Neurology – Set 4

What this deck covers

Neurology – Set 4 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. Toddler who will not wake in his cot
2. Cyst and calcium above the sella
3. Playground fall, brief sleepiness
4. Leg moves when the sole is stroked
5. Changing headache, now clumsy
6. Bruised infant and bone imaging
7. Stair fall, then sleepy
8. Foreseeing a first stroke in HbSS
9. Sudden left weakness in sickle cell
10. Weak legs, no fracture to show
11. Floppy infant after reported bed fall
12. What triggers a scan while watching
13. Cyclist struck by a car
14. Pontine lesion over three weeks
15. Weak hands, normal bone imaging
16. How far to trust the first scan
17. Girl bumping into door frames
18. Apnoea test abandoned halfway
19. Unrousable after a day of vomiting
20. Sickle cell infarct, first treatment
21. Sudden headache and limp right arm
22. Unexplained seizure at 3 months
23. Foggy and tired since a tackle
24. Hormones before tumour surgery
25. Batted on, then hard to rouse
26. Ventilator disconnected, valid result
27. Solid mass in the vermis
28. Quad bike crash with a score of 13
29. Day 3 after a riding accident
30. Coma score before she can talk
31. Bleed, bruises and normal clotting
32. Advice for the days after a head bump
33. Stopping another sickle cell stroke
34. Staging a midline fossa mass
35. Arm power falls again on day 2
36. How the other bleed would look
37. Polyuria hours after tumour surgery
38. Day-2 collapse born at 27 weeks
39. Limp and snoring beside a bottle
40. Bleed found, cause still unknown
41. Sofa slip, playing again
42. Twin carotid narrowing on angiogram
43. Pupil widening before transfer
44. A carer asks what lies ahead
45. Bleed in a healthy boy
46. The vessel behind a baby’s clot
47. Silent and floppy after surgery
48. Footballer asks about her next match
49. Weight gain after tumour surgery
50. Why the story is questioned closely

Diagnoses and management options tested

Across the fifty cases you are asked to choose between options such as: V on AVPU, near GCS 12, fit for ward observation, Flexor posturing, proving brainstem activity, Urgent non-contrast CT of the head, Unfused growth plates that hide fractures on CT, 9, so half-hourly GCS scoring is enough, Unreliable in the first 6 hours; do an LP instead, Urine screen for common drugs, Dilated retinal examination by an ophthalmologist, Extradural haematoma, CT head within 1 hour, Same-day safeguarding referral to social care, CT of chest, abdomen and pelvis with a bone scan, Fluid restriction to two-thirds maintenance, Lumbar puncture for xanthochromia.

Clinical pearls from this deck

• P on AVPU means a GCS near 8: think airway before anything else.
• Cyst plus calcification above the sella in a child is craniopharyngioma until proved otherwise.
• One risk factor, watch; two, scan.
• A cord that still works does not mean a brain that still works.
• A headache that changes to wake the child and brings morning vomiting is a tumour headache until imaging says otherwise.
• Some fractures only appear once they start to heal: repeat the survey.

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.