Neuro- Practice Q's!

Question 1

Status Epilepticus is best defined as:

A) A single seizure lasting less than 5 minutes
B) Clusters of seizures with full recovery between them
C) A seizure lasting more than 5 minutes or recurrent seizures without full recovery
D) Nocturnal seizures occurring only during sleep

Answer 1

*Answer:** C) A seizure lasting more than 5 minutes or recurrent seizures without full recovery

Question 2

What immediate action should be taken for a patient experiencing status epilepticus in a clinical setting?

A) Administer oral antiepileptic medication
B) Ensure the patient is sitting upright
C) Initiate ABC (Airway, Breathing, Circulation) and emergency seizure management
D) Allow the patient to rest quietly before providing treatment

Answer 2

Answer:** C) Initiate ABC (Airway, Breathing, Circulation) and emergency seizure management

Question 3

Which medication is NOT typically used in the emergency treatment of status epilepticus?

A) Diazepam
B) Lorazepam
C) Omeprazole
D) Phenobarbital

Answer 3

Answer: C) Omeprazole

Question 4

The ketogenic diet used in the management of seizure disorders primarily consists of:

A) High carbs, moderate protein, low fat
B) High fat, adequate protein, low carbohydrates
C) Low fat, low protein, high carbohydrates
D) Equal proportion of fat, protein, and carbohydrates

Answer 4

Answer:** B) High fat, adequate protein, low carbohydrates

Question 5

Which surgical procedure involves cutting the corpus callosum to help control seizures?

A) Hemispherectomy
B) Corpus callosotomy
C) Focal resection
D) Vagus Nerve Stimulation

Answer 5

*Answer:** B) Corpus callosotomy

Question 6

What is a critical safety consideration for patients with epilepsy regarding daily activities?

A) Avoid eating late at night
B) Never skip meals during the day
C) Avoid prolonged computer use
D) Be cautious with bathing and swimming activities

Answer 6

Answer: D) Be cautious with bathing and swimming activities

Question 7

When is it generally considered appropriate to stop antiepileptic medication in a patient?

A) No seizures for 2-3 years
B) No changes in EEG for 6 months
C) After a single episode of status epilepticus
D) When switching to a ketogenic diet

Answer 7

*Answer:** A) No seizures for 2-3 years

Question 8

Sudden Unexplained Death in Epilepsy (SUDEP) is a risk for patients with:

A) Well-controlled seizures
B) Frequent nocturnal seizures
C) History of trauma-induced seizures
D) Isolated febrile seizures in infancy

Answer 8

*Answer:** B) Frequent nocturnal seizures

Question 9

Cerebral palsy is best characterized as:

A) A progressive disease that worsens over time
B) A non-progressive neurological disorder caused by damage or defects in the brain
C) A temporary condition affecting motor skills
D) A communicable disease affecting children globally

Answer 9

*Answer:** B) A non-progressive neurological disorder caused by damage or defects in the brain

Question 10

Which of the following is the most common cause of cerebral palsy?

A) Traumatic brain injury after birth
B) Prenatal factors and brain damage during fetal development
C) Infectious diseases during infancy
D) Nutritional deficiencies in childhood

Answer 10

*Answer:** B) Prenatal factors and brain damage during fetal development

Question 11

Which variant of cerebral palsy is characterized by involuntary writhing movements?

A) Spastic
B) Ataxic
C) Athetoid
D) Hemiplegic

Answer 11

*Answer:** C) Athetoid

Question 12

What is a common surgical intervention for managing spasticity in children with cerebral palsy?

A) Botulinum toxin injections
B) Rhizotomy
C) Intrathecal antibiotics
D) Blood transfusion

Answer 12

Answer: B) Rhizotomy

Question 13

Which of the following risk factors is most strongly associated with shaken baby syndrome?

A) High Apgar scores at birth
B) Parental involvement in community activities
C) Young and/or single parenthood
D) No history of maltreatment

Answer 13

*Answer:** C) Young and/or single parenthood

Question 14

Which of the following is NOT a common classification of cerebral palsy?

A) Diplegia
B) Quadriplegia
C) Monoplegia
D) Paraplegia

Answer 14

*Answer:** C) Monoplegia

Question 15

Which of the following factors contributes to the risk of shaken baby syndrome?

A) A supportive family environment
B) Stepchild status and being under 3 years old
C) Late birth order
D) Previous high educational achievement_by_parents

Answer 15

*Answer:** B) Stepchild status and being under 3 years old

Question 16

A structural brain abnormality in cerebral palsy which involves softening of the hemispheric white matter is known as:

A) Chronic encephalopathy
B) Periventricular Leukomalacia
C) Cerebral infarction
D) Temporal lobe epilepsy

Answer 16

Answer: B) Periventricular Leukomalacia

Question 17

A 3-year-old boy named Liam is brought to your clinic for a follow-up visit. Liam was born prematurely at 30 weeks of gestation and had a very low birth weight. His parents express concerns about his motor development. Upon examination, you notice increased muscle tone in his legs, and he exhibits a scissor gait when attempting to walk. He does not use any words yet but understands simple commands. A recent MRI showed periventricular leukomalacia.

What variant of cerebral palsy does Liam likely have, based on his symptoms?

What are common associated conditions Liam might have that should be evaluated further?

Considering the likely management strategies, what might be recommended to address Liam’s spasticity?

What could have contributed to Liam developing cerebral palsy?

Answer 17

• Liam likely has spastic diplegia cerebral palsy, characterized by increased muscle tone primarily in the legs and the presence of a scissor gait.

-Based on the statistics, Liam might have speech and language disorders and could also be at risk for cognitive impairments because of his developmental delay. An evaluation by a speech therapist and a cognitive assessment might be beneficial.

-Liam may benefit from physical therapy to improve mobility and function. Botulinum toxin injections or other interventions like rhizotomy or the use of Baclofen could be considered for managing spasticity, depending on the severity

-Liam’s prematurity and very low birth weight are significant risk factors for the development of cerebral palsy, as are the findings of periventricular leukomalacia on MRI, which indicates white matter damage.

Question 18

A 2-year-old girl named Emily is brought to the emergency department by her babysitter. The babysitter reports that Emily was “not acting herself” after waking up from a nap. Upon examination, Emily is lethargic, and you note signs of bruising on her arms and torso. A CT scan reveals intracranial hemorrhage and retinal hemorrhages are observed on examination by an ophthalmologist.

What is the most likely diagnosis for Emily?

What risk factors for shaken baby syndrome might Emily have experienced in her environment?

What steps should be taken immediately to ensure Emily’s safety and well-being?

What preventive measures can be discussed with caregivers to help prevent shaken baby syndrome?

Answer 18

-Emily’s symptoms and diagnostic findings are consistent with shaken baby syndrome, also known as abusive head trauma.

-Potential risk factors include being under the care of multiple caregivers (such as a babysitter), possibly being part of a stressed or unstable family situation, and limited parental supervision.

-Emily should receive immediate medical treatment for her injuries. Additionally, it is crucial to alert child protective services to investigate suspected abuse and ensure her safety moving forward.

-Education on managing stress, understanding infant crying patterns, and teaching appropriate coping mechanisms for caregivers can help prevent shaken baby syndrome. Providing resources for support and respite care may also be helpful in reducing caregiver stress.

Question 19

Which of the following is NOT typically considered a red flag for shaken baby syndrome?

A) Delay in seeking medical help
B) Consistent and clear story from the caregiver
C) Presence of other fractures like long bone fractures
D) Changing story about how the injury occurred

Answer 19

*Answer:** B) Consistent and clear story from the caregiver

Question 20

What typically characterizes the anatomic vulnerability of infants, making them susceptible to shaken baby syndrome?

A) Thick and rigid skulls
B) Extensive musculoskeletal strength
C) Small head size and stable neck
D) Heavy and unstable heads with weak musculature

Answer 20

*Answer:** D) Heavy and unstable heads with weak musculature

Question 21

Which of the following is a common sign of shaken baby syndrome?

A) Retinal hemorrhages
B) Delayed motor milestones
C) Cough and congestion
D) Jaundice

Answer 21

Answer:** A) Retinal hemorrhages

Question 22

n cases of severe unintentional head trauma, what is the Glasgow Coma Scale (GCS) score typically?

A) 13-15
B) 9-12
C) Less than 8
D) 8-10

Answer 22

Answer:** C) Less than 8

Question 23

Observation or radiographic evaluation is often appropriate for which level of unintentional head trauma?

A) Minor, with a normal neurological exam and GCS of 15
B) Moderate, with a GCS score of 9-12
C) Severe, with prolonged loss of consciousness
D) Severe, with focal neurological deficits

Answer 23

*Answer:** A) Minor, with a normal neurological exam and GCS of 15

Question 24

Which diagnostic studies are most commonly used to assess suspected cases of shaken baby syndrome?

A) Complete blood count (CBC) and urinalysis
B) CT scan and skull radiographs
C) Electrocardiogram (ECG) and stress test
D) Spirometry and pulse oximetry

Answer 24

*Answer:** B) CT scan and skull radiographs

Question 25

Which preventive measures could you recommend to reduce the incidence of shaken baby syndrome?

A) Education on managing stress and understanding infant crying patterns
B) Switching to formula feeding to reduce crying
C) Increased use of playpens and bouncers
D) Encouraging prolonged crying sessions to strengthen lungs

Answer 25

Answer: A) Education on managing stress and understanding infant crying patterns

Question 26

A 6-month-old infant is brought to the emergency department by a caregiver who reports that the infant was found unresponsive in the crib after a nap. The caregiver reports no history of trauma but describes the infant as fussy and irritable over the past few days. Upon examination, the infant exhibits lethargy and a bulging fontanel. A head CT reveals subdural hematomas.

What are the clinical signs in this case that may indicate shaken baby syndrome?

What are some red flags in the caregiver’s report that may warrant further investigation?**

What additional diagnostic studies might be useful in this case?

What should be done if shaken baby syndrome is suspected

Answer 26

The clinical signs include lethargy, bulging fontanel, and subdural hematomas. These are consistent with intracranial injury often seen in shaken baby syndrome.

Red flags include the lack of reported trauma despite the seriousness of the condition, and the presentation of irritability and fussiness preceding the unresponsiveness.

A full skeletal survey and retinal examination could be performed to assess for other signs of abuse, such as retinal hemorrhages and other fractures.

It is critical to report the case to child protective services, remain objective, document findings meticulously, and ensure the infant receives appropriate medical care and protection.

Question 27

An 8-year-old boy is brought to urgent care after falling off his bike without wearing a helmet. He lost consciousness for a short duration but was awake on arrival. Glasgow Coma Scale (GCS) is 11, and he shows signs of disorientation and difficulty speaking.

**What level of brain injury does this case suggest and why?

*What initial management steps should be taken?**

What are some potential complications of moderate TBIs that need to be monitored?**

What care plan would you recommend upon discharge if the CT scan shows no further complications?**

Answer 27

This case suggests a moderate traumatic brain injury due to the GCS score of 11 and the loss of consciousness with disorientation.

Initial management should include monitoring vital signs, ensuring airway, breathing, and circulation are stable, and performing imaging studies like a CT scan to evaluate for intracranial injury.

Risk of intracranial hemorrhage, cerebral edema, and potential for deterioration in neurological status should be carefully monitored.

The child should be observed for worsening symptoms at home, limited in physical activities particularly contact sports, and gradually return to normal activities as tolerated. Follow-up with a healthcare provider is necessary.

Question 28

A 12-year-old girl at a soccer game collided with another player, briefly losing consciousness. Her GCS is 14, and she reports mild headache and dizziness, but she is oriented and otherwise neurologically intact.

What is the likely diagnosis based on the symptoms and GCS score?*

*Are imaging studies immediately necessary? Why or why not?

What post-injury advice should be given to the family regarding activities?*

What follow-up precautions should be discussed?**

Answer 28

The likely diagnosis is mild traumatic brain injury or concussion, based on brief loss of consciousness, mild headache, and dizziness with a GCS near the high end.

*Answer:** Imaging studies might not be necessary initially if no signs of more serious injury exist, but clinical judgment should guide the decision especially if symptoms persist or worsen.

Answer:** Advise rest and a gradual return to activities. Cognitive and physical rest is important initially. Watch for symptoms of worsening headache, nausea, vomiting, increased confusion, or irritability.

*Answer:** Schedule follow-up to reassess the girl’s condition. Discuss indications for immediate medical attention, such as seizures, prolonged confusion, or return of symptoms like severe headaches. Consider referral to a specialist if symptoms do not resolve.

Question 29

A 16-year-old male football player was diagnosed with a concussion during a game. Which of the following symptoms is least likely associated with post-concussive syndrome?

A. Headaches
B. Hemiparesis
C. Memory issues
D. Poor concentration

Answer 29

Correct Answer: B. Hemiparesis

Explanation: Hemiparesis is not typically associated with post-concussive syndrome. Tightne headaches, memory issues, and poor concentration are common symptoms.

Question 30

What is the first step in the step-wise return to activity protocol after a concussion?

A. Full-contact drills
B. Light aerobic exercise
C. Game play
D. Non-contact drills

Answer 30

Correct Answer: B. Light aerobic exercise**

Explanation: Light aerobic exercise is the first step after the initial rest period until the athlete is asymptomatic.

Question 31

Second impact syndrome can occur after a concussion. What is the main reason it poses such a high fatality risk in young athletes?

A. It only causes mild reversible cognitive effects
B. It involves injury to the spinal cord instead of the brain
C. The brain’s ability to self-regulate cerebral blood volume is compromised, leading to rapid brain swelling
D. It mainly affects older athletes with pre-existing conditions

Answer 31

Correct Answer: C. The brain’s ability to self-regulate cerebral blood volume is compromised, leading to rapid brain swelling**

Explanation: Second impact syndrome is highly dangerous due to the brain’s compromised ability to regulate blood volume, which can cause rapid brain swelling and increased intracranial pressure.

Question 32

A 15-year-old basketball player experiences “fogginess” and poor concentration two weeks after a concussion. What condition might she be exhibiting symptoms of?

A. Second impact syndrome
B. An intracranial hemorrhage
C. Post-concussive syndrome
D. Complex concussion

Answer 32

Correct Answer: C. Post-concussive syndrome**

Explanation: Symptoms like fogginess and poor concentration, persisting beyond the typical concussion recovery period, suggest post-concussive syndrome.

Question 33

Which of the following is not part of the pre-and post-neurophysiological testing for assessing a concussion in athletes?

A. ImPACT© testing
B. MRI scans
C. Memory and cognition assessment
D. Learning effects evaluation

Answer 33

Correct Answer: B. MRI scans

Explanation: ImPACT© testing focuses on cognitive assessments, such as memory and learning effects, rather than imaging studies like MRI scans.

Question 34

Jennifer is a 17-year-old high school soccer player who collided with another player during a game. She was briefly disoriented, reported headaches and dizziness, and was removed from the game. The next day, Jennifer mentions difficulty concentrating in class and feeling “foggy.”

Questions:

1. What immediate steps should be taken following Jennifer’s concussion?
2. How should Jennifer’s symptoms on the following day be interpreted?
3. What is the recommended protocol for Jennifer’s return to soccer?

Answer 34

1. Immediate Steps:
   
   • Jennifer should be removed from play immediately and should not return to play in the same game.
   • A medical evaluation should be conducted to assess the severity of the concussion and rule out more serious intracranial injuries.
2. Interpreting Symptoms:
   
   • Jennifer’s symptoms of difficulty concentrating and feeling “foggy” may indicate post-concussive syndrome since they persisted the next day. These symptoms should be monitored, and treatment tailored accordingly.
3. Return to Play Protocol:
   
   • Jennifer should follow a step-wise return-to-activity protocol:
     
     1. No activity and complete rest until asymptomatic.
     2. Begin with light aerobic exercise such as walking or cycling.
     3. Sport-specific non-contact training to gradually introduce her body to physical activity.
     4. Non-contact drills that involve more complex movement or coordination.
     5. Full-contact practice after clearance from a healthcare professional.
     6. Return to game play.

Question 35

Michael is a 15-year-old football player who presents to the clinic after sustaining a concussion two weeks ago during practice. Initially, his symptoms improved, but recently he has started experiencing headaches, difficulty sleeping, and irritability.

Questions:

1. What condition might Michael be experiencing based on his new symptoms?
2. What are possible management strategies that can be implemented?
3. What serious syndrome needs to be avoided, and how can it be prevented?

Answer 35

1. Potential Condition:
   
   • Michael’s symptoms are suggestive of post-concussive syndrome, which occurs when concussion symptoms persist beyond the usual recovery period.
2. Management Strategies:
   
   • Symptomatic treatment for headache and sleep disturbances, such as using medications like acetaminophen and possibly referral to a specialist for further evaluation.
   • Cognitive and physical rest as needed, along with gradual reintroduction to normal activities.
   • Psychoeducation and cognitive-behavioral therapy can be effective in managing irritability and psychosocial effects.
3. Avoiding Second Impact Syndrome:
   
   • Second impact syndrome, which is life-threatening, should be avoided by ensuring Michael does not return to play or activities until fully recovered and symptom-free.
   • Close monitoring, adherence to the step-wise return to play protocol, and ensuring full medical clearance before any competitive play resumes are critical preventative measures.

Question 36

Which of the following is a characteristic symptom of Tourette Syndrome?**
a) Consistent, unchanging tics
b) Repetitious, stereotyped involuntary movements and vocalizations
c) Voluntary muscle spasms
d) Only motor tics without vocalizations

Answer 36

Answer: b) Repetitious, stereotyped involuntary movements and vocalizations

Question 37

Tourette Syndrome is often misdiagnosed because:
a) Symptoms appear only after age 18
b) Tics must remain constant without change
c) It can be associated with the use of medical substances
d) Symptoms appear to be trivial or occasional

Answer 37

Answer: d) Symptoms appear to be trivial or occasional

Question 38

*Which of the following is NOT an associated disorder with Tourette Syndrome?**
a) ADHD
b) OCD
c) Diabetes
d) Poor impulse control

Answer 38

*Answer:** c) Diabetes

Question 39

What age is typical for the onset of Obsessive-Compulsive Disorder?**
a) Toddlerhood
b) Early adulthood
c) Middle age
d) Early childhood or adolescence

Answer 39

*Answer:** d) Early childhood or adolescence

Question 40

A common compulsion associated with OCD includes:**
a) Playing computer games
b) Obsessive reading of novels
c) Counting and rechecking objects
d) Excessive exercise

Answer 40

Answer: c) Counting and rechecking objects

Question 41

In the classroom, students with OCD may need which of the following accommodations?**
a) More complex assignments
b) Denying all requests for time extensions
c) Avoidance of help or shared activities
d) Help with note-taking and clear guidelines with their input

Answer 41

Answer:** d) Help with note-taking and clear guidelines with their input

Question 42

*Which ratio correctly describes the prevalence of autism between males and females?**
a) 1:1
b) 4:1
c) 2:3
d) 10:1

Answer 42

Answer:** b) 4:1

Question 43

An individual with autism may display which of the following behaviors?**
a) Highly social
b) Unyielding routines or rituals
c) Immediate adoption of new routines
d) Severely crossing objects

Answer 43

*Answer:** b) Unyielding routines or rituals

Question 44

Which diagnostic tool is commonly used for autism screening in toddlers?**
a) M-CHAT
b) MRI
c) Blood glucose level test
d) EEG

Answer 44

Answer:** a) M-CHAT

Question 45

*Which of the following therapies involves the use of visual schedules and environmental accommodations for children with autism?**
a) Floor Time
b) TEACCH
c) Music Therapy
d) Sensory Integration

Answer 45

Answer:** b) TEACCH

Question 46

Applied Behavioral Analysis (ABA) is characterized by which of the following components?**
a) Imaginary play and storytelling
b) Application of scientific principles to improve significant behaviors
c) Dietary management focusing on casein-free nutrition
d) Exclusive use of medication to manage behavior

Answer 46

*Answer:** b) Application of scientific principles to improve significant behaviors

Question 47

An alternative treatment for autism that involves the use of dietary changes includes:**
a) SSRIs
b) Secretin therapy
c) Hyperbaric oxygen
d) Casein and gluten-free diets

Answer 47

*Answer:** d) Casein and gluten-free diets

Question 48

Rett syndrome primarily affects which gender?**
a) Males
b) Females
c) Equal prevalence between genders
d) It primarily affects non-binary individuals

Answer 48

Answer:** b) Females

Question 49

A hallmark symptom in the early stages of Rett Syndrome is:**
a) Weight gain before 6 months
b) Advanced language skills
c) Hypotonia before other symptoms appear
d) Early signs of agoraphobia

Answer 49

*Answer:** c) Hypotonia before other symptoms appear

Question 50

3. The genetic mutation primarily associated with Rett Syndrome lies on which chromosome?
   a) Chromosome 21
   b) Chromosome X
   c) Chromosome 7
   d) Chromosome Y

Answer 50

*Answer:** b) Chromosome X

Question 51

What type of genetic condition is Neurofibromatosis Type 1 (NF1)?**
a) X-linked
b) Autosomal recessive
c) Autosomal dominant
d) Mitochondrial inheritance

Answer 51

*Answer:** c) Autosomal dominant

Question 52

*A common diagnostic feature of Neurofibromatosis Type 1 seen in patients includes:**
a) Café-au-lait spots
b) Reluctance to engage with peers
c) Hyperflexibility
d) Vision loss

Answer 52

Answer:** a) Café-au-lait spots

Question 53

A complication associated with Neurofibromatosis includes:**
a) High cholesterol levels
b) Hypertension
c) Spinal cord fusion
d) Type 2 diabetes

Answer 53

*Answer:** b) Hypertension

Question 54

Fragile X Syndrome has its genetic basis in mutations on which chromosome?**
a) Chromosome 21
b) Chromosome 22
c) Chromosome X
d) Chromosome Y

Answer 54

*Answer:** c) Chromosome X

Question 55

One common physical characteristic of Fragile X Syndrome includes:**
a) Large jaw and ears
b) Small hands and feet
c) Excessive hair growth
d) Asymmetrical face

Answer 55

*Answer:** a) Large jaw and ears

Question 56

Management of Fragile X Syndrome typically involves:**
a) Intensive surgical correction
b) High-dose steroid treatment
c) Supportive therapies like speech and behavioral therapy
d) Radiation treatment

Answer 56

c) Supportive therapies like speech and behavioral therapy