Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
Pediatric Neurology OSCE (PG CME -Wadia)
1. NEUROLOGY
Post Graduate CME
OSCE - Neurology
Bai Jerbai Wadia Hospital for Chidren,
Mumbai
2. 1) 4 yrs old, boy , FTND, Normal motor,
mental and language milestones.
Complaints from school – aggressive,
cant sit in one place, restless,
forgetful and impatient, problems with
friends, fights
• Diagnosis?
• 3 cardinal features of this condition
• 2 treatment options
4. 2)This child has
epilepsy, MR, ataxia,
unprovoked
laughter, severe
speech delay
• Diagnosis?
• Chromosome involved
• Inheritance
• Name a syndrome with
the same
chromosomal
abnormality
6. 3) 2 yrs old child born prematurely [28wks]
comes with complaint of delayed
achievement of motor milestones.
Examination shows hypertonia with brisk
reflexes in all 4 limbs more marked in lower
limbs.
• What is the diagnosis? Define.
• What is the MRI picture?
• What is the treatment and when do you start it?
• Name 2 conditions this child will be at risk for?
7. • Spastic Diplegia. Increased tone in all 4
extremities and face. LL>UL> face
• Periventricular leukomalacia
• Early intervention
• Learning disabilities,
• Visual concerns
• Epilepsy
• Delayed mental development
• Behavior concerns
8. 4.A full term ,male child develops jaundice
on day 3 of life, (S. bilirubin –34 mg%)and
undergoes an exchange transfusion .
• What is the immediate complication likely to
occur?
• Where is the anatomical abnormality?
• What are the long term complications?
• Name 1 investigations you would insist on
after discharge?
10. 5. A child with apparently normal birth
history :MS- social smile at 3 mths,
Sitting at 8 months, rt hand
preference at 9 mths, walking
independently at 1.6 yrs.
• What is your diagnosis?
• What investigation will you do?
• What relevant maternal history will you
ask for?
14. • Ring enhancing lesion
• NCC, tuberculoma, toxoplasma,
• abscess, tumor
• Peripheral vs central
• single vs multiple
• perilesional edema
• smooth vs irregular
• Scolex seen
• Wall thickness
• Intensity of cystic material
15.
16. 7. Diagnosis
• Name 2 other skin lesions
• Inheritance
• Other systems you would examine
• Name 3 lesions seen in the brain
18. 8. This 5 yr old comes with unsteadiness of
gait with recurrent respiratory infections.
• Diagnose the condition
Inheritance
3 salient features
2 lab
investigations
19. • Ataxia Telangiectasia
• Autosomal recessive
• FEATURES: Ataxia, telangiectasia,
immunodeficiency, recurrent sinopulmonary
infections, X ray hypersensitivity, malignancies
• LAB: Alpha feto proteins, Immunoglobulins,(low
IgA, IgG, high IgM), chromosomal breaks with
exposure to radiation.
20. 9. 8 yr old boy with headache,
vomiting, ataxia, diplopia.
• Clinical diagnosis?
• MRI shows SOL
• .Name 2 supra and infra tentorial SOLs
• For this SOL what other abnormalities
will you expect
24. 11. Child with fever, headache ,
vomiting and altered sensorium.
• CSF picture :proteins 130,
sugar 40/90,
cells 240 P40 L 60
• Give 3 differentials
• Give 2 other investigations
• Treatment options
25. • Partially treated pyogenic meningitis,
early TBM, aseptic, viral meningitis
• Latex agglutination, HSV DNA PCR, CT
scan with contrast, EEG
• Antibiotics, acyclovir 10 mg/kg 8 hrly for
14 days, AKT, supportive
26. 12.Child with fever , convulsions,
altered sensorium
CSF picture : protein 62,
cells 95 P10 L90,
sugars 45/80,
RBCs 80/ hpf
• Additional 2 investigations of choice
• Treatment with dose
27. • EEG - PLEDS-periodic lateralizing
epileptiform discharges
• HSV PCR,( ? HSV IgG, IgM ), CT scan /
MRI with contrast – bi/ uni temporal
hyperintensities
• Acyclovir 10mg/kg/dose 8 hrly for 14 -21
days
28. 13)1.5 yrs old child with fever and
convulsions.
CSF picture : proteins 80,
sugar 20 /60,
cells 500 , P 90 L 10.
• Diagnose / 3 common organisms
• Child develops tense AF with focal
convulsions on day 8. Probable causes?
• 3 Long term sequelae
30. 14)11 months old comes with
neuroregression from 5 months of
age. He is hypotonic on examination.
• Name 3 systems you would like to
examine?
• Differentials
• Give 4 DDs of cherry red spots
• Investigation of choice
32. 15)18 months old child comes with
recurrent strokes , ptosis , ataxia and
myopathy.
• Diagnosis
• Investigation of choice
• Inheritance
• Name 2 more conditions of the same
metabolic category
33. • MELAS
• Mitochondrial deletion study
MRI with spectroscopy
CSF Lactate, Blood Lactate.
ABG-Anion Gap
Metabolic Screen
• Maternal transmission
• MERRFS, Kearn Sayers, Leighs, Alpers
34. 16) 6 months old female child, FTND,
has asymmetric infantile spasms,
developmental retardation and
choroidal lacunae. MRI clinches the
diagnosis.
• What is the diagnosis?
• What is the MRI picture?
• What is the inheritance pattern?
35. • Aicardi syndrome
• Corpus callosum agenesis
• Posterior choroidal cysts,
• choroidal lacunae
• X linked Dominant
36. 17) A boy presents with this skin
lesion-
Give 4 differential diagnosis
When and how much would you
investigate?
37. • Café au lait spot.
• DD- NF,Mc cune albright, TS, Ataxia
telangiectasia, Maffuci, any
phakcomatosis, Chediak Higashi
• If asymptomatic –No treatment
VEP-Periodic intervals if
abnormal do MRI for
optic glioma
• If symtomatic –VEP, MRI,
EEG
38. 18)
• Name the sign
• 3 DDs
• 3 investigations in
sequence of
importance
• Inheritance/ locus
39. • Gowers Sign
• Duchenne, SMA III, Limb girdle
dystrophy, BMD, myopathy
• Dystrophin gene study, EMG /NCV,
CPK levels
• X linked recessive/ Xp 21
40. • Diagnosis
19)
• 2 associated
abnormalities
• Classical CNS picture
in CT scan and is
described as
• Inheritance
42. • Identify
• 20) • 2 salient features
• Criteria for diagnosis
in newborn period
are called:
• Child develops
spastic
quadriparesis.What
will you suspect?
46. • This child came
• 23) with
neuroregression
from 7 months of
age with abn hand
movts
• Diagnosis / DD
• 3 salient features
• Which milestones
are delayed?
47. • Retts syndrome /
Autism
• Autism, stereotypies,
microcephaly, loss of
fine purposeful hand
movements
• Social, language
48. 24) 10 month old , male, presents with
progressive decreased activity since 3
months of age, breathing difficulty since
8 mths and pneumonia. Examination
shows alert child with hypotonia and
absent reflexes.
• What is the diagnosis ?
• How do you confirm?
• What is the inheritance?
• Name 3 antenatal / natal features to ask for?
50. 25) 3 yrs old girl comes with drooping of both
eyelids and squint noticed since 15 days.
Abnormality seems to increase in the
evenings.
• Diagnosis?
• Any 2 relevant questions?
• How do you confirm? Name 2 relevant
investigations.
• Drug of choice.
51. • Myasthenia gravis
• Any other activity tires with time eg.
Eating, walking, speech,
• Edrophonium test / Neostigmine test
• Anticholinesterase antibody, EMG with
repititive stimulation, CTScan chest
• Pyridostigmine
55. 1)4 Yrs old boy with normal motor and
mental development becomes aphasic for
last 15 days. He had a single GTC at 3.6
yrs.CNS examination is normal.
• Investigation of choice
• Diagnosis
• Treatment options
57. 2) 6 yrs old girl with delayed development.
Perinatal hypoglycemia. Symptomatic
infantile spasms at 7 mths. Then focal
seizures, generalised, myoclonic and now
tonic.
• Diagnosis?
• Drugs used?
• AEDs to be avoided?
• Non pharmacological treatment modalities
59. 3) 10 yrs old boy presents with lip smacking,
facial and eye deviation on left lasting 2
minutes after falling asleep. Similar
history 3 and 6 months back.
• Investigation of choice?
• Diagnosis?
• Which investigation you need not do?
• Prognosis?
• Drug of choice?
61. 4)4 days old newborn, FTND presents
with multiple multifocal seizures. He
has a normal systemic examination.
• DD- 3 most imp
• If strong family history of neonatal
seizures present, what will u think
63. 5) 6 yrs old boy comes with left sided
focal seizures preceded by aura of
fearfulness. He has history of
prolonged febrile seizures at 1 yr of
age. EEG shows right temporal
epileptiform activity.
• What MRI picture do you expect?
• Which virus has been suspected for the
same lesion?
• What are the treatment options?
66. 6) What does this EEG show?
• What is the drug of choice?
• Prognosis?
• One OPD procedure to confirm
diagnosis
67. • 3 Hz spike and wave activity in Absence
seizure – childhood /Juvenile
• Valproate, Lamotrigine, clobazam
• Good in childhood, slightly less for
juvenile
• Hyperventilation
76. 10) 6 months old child with h/o
perinatal insult comes with
regression of social milestones and
clusters of startles on awakening .
• Diagnosis
• Name 2 investigations you will ask for?
78. 11) SODIUM VALPROATE
• Each 5ml of syrup contains
• Commonest 3 side effects
• Contraindicated in
• Synergistic activity with
• Dosage range
• With Lamotrigine what precautions Are
needed?
79. • 200 mg, or 40 mg/ml
• Weight gain, hair loss, hepatotoxic,
PCOD, hirsutism, hyperammonemia
• Inherited Metabolic disorder, underlying
liver dysfunction
• Lamotrigine
• 10-40 mg/kg/day
• Cut the dose of VPA when adding LMT
80. 12) Topiramate
• 2 indications
• 2 side effects
• Contraindicated in
• Tablet strength? Syrup? Any other
preparation known?
88. 16) 3 months baby has intractable
epilepsy since birth and delayed
development
• Name 2 vitamins you can try
• Does not respond to them – what
investigation next