Neurology Prometric Style Questions – 50 Cases with Answers

What this deck covers

Neurology – Prometric Style Questions, Set 1 in 50 board-style clinical cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong, with the guideline or textbook it follows named on the answer.

Board-style teaching questions for paediatricians and trainees preparing for board, MRCPCH and Prometric examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 50 cases, in order

1. A year of throbbing headaches
2. Headaches that wake him at dawn
3. A second seizure four weeks on
4. One hand jerking, fully aware
5. A stain on the forehead and lid
6. Weak legs and a sensory level
7. Cried, went blue, then floppy
8. Unsteady two weeks after chickenpox
9. Weak legs with no reflexes
10. Where most epilepsy comes from
11. Floppy, but bright eyed
12. Still fitting after two doses
13. Clusters of spasms on waking
14. Stiff legs, capable hands
15. Four migraines every month
16. Ash leaves and a heart tumour
17. A hand that will not keep still
18. Worse by evening, normal by morning
19. Climbing up his own legs
20. Vomiting, no history, old blood
21. Staring, many times a day
22. A face that woke up crooked
23. Screams when she is picked up
24. Three minutes with a fever
25. Sudden weakness at school
26. Four minutes and no cannula
27. A rash that is spreading as you watch
28. A long narrow head at four months
29. An arm that will not lift
30. The worst seizure to see in a newborn
31. Stridor in a baby with spina bifida
32. What to escalate after a head injury
33. Twitching mouth on falling asleep
34. Dropping the spoon at breakfast
35. Brown patches and freckled armpits
36. Headache in a child with a shunt
37. Planning the next pregnancy
38. Talked for an hour, then faded
39. Lids that droop by evening
40. A midline lump at the back of the head
41. The jerking stopped, but did the seizures
42. Fitting after a day of vomiting
43. Getting ready for the recording
44. Six weeks of a tilted head
45. Weak on one side after the fit
46. Preventing the next stroke
47. Handwriting that fell apart
48. Asking about the next baby
49. Skills that went backwards
50. Thirty five minutes and still fitting

Diagnoses and management options tested

Across the fifty cases you are asked to choose between options such as: Migraine without aura, Sodium valproate, Start sodium valproate at a prophylactic dose, Cryptogenic, with no identifiable cause, Vigabatrin, Neurofibromatosis type 1, Electromyography, An acute ischaemic stroke, Acute arterial ischaemic stroke, Coronal suture, Dandy-Walker malformation, Self-limited epilepsy with centrotemporal spikes, 5 mg daily, from before conception until 12 weeks, Cephalohaematoma.

Clinical pearls from this deck

• It is what happens BETWEEN the headaches that matters most; a child who is entirely normal in between rarely has anything sinister.
• A headache that wakes a child, and vomiting that relieves it, are the two red flags that should never be explained away.
• You diagnose epilepsy at the bedside and classify it with the electroencephalogram; the machine never makes the diagnosis for you.
• Classify before you prescribe: the drug that controls a focal seizure can make an absence epilepsy considerably worse.
• A port wine stain on the eyelid buys the child a lifetime of eye pressure checks; the glaucoma is silent until sight is lost.
• A sensory level is a spinal emergency; image the cord the same day, because compression and inflammation look identical at the bedside.

This deck is open to everyone with no sign-in. Work through it once for recognition, then again a week later to test yourself.

More from this system: all neurology case decks · pediatric reference values.