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MCQ Questions > Neurology > Flashcards

Neurology Flashcards

1
Q

What are the criteria needed for a low risk BRUE?

A
  • No concerns from history or exam
  • Age >60 days
  • Born 32+ weeks + corrected 45+ weeks
  • No CPR by trained provider
  • Event <1min in duration
  • First event
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2
Q

What is the recommended management for a low risk BRUE?

A
  • Educate family, offer CPR training
  • May obtain ECG, pertussis swab & observe with pulse oximetry & serial observations
  • Need NOT do a viral swab, blood glucose, serum bicarb, neuro-imaging or admission solely for cardio-monitoring
  • Do NOT do an infectious work-up, initiate home cardiac monitoring, prescribe a PPI
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3
Q

What is your differential diagnosis for acute onset ataxia?

A
  • Post infection —> cerebellitis (typically truncal), GBS (especially campylobacter), ADEM
  • Tumor (e.g. medulloblastoma, ependymoma, astrocytoma)
  • Stroke/bleed
  • Intoxication
  • OMAS (opsoclonus myoclonus ataxia syndrome)
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4
Q

What age is acute cerebellar ataxia seen? How long after a viral illness does it typically occur?

A
  • 1-3yo
  • 2-3wk after the viral illness
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5
Q

What are 8 red flags for headaches in children?

A
  • Acute onset, terrible headache —> SAH or intraparenchymal bleed
  • Progressively worsening headache —> tumor
  • Early morning awakening with headache and vomiting —> increased ICP
  • Neck stiffness, fever —> meningitis
  • Younger than 3yo
  • Presence of seizures
  • Associated mood, mental status or school performance change
  • Neurocutaneous stigmata (cafe-au-lait macules, hypopigmented macules)
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6
Q

What is the criteria for a typical migraine without aura?

A
  1. At least 5 attacks fulfilling 2-4
  2. HA lasting 2 to 72h
  3. HA with 2+:
    • Unilateral or bilateral in location (often frontal)
    • Pulsating quality
    • Moderate or severe pain intensity
    • Aggravated by or causing avoidance of routine physical activity (e.g. walking)
  4. 1+ of:
    • N/V
    • Photo/phonophobia
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7
Q

What is the criteria for Tourette syndrome?

A
  • 2+ motor tics (e.g. blinking, shrugging shoulders) + 1+ vocal tic (humming, clearing throat, yelling out a phrase)
  • Tics for at least 1 year (can occur many times per day, nearly every day or intermittently)
  • Onset <18y
  • Not due to another etiology (i.e. medications, medical conditions such as Huntington’s or post-viral encephalitis)
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8
Q

What are the typical CSF findings for Guillain Barre syndrome?

A
  • Low-normal WBC
  • Normal glucose
  • Elevated protein
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9
Q

What is the main treatment of GBS?

A

IVIG

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10
Q

What is the classic EEG finding in infantile spasms?

A

Hypsarrhythmia

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11
Q

What are the treatment options in infantile spasms?

A
  • Vigabatrin (retinal toxicity) *effective in TS
  • Prednisolone / ACTH (wt gain, HTN, irritability, adrenal suppression)
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12
Q

How can you differentiate benign myoclonus of infancy & infantile spasms?

A
  • No arm movement in BMI
  • BMIs do NOT occur in clusters
  • Normal EEG in BMI
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13
Q

What are the anti-epileptics that are most effective in childhood absence syndrome?

A

Ethosuxamide

Valproic acid

(lamotrigine)

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14
Q

What are the clinical features of benign rolandic epilepsy?

A
  • Peak onset: 7-10yo
  • Duration of seizures: 2-3min
  • Nocturnal focal seizures with movements of face / mouth
  • Can present with inability to speak (“sleep walking”)
  • May spread to be GTC
  • Most outgrow during puberty
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15
Q

What anti-epileptics should NOT be used for primary generalized epilepsy?

A

Carbamazepine

Phenytoin

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16
Q

What are the idiosyncratic reactions of the following AEDs: keppra, carbamazepine, topiramate, lamotrigine, VPA, vigabatrin

A
  1. Keppra: aggression / rage, suicidality
  2. Carbamazepine: rash, hepatitis, anemia
  3. Topiramate: weight loss, kidney stones
  4. Lamotrigine: rash
  5. VPA: weight gain, hepatitis, pancreatitis, decreased platelets, rash, hair loss
  6. Vigamatrin: retinal toxicity
17
Q

What diagnostic testing should be done for SMA and DMD?

A
  1. SMA - SMN1 gene deletion testing
  2. DMD duplication deletion analysis
18
Q

During which weeks GA does PVL occur?

A

24-32 weeks GA

19
Q

What is the criteria for conversion disorder?

A
  1. 1+ symptoms affecting voluntary motor and sensory function
  2. Clinical finds are incompatible with a recognized neurologic or medical conditions
  3. Symptom or deficit is not explained by a medical condition
  4. Symptom or deficit causes clinically significant distress or impairment in functioning (can also be La Belle Indifference)
20
Q

What is the treatment for Tics?

A
  1. Educational
  2. Psychotherapeutic (behaviour therapy)
  3. Meds - 1st line clonidine or guanficine (alpha-2 agonist), 2nd line is risperidone
21
Q

What are six red flags for syncope?

A
  1. Occurs during exercise or after prolonged exertion
  2. Severe chest pain or palpitations
  3. No warning/prodrome (no presyncope)
  4. Required CPR
  5. Neurological deficit
  6. Occurred while supine
  7. Seizure activity
  8. Family history of unexplained death
22
Q

What are the typical bacteria that cause GBS?

A
  • Typical: Campylobacter jejuni, mycoplasma, H flu
  • Others: EBV, CMV, Lyme disease, West nile (mimic)
23
Q

When do breath holding spells usually resolve?

A

5-years old

24
Q

What are the different underlying etiologies of infantile spasms?

A
  • ⅔ cases have a secondary cause
  • Includes: prior HIE, prior stroke, brain malformation, chromosomal abnormality (T21), genetics (TS)
  • ⅓ have no underlying cause
25
Q

What anti-epileptics are used in children aged <2yo?

A

Phenobarbital

Levetiracetam / Keppra

Topiramate

26
Q

What are the diagnostic teata for X-linked adrenoleukodystrophy and metachromatic leukodystrophy?

A

-X-linked adrenoleukodystrophy: VLCFA in serum, RBCs and skin fibroblasts. MRI head shows symmetric periventricular white matter lesions -ML: ARSA-A enzyme level, MRI is helpful but not adequate for diagnosis

27
Q

What is the most common cause of seizures in a neonate?

A

HIE (50-60%)

28
Q

What are red flags for a spinal dimple?

A
  1. Cutaneous lesion (hyperteochosis, hemangioma, atretic meningocele, lipoma, caudal appendage) 2. Deviated or “split” gluteal cleft 3. Multiple dimples 4. Dimple diameter > 5mm 5. Location > 2.5cm above the anal verge or above the gluteal cleft
29
Q

When would you consider doing an LP for a child with a febrile seizure?

A

-Infants < 6mo or if the child is ill-appearing at any age -Infants < 1yo with an unknown or inconplete immunization history -Children om antibiotics (can mask meningitis) -Febrile status epilepticus

30
Q

Whay are risk factors for subsequent epilepsy in a child with a febrile seizure?

A

Simple febrile seizure (1%), recurrent febrile seizures (4%), complex due to >15min duration or recurrence w/in 24h (6%), fever <1h before febrile seizure (11%), FHX epilepsy (18%), complex (focal) (29%), neurodevelopmental abnormalities (33%)

31
Q

What is the main diagnosis to rule out when a child presents with acute onset esotropia?

A

Increased ICP

32
Q

What is the CATCH rule?

A

High risk: -GCS < 15 2h after injury -Suspected open or depressed skull fractures -History of worsening headache -Irritability on exam Medium risk: -Any signs of basal skull fracture -Large boggy hematoma of scalp -Dangerous mechanism (MVC, fall from > 3ft, down 5 stairs, fall from bike without helmet)

MCQ Questions (23 decks)

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