Neurology Practice Questions

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.

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.

Question 1

Initial drug of choice in a child with status epilepticus:

Accepted Answer

Lorazepam

Answer

Phenobarbitone

Answer

Phenytoin

Answer

Valproate

Question 2

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 3

Most common acute complication of meningitis in children is –

Accepted Answer

Seizures

Answer

Hydrocephalus

Answer

Hearing loss

Answer

Mitral regurgitation

Question 4

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 5

Pyknolepsy is seen in

Accepted Answer

Absence seizures

Answer

Narcolepsy

Answer

Lennox-Gastaut syndrome

Answer

Adrenoleukodystrophy

Question 6

Management of typical febrile seizures includes all except:

Accepted Answer

Prophylactic phenobarbitone

Answer

Intermittent diazepam

Answer

Sponging

Answer

Paracetamol or ibuprofen

Question 7

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

Question 8

Commonest cause of convulsions in a child with fever is-

Accepted Answer

Febrile convulsions

Answer

Hypothyroidism

Answer

Epilepsy

Answer

Meningitis

Question 9

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 10

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

Neurology — MCQs

Neurology — MCQs

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