Meds
Seizures
Name that diagnosis
HEADACHE
Potpourii
100
This antiseizure med is often associated with gingival hyperplasia.
What is Phenytoin
100
7-year-old boy, often "blanks out" anywhere from a few seconds to 20 seconds at a time. During a seizure, he doesn't seem to hear his teacher call his name, he usually blinks repetitively, and his eyes may roll up a bit. During shorter seizures, he just stares. Then he continues on as if nothing happened. Some days Frank has more than 50 of these spells. Name the EEG pattern often associated with this condition.
What is generalized 3-Hz spike-and-wave complexes
100
Mother of a 2 year old bring her child in following multiple episodes where patient had loss of counciousness (mom calls them "passing out episodes." She goes on to say these "passing out episodes" are triggered by physically painful or emotionally upsetting events (such as his older brother taking his toy or being slapped by his sister). Patient will have a temper tantrum turn pale, stop breathing, and then have loss of consciousness. On exam patient is normal-no evidnce of abuse.
What is Breath-holding spells
100
Best imaging for subacute onset of mental status change.
What is emergent CT of head WITH IV contrast
100
Upon working up Myasthenia gravis (or any progressive weakness), remember the most important test to do first is.....
What is Force vital capacity(20ml/kg)
200
Best treatment for Absence seizure
What is ethosuximide
200
Parent reports at first they thought their child was just having little body jerks when he was moved or startled, like their other children had when they were infants. But then noticed something was wrong. The jerks became more violent, and his tiny body was thrust forward and his arms flew apart. They only lasted a few seconds but started to occur in groups lasting a few minutes. EEG revealed hypsarrythmia (slow disorganized brain waves with multifocal spike activity). Yes, you know this condition as infantile spasms, but what is the treatment.
What is ACTH
200
3 year old brought into your office in early morning following an episode of lose of consciousness with left arm shaking. The child then became rigid in only one part of the body per parents. episode lasted over 20 minutes. Patient repeated this same event in the parking lot while waiting for you to arrive. Currently on exam patient is febrile with a negative Brudzinski's sign/Kernig sign. Patient does have hemiparesis and is unable to flex left arm. The convulsion is associated with a rapidly rising temperature. Children who experience febrile seizures usually have rectal temperatures above 102[degrees]F. But most children who run a fever that high will never have a febrile seizure. The seizures often occur shortly after the fever starts. During a typical febrile seizure, the child loses consciousness and his arms and legs begin to shake. Less often, the child becomes rigid or has twitches in only one part of the body, such as one arm or leg, or on only the right or the left side. Most febrile seizures last a minute or two, although some can be as brief as a few seconds.
What is complex febrile seizure
200
The most common complication of bacterial (Pneumococcal) meningitis.
What is Hearing loss
200
The standard of care after a first unprovoked seizure is to do what (need 2/4 for credit)
What is 1. Don't treat 2. Educate on seizure first aid and seizure precautions 3. Inform of 33% of risk of recurrence 4. Inform of prognosis No need for EEG
300
Bacterial meningitis in children caused by S. pneumoniae should be treated with which med(s)
What is Ceftriaxone AND Vancomycin
300
Usually these seizures will begin in the first three years of life. EEG shows slow spike and wave activity. Patients often have mental retardation.
What is Lennox Gastaut syndrome.
300
Patient delivered vaginally at term born to a 39 year old mother with an unremarkable prenatal history. The infant’s birthweight was 3400 grams. Physical exam revealed a small mass with full thickness skin and a tuft of hair in the cervical region. Upon further exam and MRI it was revealed that the meninges and underlying spinal cord did herniate through a defect in the posterior vertebral arch. No cyst or hydrocephalous was present.
What is Myelomeningocele
300
19 year old male presents with complaint of headaches several times per week, always in the afternoon or at the end of the day. The pain starts at the base of the neck and slowly moves up until it is at his forehead. The movement from neck to forehead takes about a hour. The patient has tried eating more regularly and drinking more water and decreasing or increasing caffeine intake, but none of these is effective. When he has a headache, the only thing that helps is to lie down and close his eyes. The headaches seem to be worse with increased time at the computer. On exam, muscles of the neck, especially the sub-occipital muscle group, are very tight and tender. There are multiple trigger points in the sub-occipital muscles and in the sternocleidomastoid on the right. Pressure on the sub-occipital trigger points reproduces the headache. Range of motion is decreased in neck flexion and right rotation. Other orthopedic testing for nerve, muscle and joint involvement was negative. The temporomandibular joint (TMJ) was not contributory.Name your best diagnosis.
What is Tension Headache
300
Best treatment for newborn with erb palsey/brachial plexus palsey
What is do PT/OT once nerve swelling gone for 1-2 weeks, if that does not work after 3 months maybe surgery at that point.
400
Which syndrome is caused by mother taking antiseizure meds leading to newborn having digit and nail hypoplasia, unusal facies, and mental deficency.
What is fetal hydantoin syndrome
400
6 year old had two seizures that his father and I saw a mother reports. She goes on to say, the first one on the 9th of last month, the other on the 13th of last month... both within the first one or two minutes of him falling asleep, but both pretty mild. EEG shpws spikes and sharp waves in the central and midtemporal regions. What is the diagnosis?
What is Rolandic Epilepsy
400
A 10-year-old boy complained of leg cramps and clumsiness. His motor development was normal. He was in the fifth grade and was performing well academically. At age seven, he had begun to walk on his toes. He had sprained his right ankle twice in the last year and had also complained of hand cramps after long periods of writing. His maternal grandfather had "weak feet" and his maternal uncle had leg braces. His mother had no complaints, except for occasional leg cramps after long walks. Two younger siblings had no neurological complaints. He appeared healthy, and his gait showed toewalking and, that he was unable to walk on his heels. His heel cords were tight and there was weakness (4/5) of the dorsiflexors of both feet. The legs showed mild atrophy of the anterior tibialis and peroneal muscles. There was no atrophy or weakness of the intrinsic hand muscle. The stretch reflexes were absent in the upper and lower limbs. The plantar responses were flexor. There was decreased pricking sensation distally in stocking distribution. The great auricular nerves were enlarged on both sides, but the left was more visible. When palpated, the ulnar and peroneal nerves were found to be enlarged. He had mild pes cavus deformity.
What is Charcot-Marie-Tooth
400
Of the following which is less likely to require imaging (I.E CT scan). 1. Patient reports "Worst headache of my life" 2. Meningeal signs with focal findings. 3. Vomiting on awakening 4. suspect Ventriculoperitoneal shunt malfunction.
What is 3. Vomiting on awakening
400
19-years-old man was referred to our hospital. He complained of fatigue and headache at the time of getting up, daytime sleepiness, sudden sleep attacks and dozing off at the wheel. He became aware of insomnia at night and severe sleepiness in the daytime at the age of 13. Since he was 17 years old, he had been seized with an uncontrollable desire for sleep. The total night's sleep has often been reduced to two hours at the longest, interrupted by arousal 10 times (maximal) since he got a job. His case was diagnosed as what condition?
What is narcolepsy
500
Good treatment for cyclic vomiting
What is amitryptyline
500
13 month old boy, who presented with a history of the following spells. Over 5 minutes, there were clusters of sudden forward flexion of the head and neck; along with flaring of arms outward, and then inward. The eyes would roll up briefly with each spell. The intensity of the spasms increased as the time progressed, and then decreased. The child remained quiet with glassy eyes during and between the spasms. There was no frothing at the mouth, tonic-clonic movement, tongue biting, cyanosis, or relation to feeding. These clusters occurred about three times per day, usually shortly after awakening. The mother thought he was having abdominal cramps. Changing formula had no effect. The patient was fraternal twin B weighing 3.5 kg when born at 38 weeks via C-section. He had never been hospitalized before. Vaccinations were up to date. There was no family history of epilepsy. General physical examination including growth parameters was normal. On neurological examination, the child was developmentally delayed. He babbled without words, and could not stand without wobbling. Cranial nerve and fundoscopic examinations were normal. Muscle tone was appropriate and movements were symmetric. Reflexes were 2+. Examination of the skin, including with a Wood’s lamp, was normal. Routine admission labs were normal. EEG will likely show?
What is hypsarrhythmia
500
Teen reports pain spread out her entire arm. Typical she reports dramatic changes in the color and temperature of her skin over the affected limb, accompanied by intense burning pain, skin sensitivity, sweating, and swelling. Diagnosis is made by triphasic bone scan. Name the disease.
What is Reflex Sympathetic dystrophy
500
In Guillain-Barre Syndrome what is likely to be found in CSF.
What is Protein (high). WBC normal are normal.
500
An elongated skull (scaphocephaly) is caused by synostosis of which suture.
What is sagittal suture synostosis
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