Neurology — MCQs
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Which of the following is the most common cause of a bulging anterior fontanelle in infants?
Febrile seizures occur most frequently in children of which age group?
Which of the following is a symptom of cerebral palsy?
Which of the following statements about Rett syndrome is true?
What is the first-line treatment for West syndrome in a child with Tuberous Sclerosis?
Neurology Indian Medical PG Practice Questions and MCQs
Question 281: Which of the following is the most common cause of a bulging anterior fontanelle in infants?
- A. Hydrocephalus (Correct Answer)
- B. Benign Intracranial Hypertension
- C. Subdural Hematoma
- D. Bacterial Meningitis
Explanation: ***Hydrocephalus*** - **Hydrocephalus** is characterized by an abnormal accumulation of cerebrospinal fluid (CSF) within the brain’s ventricles, leading to increased intracranial pressure. - This increased pressure frequently manifests as a **bulging anterior fontanelle** in infants due to the expandable nature of their skull. *Bacterial Meningitis* - While **bacterial meningitis** can cause a bulging fontanelle due to inflammation and increased intracranial pressure, it is typically accompanied by other severe symptoms like fever, lethargy, and nuchal rigidity, which are not mentioned as the most common cause in isolation. - Meningitis is a serious, acute infection, often less common than hydrocephalus as a primary cause for a bulging fontanelle. *Subdural Hematoma* - A **subdural hematoma** is a collection of blood between the dura mater and arachnoid mater, usually resulting from trauma. - While it can cause increased intracranial pressure and a bulging fontanelle, it is not the most common cause and would be associated with a history of injury or specific neurological deficits. *Benign Intracranial Hypertension* - **Benign intracranial hypertension (BIH)**, also known as pseudotumor cerebri, is rare in infants and typically affects older children or adults. - It usually presents with symptoms like headache and visual disturbances, which are not primary features of an isolated bulging fontanelle in an infant.
Question 282: Febrile seizures occur most frequently in children of which age group?
- A. In the first month of life
- B. In the first six months of life
- C. Between six months and five years of age (Correct Answer)
- D. Between five and ten years of age
Explanation: ***Between six months and five years of age*** - Febrile seizures primarily occur in this age range when the developing brain is most susceptible to fever-induced neuronal hyperexcitability. - This period aligns with the peak incidence of common childhood infections that cause fever. *In the first month of life* - Seizures in the **neonatal period** (first month) are typically due to serious underlying neurological conditions, infections, or metabolic disturbances, rather than simple fever. - The brain's thermoregulatory mechanisms and seizure thresholds are different in neonates. *In the first six months of life* - While possible, febrile seizures are **less common** during the initial six months of life compared to the 6-month to 5-year window. - Seizures during this early period often warrant a more thorough investigation for other etiologies. *Between five and ten years of age* - The incidence of febrile seizures significantly **decreases** after age five, as the brain matures and becomes less prone to seizure activity in response to fever. - Seizures occurring in this age group, especially if recurrent with fever, might suggest an underlying epilepsy syndrome.
Question 283: Which of the following is a symptom of cerebral palsy?
- A. Microcephaly
- B. Ataxia (Correct Answer)
- C. Hypotonia
- D. Flaccid paralysis
Explanation: ***Ataxia*** - **Ataxia** (lack of voluntary coordination of muscle movements) is one of the primary **motor symptoms of cerebral palsy**, specifically seen in **ataxic cerebral palsy** which accounts for 5-10% of CP cases. - Ataxic CP presents with **poor coordination, tremors, and balance difficulties**, representing a distinct motor presentation pattern. - It is a direct neurological symptom resulting from **cerebellar or basal ganglia involvement**. *Hypotonia* - **Hypotonia** (decreased muscle tone) can occur in cerebral palsy, particularly as an **early finding in infants**. - However, hypotonia often **evolves into other motor patterns** (spasticity, dyskinesia) as the child develops, making it less specific as a defining symptom. - While present in some forms, it's more transitional than a consistent motor symptom across CP types. *Microcephaly* - **Microcephaly** (abnormally small head) is not a symptom of cerebral palsy itself, but rather a potential **associated condition or underlying cause**. - It suggests **abnormal brain development** which *could* lead to cerebral palsy, rather than being a neurological motor symptom *of* CP. *Flaccid paralysis* - **Flaccid paralysis** involves complete **loss of muscle tone and voluntary movement**, characteristic of **lower motor neuron lesions**, **spinal cord injury**, or certain **neuromuscular diseases**. - Cerebral palsy is an **upper motor neuron disorder** typically presenting with **spasticity, dyskinesia, or ataxia**, rather than pure flaccid paralysis.
Question 284: Which of the following statements about Rett syndrome is true?
- A. It is associated with malformation of the brain.
- B. It is an X-linked disorder. (Correct Answer)
- C. Males are more commonly affected than females.
- D. Seizures are less common in affected individuals.
Explanation: ***It is an X-linked disorder.*** - Rett syndrome is caused by mutations in the **MECP2 gene** located on the **X chromosome**. - This X-linked inheritance pattern explains the differing prevalence and severity between males and females. *It is associated with malformation of the brain.* - While Rett syndrome is a **neurodevelopmental disorder**, it is not characterized by overt structural brain malformations. - Instead, it involves **defects in brain function and development** at a molecular level, particularly affecting synaptic plasticity. *Males are more commonly affected than females.* - Rett syndrome predominantly affects **females**, as males with the causative MECP2 mutation typically experience severe encephalopathy and often die in infancy or early childhood. - Females can survive due to **X-inactivation**, which allows for a mosaic pattern of expression. *Seizures are less common in affected individuals.* - **Seizures are very common** in individuals with Rett syndrome, affecting up to 80% or more of patients. - They can manifest in various forms and often become a significant clinical challenge during adolescence and adulthood.
Question 285: What is the first-line treatment for West syndrome in a child with Tuberous Sclerosis?
- A. Valproate
- B. ACTH
- C. Vigabatrin (Correct Answer)
- D. Lamotrigine
Explanation: ***Vigabatrin*** - For infants with **West syndrome** and confirmed **tuberous sclerosis complex (TSC)**, **vigabatrin** is the recommended first-line treatment. - It targets the **GABAergic system** and is particularly effective due to its mechanism of action related to the pathogenesis of seizures in TSC. *Valproate* - While a broad-spectrum **antiepileptic drug**, **valproate** is not the first-line choice for West syndrome, especially in the context of TSC. - It is associated with potential adverse effects, including **hepatic toxicity**, which can be a concern in young children. *ACTH* - **Adrenocorticotropic hormone (ACTH)** is a highly effective treatment for **West syndrome** in general, especially when the etiology is unknown or not related to TSC. - However, due to its significant side effects and the specific efficacy of vigabatrin in TSC, **ACTH** is typically considered second-line for TSC-associated West syndrome. *Lamotrigine* - **Lamotrigine** is an antiepileptic drug that is generally not used as a first-line treatment for **West syndrome**, regardless of the underlying etiology. - It can sometimes **exacerbate infantile spasms** in some cases, making it an unsuitable initial choice.
Practice by Chapter
Seizure Disorders and Epilepsy
Practice Questions
Febrile Seizures
Practice Questions
Headache Disorders
Practice Questions
Cerebral Palsy
Practice Questions
Neural Tube Defects
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Neuromuscular Disorders
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Neurodegenerative Disorders
Practice Questions
CNS Infections
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Hydrocephalus
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Movement Disorders
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Traumatic Brain Injury
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Neuroimaging in Pediatrics
Practice Questions
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