Past Papers PDF - Neurological Exam Questions

### **Question 1** A 5-day-old term neonate is admitted to the NICU for suspected seizures. The events involve repetitive facial twitching and jerking of the right arm, lasting 20--30 seconds. The neonate remains unresponsive during these episodes. Birth history is significant for meconium-stained...

### **Question 1** A 5-day-old term neonate is admitted to the NICU for suspected seizures. The events involve repetitive facial twitching and jerking of the right arm, lasting 20--30 seconds. The neonate remains unresponsive during these episodes. Birth history is significant for meconium-stained amniotic fluid but no perinatal complications.\ MRI brain reveals restricted diffusion in the left middle cerebral artery territory.\ Amplitude-integrated EEG (aEEG) shows a discontinuous background with periodic bursts of high-amplitude sharp waves. Conventional EEG confirms left hemispheric focal sharp waves. What is the most likely diagnosis and management? **A.** Neonatal stroke with focal seizures, start anti-seizure medication\ **B.** Hypoxic-ischemic encephalopathy, initiate therapeutic hypothermia\ **C.** Neonatal myoclonus, reassure and monitor\ **D.** Pyridoxine-dependent epilepsy, trial of pyridoxine\ **E.** Benign neonatal seizures, observe without treatment **Answer:** A. Neonatal stroke with focal seizures, start anti-seizure medication ### **Question 2** A 6-month-old infant presents with clusters of flexion of the neck, arms, and legs, each lasting 1--2 seconds and occurring in series after waking. The parents report the child has developmental regression, with loss of previously acquired motor milestones. MRI brain reveals diffuse cortical atrophy.\ EEG shows high-voltage, disorganized background activity with multifocal spikes and hypsarrhythmia during sleep. What is the most likely diagnosis and treatment? **A.** Infantile spasms, start adrenocorticotropic hormone (ACTH)\ **B.** Lennox-Gastaut syndrome, initiate valproate\ **C.** Benign myoclonic epilepsy, start ethosuximide\ **D.** West syndrome, start ketogenic diet\ **E.** Neonatal seizures, start phenobarbital **Answer:** A. Infantile spasms, start adrenocorticotropic hormone (ACTH) ### **Question 3** A 10-year-old boy presents with recurrent episodes of loss of awareness lasting 10--15 seconds. During these episodes, he is noted to stare blankly, blink repetitively, and stop speaking mid-sentence. These episodes occur multiple times daily, often triggered by hyperventilation. Neurological examination is normal.\ EEG reveals generalized 3 Hz spike-and-wave discharges that are time-locked to the events. What is the most likely diagnosis and first-line treatment? **A.** Childhood absence epilepsy, start ethosuximide\ **B.** Juvenile myoclonic epilepsy, start valproate\ **C.** Frontal lobe epilepsy, initiate carbamazepine\ **D.** Psychogenic non-epileptic events, refer to psychotherapy\ **E.** Lennox-Gastaut syndrome, start lamotrigine **Answer:** A. Childhood absence epilepsy, start ethosuximide ### **Question 4** A 2-week-old neonate presents with tonic posturing of the right arm and left leg, lasting 30--60 seconds. These occur multiple times daily. The neonate was born at 39 weeks via uncomplicated delivery. MRI brain is normal.\ EEG shows multifocal sharp waves, predominantly over the central and temporal regions, without any ictal pattern. Genetic testing reveals a KCNQ2 mutation. What is the most likely diagnosis and management? **A.** Benign familial neonatal epilepsy, start anti-seizure medication\ **B.** Pyridoxine-dependent epilepsy, trial of pyridoxine\ **C.** Early myoclonic encephalopathy, initiate ketogenic diet\ **D.** Neonatal stroke, initiate anti-seizure medication\ **E.** Ohtahara syndrome, consider epilepsy surgery **Answer:** A. Benign familial neonatal epilepsy, start anti-seizure medication ### ### ### ### **Question 5** A 14-year-old boy with developmental delay and a history of epilepsy presents with frequent drop attacks. He often has tonic seizures at night, lasting 10--15 seconds, with associated cyanosis. MRI shows diffuse cortical dysplasia.\ EEG reveals a slow, disorganized background with frequent generalized slow spike-and-wave discharges during wakefulness and bursts of fast activity during sleep. What is the most likely diagnosis and treatment approach? **A.** Lennox-Gastaut syndrome, start valproate\ **B.** Dravet syndrome, initiate stiripentol\ **C.** Infantile spasms, initiate ACTH\ **D.** Landau-Kleffner syndrome, start high-dose steroids\ **E.** Absence epilepsy, start ethosuximide **Answer:** A. Lennox-Gastaut syndrome, start valproate ### Question 1: A 65-year-old male experienced a witnessed cardiac arrest and was resuscitated after 20 minutes of CPR. He underwent therapeutic hypothermia for 48 hours and is now on day 3 post-ROSC. He remains comatose with no sedatives administered since day 2. EEG during hypothermia showed a burst-suppression pattern. On day 3, during normothermia, EEG now shows generalized periodic discharges (GPDs) at 1 Hz.\ Which of the following is the most accurate prognostic conclusion?\ A. Prognosis is poor due to GPDs in normothermia.\ B. GPDs suggest moderate injury but can improve with rehabilitation.\ C. Burst suppression transitioning to GPDs indicates a favorable prognosis.\ D. EEG findings alone are insufficient for prognosis; multimodal assessment is needed.\ E. GPDs with burst-suppression are strongly correlated with brainstem function recovery. **Answer:** D ### Question 2: A 52-year-old woman who suffered cardiac arrest was treated with hypothermia for 48 hours. On day 3, EEG shows diffuse suppression (\