Neurology

Question 1

What is developmental delay?

Answer 1

Developmental delay is when a child does not reach developmental milestones at the expected time in one or more areas: gross motor, fine motor, language, cognitive, social, or emotional development.

Question 2

What are the primary domains of development assessed in children?

Answer 2

Gross motor
Fine motor and vision
Speech and language
Social and emotional

Question 3

List common causes of global developmental delay.

Answer 3

Genetic syndromes (e.g., Down syndrome, Fragile X syndrome)
Metabolic disorders (e.g., hypothyroidism, phenylketonuria)
Cerebral palsy
Autism spectrum disorder (ASD)
Perinatal asphyxia
Prematurity and associated complications

Question 4

What is the most common genetic cause of developmental delay?

Answer 4

Down syndrome.

Question 5

What are red flags for developmental delay in infants?

Answer 5

Lack of head control by 4 months
Inability to sit unsupported by 9 months
No babbling by 9 months
No walking by 18 months
Persistent primitive reflexes beyond 6 months

Question 6

_________ is the most common preventable cause of intellectual disability worldwide.

Answer 6

Hypothyroidism

Question 7

Delayed __________ development may present as difficulty grasping objects or manipulating small items.

Answer 7

Fine motor

Question 8

__________ is a neurodevelopmental disorder characterized by deficits in social communication and restrictive, repetitive behaviors.

Answer 8

Autism spectrum disorder (ASD)

Question 9

Failure to smile by __________ months is a red flag for social developmental delay.

Answer 9

2 months

Question 10

The Denver Developmental Screening Test assesses __________, __________, __________, and __________ domains.

Answer 10

Gross motor, fine motor, language, social

Question 11

Which of the following is NOT typically associated with developmental delay?
A. Congenital hypothyroidism
B. Down syndrome
C. Chickenpox
D. Fragile X syndrome

Answer 11

C. Chickenpox

Question 12

What is the best initial test for suspected developmental delay caused by a metabolic disorder?
A. MRI brain
B. Genetic testing
C. Blood and urine metabolic screening
D. Electroencephalogram (EEG)

Answer 12

C. Blood and urine metabolic screening

Question 13

Scenario: A 2-year-old child is not speaking any words, has poor eye contact, and is not engaging in play with peers.
Q: What condition should be considered, and what is the next step in management?

Answer 13

Condition: Autism spectrum disorder (ASD). Next step: Refer for a detailed developmental assessment and early intervention services.

Question 14

Scenario: A 10-month-old infant is unable to sit unsupported and has poor head control. Parents report feeding difficulties.
Q: What is the likely cause, and what investigation should be prioritized?

Answer 14

Likely cause: Cerebral palsy.
Investigation: Brain MRI to assess for hypoxic-ischaemic injury or structural abnormalities.

Question 15

Arrange the steps in the assessment of developmental delay:
A. Detailed history and developmental milestones review
B. Physical examination and neurological assessment
C. Screening for hearing and vision deficits
D. Laboratory tests and imaging as needed
E. Multidisciplinary referral (e.g., speech therapy, physiotherapy)

Answer 15

A → B → C → D → E

Question 16

What type of developmental delay is Autism spectrum disorder

Answer 16

Language and social delay

Question 17

What type of developmental delay is Cerebral palsy

Answer 17

Motor delay

Question 18

What type of developmental delay is Fragile X syndrome

Answer 18

Global developmental delay

Question 19

What type of developmental delay is Strabismus or severe visual impairment

Answer 19

Fine motor delay

Question 20

What are the pros and cons of developmental screening tools like the Ages and Stages Questionnaire (ASQ)?

Answer 20

Pros:

Early identification of delays
Easy to administer
Guides referrals for intervention
Cons:
May miss subtle delays
False positives can cause parental anxiety

Question 21

Why is early intervention important in developmental delay?

Answer 21

Early intervention maximizes the child’s potential, improves long-term outcomes, and helps mitigate secondary complications such as social isolation and behavioral challenges.

Question 22

Febrile Convulsions

Answer 22

Seizures which occur in children with a high fever between the ages of 6 months and 5 years

Question 23

Simple Febrile Convulsions

Answer 23

Simple febrile convulsions are generalised tonic clonic and last less than 15 minutes and only occur once during a single febrile illness

Question 24

Complex Febrile Convulsions

Answer 24

Complex febrile convulsions are focal seizures, last more than 15 minutes or occur multiple times during the same febrile seizures

Question 25

Other causes for Febrile Convulsions like episodes

Answer 25

Rule out other causes such as epilepsy, syncopal episode, trauma, space-occupying lesions and neurological infection

Question 26

Management of Febrile Convulsions

Answer 26

Identify and manage source of infection Control fever with simple analgesia Parental education Prognosis is slightly higher for seizures/epilepsy in the future

Question 27

Advice for parents with child who has febrile convulsions

Answer 27

●Stay with the child ●Put the child in a safe place, for example on a carpeted floor with a pillow under their head ●Place them in the recovery position and away from potential sources of injury ●Don’t put anything in their mouth ●Call an ambulance if the seizure lasts more than 5 minutes If they have complex febrile convulsions, risk is slightly higher for developing epilepsy compared to the simple febrile convulsions and for ordinary people

Question 28

Epilepsy

Answer 28

An umbrella term for a tendency to have seizures which are transient episodes of abnormal electrical activity in the brain.

Question 29

Generalised Tonic-Clonic Seizures

Answer 29

Loss of consciousness with tonic (rigidity) and clonic (rhythmic jerking) phase with possible tongue biting, incontinence, groaning and irregular breathing - After this there is a postictal period where the person is confused, drowsy and feels irritable/low

Question 30

Management of Generalised Tonic-Clonic Seizures

Answer 30

sodium valproate, lamotrigine or carbamazepine

Question 31

Focal Seizures

Answer 31

These begin in the temporal lobes and affect speech, memory and emotions. - They can present with hallucinations, memory flashbacks and deja vu.

Question 32

Management of Focal Seizures

Answer 32

lamotrigine or levetiracetam

Question 33

Absence Seizures

Answer 33

the become blank and stare into space then abruptly return to normal - During this, they are unaware of their surroundings and will not respond and these generally last for around 10-20 seconds. - Most patients stop having these with age

Question 34

Management of Absence Seizures

Answer 34

ethosuximide.

Question 35

Myoclonic Seizures

Answer 35

Sudden brief muscle contractions where the person remains awake - These are often part of juvenile myoclonic epilepsy

Question 36

Management of Myoclonic Seizures

Answer 36

sodium valproate or levetiracetam

Question 37

Tonic/Atonic Seizures

Answer 37

Sudden tension/stiffness affecting the body

Question 38

Management of Tonic/Atonic Seizures

Answer 38

sodium valproate or lamotrigine

Question 39

Which is the most common type of seizure in children?

Answer 39

Absence Seizures

Question 40

Ix for Epilepsy

Answer 40

Full history EEG should be performed after the second simple tonic-clonic seizures MRI brain to help diagnose structural abnormalities Blood electrolytes, glucose, cultures and LP can also be considered

Question 41

Management of Acute Seizures

Answer 41

Recovery position if possible - Put something soft under the head to prevent injury - Remove any obstacles that could lead to injury - Make a note of time of start and end of seizures - Call an ambulance if the seizures lasts longer than 5 minutes

Question 42

Side Effects of Sodium Valproate

Answer 42

Teratogenic, Liver damage, Hair loss, Tremors

Question 43

Side Effects of Carbamazepine

Answer 43

- Agranulocytosis, Aplastic anaemia

Question 44

Side Effects of Ethosuzimide

Answer 44

Night tremors, Rashes, N+V

Question 45

Side Effects of Lamotrigine

Answer 45

- DRESS syndrome, Leukopenia

Question 46

What is DRESS syndrome?

Answer 46

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome

Question 47

Status Epilepticus

Answer 47

Medical emergency where a seizures lasts more than 5 minutes or 2 or more seizures without regaining consciousness

Question 48

Management of Status Epilepticus

Answer 48

Management includes securing airway, high concentration oxygen, assess cardiac and respiratory function and IV lorazepam which can be repeated after 10 minutes if it continues

Question 49

Medical options to treat Status Epilepticus in the community

Answer 49

buccal midazolam and rectal diazepam.