Pediatric Flashcards
A 19-year-old man has suffered from complex-partial seizures since the age of 13. He has failed a trial of two anti-epileptic medications. His brain MRI reveals no focal abnormalities. What is the most appropriate next step in management?
a. Initiation of ketogenic diet
b. Addition of cannabidiol (CBD oil), a cannabis derivative
c. Evaluation by surgical epilepsy team for possible resective options
d. Addition of a third anti-epileptic medication
e. Implantation of a vagus nerve stimulator
c. Evaluation by surgical epilepsy team for possible resective options
A 10 year old boy presents with loss of consciousness followed by a lucid interval following a closed head injury. A head CT is shown (figure). Damage to which of the following vessels is most likely responsible for the imaging findings?
a. Superficial temporal artery
b. Middle meningeal artery
c. Vein of Labbe
d. Middle cerebral artery
e. Cerebral bridging vein
b. Middle meningeal artery
A 9 month old boy presents with scaphocephaly. X-rays confirm a sagittal synostosis. He a history of reflux disease that the family is treating with antacids. He is exclusively breast fed and his height and weight are in the 10th percentile, although occipitofrontal circumference is 80th percentile. In this case, which associated diagnosis is most likely?
a. Congenital Adrenal Hyperplasia
b. Prader-Willi Syndrome
c. Congenital Heart Disease
d. Rickets
e. Celiac Sprue
d. Rickets
A Central American patient presents with new onset seizures. CT shows hydrocephalus, and multiple calcified lesions. MRI demonstrates rim-enhancing cysts throughout the brain. What is the most likely etiology?
a. Schistosoma mansoni
b. Toxoplasma gondii
c. Plasmodium falciparum
d. Taenia solium
e. Entamoeba histolytica
d. Taenia solium
What is the most likely diagnosis demonstrated by the findings in the MRI images shown (see figures)?
a. Chordoma
b. Chiari 1 malformation with syrinx
c. Pilocytic astrocytoma
d. Basilar invagination
e. Multiple sclerosis
b. Chiari 1 malformation with syrinx
A 6-year-old girl presents with a deviated gluteal skin fold and lumbosacral dimple. A representative axial T1 non-contrast image from the patient’s lumbar MRI is shown (figure). If she is symptomatic, which is most likely?
a. Urinary incontinence
b. Flat feet
c. L5 paresthesias
d. Hypotonia
e. Anterior thigh pain
a. Urinary incontinence
A 14-year-old female presents with progressive difficulty writing. An MRI (figure) shows multiple nodular areas running along the cervical nerve roots and brachial plexus. Examination of her eyes also shows iris harmartomas. What is the most likely diagnosis?
a. Tuberous sclerosis
b. Neurofibromatosis-1
c. Neurofibromatosis-2
d. Von Hippel-Lindau
e. Ataxia-telangiectasia
b. Neurofibromatosis-1
Which of the following is the most effective sedative for pediatric trauma with severe traumatic brain injury and increased intracranial pressure?
a. Propofol
b. Sevoflurane
c. Dexmedetomidine
d. Thiopental
e. Fentanyl
e. Fentanyl
A 15-year-old girl with a history of epilepsy and learning disability presents with vomiting and somnolence. MRI shows obstructive hydrocephalus with a 3 cm calcified, contrast-enhancing intraventricular mass near the foramen of Monro, as well as several small subependymal nodules. Which cutaneous findings are most likely to be observed on physical examination?
a. Melanoblastosis cutis linearis (pigmented dermatitis)
b. Café-au-lait spots
c. Port-wine stain (nevus flammeus)
d. Adenoma sebaceum
e. Axillary freckles
d. Adenoma sebaceum
A 6-month-old girl with a lipomyelomeningocele is undergoing surgical detethering of their lumbar lipoma, filum sectioning, arachnoid adhesion lysis, and aggressive debulking of the intradural lipoma to the margins of the neural placode. What is the next surgical step?
a. Further lipoma resection until a gross total resection is achieved
b. Patch-graft duraplasty
c. Primary dural closure with a nonabsorbable monofilament suture
d. Primary dural closure with an absorbable, braided suture
e. Pial closure and tubularization of the placode/distal cord
e. Pial closure and tubularization of the placode/distal cord
An 8-year-old girl presents with obstructive triventricular hydrocephalus requiring endoscopic exploration of the ventricular system. What is the most appropriate site for surgical fenestration?
a. Lamina terminalis above the suprachiasmatic recess
b. Third ventricle floor anterior to the mammillary bodies
c. Pineal recess
d. Third ventricle floor anterior to the infundibular recess
e. Septum pellucidum superior to the fornices
b. Third ventricle floor anterior to the mammillary bodies
A 4-week-old, 26 week premature infant presents with a Grade IV intraventricular hemorrhage and posthemorrhagic hydrocephalus (Figure 1). Examination reveals stable vital signs, normal head circumference growth curve, and soft anterior fontanelle. Weight is 1.2 kg. What is the best initial management of the hydrocephalus?
a. Creation of a permanent ventriculoperitoneal shunt
b. Placement of a ventricular reservoir
c. Placement of external ventricular drain
d. Serial cranial ultrasounds with daily head circumference measurements
e. Serial lumbar punctures
d. Serial cranial ultrasounds with daily head circumference measurements
A 14 year-old is involved in a MVC and does not lose consciousness. He has a GCS of 15 and no focal deficits on neurological exam. He has no other injuries. His toxicology screen is negative. You remove his collar, and he has no palpable spinal tenderness or pain with range of motion. The correct next step would be which of the following?
a. Send patient for a MRI of the cervical spine
b. Remove the cervical collar and backboard
c. Send patient for a CT scan of the cervical spine
d. Obtain adequate cervical spine x-rays
e. Obtain flexion/extension cervical spine x-rays
b. Remove the cervical collar and backboard
An 8 year-old presents after an accident in gymnastics. He felt the immediate onset of sharp pain behind his right ear after a fall. In the emergency department an hour later he was neurologically intact. However, his head was immobile, being rotated to the right and tilted to the left with the left ear touching the left shoulder. A CT scan of the cervical spine was abnormal (Figure 1). What is the most appropriate initial treatment?
a. Rigid cervical orthosis
b. 15 pounds of cervical traction
c. Brooks fusion in situ with halo-vest immobilization
d. Open reduction and Harms fusion
e. Thermoplastic Minerva jacket
a. Rigid cervical orthosis
A 14-year-old male presented with months of slowly worsening tingling in his hands. His exam was intact. Diagnostic work-up included an MRI of the cervical and thoracic spine (figure). What is the most likely diagnosis?
a. Hemangiopericytoma
b. Astrocytoma
c. Neuroblastoma
d. Neurofibroma
e. Ependymoma
e. Ependymoma
What factor has had the single largest effect on the incidence of myelomeningocele in the United States over the past 30 years?
a. Antenatal diagnosis followed by termination
b. Changes in population demographics
c. Decreased use of seizure medication during pregnancy
d. Decreased numbers of children being born
e. Folate supplementation
e. Folate supplementation
A 5-year-old undergoes surgical resection of a posterior fossa medulloblastoma followed by chemotherapy and total neuroaxis radiotherapy, with a boost to the posterior fossa. Which endocrinological complication is most likely after radiotherapy for a posterior fossa tumor in childhood?
a. Cushing’s Syndrome
b. Addison’s Syndrome
c. Diabetes Insipidus
d. Growth Hormone Excess
e. Growth Hormone Deficiency
e. Growth Hormone Deficiency
What is the most common anatomic location of pediatric gangliogliomas?
a. Spinal cord
b. Temporal lobe
c. Brainstem
d. Frontal lobe
e. Parietal lobe
b. Temporal lobe
An 8-month-old girl with developmental delay presents to the emergency department with new onset seizure activity. On exam, the patient has slightly reduced muscular tone in the left upper and lower extremities. A non-contrast MRI is obtained (figure). What is the most likely diagnosis?
a. Porencephalic cyst
b. Arachnoid cyst
c. Holoprosencephaly
d. Schizencephaly
e. Lissencephaly
d. Schizencephaly
What is the most common side effect of vagus nerve stimulation?
a. Dyspnea
b. Cardiac arrhythmia
c. Wound infection
d. Dyspepsia
e. Voice hoarseness
e. Voice hoarseness
A 8-month-old infant was sent for imaging (figures) by his pediatrician because of irritability, poor feeding, and macrocephaly with a bulging fontanel. The preceding pregnancy and delivery had been unremarkable. The infant had been well up until this presentation, and review of systems was noncontributory. What additional diagnostic investigation is indicated?
a. Blood lead level
b. Measurement of parents’ head circumferences
c. Pyloric ultrasound
d. Dilated funduscopic examination
e. Urine amino acids
d. Dilated funduscopic examination
An 11-month-old female with a history of myelomeningocele repair and ventriculoperitoneal shunt placement presents with new stridor and vocal cord paralysis. What is the most appropriate next step in management?
a. Shunt evaluation
b. Tethered spinal cord release
c. Observation
d. EEG
e. Chiari decompression
a. Shunt evaluation
A 15 year-old boy complains of neck pain and intermittent pain about his lumbar myelomeningocele scar. A recent shunt series shows no disconnection and a head CT shows small dysmorphic ventricles. On exam, the patients is neurologically stable with chronic weakness of ankle dorsiflexion. What is the most likely source of the patient’s symptoms?
a. Ventricloperitoneal shunt malfunction.
b. Tethered spinal cord.
c. Ventriculoperitoneal shunt infection.
d. Aseptic Meningitis.
e. Chiari Il malformation.
a. Ventricloperitoneal shunt malfunction.
A 6-year-old with Down syndrome has a skull defect that has been present since birth (Figures 1 & 2). What is the correct diagnosis?
a. Dermoid cyst
b. Healed skull fracture
c. Aplasia cutis congenita
d. Bilateral parietal foramina
e. Acute skull fracture
d. Bilateral parietal foramina