Neurology — MCQs

A 9-year-old boy is sent for neurological evaluation due to episodes of apparent inattention. Over the past year, the child has experienced episodes during which he develops a blank look on his face and his eyes blink for 15 seconds. He immediately resumes his previous activity. Which of the following therapies would be most appropriate for this patient?

Neurology Indian Medical PG Practice Questions and MCQs

Question 241: All are true regarding rheumatic chorea except: (Repeat)

A. May cause Neurologic sequelae
B. Lasts for 4 to 10 wks
C. More common in girls
D. Present in sleep (Correct Answer)

Explanation: ***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.

Question 242: The common type of cerebral palsy seen in hospitals is –

A. Diplegia
B. Quadriplegia
C. Spastic (Correct Answer)
D. Monoplegia

Explanation: ***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.

Question 243: Which of the following electrolyte abnormalities is a cause of status epilepticus in a child?

A. Hypokalemia
B. Hyperkalemia
C. Hypernatremia
D. Hyponatremia (Correct Answer)

Explanation: ***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.

Question 244: Febrile seizure is called as 'complex' when it lasts for?

A. > 30 minutes
B. > 5 minutes
C. > 10 minutes
D. > 15 minutes (Correct Answer)

Explanation: ***> 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.

Question 245: 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?

A. Acute Lyme disease
B. Fifth disease
C. Possible subacute sclerosing panencephalitis (SSPE) (Correct Answer)
D. Possible hepatitis B infection

Explanation: ***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 246: 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)?

A. 3 or more febrile seizures in 6 months
B. Febrile seizures lasting more than 30 minutes (Correct Answer)
C. 6 or more febrile seizures in 1 year
D. Febrile seizures requiring pharmacotherapy to control seizures.

Explanation: **Febrile Seizure Prophylaxis - AAP Guidelines** According to current American Academy of Pediatrics (2011) guidelines, **continuous anticonvulsant prophylaxis is generally NOT recommended** for children with febrile seizures due to unfavorable risk-benefit ratio. However, among all scenarios, if any were to be considered (historically or in exceptional circumstances), it would be: ***Febrile seizures lasting more than 30 minutes*** - **Prolonged febrile seizures** (>30 minutes) represent the most severe form of complex febrile seizures - This is the scenario with highest risk of recurrence and potential complications - Historically, this was considered in older guidelines as a possible indication - **Current guidelines**: Even for prolonged febrile seizures, continuous prophylaxis is generally not recommended due to medication side effects - **Acute management**: Benzodiazepines for seizures >5 minutes; possible rescue medication prescription for home use - The risk-benefit still favors avoiding continuous prophylaxis in most cases **Why continuous prophylaxis is NOT recommended:** - **Side effects**: Phenobarbital (hyperactivity, cognitive impairment), Valproate (hepatotoxicity, teratogenicity) - **Ineffective**: Does not prevent epilepsy development - **Unnecessary**: Febrile seizures are benign and don't cause brain damage - **Poor compliance**: Long-term medication adherence is difficult **Analysis of other options:** *3 or more febrile seizures in 6 months* - Recurrence frequency alone is NOT an indication for prophylaxis - Simple febrile seizures, even if recurrent, have excellent prognosis - Parent education and fever management are appropriate *6 or more febrile seizures in 1 year* - Even very frequent febrile seizures do not warrant continuous prophylaxis - Focus remains on reassurance and supportive care - No change in long-term neurological outcome *Febrile seizures requiring pharmacotherapy to control seizures* - Acute pharmacotherapy (benzodiazepines) for active seizures is standard care - This does NOT indicate need for continuous prophylaxis - Rescue medications (diazepam rectal gel) may be prescribed for home use **Clinical Approach:** - Educate parents about benign nature of febrile seizures - Provide fever management strategies - Consider rescue benzodiazepines for select high-risk cases - Avoid continuous anticonvulsant prophylaxis

Question 247: Which of the following statements concerning spina bifida is True?

A. Spina bifida occulta occurs most often at L5-S1 level (Correct Answer)
B. Chromosomal abnormalities can be identified in approximately 50% of patients
C. A myelomeningocele is the most common type of spina bifida
D. Additional congenital abnormalities are rare findings

Explanation: **Spina bifida occulta occurs most often at L5-S1 level** - **Spina bifida occulta** is the mildest form of spina bifida, characterized by an incomplete closure of the vertebral arch without protrusion of the spinal cord or meninges. - The most common location for spina bifida occulta is the **L5-S1 vertebral level**, which often presents as a skin dimple, tuft of hair, or discolored patch in the lumbar region. *Chromosomal abnormalities can be identified in approximately 50% of patients* - **Chromosomal abnormalities** are found in a minority of patients with spina bifida, typically less than 10%, when evaluating for genetic causes. - While single-gene mutations or environmental factors contribute, spina bifida is most often considered a **multifactorial condition** rather than solely chromosomal. *A myelomeningocele is the most common type of spina bifida* - A **myelomeningocele** is the most severe and a common type of spina bifida where the spinal cord and meninges protrude through an opening in the spine. - However, **spina bifida occulta** is statistically the most common type overall, though it is often asymptomatic and may go undiagnosed. *Additional congenital abnormalities are rare findings* - **Additional congenital abnormalities** are not rare; they are frequently associated with spina bifida, particularly with myelomeningocele. - These can include **hydrocephalus**, **Chiari malformations**, urinary tract anomalies, and orthopedic issues like clubfoot, reflecting a systemic developmental disruption.

Question 248: Simple febrile seizure is defined as

A. All of the options
B. Seizure lasts < 15 min
C. Focal seizure
D. Generalized seizure <15 min, within 24 hours of fever onset, in a child 6mo-5yr (Correct Answer)

Explanation: ***Generalized seizure <15 min, within 24 hours of fever onset, in a child 6mo-5yr*** - A **simple febrile seizure** is characterized by a **generalized tonic-clonic appearance**, lasting less than 15 minutes, and occurring within 24 hours of the onset of fever. - It typically affects children between the ages of **6 months and 5 years** who do not have a history of afebrile seizures or other neurological conditions. *All of the options* - This option is incorrect because simple febrile seizures must meet **specific criteria** regarding duration, number of episodes, and seizure type to be classified as simple. - While some individual components might be correct, the definition requires a **combination of specific features**, not a general 'all of the options' approach. *Seizure lasts < 15 min* - While a duration of less than 15 minutes is a **necessary criterion** for a simple febrile seizure, it is not sufficient on its own. - Other factors such as the type of seizure (generalized), the number of seizures (single in 24 hours), and the child's age are also crucial for the definition. *Focal seizure* - A **focal seizure**, characterized by originating in a specific area of the brain and often manifesting with localized symptoms, is a hallmark of a **complex febrile seizure**, not a simple one. - Simple febrile seizures are by definition **generalized**, meaning they affect both sides of the brain from the outset.

Question 249: A child presents with an open anterior fontanelle and an audible cranial bruit. Imaging reveals a midline lesion in the brain. What is the most likely diagnosis?

A. Down syndrome
B. Malformation of vein of Galen (Correct Answer)
C. Rickets
D. Congenital hydrocephalus

Explanation: ***Malformation of vein of Galen*** - A **malformation of the vein of Galen** is a type of arteriovenous malformation that can cause greatly increased blood flow, leading to heart failure and a characteristic intracranial **bruit** audible over the skull. - The increased blood flow and often associated hydrocephalus can lead to **macrocephaly** and delayed closure of the **anterior fontanelle**. *Down syndrome* - While individuals with **Down syndrome** may have cardiac defects, a prominent intracranial bruit is not a typical feature unless associated with another condition. - The primary diagnostic features relate to distinct facial features, intellectual disability, and specific chromosomal abnormalities, not primarily a cranial bruit or specific midline brain lesion with this presentation. *Rickets* - **Rickets** is a bone disorder caused by vitamin D deficiency, leading to softening and weakening of bones, which can cause delayed fontanelle closure. - However, rickets does not cause a **cranial bruit** or a specific **midline brain lesion** as described. *Congenital hydrocephalus* - **Congenital hydrocephalus** can cause a persistently open **anterior fontanelle** and can lead to **macrocephaly** due to increased intracranial pressure. - However, a prominent **bruit** is not a characteristic feature of hydrocephalus itself; if a bruit is present, it suggests an underlying vascular anomaly like a vein of Galen malformation as the cause.

Question 250: A 9-year-old boy is sent for neurological evaluation due to episodes of apparent inattention. Over the past year, the child has experienced episodes during which he develops a blank look on his face and his eyes blink for 15 seconds. He immediately resumes his previous activity. Which of the following therapies would be most appropriate for this patient?

A. Ethosuximide (Correct Answer)
B. Diazepam
C. Observation without immediate treatment
D. Combination therapy with Carbamazepine and Primidone

Explanation: ***Ethosuximide*** - The description of **brief episodes** of staring and blinking, followed by immediate resumption of activity, is classic for **absence seizures** (petit mal seizures). - **Ethosuximide** is the drug of choice for absence seizures due to its selective action on T-type calcium channels in the thalamus, which are implicated in the pathophysiology of these seizures. *Diazepam* - **Diazepam** is a benzodiazepine primarily used for acute seizure management, status epilepticus, or as an adjunctive treatment for certain refractory epilepsies. - It is not considered a first-line agent for the long-term management of absence seizures. *Observation without immediate treatment* - While some paroxysmal events in childhood can be benign, the recurrent nature and impact on attention suggest a true seizure disorder requiring intervention. - Untreated absence seizures can affect a child’s **learning** and **academic performance** due to frequent interruptions in consciousness. *Combination therapy with Carbamazepine and Primidone* - **Carbamazepine** is effective for focal (partial) seizures and generalized tonic-clonic seizures, but it can actually *exacerbate* absence seizures. - **Primidone** is an antiepileptic drug used for focal seizures and generalized tonic-clonic seizures, but it is not appropriate for absence seizures and is less commonly used as a first-line agent given its side effect profile.

Practice by Chapter

Seizure Disorders and Epilepsy

Practice Questions

Febrile Seizures

Practice Questions

Headache Disorders

Practice Questions

Cerebral Palsy

Practice Questions

Neural Tube Defects

Practice Questions

Neuromuscular Disorders

Practice Questions

Neurodegenerative Disorders

Practice Questions

CNS Infections

Practice Questions

Hydrocephalus

Practice Questions

Movement Disorders

Practice Questions

Traumatic Brain Injury

Practice Questions

Neuroimaging in Pediatrics

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free

Neurology — MCQs

Neurology — MCQs

On this page

Practice by Chapter

Want unlimited practice?