Neurology – Set 3

What this deck covers

Neurology – Set 3 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 paediatric board, MRCPCH and licensing examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 50 cases, in order

1. A headache that has changed
2. Band-like pain for a year
3. Infant eyes fixed downwards
4. Worse after hours of DKA treatment
5. Recurrent throbbing attacks at 13
6. Warning signs taught to parents
7. Fall from height, GCS 7 on arrival
8. A big head at 2 and what does not fit
9. Whooshing in the ears with headache
10. The usual kind at her age
11. Episodic tummy pain with pallor
12. Fever, pallor and cola-coloured urine
13. One pupil changes after head trauma
14. Head climbing the centiles at 5 months
15. Painkiller taken too late
16. New squint with headache
17. Before the needle after a seizure
18. Daily headache on daily analgesia
19. Cystic fourth ventricle on imaging
20. Slow pulse after a cycling crash
21. Parents request a scan
22. Fever 6 weeks after a shunt
23. Red flags on examination
24. Big head tracking the top centile
25. Zigzag lights before attacks
26. Headache 6 hours into DKA care
27. Swollen discs with a normal scan
28. Postural headaches at 7 years
29. What the tummy attacks become
30. Fast pulse and low BP after a fall
31. Enlarging head with adducted thumbs
32. Early analgesia no longer enough
33. Bedside care for a swollen brain
34. Clumsy left hand with headaches
35. Risks of a shunt to the heart
36. Head still growing after the scan
37. Unresponsive with rigid limbs
38. Daily headache with dimming vision
39. Second look at the fundi
40. Six disabling attacks a month
41. Big head with normal milestones
42. Slow pulse, high BP, pauses
43. Weakness before headache in a family
44. Shift and effaced cisterns on CT
45. Parents ask about her future
46. One-sided weakness then headache
47. Which change in a big head matters
48. Same organism in two cultures
49. What to watch as headaches ease
50. Lost words and a large head at 2

Diagnoses and management options tested

Across the fifty cases you are asked to choose between options such as: Pain sitting across his forehead, Tremor, sweating, tachycardia and sudden hunger, Oxygen by mask and an urgent CT of the head first, Left Horner syndrome; CT angiography of the neck, Compression of the right third nerve by the uncus, Posterior fossa arachnoid cyst, Haemophilus influenzae type b, Transient visual obscurations, Idiopathic intracranial hypertension, All four ventricles large, with wide sulci, Headache diary and clinic review in 6 weeks, A generalised tonic seizure, Propranolol, Autosomal dominant.

Clinical pearls from this deck

• A headache that wakes the child, worsens lying down or on coughing and brings morning vomiting is raised pressure until imaging proves otherwise.
• Band-like, bilateral, mild, activity continues, no vomiting: tension-type.
• Setting sun means an upward gaze palsy, and that means a dorsal midbrain under pressure.
• Raised pressure slows the heart; a racing heart points elsewhere.
• In children, migraine pain is often bilateral and frontotemporal, and attacks can be as short as 2 hours.
• Headache, vomiting and drowsiness in a shunted child mean a blocked shunt until proved otherwise.

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.