Neurology – Set 5

What this deck covers

Neurology – Set 5 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. Drowsy on day 2 of ear treatment
2. A teenager’s day before the rash
3. Fever, lost words and a focal fit
4. Drowsy, ataxic, retaining urine
5. Meningitis in the first month
6. Toddler falling after chickenpox
7. Focal seizure with a ring lesion
8. Febrile infant, reassured mother
9. Three weeks of fever, now unsteady
10. School decline, then head drops
11. When the spinal needle must wait
12. Mottled infant with spreading spots
13. Muddled after flu, scan arranged
14. Wobbly after a weekend away
15. Back from abroad, many past courses
16. Wrong words, right-sided twitching
17. How a vegetarian child caught it
18. A month of fever, now double vision
19. Naming the organism after antibiotics
20. Cloudy CSF, 3 hours into treatment
21. Spinal fluid in demyelination
22. Virus confirmed, how long to treat
23. Why the brain swells in meningitis
24. Irritable baby with new skin marks
25. Lymphocytes, low sugar, clear fluid
26. Unsteady after chickenpox, on watch
27. Agitated and mute a month later
28. Puffy eyelids on day 3 of treatment
29. One check before killing the parasite
30. Head drops years after measles
31. Catheterised, drowsy, MRI abnormal
32. Meningitis organisms and deafness risk
33. Two hours after resuscitation
34. An add-on once treatment has begun
35. Myoclonus, dementia and a spinal tap
36. Fever back on day 6, full fontanelle
37. Outlook for a wobbly gait
38. One cyst with a scolex on MRI
39. Negative result, signs unchanged
40. Ready for home after meningitis
41. Painful blurred eye months later
42. The family at home after a case
43. Regimen for TB in the meninges
44. Parents ask about the future
45. Before discharge, protecting home
46. Writhing toddler, virus now cleared
47. Six months on, stop the drug?
48. Classifying a second attack
49. A warning sign at ataxia review
50. Could it have been avoided?

Diagnoses and management options tested

Across the fifty cases you are asked to choose between options such as: CT scan of the head before any antibiotic is given, Herpes simplex virus encephalitis, Low-grade glioma, Juvenile neuronal ceroid lipofuscinosis, High T2 signal limited to the medial temporal lobes, Left medial temporal and insular T2 high signal, Meningococcal PCR on EDTA blood, 10 days, stopping once the fever settles, Acid-fast smear alone on a small sample, Isotonic fluid restricted below maintenance, Oral prednisolone 1 mg/kg for 5 days, IV immunoglobulin 2 g/kg over 2 days, Lasting unsteadiness in about half of children, Only if his parents notice a hearing problem.

Clinical pearls from this deck

• An infant with an ear infection who becomes drowsy on oral antibiotics has meningitis until a lumbar puncture says otherwise.
• Cold hands, leg pain and odd skin colour come before the rash.
• Fever with a change in behaviour or a focal seizure is herpes simplex encephalitis until proved otherwise: aciclovir comes first.
• Drowsiness plus signs in several places of the brain and cord, two weeks after a cold, is post-infectious demyelination until MRI says otherwise.
• In the newborn, meningitis looks like sepsis: if the baby is unwell, think lumbar puncture.
• Wobbly but bright, two weeks after chickenpox: that is the benign cerebellar story.

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.