Coma, Encephalopathy and Cranial Nerve Palsies — Board-Style Questions

What this deck covers

Coma, Encephalopathy and Cranial Nerve Palsies in 18 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 paediatric board, MRCPCH and licensing examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 18 cases, in order

1. A bottle on the floor
2. One hour, and worse each minute
3. Two hours and no explanation
4. Different from this morning
5. Only when the nail bed is pressed
6. Before the syringe goes in
7. Worse with every viral illness
8. She cannot see, but her pupils work
9. The whole family at once
10. Four days after the drowning
11. Drooping since she woke
12. Eighteen hours in
13. Seven weeks of getting worse
14. The ear hurt first
15. Noticed this morning
16. Clearer when the lights go down
17. Trouble on the stairs
18. After an argument at school

Diagnoses and management options tested

Across the 18 cases you are asked to choose between options such as: Posterior reversible encephalopathy syndrome, Viral gastroenteritis affecting the whole household, A lesion of the trigeminal nerve, A microvascular cause, Myasthenia gravis of the ocular type.

Clinical pearls from this deck

• Three findings and one drug. Coma, tiny pupils, slow breathing means naloxone before anything else.
• Parasympathetic fibres ride on the outside of the third nerve. That is why the pupil warns you first.
• The pupils are the most robust sign in the head. If they still work, think chemistry before structure.
• Watch the arms. Flexing in is higher, extending out is lower, and the direction of travel is the prognosis.
• P on the quick scale is eight on the long one, and eight is the number that means intubate.
• Thirty seconds of documentation before the syringe. Nobody can recreate that examination afterwards.

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.