MOTOR DISEASES
1) About 12 days after a mild upper respiratory tract infection, a 12 year old boy complains of weakness in his lower extremities. Over several days, the weakness progress to include hid hand. On examination he has the weakness described and no lower extremity deep tendon reflex, muscular atrophy or pain. Spinal fluid studies are notable for elevated protein only. likely diagnosis would be
A. Bell palsy
B. Muscular dystrophy
C. Guillen barre syndrome
D. Charcot marie tooth disease
E. Werdnig Hoffman disease
2) 5 year old boy presented with progressive lower limb weakness for 3 days. one week after starting school. an examination lower limb power G 2. leg reflex absent. no bladder symptoms. indication for viral isolation.
a. to identify surveillance
b. possible diagnosis of polio
c. to exclude the polio
d. to identify the immunization problem
3) Regarding Guillain Barre Syndrome
a) CSF protein characteristically reduces in amount with progression of diseases
b) It is an illness ascending asymmetrical type of muscle weakness
c) This is An autosomal recessive condition
d) There is no change in bowel or bladder function
e) Immunoglobin infusion is preferable to plasma exchange
4) 5 year old child with TOF presented with progressive right side hemiparesis after diarrhea. Most likely diagnosis?
a) Left middle cerebral artery thrombosis
b) Left middle cerebral artery embolism
c) Left middle cerebral artery septic emboli
d) Left cerebral abscess
e) Left cerebral hemispheric infraction
5) A grade 1 student present with bilateral lower limb flaccid paralysis, areflexia and no bladder involvement 1 week after school admission. What is the most appropriate reason for you to send his stool samples for polio virology?
a) To confirm case of polio
b) To exclude cases of polio
c) To detect vaccine derived poliomyelitis following school admission
d) To follow polio surveillance guidelines
e) To make measures to prevent spreads of polio to other students
6) About 12 days after a mild upper respiratory tract infection, a 12 year old young boy complains of weakness of his lower extremities. Over several days the weakness progress to include his trunk. On the examination, he has the weakness described and no lower extremity deep tendon reflexes, muscular atrophy or pain. Spinal fluid studies are notable for elevated protein only. The most likely diagnosis would be,
a) Bell’s palsy
b) Muscular dystrophy
c) Guillen barre syndrome
d) Charcot maries tooth disease
e) Werdnig Hoffman disease
7) Guillain- Barre syndrome
a. Is associated with asymmetrical flaccid paralysis
b. Is an ascending paralysis
c. Is associated with sensory deficits
d. Is treated with immunoglobulins
e. Leads to permanent brain damage
CNS INFECTIONS
1)18 month old child presented with a 6 days history of fever, vomiting, irritability and dry cough. She was treated with oral antibiotics by several practitioners prior to admission. Result of CSF analysis: Appearance-colourless, protein-80mg/di, sugar 40mg/dl, cells:Neutrophil-25, lymphocyte-40, RBS-100. Basic investigation to identify underlying causative organism,
a. Bacterial antigen test in CSF
b. Blood culture and ABST
c. CSF culture and ABST
d. CSF direct smear and gram stain
e. CSF direct smear and Zilch-Nelson stain
2).months old boy having a dry cough presented with fever and drowsiness. He was previously treated by a GP with oral antibiotics. CSF full report; colourless, glucose 40mg/dl, protein elevated, lymphocytes- 60%, polymorphs-high, RBS-100mg/dl.
What is the best investigation to diagnose?
a) Detection of bacterial antigens in CSF
b) Blood culture and ABST
c) CSF for culture and ABST
d) CSF for gram stain
e) CSF for Zeil-Neilson stain
3) CSF analysis?
a. Increased polymorpho nuclear leucolytes in bacterial meningitis
b. Decreased sugar in tuberculosis meningitis
c. Protein increased in viral infection
d. Lymphocytes predominant in TB meningitis
e. Mycobacterium on gram stain
4). 1 year old girl presented with left sided weakness and dilated left pupil while treating for meningitis. Lumbar puncture: appearance turbid, lymphocyte 75, neutropil 5, protein 3000[15-40), glucose 3 mmol, gram stain organism, culture- no growth, ESR-120, imaging revealed calcified region in the right cerebral cortex. Which of the following is the likely dx?
a. Viral encephalitis
b. SSPE
c. meningitis with abscess
d. Bacterial encephalitis
e. Aseptic meningitis
5) In a suspected case of Meningitis
a. Treatment should be with held to confirm the diagnosis
b. LP is done without local anesthesia If the child not responding pain
C Delay until the FBC report is available
d. Presence of lung signs makes diagnosis unlikely
e. Immunization history is of no value
6) Regarding clinical presentation of meningitis?
a) Neck stiffness is more useful sign in 1 year old child with meningitis.
b) Seizures occur in 50% of patients.
c) Fever is not always present at presentation in acute bacterial meningitis.
d) Bulging or tense anterior fontanella is a useful sign in young infants.
e) Papilloedema is rare in acute uncomplicated bacterial meningitis.
7) A nine year old boy was admitted to the paediatric ward with tingling sensation of both lower limbs for 2 days duration.On the day of admission, he had a fall while climbing stairs. On examination, lower limb power was grade 3. Few hours later he complained of difficulty in breathing What is the most likely etiological agent for this child's problem?
a) Polio virus
b) Clostidium botulinum
8). Regarding management of CNS infection in children
a.) Gp-B Streptococcal infection treated for 21 days of antibiotics
b). Close contact of Meningococcal meningitis should receive prophylaxis
c.)Multiple cranial nerve involvement is seen in TB meningitis
d.) Herpes virus infection leads to temporal sclerosis
e.)HSV encephalitis should need Hearing assessment
9) A 3 month old baby with bacterial meningitis is on IV cefotaxime. In spite of the above treatment she continued to have fever spikes and looked unwell. What is the most appropriate next step in the management at this stage?
a) Change the antibiotics to a higher spectrum
b) Request a repeat CRP and FBC
c) Request an USS brain
d) Refer for neurosurgical opinion
10) Regarding management of CNS infection in children
a). Gp-B Streptococcal infection treated for 21 days of antibiotics
b.) Close contact of Meningococcal meningitis should receive prophylaxis
c)Multiple cranial nerve involvement is seen in TB meningitis
d). Herpes virus infection leads to temporal sclerosis
e). HSV encephalitis should need Hecring assessment
11) Which of the following can occur as the complication of Bacterial meningitis?
a) Waterhouse-Friderichsen syndrome.
b) Cerebral abscess.
c) Necrotizing enterocolitis.
d) Purpurafulminans.
e) Spinal muscular dystrophy.
12)Prophylactic antibiotics are indicated for close contacts of a patient with meningitis when the aetiological agent is
a) Streptococcus pneumoniae
b) GBS
c) H.influenza type b
d) E.coli
e) Neisseria meningitidis
13) Niesseria meningitidis
a) Is a gram negative cocci
b) well sensitive to macroiides
c) is a common cause of aseptic meningitis
d) commonest cause for pre school age meningitis
e) can cause severe respiratory distress
14). 10 year old girl presented with left sided weakness and dilated left pupil while treating for meningitis. lumbar puncture- appearance turbid, lymphocyte 75, neutrophil 5, Pr 3000 (15-40), glucose 3 mmoles , gram stain no Organism, culture-no Growth. ESR- 120. imaging study revealed calcified lesion in the right cerebral cortex. WOF is the likely diagnosis
a) viral encephalitis
b) SSPE
c) bacterial meningitis with Abscess
d) herpetic encephalitis
e) TB meningitis
15) 18 month old boy having a dry cough presented with fever and drowsiness. he was previously treated by GP with oral antibiotics. CSF full report; colorless, glucose 40 mg/dL, protein- elevated, lymphocytes60%, RBS- 100 mg/dL.
What is the best investigation to diagnose?
a) Detection of bacterial antigens in CSF
b) blood culture an ABST
c) CSF for culture and ABST
d) CSF for gram stain
e) CSF 4 Zeil- Neilson stain
16) Regarding rabies
a) Domestic rat have been implicated in the transmission of rabies
b) Rabies virus will penetrate the intact mucus membrane
c) Vaccination give 100% sero-conversion
d) Sensitivity test should be done before giving human rabies immunoglobulin
e) If patient develops reaction to rabies immunoglobulin should not give IV hydrocortisone
17) Clinical features more favors of herpes simplex encephalitis:
a) Involve frontal and temporal lobe
b) Focal convulsion
c) Focal change in EEG
d) Presence of RBC in non traumatic CSF
e) Increased C reactive protein
UNCONSCIOUS PATIENT
1) A 3 year old girl is presented with a sudden onset LOC. she's having multiple bruises over the trunk, what is the next step in the Mx?
a) Urgent CT brain
b) skeletal survey
c) Judicial medical referral
d) start head injury observation
e) order and EEG
2) A 2 year old child admitted because of weakness proceeding to coma. According to the parents, he had been well until several hours prior to admission, when they noted diarrhoea, cough, wheezing and sweating. Physical examination reveals a comatose child with diffuse weakness. Pupils are pinpoint and unresponsive. Examination of the chest reveals generalized wheezing. Oral secretions are copious. Which of the following should you administer at this time
a) Adrenaline
b) Atropine
c) Cefotaxime
d) Methylprednisolone
e) Edrophonium
CEREBELLAR DISEASE
1) 4 year old girl presented with torticollis and ataxia for 3 weeks. On examination she is irritable, head deviation, ataxia, past pointing, dysdiadokokinaesia. Bp 120/80, pr 60, what is the diagnosis?
a) Transverse myelitis
b) Meduloblastoma
c) Fedrich ataxia
d) Dystonic reaction to drug
e) Viral encephalitis
SEIZURE
1) A 2 week old baby born by Em LSCS presented to the hospital with 2 episodes of seizures and feeding also not well for 12 hours duration. Baby is drowsy. Temperature 35.5°C Blood glucose – 40mg/dl S.calcium – 8.2mg/dl(NL 8.2-10.9) S.Na+ - 132mmol/l(NL 130-142) S.K+ - 4.3mmol/l(NL 3.2-5.2) What is the most likely diagnosis?
a) Hypoglycaemia
b) Meningitis
c) Hypocalcaemia
d) Hyponatremia
e) Hypoxic ischemic encephalopathy
2) A eight month old child was seen with inconsolable cry and one episode of seizure and feeding febrile and recent scar was noted on his anterior chest. Further examination revealed, full fontanelle and reduced movements in right upper limb. Above findings are more consistent with,
a) Acute pyogenic meningitis
b) Viral encephalitis
c) Non accidental injury
d) Space occupying lesion
e) Cerebral oedema
3). Regarding simple febrile convulsions
a) Occur after the 1st 48 hours of the illness
b) Long term anti-epileptics are indicated
c) Can cause status epilepticus
d) Requires neuro imaging
e) Contraindication for DPT vaccination
4). Febrile fits
a. Fit with low grades of fever indicate higher risk of recurrence
b. Fits lasting more than 30 minutes should be treated with IV antibiotics
c. Fits within few hours of fever should be evaluate for meningitis
d. Risk of neurological impact can be reduces by AED
e. Are common among children with neurological impairment
5). An 18 month old child presents to the emergency centre having had a brief, generalized tonic clonic seizure. He is now postictal and has a temperature of 40C. during the lumbar puncture (which proves to be normal) he has a large watery stool that has both blood and mucous in it. The most likely diagnosis in this patient is
a. salmonella
b. enterovirus
c. Rotavirus
d. campylobacter
e. Shigella
6). A 2 year old child presents with fever and one episode of generalized tonic clonic seizure of 5 minutes duration. Most appropriate management ache. time of discharge is.
a) Start sodium valproate from next seizure
b)Reassure
c) Inform mother about the increased risk of developing epilepsy
7) Features to differentiate pseudo seizures from epileptic seizures
a.gradual onset
b. pelvic thrusting
c. cyanosis
d. body roling
e. tongue biting
8) Epilepsy
a) Recurrent uncontrolled discharge of electrical activities should result in motor manifestations.
b) Should be treated with AED
c) Hypocalcaemia may be the cause
d) Schooling should be avoided
e) May develop fits with fever
9) In the management of tonic convulsions (status epilepticus)
a) Measuring blood glucose is not important
b) Diazepam IV can be given
c) If not responding for first bolus of diazepam phenytoin IV should be given
d) Defined as seizure lasting more than 30 mins
e) Paraldehyde is given IM
10) Correctly matched pair
a) Absence seizure – sodium valproate
b) Infantile spasms – prednisolone
c) Myotonic seizure – phenobarbitone
d) Status epilepticus – phenytoin
e) Temporal lobe epilepsy – ethosuximide
11) Following are commonly matched
a) Déjà vu – temporal lobe epilepsy
b) Night terrors – petite mal
c) Vacant episodes – abscense seizures
d) Aura of fear – benign rolandic epilepsy
e) Development regression – west syndrome
12) A 4 year old girl presented with a GTC convulsion. She had abdominal pain and watery stools with mucus for 3 days. She has not passed urine for 12 hours. Tempersture was 37.20C, WBC – 30000/mm3 ( N – 82% , L – 18% , platelets – 110,000/mm3 ). What feature in the blood picture will confirm the diagnose?
a) Burr cells with acanthocytes
b) Heinzbodies with polychromasia
c) Marked anisopoikilocytosis
