Neurology with Special Qualification in Child Neurology Exam Prep
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Free Child Neurology Practice Questions

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The Child Neurology exam has 400 questions and runs 7 hours 10 minutes.

These 10 free Child Neurology questions are organized by exam domain, so you can see how each part of the Neurology with Special Qualification in Child Neurology blueprint is tested. Reveal the answer and explanation under each question.

Domain 2: Epilepsy and episodic disorders (8-12%)

Question 1

A 7-month-old boy is brought in after two weeks of clusters of sudden symmetric flexion of the neck, trunk, and arms, occurring on awakening. His development has plateaued. Examination under a Wood lamp reveals three hypopigmented macules on the trunk, and echocardiography performed for a murmur showed a cardiac rhabdomyoma. EEG shows high-voltage chaotic slowing with multifocal independent spikes. Which is the most appropriate first-line treatment?

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Correct answer: B - Vigabatrin

Question 2

A 7-year-old girl has 20 to 30 daily episodes of brief staring with eyelid flutter, each lasting about 8 seconds with abrupt onset and offset and no postictal confusion. Three minutes of hyperventilation reproduces an episode. EEG shows generalized 3 Hz spike-and-wave discharges on a normal background. She has never had a convulsion. Which is the most appropriate initial medication?

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Correct answer: D - Ethosuximide

Domain 4: Genetic and developmental disorders (8-12%)

Question 3

A term male infant feeds well for 48 hours and then becomes progressively lethargic with tachypnea and poor feeding. Plasma ammonia is 780 micromol/L. Arterial blood gas shows pH 7.51 with pCO2 24 mm Hg. The serum anion gap is normal, urine ketones are negative, blood glucose is normal, and urine orotic acid is markedly elevated. Which is the most likely diagnosis?

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Correct answer: B - Ornithine transcarbamylase deficiency

Question 4

A 5-month-old infant has a capillary malformation involving the right forehead, upper eyelid, and nose, and has had two focal seizures with left arm clonic movements. MRI shows right hemispheric leptomeningeal enhancement. In addition to seizure management, which recurring evaluation is most important?

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Correct answer: D - Serial intraocular pressure measurement

Domain 6: Neuromuscular diseases (8-12%)

Question 5

A previously healthy 4-month-old infant has had three days of constipation followed by a weak cry, poor suck, bilateral ptosis, and generalized hypotonia with preserved alertness. The pupils are dilated and sluggishly reactive. Repetitive nerve stimulation at 50 Hz produces an incremental response. Which is the most appropriate treatment?

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Correct answer: A - Human-derived botulism immune globulin

Question 6

A term newborn has severe generalized hypotonia, facial diplegia with a tented upper lip, bilateral talipes equinovarus, and respiratory failure requiring intubation. The pregnancy was complicated by polyhydramnios and reduced fetal movement. Percussion of the infant's thenar eminence produces no sustained contraction. Which is the most useful immediate diagnostic step?

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Correct answer: C - Examination of the infant's mother for myotonia

Domain 7: Movement disorders (4-6%)

Question 7

A 6-year-old girl was diagnosed with spastic diplegic cerebral palsy at age 3. She was born at term after an uncomplicated pregnancy and delivery, and her milestones were normal until age 2. Her parents report that she walks almost normally in the morning but develops progressive toe-walking, leg stiffness, and falls by late afternoon. Examination shows lower limb dystonia and brisk reflexes without ataxia. Brain MRI is normal. Which is the most appropriate next step?

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Correct answer: A - Therapeutic trial of low-dose levodopa

Domain 9: Neuroinfectious diseases (7-9%)

Question 8

A 5-year-old girl presents with 24 hours of fever, confusion, and two focal seizures with right arm clonic activity. MRI shows left temporal and inferior frontal T2 hyperintensity with petechial hemorrhage. Lumbar puncture shows 85 lymphocytes/mm3, 40 red cells/mm3, protein 78 mg/dL, and normal glucose. Herpes simplex virus polymerase chain reaction is pending. Which is the most appropriate next step?

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Correct answer: A - Initiate high-dose intravenous acyclovir

Domain 17: Questions not associated with a specific neurologic disorder (4-6%)

Question 9

A 64-year-old man has acute onset of left arm and leg weakness. On examination, the right eye is deviated laterally and inferiorly with complete ptosis and a fixed dilated pupil. The left lower face is weak with sparing of the forehead. Sensation is intact. Where is the lesion most likely located?

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Correct answer: C - Right midbrain

Domain 18: Neuroimmunologic and paraneoplastic CNS disorders (1-3%)

Question 10

A 16-year-old girl is admitted with two weeks of insomnia, paranoia, and agitation, followed by focal seizures and, over the past three days, continuous orofacial dyskinesias with episodes of tachycardia alternating with bradycardia. Brain MRI is normal. Which investigation is most likely to establish the diagnosis?

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Correct answer: D - Cerebrospinal fluid NMDA receptor antibody testing

The rest of the Child Neurology blueprint

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