Neurology MCQ Flashcards by Chidera Nwaroh

A 15-year-old with depression presents in status epilepticus with flushing, mydriasis, and widened QRS. Which anti-epileptic drug is contraindicated?

A. Fosphenytoin
B. Levetiracetam
C. Phenobarbital
D. Lorazepam

Fosphenytoin

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You are seeing a child who is noted to be clumsy since childhood. You see telangiectasias on her sclera. What lab test are you most likely to find?

A. Low platelets
B. Low complement
C. Low AFP
D. Low IgA

Low IgA

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15-year-old female presenting with a tonic-clonic episode in the shower. Also noted to be clumsy in the morning. What investigation is best to determine the diagnosis?

A. EMG
B. EEG
C. ECG
D. Tilt table testing

EEG

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A child is referred to you by his family physician. He has a history of an idiopathic generalized epilepsy (no specific diagnosis was given). This child has been taking valproic acid for her epilepsy and has been seizure free for the past 9 months. His primary care physician has ordered a valproic acid level recently, and it was found to be subtherapeutic. What is your approach to management of this patient?

A. Repeat valproic acid level
B. Increase valproic acid dose
C. Stop valproic acid
D. No change to current medication dosing

Increase valproic acid dose

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14 yo F with on week of difficulty walking and paresthesia of lower limbs. No bladder or bowel symptoms. On exam, noted to have decreased power in lower extremities and diminished ankle and knee reflexes bilaterally.
What finding on MRI would support the diagnosis?

A. Ring enhancing lesion at T12 level (maybe L1)
B. Edema of the spinal cord at the L1 level (maybe T12)
C. Hyperintense white matter lesions at the thoracic level
D. Enhancement of cauda equina roots

Enhancement of cauda equina roots

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A 5-month-old female presents with two weeks of episodes where she has arm spasms with flexion of the neck. The episodes last a few seconds each. They happen intermittently throughout the day but are more frequent after she wakes up. She is otherwise behaving normally and eating well. Physical exam is normal. He does not have any skin findings.

A. Benign familial convulsions
B. Benign myoclonus of infancy
C. Infantile spasms
D. Frontal lobe epilepsy

Infantile spasms

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3-month-old brought in by parents for vision concerns. On examination, right eye smaller in size, horizontal nystagmus, and pupil irregular defect. What is the most likely diagnosis?

A. Horners
B. Aniridia
C. Coloboma
D. Congenital glaucoma

Coloboma

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4 month old with 3 day history of poor suck, weak cry and poor feeding. Also noted 1 week history or constipation. On exam, alert but poor head control and general hypotonia. Shallow resps. Intact DTRs. What is the process occurring in baby?

A. Autoimmune something
B. Toxin mediated irreversible blockade of acetylcholine
C. Post infectious immune mediated polyneuropathy
D. Degeneration of anterior horn cells

Toxin mediated irreversible blockade of acetylcholine

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7 year old boy who is an ex-32 weeker brought to clinic by his parents for concerns around being clumsy. He has trouble with art (holding the paintbrush) and doing his shoe laces. He also struggles with scissors. He has a normal neuro exam except for slower rapid alternating hand movements and finger to nose testing. What is the most likely underlying diagnosis?

a) developmental coordination disorder
b) cerebral palsy
c) cerebellar ataxia
d) myotonic dystrophy

developmental coordination disorder

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18 month old who is not yet walking and has bilateral lower limb hypertonia. Was born at 30 weeks gestation, apgars 8+9, with no immediate perinatal concerns. U/S in first week of life showed bilateral mild IVH. What is the explanation for his findings?

Cerebral palsy spastic diplegia as at risk with prematurity
This is normal in premature infants
Have to rule out myotonic dystrophy with a molecular diagnosis
It can’t be CP because there was no asphyxia at birth

Cerebral palsy spastic diplegia as at risk with prematurity

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Infant diagnosed with SMA (Stem mentions confirmatory testing already done after positive newborn screen). What is the mechanism of action of the commonly available treatment (nusinersen)?

a) Increases the number of functional SMN protein
b) Delivery of healthy copies of SMN1 gene into cells
c) Stabilization of the myelin sheath
d) unknown

Increases the number of functional SMN protein

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10 month old found to be lethargic 45 minutes after swimming lesson. Generalized tonic clonic seizure. No evidence of head injury on assessment. Rectal temp 35.5C. What is the most likely etiology of his presentation?

A. Chlorine poisoning
B. Water intoxication
C. Occult head trauma
D. Hypothermia

Water intoxication

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3 year old male presenting with a 30 minute GTC, in the ED protecting his airway he has a heart rate of 220 BPM, resp rate is tough to assess, BP 150/80 O2 saturation is 93%, temp 38.9.

What is the most appropriate initial management?

A. Endotracheal intubation
B. Obtain IO acess
C. Obtain IV access
D. IN midaz

IN midaz

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12yo boy with progressive CN6 palsy (described as unable to abduct left eye, diplopia when looking laterally). What is the most appropriate next step?

A. Urgent MRI head
B. Ophtho referral
C. Reassure and follow-up in 2wk
D, Something else

Urgent MRI head

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A 14-year-old girl presents with a 1-week history of intermittent diplopia and difficulty swallowing. On assessment, you note bilateral mild ptosis and dysphonia. What other physical examination finding would support your suspected diagnosis?

A. Bilateral miosis
B. Relative afferent pupillary defect
C. Upward gaze fatigability
D. Percussion myotonia

Upward gaze fatigability

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15 mo boy with 1 week history of not walking. Previously walked well since 11 months. Parents have noticed rapid, irregular eye movements over past three days. Also difficulty self-feeding due to jerking movements of the arms. He is irritable. Which investigation is most likely to give you the diagnosis?

A. Abdo ultrasound
B. LP
C. Head MRI
D. MIBG scan

MIBG scan

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5 yr went camping with family 2 weeks ago. Now has unilateral facial palsy and expanding circular erythematous rash on back. What test to confirm diagnosis?

A. Lyme serology
B. HSV serology
C. PCR for boresi? (Something unfamiliar)
D. NPS for mycoplasma

Lyme serology

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2 year old boy falls on the pavement in the driveway and screams bloody murder and then goes red and then goes blue and passes out and has a few abn movements and then goes back to normal. This happened to him once before when he stubbed his toe in the kitchen or something. What’s the work up?

A. ECG
B. EEG
C. CXR
D. CBC and ferritin

CBC and ferritin

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Newborn term boy with right sided mouth drooping during crying only. Not evident at rest. Symmetric forehead movement, nasolabial folds, and eye opening. No other neurological deficits on exam. What other investigations should you do?

A. MRI Head and neck
B. Thyroid studies
C. Echocardiogram
D. Chromosomal microarray

Echocardiogram

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Girl with longstanding epilepsy on multiple antiepileptics. AUS shows bilateral nephro calculi. Which AED is most likely to cause this

A. VPA
B. Lamotrigine
C. Carbamazepine
D. Topiramate

Topiramate

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2 year old girl with generalized tonic clonic seizures, afebrile, received x1 IN Midazolam and x1 IV Midazolam. 5 mins later she is still seizing. She is now hypotensive with shallow respirations and is being bag mask ventilation. What is the most appropriate next step in management?

A. Fosphenytoin
B. Phenobarbital
C. Valproate
D. Levetiracetam

Levetiracetam

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Which of the following associated with a sacral dimple in a neonate would prompt you to investigate further?

A. Mongolian spot overlying
B. Above gluteal cleft
C. 3mm in diameter
D. 2cm above anus

Above gluteal cleft

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Difficult extraction SVD with forceps. Neonate has left sided hand paralysis, miosis and ptosis (also on left side). Moro reflex is intact but left hand does not move. Where is the lesion?

A. Anterior horn of spinal cord
B. Brainstem
C. C7-T1 nerve root
D. C5-C6 nerve root

C7-T1 nerve root

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6 yo girl is an unrestrained passenger in an MVA on the highway. Ejected from the vehicle, unresponsive at the scene. Stabilized by EMS, brought to hospital. Her head CT shows small areas of hemorrhage at the border between the white and grey matter. Clinical presentation and imaging most consistent with:

A. Diffuse axonal injury
B. Cerebral contusion
C. Subdural hemorrhage
D. Cerebral edema

Diffuse axonal injury

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A woman has a prenatal ultrasound at 38 weeks and it shows an absent corpus callosum. Which of the following is an associated outcome? A. Tic disorder B. Discoordination C. Hypopituirism D. Aggression

Hypopituirism

15y boy with 6 mo history of abnormal movements twice weekly. Lasts 5-10 min. Eyes closed during episode no incontinence. Alert and able to recall details after event. Brother has history of focal seizures and uncle had tonic clonic seizures after removal of an astrocytoma. What is the next best step? A. Brain MRI B. Sleep deprived EEG C. Explore more psychosocial history D. Consult neurology

Sleep deprived EEG

2-year-old with acute ataxia, eye movement and muscle twitching. What is the most likely diagnosis? A. Neuroblastoma B. Cerebellitis

Neuroblastoma

A teenager on Accutane has a headache, what finding do you expect?

Papilledema

A 6 year old boy presents with a 3 month history of dizziness with associated vomiting and eye fluttering. There are no obvious triggers and he recovers on his own completely after each episode. There is a family history of migraines. His neurological exam is completely normal. What do you do? A. Reassure B. MRI C. Refer to ENT D. EEG

MRI

A child present with visual disturbances and found to have a Craniopharingioma. What is the most likely visual disturbance? a. Central scotoma b. Bitemporal hemianopia c. Superior visual field defect d. Inferior visual field defect

Bitemporal hemianopia

Child who had viral symptoms 1-2 weeks ago developed sudden ascending paralysis. No reflexes and was intubated. Best test to confirm diagnosis? A. MRI Brain B. Viral Studies C. CSF D. Anti-acetylcholine receptor antibodies

CSF

A 6-month-old girl is referred to your clinic after presenting to her family doctor’s office. Her parents have noted that she has been favouring the left hand for several months. She is unable to support herself in a sitting position. On your examination, she has protective reflexes on the left side, but none on the right side. She also has a fisted hand on the right side. What is the most likely explanation for these findings? A. Brachial plexus injury B. Trauma to right arm C. Spastic diplegia D. Right hemiplegia

Right hemiplegia

School-aged child with a description of absence seizures at school noted by the teacher and consistent findings on EEG. What medication should you start? A. Carbamazepine B. Clobazam C. Ethosuximide D. Levetiracetam

Ethosuximide

You are seeing a 5-year-old boy who is having difficulty walking now after he previously walked at 12 months. His development has otherwise been normal. You notice that he has very well-defined calves. What test would be most in keeping with your suspected diagnosis?

Elevated CK

A 13-year-old girl presents with her first episode of a generalized tonic-clonic seizure in the morning. On history she mentions that she has been dropping objects recently. What is the most likely diagnosis? A. Dravet syndrome B. Juvenile myoclonic epilepsy C. Benign Rolandic epilepsy

Juvenile myoclonic epilepsy

An 18moF with a known seizure disorder presents in status epilepticus. Before arriving in the ED, EMS has already given them multiple doses of benzodiazepines (at least 3 doses via different routes) and one dose of IV phenytoin at 20 mg/kg. They are still seizing. What medication do you give them next? A. Fosphenytoin B. Valproic acid C. Phenobarbital D. Midazolam infusion

Phenobarbitol

Teenage kid with new behavioral concerns, anxiety, depression. On examination has hepatomegaly and intentional tremor. Bloodwork shows DAT negative hemolytic anemia. What will you recommend? A. Low zinc diet B. Decrease intake of shellfish, nuts, chocolate C. Decrease vitamin B6 in diet D. Deferoxamine

Decrease intake of shellfish, nuts, chocolate

Newborn baby born with hypotonia. History of decreased fetal movements. Normal facial movements. Alert. Weak extremities and low tone. Absent reflexes. What is the most likely diagnosis? A. SMA B. Prader willi C. Myotonic dystrophy

SMA

A parent calls your office. Her 12 year-old adolescent is lying in bed and has not woken up in the last 2 hours. She has had 2 similar episodes in the past 6 months. When her mother exerts a painful stimulus, the girl turns over in her bed. Her pupils are equally round and reactive to light. The most likely diagnosis is: A. A confusional migraine B. A brain tumour C. Meningitis D. A Non-convulsive seiizure

A confusional migraine

Girl (8?) with ptosis. Holding her head tilted backward so she can see. Ptosis present, neuro exam otherwise normal.Can walk up the stairs and lift her arms above her head. Normal reflexes, normal strength. What will best give the diagnosis? A. Nerve conduction studies B. Anti acetylcholine receptor antibodies C. IV edrophonrium D. MRI brain

MRI brain

4yo male with multiple hypomelanotic macules, rough raised lesion with orange peel consistency in the lumbar area, 3 cafe’ au lait spots and retinal hamartoma. What are they most at risk for? A. Optic Nerve Glioma B. Cataracts C. Vestibular schwannoma D. Cardiac Rhabdomyoma

Cardiac Rhabdomyoma

7 year old male with behavioural concerns. He did well in grade 1 but in grade 2 he is having attention difficulties and disruptive behaviors. On physical exam he is ataxic. Despite it being march, he has tan lines. What investigation is the most likely to give you the diagnosis? A. Brain MRI B. Very long chain fatty acids C. Chromosomal microarray D. Early morning cortisol

Very long chain fatty acids

5 year old male who suddenly stops talking. Previously otherwise well. He recently had a generalized seizure and EEG during sleep shows epiletiform activity. What is the most likely diagnosis? A. Lennox-Gastaut B. Landau-Kleffner C. West D. Dravet

Landau-Kleffner

A 5 yo boy’s teacher raised concerns for his behaviour. He has 30-40 second episodes where he appears frightened, stares, rubs his hands together and speaks gibberish. What is the most likely diagnosis? A. Self stimulation B. Absence C. Temporal lobe epilepsy D. Complex tics

Temporal lobe epilepsy

17 year old male. Mother describes that he seems to be seeing things that are not there. Over the past couple of months has also been withdrawn, spending more time alone in his room, and has lost interest in usual activities. He has also been walking around talking to himself. Which is the most likely diagnosis? A. Schizophrenia B. Wilson’s C. Autoimmune encephalitis D. Antisocial personality disorder

Autoimmune encephalitis

5 mo with 3wk history flexion at waist with stiffening of limbs a few times a day lasting for a few seconds. Which medication will be most effective for the most likely diagnosis A. Vigabatrin B. Clobazam C. Carbamazepine D. Phenobarb

Vigabatrin

mo with hypotonia, but alert. No DTR, tongue fasciculation. Parent ask you what are the chances of having another child with the condition. A. 25% B. 50% C. 50% if male D. Same as the general population

25%

A child has concern for tourettes syndrome. What do you need to make the diagnosis? A. 1 motor tic and 1 vocal tic for 1 year B. 2 motor tics and 1 vocal tic for 1 year C. 1 motor tic and 2 vocal tics for 1 year D. 2 motor tics and 2 vocal tics for 1 year

2 motor tics and 1 vocal tic for 1 year

14 yo F with 3 generalized seizures and 1 week history of disinhibited behaviour and confusion. On exam, has writhing movements of the face and tongue, hypertension, and tachycardia. No focal neurological signs. What is the test most likely to reveal the diagnosis? A. cEEG B. Urine and blood tox C. CSF antibodies D. Brain MRI

CSF antibodies

A teenage presents with progressive distal weakness after an illness last week, on examination he does not have reflexes in his legs bilaterally. What is the most likey pathogen that he was infected with? A. Campylobacter B. Giardia C. Entamoeba histolitica D. Shigella

Campylobacter

A 1 month old is referred to you for hypotonia and poor feeding. She is hypotonic and frog legged but is able to move against gravity. DTRs absent. What would be an expected exam finding: A. Bilateral ptosis B. Percussion myotonia C. Tongue fasciculations D. Hepatomegaly

Tongue fasciculations

8 year old sleepwalking four times a week at midnight. Parents have put up a gate at stairs, concerned about safety. What do you recommend? A. Benzo B. Melatonin C. Scheduled wake up at 11:30 pm D. Reassure because it will resolve in 6 months

Scheduled wake up at 11:30 PM

18 month old previously healthy child cries to be picked up by mother, immediately followed by a 5-10 second episode of going limp. When mother picks her up, she resumes crying. She has had 1 similar episode a week prior. Physical examination is normal. What investigation would you do? A. Serum ferritin B. EEG C. Echocardiogram D. CT head

Serum ferritin

4 year old girl with 3 GTC seizures in past week. Several days of emotional lability and confusion. In ED, mild tachycardia and hypertension. Abnormal (writhing) mouth/facial movements. Which diagnostic test will best determine the diagnosis? A. Continuous EEG B. Drug Screen (blood and urine) C. Head MRI D. CSF auto-antibodies

CSF auto-antibodies

17 yo girl with 8 month history of amenorrhea and headaches. Intermittent bothersome galactorrhea. High prolactin on bloodwork. MRI showed adenoma 5mm x7mm. What is the best treatment option? A. Dopamine agonist B. No treatment; repeat MRI in 12 months C. Transsphenoidal removal of adenoma D. OCP

Dopamine agonist

Which Antiepileptic causes hepatotoxicity, thrombocytopenia, and pancreatitis? A. VPA B. Carbamazepine C. Lamotrigine D. Phenytoin

VPA

8 week old, ex 35 weeker with an episode of hypotonia and apnea lasting 15-20 second, after regurging from a feed. No cyanosis, no generalized tonic clonic movements. Parents stimulated and he cried. Physical examination is normal. CBC, lytes, CXR, normal. What to do? A. Reassure and send home. B. Admit for cardioresp monitoring for 24-48 hours C. Outpatient upper GI D. Outpatient EEG

Admit for cardioresp monitoring for 24-48 hours

Description of girl with regression, loss of hand movement, acquired microcephaly. Investigation that will most likely reveal the underlying diagnosis? A. MECP2 analysis B. Microarray C. VLCF analysis D. Methylation studies

MECP2 analysis

Newborn with flail arm and horner’s. What is your next best step? A. MRI brain B. CT chest and spinal roots C. Refer to physiotherapy

Refer to physiotherapy

14 year old with headaches every few weeks for the last 1-2 years. Not worsening in intensity or frequency. Never while asleep. Otherwise well. Does notice they are worse when he coughs or bears down for BM A. MRI B. Headache diary C. Amitriptyline D. Flunarizine

Headache diary

Female dropping things in the morning and lost consciousness in the shower . Test? A. EEG B. ECG C. Tilt table

EEG

Female fainting, has prodromal symptoms before (black vision, lightheaded, feels warm and sweaty) had a GTC with incontinence when her dad held her in a sitting position . Next step A. EEG B. MRI C. ECG D. Blood pressure/HR laying and standing

MRI ***

DMD, hypercapnea on AM gas - due to? A. nocturnal hypoventilation B. Heart failure

nocturnal hypoventilation

Infant. 6 months rolled fine. 9 mo had difficulties sitting on own. Now has absent reflexes. Weakness. Facial muscles preserved. Best test for diagnosis? A. SMN genetic testing B. EMG C. Muscle biopsy

SMN genetic testing

Teenager who had fainting episode after getting an vaccination. Presents in ED with right arm stiffening and clonic movements of one limb for 5 minutes. Period of sleepiness after, but able to preserve protective reflexes. Normal neurologic exam. Kid doesn’t seem troubled by this. Investigation? A. EEG B. Observe C. MRI

Observe

9 week old infant who went pale and limp in dad’s arms. Term. Lasted less than 30 seconds. Now examines well in ED. What to do? A. Reassure, no further investigations B. EEG C. ECG

Reassure, no further investigations

18 month old who was in a stroller, coughed, turned red and stiff, then limp and pale. Mom had to stimulate her. What was the most likely cause? A. Seizure B. GERD C. Bronchiolitis

GERD

18 month old who wakes up screaming, inconsolable, parents at loss of what to do. Does not recall events. A. Reassure B. EEG C. MRI D. Refer to psych

Reassure

You are seeing a 4mo with a 24 hour history of poor feeding. He has just started solids. On examination, there is facial and limb weakness. Pupillary response is normal? DTR are absent. A. Botulism B. SMA C. Mytonic dystrophy

Botulism

Kid with campy + diarrhea and leg weakness/ GBS. Treatment? A. Steriods B. Antibiotics C. IVIG D. NSAIDs

IVIG

Seizures kid on Clobazam at home. Got one IN midaz what is next step. A. Iv fospheny B. Iv phenytoin C. IV midaz D. IN midaz

IV midaz

18 month old boy with first episode febrile seizure. What factor influences likelihood of repeat febrile seizure? a. MRI result b. EEG result c. Family history of febrile seizures d. Etiology of fever

Family history of febrile seizures

14 year old girl with asthma has throbbing headaches associated with nausea, photophobia. Her mother has a history of migraines. What treatment do you offer for prophylaxis? a. Amitriptyline b. Propranolol c. Phenytoin d. Sumatriptan e. Ergotamine

Propanalol

A baby is diagnosed with Erb’s palsy. What are you likely to see: a) symmetric Moro b) intact biceps reflex c) intact grasp reflex d) intact wrist extension

Intact grasp reflex

Neurology MCQ Flashcards

(76 cards)