Neurology — Prometric Style Questions, Set 2

What this deck covers

Neurology – Prometric Style Questions, Set 2 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. The bath that set it off
2. Falls, stiffening and a slow trace
3. Words that went away
4. Sick in the night, three times
5. When more tablets stop helping
6. Choosing for the next ten years
7. Worse since the tablets started
8. A rash ten days in
9. Free of fits, but not himself
10. Two good years, now what
11. Swollen discs, normal scan
12. Tablets on most days
13. Discs that only look full
14. A band across the forehead
15. Worst in under a minute
16. The handshake that told you
17. Tripping, and his father too
18. Too weak to lift her head
19. Enzymes from the wrong organ
20. Treating a baby who looks well
21. Movements that stop at play
22. Eyes that will not settle
23. Turning her head to look
24. Eyes up, and still talking
25. Attacks that start with standing
26. One crop of white matter spots
27. Old numbness, new blurring
28. Both eyes, over three days
29. A long lesion in the cord
30. Psychiatric until she seized
31. Measles, eleven years on
32. Failing at school and tanned
33. Hands that stopped working
34. Strokes that keep resolving
35. Going blind and losing skills
36. Three big, one normal
37. The tap that must wait
38. A cyst where the vermis should be
39. Fever three weeks after surgery
40. A big head that stays big
41. Sudden and unchanging
42. Pressure after an ear infection
43. Weak after the candles
44. Blood in a well child
45. Well between the seizures
46. A clean trace, two real fits
47. Which scan for a wobble
48. Weak legs, normal enzyme
49. Answering the parents’ question
50. Before the examination begins

Diagnoses and management options tested

Across the fifty cases you are asked to choose between options such as: Sodium valproate, Cyclical vomiting syndrome of childhood, Carbamazepine aggravates generalised seizure types, The drug may be stopped abruptly now that he is well, Immediate lumbar puncture to measure the pressure, Spinal muscular atrophy of infantile onset, As released from muscle rather than from the liver, A posterior fossa tumour compressing the cerebellum, Paroxysmal kinesigenic dyskinesia, MOG antibodies in the blood, Juvenile myoclonic epilepsy of late onset, A mitochondrial disorder inherited from his mother, Give antibiotics now and defer the lumbar puncture, Urgent neurosurgical referral for a shunt.

Clinical pearls from this deck

• Ask about the bath. A seizure provoked by warm water, not by illness, points at temperature itself and names the syndrome.
• The tonic seizure in sleep is the one that separates this from every other epilepsy with drop attacks, and it is the one families never mention unaided.
• A child who seems deaf with normal hearing tests has a cortex that cannot decode sound. Record the sleep trace before anything else.
• Vomiting can be the whole seizure. Ask where the eyes were pointing, and the gastroenteritis diagnosis falls apart.
• Two failed drugs is the referral point, not ten. The years spent on drugs four to eight are years of seizures nobody gets back.
• The question is never whether she could be pregnant now. It is whether she could ever be, and at fourteen the answer decides the prescription.

Work through the deck once for recognition, then again a week later to test yourself — each question gives the answer and explains why every other option fails.

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