Babies!
Infection
seizure or nah?
Wildcard!
100
In the Newborn Nursery, you notice a midline tuft of hair on the newborn’s lower back. This diagnosis is associated with a lack of what vitamin.
folic acid
100
Dexamethasone administration prior to antibiotics in bacterial meningitis can help decrease the risk of this long term outcome
sensorineural hearing loss
100
An 18 mo old is playing with a toy. The parent removes the toy. The child begins to scream, then becomes silent, turns blue, and falls to the ground. He has several tonic clonic jerks. Within 45 seconds the episode ends.This is the 3rd time they have an one of these episodes. Their sibling had these episodes too.
Breath holding spell
100
You are doing a newborn exam on a LGA infant s/p vaginal delivery c/b shoulder dystocia and catch this diagnosis.
Erb Palsy (c5-6)
200
You should consider this diagnosis in a infant with lethargy and suspected NAT
subdural hematoma
200
If a newborn fails their hearing screen, this test should be sent prior to discharge
CMV
200
A 5 yo has been getting in trouble at school for not paying attention. His teacher says he suddenly “zones out” and does not respond. His EEG showed 3 hz spike and wave c/w this diagnosis.
Absence seizures
200
This is the most common condition causing pediatric stroke
Sickle Cell
300
This is the diagnosis for a 6 mo old who presents with parental concerns for arm and leg flail up in clusters. Sometimes head nods. It often happens when waking up.
infantile spasms
300
You are in the NICU with a febrile ex-31 weeker. You get an LP, the tap is bloody and never clears. Cell count is c/w bacterial meningitis, but you also notice the RBC count in 60k. After starting abx and acyclovir, you talk with your attending about this next step.
Head imaging to look for ICH
(this infant had SDH and SAH)
300
A 16 yo with PTSD and anxiety presents to the ED with c/f seizures. She had a 15 minute episode where she fell down and was asynchronously moving all extremities and had urinary incontinence. She is able to recall the entire episode. The episode resolved on its own. No post-ictal state. The episode was witnessed by mom and sister. EEG most likely shows this.
Normal (likely NES)
300
A 4 y/o boy presents with frequent falls and toe walking. His parent noticed he needs to “walk” his hands up his shins, knees, and thighs to stand up. You suspect this diagnosis.
Duchenne's Muscular Dystrophy
400
This is the classic EEG finding for infantile spasms
Hypsarrhythmia
400
You are called by the RN for your patient with Guillain Barre. His NIF is now -30 and has changed more than 30% in the past 24 hours. This is the reason you call an RRT.
Impending Respiratory Failure
(consider intubation when -25)
400
A 23 mo old presents to the ED after a 4 minute episode of upper and lower extremity shaking. He is now back to baseline. He has been sick with URI symptoms and has a fever to 103. The family wants a neurology consult but you reassure them that this is the diagnosis.
Febrile seizure
400
An previously healthy 20 mo F is brought into clinic by her parents. She has been developing appropriately, but recently they have noticed that she has been doing repetitive hand movements like shes clapping, is no longer interested in her toys, is now breath holding then hyperventilating. She is also speaking less. After a thorough workup, you get genetic testing results showing this gene is deleted
MECP2 (Rett Syndrome)
500
Previously healthy 5-month-old male infant presents with constipation x3 weeks, progressive lethargy and loss of developmental milestones over 2 weeks, and poor feeding. On exam: hypotonic, flaccid extremities, no suck, no moro. You are concerned about this diagnosis.
Infantile botilusm
500
A previously well 9-month-old girl presented with fever, lethargy, and a 40 min focal seizure. An LP and MRI are performed. Before the LP results, you see this on MRI. You suspect what diagnosis?
HSV encephalitis
500
A 2 yo presented to the ED s/p 2 episodes of “jolting” arm movements. Mom reports both times were after he opened a piece of tupperware that had a loud pop. She brought the container with her. On exam, he has brief 1-2 seconds extension and external rotation of b/l arms and upward eye roll with immediate return to baseline. You believe this is the diagnosis.
reflex seizure
500
A 15 yo with ulcerative colitis presents to the hospital with Hbg 6 and in a IBD flare. Over the past 5 days she has had frontal HA that did responded minimally to migraine cocktail and did not improve with blood transfusions. You should have this diagnosis on your ddx given her IBD.
Central Venous Sinus Thrombosis