Pediatrics Recalls By Subject – Neurology

A 17-year-old girl has been having migraines for the last 2 years, and has been treated with acamol (acetaminophen). Lately she reports a significant increase in frequency of the migraines, with no change in their character. Neurological examination is normal.

Which of the following is the most recommended prophylactic drug at this point?

A 4-month-old infant presents with infantile spasm episodes, worsening over the last 4 weeks. Findings in physical examination are shown in the picture.

Which of the following is the most appropriate first line anti-epileptic drug?

A 6-year-old girl presents with a week of lower limbs weakness, numbness up to the navel level, with trouble in urinating and defecating. These complaints followed a febrile illness. CSF examination revealed a negative gram stain, and a slightly increased protein level.

Which of the following is the most appropriate treatment?

A 16-year-old, generally healthy boy presents with fever, headaches, dyspnea, hemoptysis, malaise, and hematuria. Examination reveals he is pale, with respiratory rate of 24/min, bilateral lung rales with reduced breath sounds on the right, and sensitivity upon sinus percussion. No other abnormal findings.

Which of the following diagnostic tests will facilitate decisions regarding the most likely diagnosis?

A 7-year-old girl’s parents and teachers report recent episodes of unawareness and stillness, occurring a few times a day and lasting 5-10 seconds. EEG is below.

Which of the following is the most likely diagnosis?

A 12-year-old boy presents with the physical findings in the photos below

Which of the following will most likely be found in this patient?

A 10-year-old’s parents complain he daydreams and they have to repeat every order several times.

They report he is unorganized, forgets to do his homework, and has difficulties in school. His physical examination is normal.

Awake and sleep EEG are normal.

Which of the following is the next diagnostic test?

A 3-year-old boy presents with a first episode of a febrile seizure.

Which of the following is a criterion for defining the seizure as a complex febrile seizure?

A 4-year-old boy presents with proximal weakness over the last months. Examination is positive for calf
muscle hypertrophy and laboratory tests reveal elevated CPK.
Which of the following is the cardiac manifestation of the child’s most likely disease?

A 3-year-old girl is diagnosed with neurofibromas, skin hyperpigmented lesions, scoliosis, iris tumors,
and learning disabilities. Her brother who is 6-month-old has skin hyperpigmented lesions (more than 5) without any other signs. Genetic testing is positive for neurofibromatosis type 1 with the same NF1 gene mutation in both of them.
Which genetic principle is demonstrated is this case?

Which of the following is an indication for brain imaging for headaches in children?

A 3-year-old male toddler, normally healthy, is examined in the emergency room due to a generalized tonic-clonic seizure that lasted about ten minutes. During his examination, a temperature of 40°C was measured. The parents describe a similar incident approximately six months ago.

How can the seizure be defined?

A 6-year-old boy is getting up from the floor as seen in the images. Blood test demonstrates CPK levels of 25,000 IU/L
(normal below 160).

What is the most likely diagnosis?

A 10-year-old boy complains of weakness and back pain. On his examination – weakness in the lower extremities. After a few days, weakness also appeared in the upper limbs. On the physical examination, reflexes cannot be produced. The parents mention that about two weeks before the onset of the complaints, he suffered from diarrhea. A lumbar puncture was performed.

Which finding in the cerebrospinal fluid (CSF) will support the presumed diagnosis with the highest probability?

A 10-year-old boy presents with the findings in the image below. In addition, several Lisch nodules are observed in the eye examination.

Which of the following findings may most likely accompany his illness?

A 6-year-old boy presents with multiple short episodes of staring and detachment from his surrounding occurring at all hours of the day for the last few weeks. Hyperventilation worsens the episodes. EEG demonstrates general bursts of slow spikes and waves pattern.

Which of the following describes the appropriate treatment for this condition?

A 13-year-old complains of double vision and has been seen holding his eye open with his fingers to prevent it from intermittently closing. The symptoms are worse in the evenings. Recently he has been exhibiting difficulties in swallowing food.

Which of the following test will promote the diagnosis?

A 10-year-old boy’s examination reveals the findings in the photos

Which of the following is a complication of the boy’s disease?

Which of the following is characteristic of Horner’s syndrome?

A 6-months-old generally well infant presents with 2 weeks of episodes of “arm and head stretching”, more often around falling asleep and arousing. The episodes occur more often over the last week, and the parents report he stopped smiling and is less alert lately. EEG is attached.

Which of the following is the most likely diagnosis?

A 16-year-old boy presents with 4 months of leg pain, appearing mostly in the evenings before he goes to sleep, and at rest. The pain is relieved by moving the legs. Additionally, over the last few months his school work has deteriorated due to day time tiredness. Physical examination and laboratory tests are normal.

Which of the following is the most appropriate treatment?

Which of the following is a major risk factor for recurrent febrile seizures?

A 2-months-old baby, with parents who are first degree relatives, presents with weakness upon moving his limbs, and difficulty raising his head when in the prone position. Examination reveals an alert baby, which follows well with his eyes. No reflexes were obtained, there were tongue fasciculations, and the finding in the attached picture.

Which of the following is the most likely diagnosis?

A 15-year-old obese girl presents with afebrile headaches for the last 4 weeks. Ophthalmology reveals blurred borders of the optic disc; brain MRI was normal. Lumbar puncture revealed a high opening pressure.

Which of the following is a common complication of her diagnosis?

A 5-year-old male began walking at the age of 1.8 years; his parents report clumsy gait, difficulty going up and down stairs, and difficulty transitioning from sitting to standing. On physical examination – bilateral calf hypertrophy. In laboratory tests, CPK values around 3000 in several tests. Family history – brother with a similar history.

Which of the following findings is common in the toddler’s diagnosis?

The following finding (image below) is demonstrated in a few-hours-old newborn.

Which of the following actions could have prevented the phenomenon?

A 3-month-old male, hospitalized for investigation of suspected convulsions. On examination – findings are demonstrated in the image (below). Brain imaging (CT) showed subependymal nodules.

Which of the following findings is typical of the probable diagnosis in this case?

In a brain ultrasound (US) of a premature baby born at week 32 weighing 1400 grams, the finding described in the image was observed.

Which of the following complications is common in the context of the presumed diagnosis?

A 4-year-old male, known history of upper respiratory tract diseases and recurrent pneumonia, referred due to ataxic gait that is worsening over time. On examination – findings as described in image.

Which of the following is the most recommended treatment?

You are examining a newborn with the findings described in the image. Background: born to a mother who suffered from diabetes during pregnancy, with a birth weight of 5,200 kg, vaginal birth.

What is the most appropriate treatment for his condition?

A 14-year-old boy is evaluated due to hearing loss and myoclonic seizures appearing over the last 6 months. Up until then he was well, with normal development. His maternal aunt died of progressive dementia and ataxia at the age of 37. His maternal grandmother was diagnosed with diabetes and hearing loss and died at the age of 80 years. Examination reveals short stature, cachexia, ataxia and myoclonus. Laboratory results are significant for elevated serum and cerebrospinal fluid lactate. Which of the following genetic tests will be the most helpful with this patients’ diagnosis?

Which of the following is indicated in the routine workup of a child with a new diagnosis of autism spectrum disorder with no additional neurological or physical findings?

An infant’s neurological exam is positive for the finding in the photo

Which of the following is true?

A 10-year-old male presents with progressive muscle weakness that started about 5 days ago in the legs and continued to rise in the direction of the hands and the face. Around two weeks ago, he suffered from diarrhea, and since then has been complaining of increasing fatigue. The weakness progresses fast, and he struggles to hold objects in his hand and lift his legs from the bed. He is also complaining of dyspnea. On the examination, symmetrical weakness of the limbs, and weakened reflexes.

What is the most appropriate treatment in this case?

A 5-year-old female presents with a complaint of loss of visual acuity. On examination, findings seen on the attached image are noted. The child’s mother reports having similar findings.

What is the next step to be taken?

A 6-year-old female had fever and myalgia one week ago. She now presents with decreased level of consciousness, limb weakness, and gait instability. A brain MRI shows findings presented in the attached image.

What is the recommended treatment at this stage?

At a summer camp in South Israel, 20 children developed watery diarrhea requiring medical treatment and fluid administration. Roast chicken was served in the camp dining room the day before. Three weeks later, one of the children was hospitalized with weakness in the legs. On neurological examination in the ER, patellar reflexes were absent.

Which of the following is the most likely cause of the outbreak?

A 4-month-old female presents to the emergency department following her first generalized seizure lasting approximately one minute. She has no prior neurological issues or family history of seizures. On examination of the child: her temperature is 39°C, she is fully conscious with a normotensive fontanelle, and the remainder of her examination is unremarkable.

What is the most appropriate next step in management?

A 10-day-old newborn female was born in a normal delivery, with a birth weight of 4.500 kg with the finding described in the image.

What would be the most appropriate treatment at this stage?

Which of the following is considered an indication to perform brain imaging for a child suffering from recurrent headaches?

Which of the following patients suffers from a complex febrile seizure?

Male, 5 months old. From the age of two months, a significant motor delay and hypotonia have been reported. Upon examination: significant Head Lag, he lies in a frog-leg position, tongue fasciculations, and absence of patellar reflexes. A molecular test indicates a homozygous pathogenic variant in the SMN1 gene.

Which anatomical part is most likely affected in this case?

A 14-year-old boy, has had recurring headaches for about a year. Pulsating pains, mostly bilateral, accompanied by nausea and photosensitivity. The episodes occur twice a weak, sometimes after stress at school or skipping a meal. Lately, the boy has been avoiding social activities, fearing an episode. The pediatrician is considering initiation of acute treatment during an episode. Which of the following medications is the most suitable?

A 10-month-old boy is referred for investigation due to recurring episodes of cramps in extremities. Congenital skin defects, attached in the following photo are seen in the examination. The EEG test is also attached

Which of the following diagnoses is the most likely?

A 15-year-old girl, has been complaining for two weeks of hand twitches in the morning hours, which make her drop things. EEG demonstrated 4-5 Hertz poly-spike and slow wave. What is the most likely diagnosis?

A 6-year-old girl is admitted to the ER due to reduced consciousness, bilateral weakness and ataxia, following a mild viral disease. Brain MRI showed the
findings in the image.

What is the most suitable treatment for her condition?

A 6-week-old boy, his parents are first cousins, was examined for congenital hypotonia. In his examination, alert and demonstrates gaze following, no reflexes, tongue fasciculations and in addition, a finding that appears in the attached image:

What is the baby’s likely diagnosis?

A 5-year-old boy with a history of seizures from infancy, developmental delay and hypotonia, referred to brain MRI. Examination demonstrated cortical tubers and subependymal subventricular lesions. What is the most likely diagnosis?

A 7-year-old boy comes in for consultation due to difficulty concentrating, hyperactivity and aggressive (impulsive) behavior at school and at home. The teacher reports difficulty sitting in one place, tendency to interrupt the lessons and difficulty completing assignments. The parents note that these behaviors are present since kindergarten.

What is the most likely diagnosis?