Pre-test Neuro Pediatri

An 18-month-old with 39.5 °C fever from viral pharyngitis has a 3-minute generalized tonic–clonic seizure that stops spontaneously. In the ED he is alert without focal deficits, no nuchal rigidity, well hydrated. First seizure. Blood glucose normal; sodium normal. Normal pregnancy and development; immunizations up to date. No family history of epilepsy. Most appropriate evaluation?

• Immediate head CT

• Routine EEG

• Identify infection source + counseling

• LP in all cases

• Prophylactic valproate

A 2-year-old (11 Kg) with prior febrile seizures develops a seizure at home lasting >3 minutes with fever 38.8 °C. No IV access. Parents were trained in safe positioning and have a rescue medication. The child is breathing spontaneously; no cyanosis. After airway positioning, a non-IV emergency medication is needed. Which drug is correct?

• Rectal diazepam 10 mg

• Buccal midazolam 0.2 mg/kg

• Rectal diazepam 5 mg

• IM phenobarbital 20 mg/kg

• Intramuscular midazolam 0,2 mg/kgb

A 14-month-old with 38.7 °C fever has a 12-minute focal seizure, prolonged postictal phase, and vomiting. Exam shows positive nuchal rigidity and photophobia; mental status is drowsy; hemodynamics are stable. No prior antibiotics. Blood glucose normal. Which test is most appropriate ?

• No LP needed

• Lumbar puncture after stabilization

• Head CT first in all cases

• Emergency EEG

• Blood culture only

Seizure persists after two adequate doses of diazepam rectal. IV access is established; blood pressure stable; glucose normal. No drug allergies. Recommended choice?

• IV Phenytoin 20 mg/kg

• IV Phenobarbital 10 mg/kg

• IV Midazolam 200 mcg/kg

• IV Diazepam 0,2 mg/kg

• Repeat diazepam rectal

A 6-year-old often “stares” for 10–15 seconds, abruptly stops activity, and immediately recovers without confusion. Occurs several times daily with declining school performance. Neurologic exam normal. Interictal EEG shows generalized 3-Hz spike–wave complexes. No focal seizures or complex febrile seizures. Basic metabolic workup normal. Best first-line medication?

• Carbamazepine

• Phenitoin

• Phenobarbital

• Valproate acid

• Valproate acid

A 12-year-old has focal seizures beginning with oral tingling aura, followed by brief impaired awareness and oromotor automatisms; postictal sleepiness. Brain MRI is normal; EEG shows perisylvian focal activity. No hepatic comorbidity. Most appropriate initial choice?

• Levetiracetam

• Levetiracetam

• High-dose valproate

• Topical lidocaine

• Daily diazepam

A 5-year-old with cyanotic congenital heart disease presents with 10 days of fever, headache, vomiting, and right arm weakness. No head trauma. Contrast CT shows a ring-enhancing lesion in the left parietal lobe with vasogenic edema; WBC 18,000/µL. Mild aphasia; GCS 14; no herniation signs. Best initial therapy while awaiting cultures and neurosurgical consult

• Amoxicillin

• IV ceftriaxone + metronidazole

• IV ceftriaxone + metronidazole

• Steroids alone

• Rifampin monotherapy

An 8-year-old with chronic otitis media presents with fever, headache, and focal seizures. Neurologic status stable; no brainstem deficits. Plain films are normal. Which imaging is most sensitive for early diagnosis?

• Noncontrast CT

• Contrast MRI

• Skull x-ray

• Transcranial ultrasound

• Mastoid x-ray

A 9-year-old one week after influenza develops symmetric ascending leg weakness, paresthesias, and calf pain. DTRs decreased; sensation relatively intact; afebrile. Strength 4-/5 proximally and 3+/5 distally; waddling gait. LP on day 5 shows 3 cells/µL and protein 38 mg/dL. NIF −30 cmH₂O. Most accurate interpretation of CSF at this time?

• Normal CSF

• Albuminocytologic dissociation

• Pleocytosis

• CSF glucose must be low

• LP is not useful

A 9-year-old with GBS has progressive weakness and areflexia. No renal failure or severe sepsis. Hemodynamics are good. Electrophysiology is planned. Primary pharmacologic therapy?

• Single-dose IV methylprednisolone

• IVIG 0.4 g/kg/day for 5 days

• Azithromycin

• IV diazepam

• Carbamazepine