Neurology Practice Questions

Q: Commonest cause of convulsions in a child with fever is-

Febrile convulsions. ***Febrile convulsions*** - **Febrile convulsions** are the most common cause of seizures in children aged 6 months to 5 years that are associated with a fever but without any evidence of intracranial infection or other defined cause. - They occur in response to a rapid rise in body temperature, typically presenting as generalized tonic-clonic seizures that are usually brief and self-limiting. *Hypothyroidism* - While congenital hypothyroidism can rarely cause developmental delays and neurological issues, seizures are not a common or typical presentation, especially as the primary symptom in children with fever. - Furthermore, seizures related to hypothyroidism would not usually be linked to a fever as the direct precipitating factor. *Epilepsy* - **Epilepsy** involves recurrent, unprovoked seizures, meaning they are not generally triggered by a fever in the absence of other underlying causes. - Although some febrile seizures can evolve into epilepsy, a single seizure in the presence of fever is more likely to be a febrile convulsion than an indication of epilepsy. *Meningitis* - **Meningitis** is a serious infection of the membranes surrounding the brain and spinal cord that can cause seizures in children with fever. - However, it is far less common than febrile convulsions and would present with additional symptoms such as **nuchal rigidity**, **altered mental status**, and other signs of severe illness, which are not implied by the question's simple presentation.

Q: Which of the following is LEAST preferred as first-line treatment for pediatric status epilepticus?

Clonazepam. ***Clonazepam*** - While a benzodiazepine, **clonazepam** is generally not considered a first-line agent for acute status epilepticus due to its **slower onset of action** compared to other benzodiazepines like midazolam or diazepam. - Its longer half-life also makes it less ideal for rapid termination of seizures when immediate action is needed to prevent neuronal injury. *Fosphenytoin* - **Fosphenytoin** is a **prodrug of phenytoin** that is often used as a second-line agent for status epilepticus after benzodiazepines have failed. - It can be administered more rapidly and has a lower risk of local injection site reactions compared to phenytoin, making it a viable option when first-line agents are insufficient. *Diazepam* - **Diazepam** is a **short-acting benzodiazepine** that is a preferred first-line treatment for status epilepticus, especially in the pre-hospital setting or as an initial hospital intervention. - It has a **rapid onset of action** when administered intravenously or rectally, effectively terminating seizures quickly. *Phenobarbital* - **Phenobarbital** is a **barbiturate** that acts as a potent anticonvulsant and is considered a second-line or third-line treatment option for status epilepticus, particularly in pediatric patients. - While effective, its use is often reserved for cases unresponsive to benzodiazepines due to its potential for **respiratory depression** and sedative effects.

Q: All are true regarding rheumatic chorea except: (Repeat)

Present in sleep. ***Present in sleep*** - **Sydenham chorea**, or rheumatic chorea, typically **disappears during sleep**. This distinguishes it from other movement disorders. - The involuntary movements are suppressed by the **inhibitory mechanisms** of the central nervous system activated during sleep. *May cause Neurologic sequelae* - Although Sydenham chorea is often self-limiting, some patients may experience **long-term neurologic sequelae**, such as learning difficulties, ADHD-like symptoms, or obsessive-compulsive disorders (OCDs). - These sequelae can affect **cognitive function** and behavior, even after the choreic movements resolve. *Lasts for 4 to 10 wks* - The acute phase of Sydenham chorea typically has a duration of **several weeks to a few months**, commonly ranging from **4 to 10 weeks**. - However, some cases can be more protracted, lasting up to 6 months or even longer in rare instances. *More common in girls* - Sydenham chorea exhibits a **higher incidence in females**, particularly during childhood and adolescence. - The exact reasons for this **gender predisposition** are not fully understood but may involve hormonal or immunological factors.

Q: The common type of cerebral palsy seen in hospitals is –

Spastic. ***Spastic*** - **Spastic cerebral palsy** is the most prevalent form, accounting for approximately 80% of all cases. - It is characterized by **increased muscle tone** (spasticity), leading to stiff and awkward movements. *Diplegia* - **Spastic diplegia** is a subtype of spastic cerebral palsy where primarily the legs are affected, with arm involvement being less severe or absent. - While common, it is a specific distribution pattern within the broader category of spastic cerebral palsy, rather than the overarching common type itself. *Quadriplegia* - **Spastic quadriplegia** is a severe form of spastic cerebral palsy affecting all four limbs, the trunk, and often the face. - It is a significant disability but represents a less common and more debilitating subtype compared to spastic cerebral palsy in general. *Monoplegia* - **Monoplegia** is a very rare form of cerebral palsy where only one limb is affected. - It is one of the least common types of cerebral palsy presentations.

Q: Which of the following electrolyte abnormalities is a cause of status epilepticus in a child?

Hyponatremia. ***Hyponatremia*** - **Hyponatremia** (low sodium levels) can lead to **cerebral edema**, increasing intracranial pressure and predisposing to seizures, including status epilepticus, especially in children. - Rapid shifts in fluid balance and electrolyte disturbances, such as those seen with severe hyponatremia, can destabilize neuronal membranes and trigger **sustained seizure activity**. *Hypokalemia* - While significant **hypokalemia** (low potassium) affects cardiac and muscular function, it is **less commonly a direct cause of seizures** or status epilepticus compared to sodium imbalances. - Severe hypokalemia can impact neuronal excitability but primarily causes **muscle weakness** and **cardiac arrhythmias**. *Hyperkalemia* - **Hyperkalemia** (high potassium) primarily affects **cardiac conduction** and neuromuscular function, leading to **bradycardia** or **cardiac arrest**. - It is **not typically associated with seizures** or status epilepticus in children. *Hypernatremia* - **Hypernatremia** (high sodium) indicates a relative water deficit, leading to cell shrinkage and potentially **intracranial hemorrhage** or **thrombosis**. - While severe hypernatremia can cause neurological symptoms like **lethargy** or **coma**, it is **less commonly a direct cause of status epilepticus** compared to hyponatremia.

Q: What is the drug of choice for acute treatment of febrile seizures?

Diazepam. ***Diazepam*** - **Diazepam** is the drug of choice for the acute treatment of febrile seizures because of its **rapid onset of action** and effectiveness in stopping ongoing seizures [1]. - It is often administered **rectally** or intramuscularly in an emergency setting by parents or caregivers, which is crucial given the urgency of treating a seizure [1]. *Phenobarbitone* - While **phenobarbitone** has anticonvulsant properties, it is typically used for **long-term prophylaxis** in children with recurrent or high-risk febrile seizures, not for acute treatment. - It has a **slower onset of action** and can cause **sedation**, making it less suitable for immediate seizure termination [3]. *Valproate* - **Valproate** is an antiepileptic drug used for various seizure types but is generally **not recommended for acute treatment of febrile seizures** due to its slower onset and potential side effects in young children [2]. - Its use is more relevant in epilepsy management and **long-term seizure prevention**, not as a first-line agent for acute febrile seizure termination [2]. *Carbamazepine* - **Carbamazepine** is primarily used for **focal seizures** and **trigeminal neuralgia** and is not indicated for the acute management of febrile seizures [2]. - It has a **slower onset** and a different mechanism of action that is not optimal for rapidly stopping a febrile seizure.

Q: A 15-year-old boy presented with day dreaming and decline in school performance. The likely possibility is?

Typical absence seizure. ***Typical absence seizure*** - This presentation of **daydreaming** and **decline in school performance** is characteristic of typical absence seizures, which involve brief episodes of impaired consciousness without loss of postural tone. - These seizures are common in childhood and adolescence, often manifesting as staring spells that can be mistaken for inattention. *Atonic seizure* - An atonic seizure involves a **sudden loss of muscle tone**, leading to a sudden drop or fall, which is not described here. - While it can cause brief loss of consciousness, the primary feature is the motor event. *Myoclonic seizure* - Myoclonic seizures are characterized by **sudden, brief, jerking movements** of a muscle or muscle group. - They are typically very brief and do not involve the sustained staring spell or impaired awareness described. *Atypical absence seizure* - Atypical absence seizures have a **more gradual onset and offset** than typical absence seizures, and may be associated with more noticeable motor signs and less complete loss of awareness. - Daydreaming and decline in school performance are classic for typical, not atypical, absence seizures.

Q: Febrile seizure is called as 'complex' when it lasts for?

> 15 minutes. ***> 15 minutes*** - A **complex febrile seizure** is defined by one or more of the following characteristics: duration longer than **15 minutes**, occurrence more than once within 24 hours, or a focal nature. - This longer duration distinguishes it from a **simple febrile seizure**, which typically lasts less than 15 minutes. *> 30 minutes* - While a seizure lasting more than **30 minutes** is certainly complex, the clinical threshold for defining a complex febrile seizure is met at **15 minutes**. - A seizure lasting over 30 minutes would also be classified as **status epilepticus**, which is a more severe condition requiring urgent intervention. *> 5 minutes* - A seizure lasting more than **5 minutes** but less than 15 minutes is usually still considered a **simple febrile seizure** if other complex features are absent. - Febrile seizures often last between 2 to 5 minutes, making this duration not typically indicative of complexity on its own. *> 10 minutes* - A seizure lasting more than **10 minutes** is approaching the complex definition but does not quite meet the standard **15-minute threshold** for a complex febrile seizure based on duration. - It is still commonly considered within the range of a simple febrile seizure unless other factors like *focality* or recurrence are present.

Q: A pediatric patient with progressively developing degenerative neurologic disease/disorder has an elevated CSF antibody titer to measles virus. You should suspect which of the following?

Possible subacute sclerosing panencephalitis (SSPE). ***Possible subacute sclerosing panencephalitis (SSPE)*** - **SSPE** is a rare, fatal, progressive neurodegenerative disease caused by **persistent measles virus infection** of the central nervous system. - The diagnosis is strongly supported by **markedly elevated CSF antibody titer to measles virus** (often >1:256) with increased CSF measles IgG. - Clinical features include progressive intellectual deterioration, behavioral changes, myoclonic jerks, and eventual vegetative state. - Typically occurs **7-10 years after initial measles infection**, with peak incidence in children and adolescents. - EEG shows characteristic **periodic complexes (Radermecker complexes)** with burst-suppression pattern. *Acute Lyme disease* - Caused by the bacterium *Borrelia burgdorferi*, transmitted by tick bites. - Neurological manifestations (neuroborreliosis) include facial palsy, meningitis, and radiculopathy—not progressive degenerative disease. - Diagnosis involves **Lyme serology** (ELISA, Western blot), not measles antibodies. - Presents with classic **erythema migrans rash** in early stage. *Fifth disease* - Caused by **Parvovirus B19** and typically manifests as "slapped cheek" rash (erythema infectiosum). - A self-limited illness in immunocompetent children with no association with progressive neurodegeneration. - Not associated with **elevated measles antibody titers** or chronic CNS infection. *Possible hepatitis B infection* - Caused by **hepatitis B virus** and primarily affects the liver, causing acute or chronic hepatitis. - Does not cause **progressive degenerative neurological disease** or elevated measles virus antibodies. - Neurological complications are rare and typically related to vasculitis, not direct CNS infection.

Question 1

Commonest cause of convulsions in a child with fever is-

Accepted Answer

Febrile convulsions

Answer

Hypothyroidism

Answer

Epilepsy

Answer

Meningitis

Question 2

Which of the following is LEAST preferred as first-line treatment for pediatric status epilepticus?

Accepted Answer

Clonazepam

Answer

Fosphenytoin

Answer

Diazepam

Answer

Phenobarbital

Question 3

All are true regarding rheumatic chorea except: (Repeat)

Accepted Answer

Present in sleep

Answer

May cause Neurologic sequelae

Answer

Lasts for 4 to 10 wks

Answer

More common in girls

Question 4

The common type of cerebral palsy seen in hospitals is –

Accepted Answer

Spastic

Answer

Diplegia

Answer

Quadriplegia

Answer

Monoplegia

Question 5

Which of the following electrolyte abnormalities is a cause of status epilepticus in a child?

Accepted Answer

Hyponatremia

Answer

Hypokalemia

Answer

Hyperkalemia

Answer

Hypernatremia

Question 6

What is the drug of choice for acute treatment of febrile seizures?

Accepted Answer

Diazepam

Answer

Phenobarbitone

Answer

Valproate

Answer

Carbamazepine

Question 7

A 15-year-old boy presented with day dreaming and decline in school performance. The likely possibility is?

Accepted Answer

Typical absence seizure

Answer

Atonic seizure

Answer

Myoclonic seizure

Answer

Atypical absence seizure

Question 8

Febrile seizure is called as 'complex' when it lasts for?

Accepted Answer

> 15 minutes

Answer

> 30 minutes

Answer

> 5 minutes

Answer

> 10 minutes

Question 9

A pediatric patient with progressively developing degenerative neurologic disease/disorder has an elevated CSF antibody titer to measles virus. You should suspect which of the following?

Accepted Answer

Possible subacute sclerosing panencephalitis (SSPE)

Answer

Acute Lyme disease

Answer

Fifth disease

Answer

Possible hepatitis B infection

Question 10

According to current AAP guidelines, which of the following scenarios would be considered a relative indication for continuous antiepileptic prophylaxis in febrile seizures (though still generally not recommended)?

Accepted Answer

Febrile seizures lasting more than 30 minutes

Answer

3 or more febrile seizures in 6 months

Answer

6 or more febrile seizures in 1 year

Answer

Febrile seizures requiring pharmacotherapy to control seizures.

Neurology — MCQs

Neurology — MCQs

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