seizures) - It serves as **rescue medication** to abort an ongoing seizure rather than daily prophylaxis - Its role in typical febrile seizure management is controversial and limited, but it may be mentioned in comprehensive management discussions *Sponging* - **Tepid sponging** is a supportive physical cooling measure used in fever management - While it does not prevent febrile seizures, it is part of general **symptomatic care** for fever reduction - Typically used alongside antipyretics to help lower body temperature and improve comfort *Paracetamol or ibuprofen* - **Antipyretics** are standard management for fever control and improving the child's comfort - While they do **not reliably prevent** febrile seizures from occurring, they are essential for **symptomatic fever management** - Recommended as first-line treatment for fever in children with febrile seizures

Q: The type of cerebral palsy characterized by constant and uncontrolled motion of involved muscles is called:

Athetosis. ***Athetosis*** - **Athetoid cerebral palsy** is characterized by **involuntary, slow, writhing movements** affecting the limbs and often the face and trunk. - These uncontrolled movements are due to damage to the **basal ganglia**, responsible for motor control and coordination. *Rigidity* - **Rigidity** is a form of hypertonia characterized by a constant, uniform resistance to passive movement throughout the range of motion. - It does not specifically describe constant and uncontrolled motion, but rather **increased muscle tone** that hampers movement. *Spasticity* - **Spasticity** is a type of hypertonia characterized by a velocity-dependent increase in muscle tone, often with a "clasp-knife" phenomenon. - It involves **exaggerated reflexes** and muscle stiffness, which is different from continuous, uncontrolled movements. *Ataxia* - **Ataxia** refers to impaired coordination and balance, leading to unsteady gait and difficulty with fine motor skills. - It is caused by damage to the **cerebellum** and typically involves a lack of smooth, coordinated movement rather than uncontrolled motion of involved muscles. *Hypotonia* - **Hypotonia** refers to decreased muscle tone, resulting in floppiness and reduced resistance to passive movement. - It is the opposite of the uncontrolled, involuntary movements seen in athetosis and is sometimes seen in early infancy before other CP types become apparent.

Question 1

All are characteristic features of cerebral palsy except

Accepted Answer

Erb's palsy

Answer

Hypotonia

Answer

Epilepsy

Answer

Spasticity

Question 2

Which of the following is NOT true regarding rheumatic chorea in children?

Accepted Answer

Within 8-12 weeks of disease

Answer

Chorea disappears during sleep

Answer

Remits spontaneously

Answer

Rapid jerky movements of distal extremities

Question 3

Which of the following is the most common neurocutaneous syndrome?

Accepted Answer

Neurofibromatosis

Answer

Sturge Weber syndrome

Answer

Von Hippel Lindau disease

Answer

Tuberous sclerosis

Question 4

Initial drug of choice in a child with status epilepticus:

Accepted Answer

Lorazepam

Answer

Phenobarbitone

Answer

Phenytoin

Answer

Valproate

Question 5

What is the typical age of occurrence of febrile seizures in children?

Accepted Answer

6 months - 60 months

Answer

5 months - 60 months

Answer

1 year - 50 months

Answer

1 year - 5 years

Question 6

Most common acute complication of meningitis in children is –

Accepted Answer

Seizures

Answer

Hydrocephalus

Answer

Hearing loss

Answer

Mitral regurgitation

Question 7

A 2-year-old boy has been doing well despite his diagnosis of tetralogy of Fallot. He presented to an outside ER a few days ago with a complaint of an acute febrile illness for which he was started on a "pink, bubble-gum tasting antibiotic." His mother reports that for the past 12 hours or so he has been holding his head saying it hurts and he is less active than normal. On your examination, he seems to have a severe headache, nystagmus, and ataxia. Which of the following would be the most appropriate first test to order?

Accepted Answer

CT or MRI of the brain

Answer

Lumbar puncture

Answer

Urine drug screen

Answer

Blood culture

Question 8

Pyknolepsy is seen in

Accepted Answer

Absence seizures

Answer

Narcolepsy

Answer

Lennox-Gastaut syndrome

Answer

Adrenoleukodystrophy

Question 9

Management of typical febrile seizures includes all except:

Accepted Answer

Prophylactic phenobarbitone

Answer

Intermittent diazepam

Answer

Sponging

Answer

Paracetamol or ibuprofen

Question 10

The type of cerebral palsy characterized by constant and uncontrolled motion of involved muscles is called:

Accepted Answer

Athetosis

Answer

Rigidity

Answer

Spasticity

Answer

Ataxia

Answer

Hypotonia

Neurology — MCQs

Neurology — MCQs

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