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NEURO-RHEUMA Flashcards

1
Q

The absolute indication of lumbar puncture is:
A. Seizure
B. Infection
C. Hemorrhage
D. Brain tumor

A

Infection

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2
Q

A 4-month-old girl presenting with status epilepticus at the emergency room was noted to have an occipital cephalohematoma on palpation of the head. What is the imaging modality of choice to evaluate for intracranial hemorrhage and to rule out a skull fracture?
A. Skull x-ray
B. Cranial ultrasound
C. Plain cranial CT scan
D. Cranial MRI

A

Plain cranial CT scan

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3
Q

Which is a contraindication to performing a lumbar tap?
A. Loss of brainstem reflexes
B. Thrombocytopenia of <50 x 109/L
C. Seizures and nuchal rigidity suggestive of CNS infection
D. Lack of a cranial CT scan to rule out a mass lesion of the brain prior to a lumbar tap

A

Loss of brainstem reflexes

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4
Q

Epilepsy is a paroxysmal brain disorder characterized by the following, except
A. Has a lifetime predisposition to generate seizures
B. Can lead to intellectual disability if left unrecognized or untreated
C. Etiology may be structural, metabolic, infectious, or unknown
D. Considered when there is at least 1 unprovoked seizure plus an associated neurodevelopmental abnormality

A

Considered when there is at least 1 unprovoked seizure plus an associated neurodevelopmental abnormality

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5
Q

In the evaluation of the first seizure, magnetic resonance imaging (MRI) should be seriously considered in all of the following conditions, except
A. Children <1-year old
B. Unexplained acute psychosis
C. Benign partial epilepsy of childhood
D. Electroencephalography showing secondary
generalized epilepsy

A

Electroencephalography showing secondary
generalized epilepsy

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6
Q

True regarding treatment of migraine headaches, except
A. IV prochlorperazine plus ketorolac has a better response rate of 93%
B. The most commonly used preventive therapy for migraine is amitriptyline
C. The most effective abortive treatment is to use NSAIDs first, limited to <2-3 attacks per month then adding triptan if nonresponsive to NSAIDs
D. IV prochlorperazine is very effective in aborting an attack in the emergency room with 75% improvement at 1 hour

A

The most effective abortive treatment is to use NSAIDs first, limited to <2-3 attacks per month then adding triptan if nonresponsive to NSAIDs

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7
Q

Which of the following statements is true regarding tuberous sclerosis complex (TSC)?
A. The hallmark of TSC is a cortical tuber best demonstrated in brain MRI
B. To count as a major feature, at least 3 hypermelanotic macules must be present
C. Spontaneous genetic mutations occur in majority of cases resulting to loss of tumour suppression
D. Brain MRI is recommended every 1-3 years for those with symptomatic subependymal giant cell astrocytomas (SEGA)

A

Brain MRI is recommended every 1-3 years for
those with symptomatic subependymal giant cell astrocytomas (SEGA) ??

The hallmark of TSC is a cortical tuber best demonstrated in brain MRI??

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8
Q

Cranial CT is a valuable diagnostic tool in the evaluation of the following conditions EXCEPT
A. acute infarcts
B. skull fractures
C. impending herniation
D. intracranial hemorrhages

A

acute infarcts

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9
Q

The following are indications for neuroimaging in a child with a headache EXCEPT
A. frontal headache
B. brief cough headache
C. abnormal neurologic examination
D. headache worst on first awakening

A

frontal headache

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10
Q

The main difference between simple febrile and complex febrile seizures is:
A. the gender of the patient
B. the temperature during the seizure
C. the length of time of the seizure episode
D. the number of seizure episodes in a 24-hour period

A

the length of time of the seizure episode

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11
Q

The following are TRUE about Absence seizures EXCEPT:
A. last for > 30 secs
B. common in >6 yrs old
C. not associated with postictal state
D. patients resume activity after a seizure

A

last for > 30 secs

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12
Q

Benign Rolandic Epilepsy or Benign Childhood Epilepsy shows the following characteristics EXCEPT:
A. seizures resolve y 16 years
B. it is a single nocturnal seizure
C. altered consciousness is common
D. postictal confusion and aura are rare

A

altered consciousness is common

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13
Q

One of the following statements are true for generalized-tonic seizures:
A. usually starts with sudden cry
B. post-ictal state is sudden drowsiness
C. tonic phase shows generalized contractions
D. clonic phase shows snapping of jaw with cyanosis

A

clonic phase shows snapping of jaw with cyanosis

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14
Q

The following are characteristics of West syndrome EXCEPT:
A. begins @ 4-8 mos
B. ECG shows hypsarrythmia
C. brief symmetric contractions of neck, trunk, extremities
D. loss of body tone and falling and slumping forward

A

loss of body tone and falling and slumping forward

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15
Q

The initial management of a febrile seizure in an emergency room setting is:
A. start IV fluids
B. securing the airway
C. give diazepam per rectum
D. give paracetamol per rectum

A

give diazepam per rectum

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16
Q

The initial management of a febrile seizure in an emergency room setting is:
give diazepam per rectum

——-

After the initial management, what will be your next step?
A. start IV fluids
B. securing the airway
C. give diazepam per rectum
D. give paracetamol per rectum

A

give paracetamol per rectum

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17
Q

The following are risk factors for recurrence of febrile seizures EXCEPT:
A. Fever is > 38C
B. less than 1 year old
C. duration of fever <24 hrs
D. family history of febrile seizure

A

family history of febrile seizure

PS: basin all are major except ang pasabot ni doc ani?

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18
Q

Severe myoclonic epilepsy of infancy is also known as:
A. West syndrome
B. Dravet syndrome
C. Ohtahara syndrome
D. Janz syndrome

A

Dravet syndrome

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19
Q

Guillain Barre Syndrome is an autoimmune disorder of postinfectious polyneuropathy involving mainly motor but also sensory and sometimes autonomic nerves. All the following are required in diagnosis ЕХСЕРТ
A. CSF study
B. muscle biopsy
C. electromyography
D. motor nerve conduction study

A

muscle biopsy

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20
Q

Of the following, the MOST recognized sign of impending respiratory failure in Guillain Barre Syndrome is:
A. dysphagia
B. tachypnea
C. altered sensorium
D. vasomotor instability

A

dysphagia

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21
Q

Juvenile myoclonic epilepsy is also known as:
A. West syndrome
B. Dravet syndrome
C. Ohtahara syndrome
D. Janz syndrome

A

Janz syndrome

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22
Q

Electroencephalogram (EEG) in febrile seizure is characterized by the following EXCEPT
A. an EEG need not normally be performed in first simple febrile seizure
B. spikes during drowsiness are often seen in children with febrile seizures
C. an abnormal EEG could predict the future recurrence of febrile seizures or epilepsy
D. an EEG performed within 2 wk of a febrile seizure often have nonspecific slowing

A

an abnormal EEG could predict the future recurrence of febrile seizures or epilepsy

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23
Q

Matching type.
A. Tuberous sclerosis
B. Neurofibromatosis

  1. Lisch nodules
  2. Mental retardation
  3. Cafe au Lait spots
  4. Ash leaf patch, shagreen patch
  5. Axillary freckling or inguinal freckling
A
  1. Lisch nodules — B. Neurofibromatosis
  2. Mental retardation — A. Tuberous sclerosis (both??)
  3. Cafe au Lait spots — B. Neurofibromatosis
  4. Ash leaf patch, shagreen patch — A. Tuberous sclerosis
  5. Axillary freckling or inguinal freckling — B. Neurofibromatosis
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24
Q

A previously normal, healthy 8-month-old female infant was brought to the ER due to a first febrile seizure. She was examined in active generalized tonic seizure for 3 minutes which was controlled with IV diazepam. She was febrile at 39.2 C that started 5 hours prior to ER consult. Review of the infant’s history revealed a strong family history of febrile seizures and a family history of epilepsy as well. The informant thinks she has completed all immunizations at the barangay local health center. Pertinent findings include lethargy, nuchal rigidity, & sluggishly reactive pupils.

——-

Which is a major risk factor for febrile seizure recurrence present in this case?
A. Female gender
B. Family history of epilepsy
C. Strong family history of febrile seizures
D. Fever starting 5 hours prior to seizure and ER
admission

A

Fever starting 5 hours prior to seizure and ER
admission

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25
Q

A previously normal, healthy 8-month-old female infant was brought to the ER due to a first febrile seizure. She was examined in active generalized tonic seizure for 3 minutes which was controlled with IV diazepam. She was febrile at 39.2 C that started 5 hours prior to ER consult. Review of the infant’s history revealed a strong family history of febrile seizures and a family history of epilepsy as well. The informant thinks she has completed all immunizations at the barangay local health center. Pertinent findings include lethargy, nuchal rigidity, & sluggishly reactive pupils.

——-

Which of the following indications for a lumbar tap best applies to this case?
A. lumbar tap should be done if immunization status is unknown
B. lumbar tap should be done in all infants younger than 12 months old
C. lumbar tap should be done immediately to
allow early initiation of antibiotic treatment
for confirmed bacterial meningitis
D. lumbar tap should be done immediately especially in the presence of nuchal rigidity, sluggishly reactive pupils, and decreasing sensorium

A

lumbar tap should be done immediately to
allow early initiation of antibiotic treatment
for confirmed bacterial meningitis

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26
Q

This is a stronger predictor of the presence of rheumatic diseases and a reason for referral to a Pediatric Rheumatologist.
A. Arthralgia
B. Arthritis
C. Weakness
D. Malar rash

A

Arthritis

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27
Q

Gottron papules when present plus the associated heliotrope rash is suggestive for this rheumatic condition:
A. Systemic lupus erythematosus
B. Juvenile idiopathic arthritis
C. Juvenile dermatomyositis
D. Psoriatic arthritis

A

Juvenile dermatomyositis

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28
Q

This sign when present can be seen in both rheumatic cause such as vasculitis or in non-rheumatic conditions such as Meningococcemia
A. Malar rash
B. Heliotrope rash
C. Gottron papules
D. Purpuric rash

A

Purpuric rash

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29
Q

This imaging tool helps localise areas of abnormality in the patient with diffuse pains caused by osteomyelitis, neuroblastoma, chronic multifocal osteomyelitis, systemic arthritis:
A. CT scan of the bone
B. Radionucleotide bone scans
C. Magnetic resonance imaging
D. Plain radiographs

A

Radionucleotide bone scans

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30
Q

This TNF-α antagonist is given especially to those patients who failed to respond to methotrexate.
A. Adalimumab
B. Etanercept
C. Infliximab
D. Golimumab

A

Etanercept

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31
Q

It is the virus associated with post infectious arthritis that involves large joints especially the knees:
A. Hepatiti
B. Rubella
C. Hepatitis B
D. Mumps

A

Mumps

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32
Q

This virus associated arthropathy occurs in young women that presents with arthralgia of the knees and hands usually begins within 7 days of onset of the rash or 10-28 days after immunization:
A. Hepatitis B arthritis-dermatitis syndrome
B. Varicella associated arthropathy
C. Rubella associated arthropathy
D. Parvovirus B19 arthropathy

A

Rubella associated arthropathy

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33
Q

It is the complication noted in children with reactive arthritis:
A. Encephalomyelitis
B. Uveitis
C. Arthritis dermatitis syndrome
D. Cardiomyopathy

A

Uveitis

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34
Q

Most common cause of mortality in Systemic lupus erythematosus:
A. Infection
B. Complications of glomerulonephritis
C. Neuropsychiatric disease
D. Atherosclerosis

A

Atherosclerosis

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35
Q

What is the most feared complication in Neonatal lupus?
A. Hydrops fetalis
B. Congenital heart block
C. Hepatitis
D. Valvular dysfunction

A

Congenital heart block

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36
Q

Which of the following is the etiology of Juvenile dermatomyositis?
A. Complex and includes genetic predisposition and possibly an infectious trigger.
B. History of infection 3 months before onset is noted (Upper respiratory or Gastrointestinal infection)
C. Patients often have family members, especially mothers and sisters, with the same condition or other autoimmune diseases.
D. Infectious agents may be responsible for inducing the aberrant innate immune system attacks such as your Herpes simplex virus type 1 and Parvovirus B19.

A

History of infection 3 months before onset is noted (Upper respiratory or Gastrointestinal infection)

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37
Q

This clinical feature is described as a thickened erythematous and scaly rash that develops over the palms and soles along the flexor tendons.
A. Gottron papules
B. Coup de sabre lésion
C. Shawl sign
D. Mechanic’s hands

A

Mechanic’s hands

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38
Q

Which of the following differential diagnoses for Juvenile dermatomyositis that presents with muscle weakness but without a rash.
A. Staphylococcal pyomyositis
B. Mixed connective tissue disease
C. Muscular dystrophies
D. Bartonella infection

A

Muscular dystrophies

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39
Q

This manifestation of Pediatric scleroderma is confined to the dermis, occasionally superficial panniculus; well-circumscribed, circular area of induration, often a central waxy, ivory-coloured area surrounded by a violaceous halo.
A. Plaque morphea
B. Bullous morphea
C. Linear scleroderma
D. Deep morphea

A

Plaque morphea

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40
Q

For a criterion of Juvenile systemic sclerosis to be fulfilled it needs to have at least:
A. 3 minor criteria
B. 2 major and 1 minor criteria
C. 1 major and 2 minor criteria
D. 2 major criteria

A

1 major and 2 minor criteria

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41
Q

The classic triphase sequence of Raynaud phenomenon is:
A. Venous stasis; vasoconstriction arterial in Reflex vasodilation caused by the factors hypoperfusion and released from the ischemic phase
B. Initial arterial vasoconstriction resulting in hypoperfusion and pallor; Venous stasis; Reflex vasodilation caused by the factors released from the ischemic phase
C. Venous stasis; Reflex vasodilation caused by the factors released from the ischemic phase Initial arterial vasoconstriction resulting in hypoperfusion and pallor
D. Reflex vasodilation caused by the factors released from the ischemic phase; Initial arterial vasoconstriction resulting in hypoperfusion and pallor, Venous stasis

A

Initial arterial vasoconstriction resulting in hypoperfusion and pallor; Venous stasis; Reflex vasodilation caused by the factors
released from the ischemic phase

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42
Q

Behcet disease is an autoinflammatory disease with recurrent oral ulcerations, uveitis and skin abnormalities. Of the manifestations mentioned which is the most frequent initial symptom:
A. Painful oral ulcer
B. Uveitis
C. Erythema nodosum
D. Genital scars

A

Painful oral ulcer

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43
Q

What is the current gold standard for diagnosis for Sjogren syndrome?
A. Detection of SSA and SSB antibodies
B. Hypergammaglobulinemia
C. Biopsy of parotid glands
D. (+) Rheumatoid factor

A

Biopsy of parotid glands

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44
Q

Which of the following describes Henoch - Schoenlein Purpura (HSP):
A. Affects females more than males
B. Many cases follow a documented gastrointestinal infection
C. It is the most common medium vessel vasculitis
D. It is characterized by leukocytoclastic vasculitis

A

It is characterized by leukocytoclastic vasculitis

45
Q

The Hallmark of HSP is the presence of a palpable purpuric rash, with symmetric skin lesions and occurs in this area:
A. On the trunk area
B. Shoulder portion of the upper extremities
C. Lesions on the periorbital area
D. Extensor aspect of the upper extremities

A

Extensor aspect of the upper extremities

46
Q

Most commonly involved branch for Takayasu arteritis includes:
A. Renal artery
B. Femoral artery
C. Abdominal artery
D. Pulmonary artery

A

Renal artery

47
Q

For a patient to be considered a Behcet
disease based on the ISG criteria, it requires the presence of oral ulcers along with 2 major features such as:
A. Venous thrombosis and sclerodactyly
B. Venous thrombosis and arterial aneurysm
C. Anterior uveitis and necrotic folliculitis
D. Erythema nodosum and Sclerodactyly

A

Anterior uveitis and necrotic folliculitis

48
Q

Based on the 2017 AHA definition for giant
coronary aneurysms, a z score of ≥10 or an absolute dimension of ≥8mm is associated with:
A. Pericardial effusion
B. Diminished left ventricular systolic function
C. Angina and myocardial infarction
D. Myocarditis

A

Angina and myocardial infarction

49
Q

What will be your treatment regimen for a
patient diagnosed for Systemic lupus erythematosus? *
A. Give methotrexate, advised avoidance of prolonged direct sun exposure
B. Use of sunscreen and avoidance of prolonged direct sun exposure, give hydroxychloroquine, check lipid profile
C. Use of sunscreen and avoidance of prolonged direct sun exposure, give hydroxychloroquine, check for cardiovascular risk factors, routine immunization
D. Use of sunscreen and avoidance of
prolonged direct sun exposure, give corticosteroids, check for cardiovascular risk factors (lipid profile, BMI, blood pressure monitoring), intake of Vitamin D

A

Use of sunscreen and avoidance of prolonged direct sun exposure, give corticosteroids, check for cardiovascular risk factors (lipid profile, BMI, blood pressure monitoring), intake of Vitamin D

50
Q

Poorer prognosis of Juvenile idiopathic arthritis is related to: *
A. Fever lasting >3 months and increased inflammatory marker
B. Leg length discrepancy
C. Young age of onset with RF seropositivity
D. Presence of anti-cyclic citrullinated peptide antibodies

A

Fever lasting >3 months and increased inflammatory marker

51
Q

This condition is associated with genetic predisposition toward slow drug acetylation and manifestations typically resolve after withdrawal of the offending medication.
a. Enthesitis related arthritis
b. Vasculitides
c. Drug-induced lupus
d. Juvenile idiopathic arthritis

A

Drug-induced lupus

52
Q

This specific spondyloarthritis presents with disease; the arthritis is typically asymmetric and involves ≤4 joints most frequently the knees, ankles and hips in the first 6 months with inflammation of the small joints of the foot ortarsitis.

a. Psoriatric Arthritis
b. Enthesitis-related Arthritis (ERA)
c. Ankylosing spondylitis
d. Juvenile Idiopathic Arthritis

A

Enthesitis-related Arthritis (ERA)

53
Q

This drug has been used for Juvenile dermatomyositis, Lupus-associated thrombocytopenia, Polyarticular JIA, with a dose of 1 - 2 g/kg/doseadministered once a
month:
a. Canakinumab
b. Intravenous immunoglobulin
c. Cyclophosphamides
d. Anakinra

A

Intravenous immunoglobulin

54
Q

This is the characteristic finding of advanced ankylosing spondylitis and is rare in early disease particularly in childhood.
a. Sclerosis
b. Osteoporosis
c. Bamboo spine
d. Subchondral erosions

A

Bamboo spine

55
Q

Juvenile scleroderma encompasses a range of conditions unified by the presence of fibrosis of the skin. This is believed to be a key process in the pathogenesis of both localized and systemic scleroderma.
A. Autoimmunity
B. Fibrosis
C. Vasculopathy
D. Subclinical graft vs host reaction

A

Autoimmunity

56
Q

Long term therapy for patients with
coronary abnormalities include(s):
A. Aspirin (3 - 5 mg/kg/day) orally once daily + Clopidogrel (1 mg/kg/day)
B. Aspirin (3 - 5 mg/kg/day) orally once daily + Clopidogrel (0.5 mg/kg/day)
C. Aspirin (30 - 50 mg/kg/day) orally once daily + Clopidogrel (1 mg/kg/day)
D. Aspirin (30 - 50 mg/kg/day) orally once daily + Clopidogrel (0.5
mg/kg/day)

A

Aspirin (3 - 5 mg/kg/day) orally once daily + Clopidogrel (1 mg/kg/day)

57
Q

Desiree, 3 years old female complained of joint pains specifically on the knee with easy fatigability during preschool activities which was noted about 2 months ago. Her mother thought that this was initially due to her increased daily activities. However she later developed fever with rash which prompted them to eventually seek consult. When you saw her, physical examination further revealed involvement of 4 joints presenting with tenderness, swelling and limited range of motion. Rashes were non-pruritic, linear and are distributed over the trunk and proximal extremities. Patient also presented with hepatosplenomegaly and lymphadenopathy. Based on the history and physical examination of the patient what will be your initial assessment?
A. Juvenile dermatomyositis
B. Acute rheumatic fever
C. Systemic lupus erythematosus
D. Juvenile idiopathic arthritis

A

Juvenile idiopathic arthritis

58
Q

Anastasia, 8 years old female, came in for facial rashes crossing the nasolabial fold associated with periorbital edema. You are considering Juvenile dermatomyositis for this patient.
What initial evaluation tests will you perform to further establish your impression?
a. CBC, CPK, ESR, ALT, AST, Aldolase, ANA, LDH
b. CBC, CPK, ALT, AST, LDH, Aldolase, ANA
c. CBC, ALT, AST, ANA, LDH, Aldolase
d. CBC, CPK, ALT, AST, Creatinine, Albumin, ANA, LDH

A

CBC, CPK, ALT, AST, LDH, Aldolase, ANA

59
Q

In a case of Juvenile idiopathic arthritis, what early radiologic findings will you expect to find?
A. Loss of cartilage and degrees of bony destruction and fusion
B. Peripheral joints may exhibit periarticular osteoporosis
C. Indistinct margins and erosions that can result in joint space widening
D. Soft tissue swelling with periarticular osteopenia

A

Soft tissue swelling with periarticular osteopenia

60
Q

Common but nonspecific laboratory findings for HSP includes:
A. Leukopenia, normal hemglobin, thrombocytosis
B. Leukocytosis, anemia, thrombocytopenia
C. Leukocytosis, anemia, normal platelet count
D. Normal WBC, anemia, thrombocytopenia

A

Leukocytosis, anemia, normal platelet count

61
Q

Non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed to decrease both the pain and the acute and chronic inflammation associated with arthritis, pleuritis, pericarditis, uveitis and
cutaneous vasculitis. The said mechanism of action of this drug is to:
A. Inhibition of folate dependent processes by MTX polyglutamates primarily their effect
B. on the enzyme 5-aminoimidazole-4-carboxamide ribonucleotide (AICAR) transformylase
C. Inhibiting the enzyme cyclooxygenase (COX) which is critical in the production of prostaglandins.
D. Soluble, fully human fusion protein of the extracellular domain of CTLA-4. Acts as a co-stimulatory signal inhibitor by binding competitively to CD80 or CD86 where itselectively inhibits T-cell activation.
E. Chimeric human/mouse monoclonal antibody that binds to soluble TNF-α and its membrane bound precursor, neutralizing its action

A

Inhibiting the enzyme cyclooxygenase (COX) which is critical in the production of prostaglandins.

62
Q

This drug is used as a secondary disease modifying agent to reduce rash and maintain
remission for those with Juvenile dermatomyositis.
*
A. Intravenous gamma globulin
B. Methylprednisolone
C. Hydroxychloroquine
D. Methotrexate

A

Hydroxychloroquine

63
Q

It is defined as joint inflammation following urogenital infections
a. Juvenile dermatomyositis
b. Reactive arthritis
c. Ankylosing spondylitis
d. Post-infectious arthritis

A

Reactive arthritis

64
Q

JP, 4 year old male was admitted for high
grade fever (Tmax >39C) for 4 days, unresponsive to antipyretics, his mother described him to be flushed looking, with
reddish eyes. Upon physical examination he
had bilateral nonexudative conjunctival injection, unilateral lymphadenopathy,
strawberry tongue and edematous hands.
You are considering Kawasaki disease for
this patient. 2d echo was requested to check
for cardiac involvement; What condition occurs during acute Kawasaki disease?
a. Myocarditis
b. Thrombosis
c. Myocardial infarction
d. Angina

A

Myocarditis

65
Q

This treatment for Takayasu arteritis is reserved for severe or refractory disease:
a. Methylprednisolone
b. Methotrexate
c. Azathioprine
d. Cyclophosphamide

A

Cyclophosphamide

66
Q

What phase of Kawasaki disease presents with desquamation and thrombocytosis?
a. Convalescent phase
b. Acute clinical phase
c. Acute febrile phase
d. Subacute phase

A

Subacute phase

67
Q

This Non-biologic Disease Modifying Anti-rheumatic Drug (NDMARDs) used primarily for treatment of lupus, uveitis and autoimmune skin manifestations.
a. Methotrexate
b. Mycophenolate mofetil
c. Sulfasalazine
d. Leflunomide

A

Mycophenolate mofetil

68
Q

This NDMARD is associated with severe systemic hypersensitivity and Stevens-Johnson Syndrome:
A. Sulfasalazine
B. Methotrexate
C. Hydroxychloroquine
D. Leflunomide

A

Sulfasalazine

69
Q

A biologic agent that is a used as a treatment for B-cell non-Hodgkin lymphoma and is FDA approved for use in Adult RA and idiopathic thrombocytopenic purpura but does not have a pediatric indication.
A. Rituximab
B. Golimumab
C. Belimumab
D. Infliximab

A

Rituximab

70
Q

2d-echo is the most useful test to monitor
for coronary artery abnormalities, based on the AHA z-score Classification system for aneurysms, a small aneurysm is considered if
it has:
A. >1.5 to 5 mm
B. >= 3.5 to <5 mm
C. >3 to <5 mm
D. ≥2.5 to <5 mm

A

≥2.5 to <5 mm

71
Q

This is the most common recurrent fever in children with fever episodes that last 4-6 days regardless of antipyretic or antibiotic treatment, associated with mild leukocytosis and elevated acute phase reactants:
A. Tumor Necrosis Factor Receptor-Associated Periodic Syndrome
B. Periodic Fever, Aphtous Stomatitis, Pharyngitis and Adenitis (PFAPA)
C. Hyperimmunoglobulinemia D with Periodic Fever Syndrome (HIDS)
D. Familial Mediterranean Fever (FMF)

A

Periodic Fever, Aphtous Stomatitis, Pharyngitis and Adenitis (PFAPA)

72
Q

Lisa, 15 years old female complained of joint pains (hands, knees) usually with morning stiffness, she also noted easy fatigability during her extracurricular activities in school. Condition was eventually associated with fever and the occurrence of facial rash most noted after prolonged outdoor daytime activities. She was eventually admitted and further evaluation
with laboratory tests revealed anemia, thrombocytopenia by CBC, Proteinuria on
urinalysis, and a positive ANA test since you
were already considering a rheumatic condition for this case. With the above history, clinical manifestations and laboratory results, what will be your working diagnosis?
A. Juvenile idiopathic arthritis
B. Systemic lupus erythematosus
C. Post streptococal glomerulonephritis
D. Acute rheumatic fever

A

Systemic lupus erythematosus

73
Q

Andrew a 10 year old male came in for consult due to swelling of the parotid area for almost a week. Other associated signs and symptoms include dry eyes, fever and lower extremity weakness. You were entertaining Sjorgen syndrome. Laboratory tests revealed elevated ESR, leukopenia on CBC and elevated serum amylase. Based on the Proposed criteria for Sjorgen syndrome; How many needed criterion must be fulfilled for a condition to be considered as such?
A. <4 criteria
B. 4 - 5 criteria
C. ≥4 criteria
D. ≤4 criteria

A

≥4 criteria

74
Q

This is considered as a Major criteria for Familial Mediterranean Fever (FMF):
A. Incomplete abdominal attack
B. Favorable response to colchicine
C. Incomplete attacks involving chest pain
D. Incomplete attacks involving monoarthritis

A

Incomplete abdominal attack

75
Q

Which is a complication of uveitis?
A. Cataract
B. Retinal vaculitis
C. Retinal detachment
D. Vitreitis

A

Retinal detachment

76
Q

ADHD patients can best be managed with one of the following:
a. Stimulants
b. Clonidine
c. Methylphenidate
d. structured routine response consistency

A

structured routine response consistency

77
Q

Which of the following findings is alarming and should prompt the physician to do further
investigation?
a. Moro & parachute reflexes in a 6-month old
b. An infant who feeds from a spoon by 18 months old
c. Retinal hemorrhages in a full-term neonate delivered via vaginal delivery
d. Soft cranial bruit over the anterior fontanel in a 40-month old with febrile illness

A

Soft cranial bruit over the anterior fontanel in a 40-month old with febrile illness

78
Q

The prevalence of cerebral palsy increases in the following conditions, except
a. Antenatal infection
b. Death of a twin in utero
c. Magnesium sulfate in preterm labor
d. Enhanced survival of very premature infants

A

Death of a twin in utero

79
Q

The neurodevelopmental function (cognition) is dependent mainly on the development of the
following functions EXCEPT
a. sensory and motor
b. Language
c. Visual–spatial
d. Intellectual
e. cerebeller

A

cerebeller

80
Q

Diagnosis of autistic spectrum disorder (ASD) depends partly but importantly on assessment
of language. All the following may raise your concern regarding language development and may indicate ASD EXCEPT
a. absent babbling by 6 months
b. absent gestures by 12 month
c. absent single words by 16 month
d. absent 2-word purposeful phrases by 24 month

A

absent babbling by 6 months

81
Q

One of the following neurologic signs and/or symptoms is most useful in the localization of a
CNS lesion?
a. Unsteadiness while sitting in a 6-year old
b. Extension of the great toe & fanning of the remaining toes on stimulation of the lateral aspect of the sole of the foot in a neonate
c. Seizures with lethargy & nuchal rigidity in any age
d. Incomplete abduction of the eyes on lateral gaze

A

Incomplete abduction of the eyes on lateral gaze

82
Q

All the following should raise the suspicion of autistic spectrum disorders (ASD) EXCEPT
a. sibling with ASD
b. playmate concern
c. parental concern
d. caregiver concern
e. Epediatrician concern

A

playmate concern

83
Q

All the following are red flags in the history of children with specific learning disorders (SLD)
EXCEPT
a. parents concern about academic performance
b. inconsistency in marks report from grade to grade
c. struggling with home work activities
d. positive vision or hearing test
e. positive standard screening test

A

inconsistency in marks report from grade to grade

84
Q

Of the following, the MOST common presenting behavior in girls with attention-deficit hyperactivity disorder is:
a. inattentive
b. hyperactive
c. impulsive
d. disruptive
e. combined

A

inattentive

85
Q

Which is a red flag for an 8 month old child?
a. not saying “dada”
b. not interested in “peek-a-boo”
c. not able to hold a rattle on both hands
d. does not stand while holding on

A

not interested in “peek-a-boo”

86
Q

The following is a gross motor red flags EXCEPT
a. @ 4 years old, does not hop
b. @ 5 mos, does not roll over
c. @ 7 mos, does not sit with support
d. @ 10 mos, does not stand while holding on

A

@ 7 mos, does not sit with support

87
Q

Which of the following statements is true regarding neurofibromatosis?
a. Neurofibromas typically involving the skin
are the hallmark of neurofibromatosis
b. Iris hamartomas are characteristically absent in NF-2
c. Brain MRIs should be done to detect “unidentified bright objects”
d. ≥6 café-au-lait macules > 5mm in prepubertal patients are specific for NF-1

A

≥6 café-au-lait macules > 5mm in prepubertal patients are specific for NF-1

88
Q

Which of the following statements is true regarding neurofibromatosis?
a. Neurofibromas typically involving the skin
are the hallmark of neurofibromatosis
b. Iris hamartomas are characteristically absent in NF-2
c. Brain MRIs should be done to detect “unidentified bright objects”
d. ≥6 café-au-lait macules > 5mm in prepubertal patients are specific for NF-1

A

≥6 café-au-lait macules > 5mm in prepubertal patients are specific for NF-1

89
Q

Benign myoclonic epilepsies are often best treated with
a. clonazepam
b. lamotrigine
c. topiramate
d. valproate
e. benzodiazepines

A

valproate

90
Q

A 9-month old male child was in active seizure at the ER. He was febrile. Laboratory work-up in
this patient includes EXCEPT:
a. CBC
b. EEG
c. Urinalysis
d. Lumbar tap

A

Urinalysis

91
Q

Which is not a red flag for a 2 year old?
a. screams easily
b. not able to stack 5 blocks
c. no repetition of words
d. does not categorize similarities
e. Stiffens when approached

A

Stiffens when approached

92
Q

Which statement is FALSE regarding specific learning disorders (SLD)?
a. it focuses on academic skill development
b. it is a type of neurodevelopmental dysfunctions
c. the overall estimates of the prevalence of SLD range from 3-10%
d. includes students did well in academic testing but not in intelligence testing

A

includes students did well in academic testing but not in intelligence testing

93
Q

Absence seizures are MOST often initially treated with
a. ethosuximide
b. valproate
c. lamotrigine
d. acetazolamide
e. clonazepam

A

ethosuximide

94
Q

High-voltage, slow, chaotic background with multifocal spikes is a typical electroencephalographic finding in:
a. Lennox-Gastaut syndrome
b. West syndrome
c. Dravet syndrome
d. Landau-Kleffner syndrome

A

West syndrome

95
Q

All the following are characteristic features of autistic spectrum disorder (ASD)EXCEPT
a. defective social communication
b. highly restricted fixated interests
c. scarce of gesture use
d. stereotyped motor movements
e. absence of routines

A

absence of routines

96
Q

The behavioral changes in attention-deficit/hyperactivity disorder (ADHD) should met all the following criteria EXCEPT
a. developmentally inappropriately far comparing with other children of the same age
b. must begin before age 6 yr
c. must be present for at least for 6 mo
d. must be present in 2 or more settings
e. must not be secondary to another disorder

A

must begin before age 6 yr

97
Q

Ideally all children should be subjected to routine screening for autistic spectrum disorders at age of
a. 06and12mo
b. 12and18mo
c. 18and 24mo
d. 24and30mo
e. 30and18mo*

A

18and 24mo

98
Q

Case:
A 13-year old female with mental retardation was brought in for consult due to headache. The mother reported that when it happens the patient would hit her forehead several times as if indicating pain in the frontal area and she would not stop shouting and crying. This has happened 3 times already in the past 2 months. In all three occasions, the patient would gradually become clumsy and drowsy followed,
within an hour, by head slapping and the incessant crying often lasting for several hours. There was no family history of migraine, tumors, or epilepsy. There were no lateralizing signs noted on physical examination.

——-

Headache management plan should include which of the following?
a. Acute treatment + biobehavioral therapy
b. Acute & preventive strategy + biobehavioral therapy
c. Acute & preventive strategy + biobehavioral therapy + neuroimaging
d. Acute & preventive strategy + biobehavioral therapy + EEG & neuroimaging

A

Acute & preventive strategy + biobehavioral therapy + neuroimaging

99
Q

Case:
A 13-year old female with mental retardation was brought in for consult due to headache. The mother reported that when it happens the patient would hit her forehead several times as if indicating pain in the frontal area and she would not stop shouting and crying. This has happened 3 times already in the past 2 months. In all three occasions, the patient would gradually become clumsy and drowsy followed,
within an hour, by head slapping and the incessant crying often lasting for several hours. There was no family history of migraine, tumors, or epilepsy. There were no lateralizing signs noted on physical examination.

——-

Given the limited reliability of both informant and patient, what is the most likely consideration in this case?
a. Migraine without aura
b. Migraine with typical aura
c. Migraine with atypical aura
d. Tension-type headache

A

Migraine with typical aura

100
Q

Epilepsyisdefinedas:*
a. less than 2 unprovoked seizures occurring in a time frame of >24 hrs
b. More than 2 provoked seizures in >24 hrs
c. More than 2 unprovoked seizures in > 24 hours
d. More than 2 unprovoked seizures in less than 24 hours

A

More than 2 unprovoked seizures in > 24 hours

101
Q

Which diagnostic procedure is done to a 5-month old with simple febrile seizure: *
a. EEG
b. Lumbar puncture
c. Cranial ultrasound
d. Serum sodium, potassium, glucose
e. All of the above

A

Lumbar puncture

102
Q

Triad of West sydrome includes EXCEPT: *
a. Infantile spams
b. hypsarrhytmia
c. Developmental regression
d. polyspike burst in wakefulness

A

polyspike burst in wakefulness

103
Q

Absence seizures are described as the following EXCEPT: *
a. focal type of seizure
b. generalized type of seizure
c. no postictal period
d. may have simple autisms

A

focal type of seizure

104
Q

Partial seizures are common in: *
a. frontal lobe epilepsy
b. parietal lobe epilepsy
c. occipital lobe epilepsy
d. temporal lobe epilepsy

A

temporal lobe epilepsy

105
Q

It is also called the infantile epileptic encephalopathy. *
a. West syndrome
b. Dravet syndrome
c. Ohtahara syndrome
d. Janz syndrome

A

Ohtahara syndrome

106
Q

A previously normal, healthy 8-month old female infant was brought to the ER due to a first episode of febrile seizure described as generalized tonic-clonic for 3 minutes, controlled by IV diazepam. She was febrile at 39.2 that started 5 hours prior to ER consult. There was a strong family history of febrile seizures and a family history of epilepsy as well. The informant thinks she has completed all immunizations at the barangay local health center. Pertinent findings include lethargy, nuchal rigidity and sluggishly reactive pupils.

What is the cumulative risk for subsequent epilepsy in this case? a. 1%
b. 6%
c. 19%
d. 33%

A

19%

107
Q

According to the PPS, a 16-month old presenting with simple febrile seizure, lumbar tap is routinely done. *
True/False

A

True

108
Q

EEG is routinely done to patients with complex febrile seizures regardless of age. *
True/False

A

True

109
Q

Anticonvulsants are given as maintenance medications after an episode of febrile seizure. True
False

A

False

PEDIA (4 decks)

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