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Pediatrics > Neurology MCQ > Flashcards

Neurology MCQ Flashcards

1
Q

how to differentiate between secondary and primary generalized seizures

secondary generalized seizure = focal to bilateral tonic-clonic seizure

A

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.

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2
Q

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

A

focal emotional seizure with fear

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3
Q

somatosensory seizures originate from

A

Postcentral gyrus of parietal lobe

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4
Q

motor seizures originate from

A

Precentral gyrus of Parietal lobe

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5
Q

Visceral and autonomic seizures originate from

A

Insula
cingulate gyrus
frontal temporal areas

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6
Q

Gustatory seizure originates from

A

Parietal areal
insula

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7
Q

Olfactory seizure originates from

A

mesial temporal or orbitofrontal regions

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8
Q

what is the duration of tonic seizures

A

3 seconds ~ 2 minutes

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9
Q

how to differentiate between clonic seizures and repetitive serial
myoclonic seizures

A
  1. rhythmicity of the jerking
  2. Loss of consciousness
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10
Q

duration of epileptic spasms

A

1 ~ 2 seconds

Longer than Myoclonic jerk
shorter than Tonic seizure

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11
Q

The peak age at onset of infantile spasms is

A

3 - 8 Months

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12
Q

what is criteria of epilepsy

A

> 2 unprovoked seizures occurring >24 hours apart

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13
Q

which abnormal lab is most commonly associated with seizures

A
  1. Glucose abnormalities
  2. Hyponatremia
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14
Q

what is the most common cause of seizures in childhood

A

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

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15
Q

what is the peak age of febrile seizures

A

12 ~ 18 months

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16
Q

what is the investigation of choice in epilepsy

A

MRI

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17
Q

choice of drug in Epilepsy depends on

A

Seizure type

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18
Q

in drug therapy of epilepsy, If control is poor on the first drug at the highest tolerated dose, what is the next step?

A

treatment should be then changed to
monotherapy with another first line drug

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19
Q

if treatment with another first line drug failed

A

treat with a maximum of two anti convulsants

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20
Q

when to stop AED

A

after 2 years seizure-free

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21
Q

AED of choice in Generalized tonic–clonic

A
  1. Sodium valproate
  2. Lamotrigine
  3. Levetiracetam
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22
Q

AED of choice in Tonic or Atonic

A

Sodium valproate

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23
Q

AED of choice in Absence

A

ethosuximide

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24
Q

AED of choice in Myoclonic

A

Sodium valproate

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25
Q

AED of choice in Focal

A

Lamotrigine

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26
Q

in Status epilepticus, t1 refers to

A

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

27
Q

in Status epilepticus, t2 refers to

A

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

28
Q

most common cause of status epilepticus

A

de novo due to acute cerebral disturbances

29
Q

Age of CP affection

A

up to 3 years

30
Q

what is the immediate effect of asphyxia

A

hypoxic ischemic encephalopathy

31
Q

what is the immediate effect of kernicterus

A
  1. lethargy
  2. ↑ muscle tone
  3. decreased Moro sign
  4. opisthotonus
32
Q

what is the delayed effect of kernicterus

A
  1. Choreoathetoid CP
  2. Sensorineural deafness
33
Q

which area of the brain is affected in Spastic type CP

A

Motor area 4

34
Q

which area of the brain is affected in ataxic CP

A

Cerebellum

35
Q

which area of the brain is affected in Extrapyramidal type

A

Basal ganglia

36
Q

which type of Cerebral palsy is commonly associated with epilepsy

A

Spastic Quadriplegic CP

then spastic hemiplegic

37
Q

what is rapid bed side test for coma

A

Blood glucose

38
Q

signs of meningeal inflammation in infants

A

irritability, restlessness, depressed mental
status, and poor feeding

Babinski and kernig is for children over 12 months

39
Q

Normal rate of CSF production

A

0.3 ~ 0.5 ml/min = 20 ml/h

40
Q

Normal CSF volume

A

50 ml in infants
150 ml in Adults

41
Q

Most of CSF is ……

A

Extra ventricular

42
Q

Most common cause on congenital Hydrocephalus is

A

Aqueductal stenosis

XLR - Spina bifida occulta

43
Q

congenital infection associated with Congenital Hydrocephalus

A

Toxoplasma

44
Q

patient with congenital infection developed Periventricular calcifications

A

CMV

45
Q

patient with congenital infection developed scattered calcifications and choreoretinitis

A

Toxoplasma

46
Q

Why to auscaltate head of patient in Hydrocephalus

A

to detect Bruit → A-V malformation of Great cerebral vein of Galen

47
Q

most common place for Meningeocele

A

Lumbosacral area

48
Q

what is the preferred treatment for Hydrocephalus

A

Surgical

49
Q

most common shunt used in hydrocephalus

A

ventriculoperitoneal (spitz holter)

50
Q

disadvantage of Ventriculoarterial shunt

A

arrythmia & Volume overload

51
Q

what is the second line surgical approach for Hydrocephalus

A

Ventriculopleural shunt

52
Q

Using CT, how to differentiate between compensated & non compensated Hydrocephalus

A

by transependymal CSF permeation in the
periventricular white matter

53
Q

what is the most common cause of death in CP

A

Aspiration pneumonia & infections

54
Q

in Transverse myelitis, UMNL manifestations appear after

A

3 ~ 6 weeks

55
Q

value of MRI in transverse myelitis

A

Exclude Autoimmune encephalitis and spinal cord compression

56
Q

muscle weakness distribution in myopathy vs neuropathy

A

Myopathy → Proximal > distal
Neuropathy Distal > proximal

57
Q

cause of death in SMA I

A

bronchopneumonia and respiratory failure

58
Q

what are the onsets for SMA

A
  1. SMA I → 2~6 months (starts IU / 1st 24h)
  2. SMA II → 6 ~ 18 months
  3. SMA III → >18 months
  4. SMA IV → Adult onset
59
Q

what is the mainstay treatment for Guilian Barre $

A

Plasmapheresis/Intravenous Immunoglobulin

60
Q

Regarding congenital myopathies, the definitive diagnosis of each type is
determine by

A

histopathological finding in muscle
biopsy

61
Q

how to differentiate between Congenital myopathy and muscular dystrophy

A

**Congenital myopathy ** → Earlier, static, Normal CK, Mutations in Protein / Enzymes

Muscle Dystrophy → Later, Progressive, ↑↑ CK, Mutations in cell membrane

62
Q

mode of inheritance in DMD

A

XLR

63
Q

how to differentiate between bulbar and pseudo bulbar palsy

A

Bulbar → uvula deviated to the normal site and absent Gag reflex

Pediatrics (5 decks)

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