Neurology MCQ Flashcards
how to differentiate between secondary and primary generalized seizures
secondary generalized seizure = focal to bilateral tonic-clonic seizure
on the basis of other evidence that supports a focal epilepsy/etiology, or there may be asymmetry seen in the focal to bilateral tonic-clonic seizure (such as head/eye version to one side, asymmetric amplitude to the motor features), and this asymmetry is seen consistently from seizure to seizure.
patient is able to identify that fear is the primary onset feature of the seizure, and results in immobility, what is the type of seizure
focal emotional seizure with fear
somatosensory seizures originate from
Postcentral gyrus of parietal lobe
motor seizures originate from
Precentral gyrus of Parietal lobe
Visceral and autonomic seizures originate from
Insula
cingulate gyrus
frontal temporal areas
Gustatory seizure originates from
Parietal areal
insula
Olfactory seizure originates from
mesial temporal or orbitofrontal regions
what is the duration of tonic seizures
3 seconds ~ 2 minutes
how to differentiate between clonic seizures and repetitive serial
myoclonic seizures
- rhythmicity of the jerking
- Loss of consciousness
duration of epileptic spasms
1 ~ 2 seconds
Longer than Myoclonic jerk
shorter than Tonic seizure
The peak age at onset of infantile spasms is
3 - 8 Months
what is criteria of epilepsy
> 2 unprovoked seizures occurring >24 hours apart
which abnormal lab is most commonly associated with seizures
- Glucose abnormalities
- Hyponatremia
what is the most common cause of seizures in childhood
Febrile seizures
occurring in 2 to 5% of children between the ages of 6 months and 6 years
with a temperature of 38°C or higher
what is the peak age of febrile seizures
12 ~ 18 months
what is the investigation of choice in epilepsy
MRI
choice of drug in Epilepsy depends on
Seizure type
in drug therapy of epilepsy, If control is poor on the first drug at the highest tolerated dose, what is the next step?
treatment should be then changed to
monotherapy with another first line drug
if treatment with another first line drug failed
treat with a maximum of two anti convulsants
when to stop AED
after 2 years seizure-free
AED of choice in Generalized tonic–clonic
- Sodium valproate
- Lamotrigine
- Levetiracetam
AED of choice in Tonic or Atonic
Sodium valproate
AED of choice in Absence
ethosuximide
AED of choice in Myoclonic
Sodium valproate
AED of choice in Focal
Lamotrigine
in Status epilepticus, t1 refers to
Time when a seizure is likely to be prolonged leading to continuous seizure activity (or time to start ttt)
Tonic - clonic SE = 5 min
Focal SE with impaired consciousness = 10 min
in Status epilepticus, t2 refers to
Time when a seizure may cause long term consequences (including neuronal injury, neuronal death, alteration of neuronal networks and functional deficits)
Tonic - clonic SE = 30 min
Focal SE with impaired consciousness = 60 min
most common cause of status epilepticus
de novo due to acute cerebral disturbances
Age of CP affection
up to 3 years
what is the immediate effect of asphyxia
hypoxic ischemic encephalopathy
what is the immediate effect of kernicterus
- lethargy
- ↑ muscle tone
- decreased Moro sign
- opisthotonus
what is the delayed effect of kernicterus
- Choreoathetoid CP
- Sensorineural deafness
which area of the brain is affected in Spastic type CP
Motor area 4
which area of the brain is affected in ataxic CP
Cerebellum
which area of the brain is affected in Extrapyramidal type
Basal ganglia
which type of Cerebral palsy is commonly associated with epilepsy
Spastic Quadriplegic CP
then spastic hemiplegic
what is rapid bed side test for coma
Blood glucose
signs of meningeal inflammation in infants
irritability, restlessness, depressed mental
status, and poor feeding
Babinski and kernig is for children over 12 months
Normal rate of CSF production
0.3 ~ 0.5 ml/min = 20 ml/h
Normal CSF volume
50 ml in infants
150 ml in Adults
Most of CSF is ……
Extra ventricular
Most common cause on congenital Hydrocephalus is
Aqueductal stenosis
XLR - Spina bifida occulta
congenital infection associated with Congenital Hydrocephalus
Toxoplasma
patient with congenital infection developed Periventricular calcifications
CMV
patient with congenital infection developed scattered calcifications and choreoretinitis
Toxoplasma
Why to auscaltate head of patient in Hydrocephalus
to detect Bruit → A-V malformation of Great cerebral vein of Galen
most common place for Meningeocele
Lumbosacral area
what is the preferred treatment for Hydrocephalus
Surgical
most common shunt used in hydrocephalus
ventriculoperitoneal (spitz holter)
disadvantage of Ventriculoarterial shunt
arrythmia & Volume overload
what is the second line surgical approach for Hydrocephalus
Ventriculopleural shunt
Using CT, how to differentiate between compensated & non compensated Hydrocephalus
by transependymal CSF permeation in the
periventricular white matter
what is the most common cause of death in CP
Aspiration pneumonia & infections
in Transverse myelitis, UMNL manifestations appear after
3 ~ 6 weeks
value of MRI in transverse myelitis
Exclude Autoimmune encephalitis and spinal cord compression
muscle weakness distribution in myopathy vs neuropathy
Myopathy → Proximal > distal
Neuropathy Distal > proximal
cause of death in SMA I
bronchopneumonia and respiratory failure
what are the onsets for SMA
- SMA I → 2~6 months (starts IU / 1st 24h)
- SMA II → 6 ~ 18 months
- SMA III → >18 months
- SMA IV → Adult onset
what is the mainstay treatment for Guilian Barre $
Plasmapheresis/Intravenous Immunoglobulin
Regarding congenital myopathies, the definitive diagnosis of each type is
determine by
histopathological finding in muscle
biopsy
how to differentiate between Congenital myopathy and muscular dystrophy
Congenital myopathy → Earlier, static, Normal CK, Mutations in Protein / Enzymes
Muscle Dystrophy → Later, Progressive, ↑↑ CK, Mutations in cell membrane
mode of inheritance in DMD
XLR
how to differentiate between bulbar and pseudo bulbar palsy
Bulbar → uvula deviated to the normal site and absent Gag reflex
most common cause of CP
- Meningitis
- head injury
most common form of cp
spastic
two of the following : Abnormal movement pattern - ↑ Tone - abnormal reflexes
a child with ↑ bilirubin develops which type of CP
choreoathetoid
arousal depends on
communication between the
ascending reticular activating system (ARAS)
which is located in the brain stem and its targets in the hypothalamus, thalamus, and
cerebral cortex
Awareness depends on
connections between cortical and subcortical structures; cerebral
hemispheres
absent doll’s eye response indicates
brainstem dysfunction
most common organisms causing meningitis
- Strept. pneumoniae
- H. Influenza
- Neisseria Meningitidis
1 & 3 → Rapid onset
MOT of bacterial meningitis
- Droplet of RT / throat secretion → hematogenous spread to BBB
- direct inoculation from penetrating head injury
most common organism causing brain abscess
Streptococcus anginosus
2nd → Staph aureus
mode of inheritance in SMA
AR
