Peds 20 Flashcards
Nick is a 7-year-old male with a history of chronic intermittent headaches and an acute increase in headache frequency in the setting of well controlled allergic rhinitis, a family history of migraines, and recent family stressors. He has a normal neurologic examination, notably normal visual acuity and no clinical signs of increased intracranial pressure. What is the management plan at this point?
A. Begin a tricyclic antidepressant B. Do a lumbar puncture C. Have Nick and his mother complete a two-week headache diary and follow up shortly thereafter D. Schedule an MRI of the brain E. Send Nick to see a psychiatrist F. Order a CT of the sinuses
C. Have Nick and his mother complete a two-week headache diary and follow up shortly thereafter
Nick is a 7-year-old male with a history of chronic intermittent headaches and an acute increase in headache frequency in the setting of well controlled allergic rhinitis, a family history of migraines, and recent family stressors. He has new onset ataxia; worsening headache that awakens him from sleep; vomiting upon waking up.
What is the suspected dx and next step in management?
Cerebellar tumor
MRI of brain
A 7-year-old male presents with a five-year history of intermittent vomiting, vertigo, and throbbing unilateral headaches that seem to be induced by emotional stress and when his teacher wears perfume. The headaches occur 1-2 times a month and interfere with his school attendance and lifestyle. He reports that the pain is not worsened by long naps or coughing. His mother reports that she has a history of headaches that started as a child and wonders if her son inherited this from her. His neurological exam shows no focal deficits. What is the next step in diagnosis or treatment?
A. NSAIDs
B. MRI
C. Referral to an ENT surgeon
D. Trial of prophylactic medication for migraine headaches
D. Trial of prophylactic medication for migraine headaches
A 7-year-old male with a past medical history of headaches presents with increased frequency and severity of headaches along with new onset vomiting. When the boy was walking into the room, he had a wide stance and nearly tripped twice. Which of the following is the most appropriate next step?
A. Computed tomography B. Daily headache diary C. Intraventricular pressure monitoring D. Lumbar puncture E. Magnetic resonance imaging
E. Magnetic resonance imaging
A 3-year-old female presents to the ED with sudden onset difficulty walking. She does not have a fever, headache, nausea, or vision changes, but two weeks ago she had a runny nose, a fever, and a rash. Musculoskeletal exam reveals no abnormalities of lower extremities. Neurologic exam reveals bilateral horizontal nystagmus, wide based stance and swaying, and bilateral overreaching on finger to nose test. An LP is performed which reveals a normal CSF. Which of the following is the most likely diagnosis?
A. Hydrocephalus B. Infectious cerebellitis C. Migraine headache D. Opsoclonus-myoclonus syndrome E. Post-infectious cerebellitis
E. Post-infectious cerebellitis
Post-infectious cerebellitis (often called acute cerebellar ataxia) typically presents in a younger child with ataxia, nystagmus, vomiting and sometimes dysarthria. It is believed to be an autoimmune response leading to demyelination of the cerebellum occurring several weeks after a viral infection such as varicella or coxsackie virus.
A 12-year-old female presents to her pediatrician complaining of a headache of gradual onset x 3 hours, non-provoked and described as a “big rubber band around my whole head” and a 5 out of 10 on the pain scale. The pain is not throbbing, and there is no associated photophobia, nausea or vomiting. The patient is afebrile, and there are no neurologic deficits during physical exam. Her mother states her pain is typically relieved with ibuprofen, but her mother is concerned that the patient may have migraines because she has a few headaches every month after school. The child is otherwise healthy. What is the most likely cause of her headaches?
A. Brain tumor B. Idiopathic intracranial hypertension C. Migraine D. Sinusitis E. Tension-type headache
E. Tension-type headache
