-
Question 1
Correct
-
A 11-year-old is referred to neurology due to episodes her GP feels are epileptiform. Her mother reports that she appears to just 'stop', sometimes even in mid conversation, for several seconds at random times during the day. During these episodes, she can be unresponsive to questioning and has no recollection of them.Which of these drugs is contraindicated in this condition?
Your Answer: Carbamazepine
Explanation:The patient’s history points to absence seizures. Carbamazepine has been shown to aggravate generalized seizure types, especially absence seizures, because it acts directly on the ventrobasal complex of the thalamus which is critical to the neurophysiology of absence seizures.
-
This question is part of the following fields:
- Neurology
-
-
Question 2
Correct
-
Neurofibromatosis is characterised by which of the following?
Your Answer: Scoliosis
Explanation:Neurofibromatosis (aka Von Recklinghausen’s disease) includes: neurofibrosarcomas, pheochromocytoma, optic nerve tumours, scoliosis and acoustic neuromas.
-
This question is part of the following fields:
- Neurology
-
-
Question 3
Correct
-
A 12-year-old girl is recovering from bilateral parotitis. She complains of a continuous headache and drowsiness. A CT brain is done which is normal. What is the best definitive investigation in this case?
Your Answer: Lumbar puncture
Explanation:This patient might have viral meningitis as he recently suffered viral parotitis(Mumps). Microscopy and culture of the CSF would show a CSF lymphocytosis.
-
This question is part of the following fields:
- Neurology
-
-
Question 4
Correct
-
A 12-year old girl was brought to the hospital with recurrent headaches for 6 months. Her physical examination revealed no abnormality. A CT scan of the head revealed a suprasellar mass with calcifications, eroding the surrounding sella turcica. The lesion is likely to represent:
Your Answer: Craniopharyngioma
Explanation:Craniopharyngiomas (also known as Rathke pouch tumours, adamantinomas or hypophyseal duct tumours) affect children mainly between the age of 5 and 10 years. It constitutes 9% of brain tumours affecting the paediatric population. These are slow-growing tumours which can also be cystic, and arise from the pituitary stalk, specifically the nests of epithelium derived from Rathke’s pouch. Histologically, this tumour shows nests of squamous epithelium which is lined on the outside by radially arranged cells. Calcium deposition is often seen with a papillary type of architecture.
ACTH-secreting pituitary adenomas are rare and mostly microadenomas. Paediatric astrocytoma’s usually occur in the posterior fossa. Although null cell adenomas can cause mass effect and give rise to the described symptoms, they are not suprasellar. Prolactinomas can also show symptoms of headache and disturbances in the visual field, however they are known to be small and slow-growing. -
This question is part of the following fields:
- Neurology
-
-
Question 5
Correct
-
An 8-month-old infant is presented to the paediatrics ward with a history of delayed developmental milestones since birth. On examination, he has poor muscle tone and balance, and a head circumference, which is greater than normal. Imaging of the patient's head revealed a diminished cerebellar vermis, a large fourth ventricle, and an enlarged posterior fossa. What is the most likely diagnosis?
Your Answer: Dandy-Walker syndrome
Explanation:Dandy-Walker syndrome is characterised by symptoms of brain maldevelopment that are seen in this patient. A large cranium indicates hydrocephalus, and the hypotonia indicates poor limb development.
-
This question is part of the following fields:
- Neurology
-
-
Question 6
Incorrect
-
A 13-year-old boy complains of several episodes of collapse. He describes the majority of these episodes occurring when he is laughing. He states that he loses power in his legs and falls to the ground. He is alert throughout and recovers quickly. He also describes excessive daytime sleepiness with episodes in the morning of being awake but being unable to move his body. Examination is unremarkable. A diagnosis of narcolepsy is made. Which of the following is the first line treatment for excessive daytime sleepiness?
Your Answer: Sertraline
Correct Answer: Modafinil
Explanation:Narcolepsy is a rare condition characterised by excessive daytime sleepiness, sleep paralysis, hypnagogic hallucinations, and cataplexy (sudden collapse triggered by emotion such as laughing or crying). There is no cure for narcolepsy. Treatment options include stimulants, such as methylphenidate (Ritalin) or modafinil (Provigil), antidepressants, such as fluoxetine (Prozac), citalopram (Celexa), paroxetine (Paxil), sertraline (Zoloft) and sodium oxybate (Xyrem). Modafinil has replaced methylphenidate and amphetamine as the first-line treatment of excessive daytime sleepiness (EDS).
-
This question is part of the following fields:
- Neurology
-
-
Question 7
Correct
-
A 10-year-old gentleman is referred with a six month history of daily headache, which is mostly frontal in location and occasionally associated with nausea.He has been taking paracetamol 3 g daily, aspirin 300 mg thrice daily, and codeine 40 mg thrice daily, all of which have had only a temporary effect. He has a two year history of depression treated with paroxetine. No abnormalities were found on examination.What is the most likely diagnosis?
Your Answer: Analgesic misuse headache
Explanation:Because of the patient’s history of chronic analgesic use of daily paracetamol intake, the most likely diagnosis of this case is Analgesic misuse headache. In these cases, the headache is only temporarily relieved by analgesics. Treatment involves gradual withdrawal of analgesics.
-
This question is part of the following fields:
- Neurology
-
-
Question 8
Correct
-
A 7-year-old boy was brought to the ED in an unconscious and apnoeic state. What is your immediate management of this case?
Your Answer: Secure airway
Explanation:ABC : Airway, breathing, circulation is the order of assessment in any patient that is unconscious and apnoeic.
-
This question is part of the following fields:
- Neurology
-
-
Question 9
Correct
-
A 14 year-old is brought to the ED after being hit on the head with a cricket ball during a match. His teacher describes that he initially collapsed on the ground and complained of a sore head. Two minutes later, he got up and said he felt OK and continued playing. However, 30 minutes later he suddenly collapsed and lost consciousness. What injury is he most likely to have sustained?
Your Answer: Extradural haematoma
Explanation:A lucid interval, in which the patient portrays a temporary improvement in condition after a traumatic brain injury, is especially indicative of an epidural haematoma.
-
This question is part of the following fields:
- Neurology
-
-
Question 10
Incorrect
-
A 12 year old female presents at her local emergency room with a complete loss of consciousness, intercostal retractions, no residual signs and no post-ictal phase. She later went on to have a full recovery. From the list of options, choose the most probable diagnosis.
Your Answer: Febrile convulsion
Correct Answer: Partial generalized seizure
Explanation:The symptoms of a partial generalized seizure are consistent with this patient.
-
This question is part of the following fields:
- Neurology
-
SESSION STATS - PERFORMANCE PER SPECIALTY
