09-21-2014, 12:22 PM
Plz tell first diagnosis and the reasons. Why? Thanks..
1. A one year old girl is brought to ER. Mother describes what sounds like a generalized seizure that last for 5 minutes. Prior to this, she was fine until she developed a fever to 105F "rather rapidly". After the seizure, she felt cool again, but now has developed a rash. On exam, the child is awake and crying, is now afebrile, and RR, HR and BP are normal. He exam is completely normal. The child's birth hx and medical hx over the first year are unremarkable. Family hx is negative fore seizures or neurological problems. Mother states that this occurred once with an older sibling when the child was 18 months old. The next best step in management is to:
a. Perform LP
b. schedule EEG
c.Order MRI of the brain
d. Start the patient on phenobarbital
e. Perform no test and give no treatment
2. A 2 year old girl, who has been a well-child to this point has developed a seizure. the mother tells the pediatrician that her right arm was shaking and that she "passed out". This lasted about 3 or 3 minutes, whereupon the girl regained consciousness but seemed to be very sleepy. You are now examining her about one hour after the episode. She is is asleep in her mothers arms and is arousable but lethargic. She is breathing comfortably, is pink with oxygen saturation in room air of 99%. Her HR and BP are normal and her neurological exam is normal. Fundoscopic exam is normal. The best test to determine the possible etiology for this seizure is :
a. EEG
b.CT scan
c.MRI
d.CSF protein concentration
e. Blood for molecular analysis of a specific genetic defect.
3. A term infant is born through thick meconimum with a non-traumatic delivery. There are also later decelerations, and a cord pH of 7.15. The neonatology team is called to the delivery room to attend this delivery. The infant is born limp without respirations. He is is immediately intubated and suctioned with scant meconium below the cords. He is then ventilated through the ETT with a bag and 100%oxygen and the infant begins to breathe and become pink. Apgar scores are 2,5 and 6. The EET is removed and he continues to breathe well in room air. The infant is then raken to the NICU for observation. At 10 hours of age, he has multiple apneic events, hypotonia and eye blinking. He is re-intubated and placed on ventilator. Continous EEG monitoring shows seizure activity. The most likely cause of the seizures in this newborn is:
a.Meningitis
b.Hypocalcemia
c.Subarachnoid hemorrhage
d. Hypoxic-ischemic encephalopathy
e.An inborn error of metabolism
1. A one year old girl is brought to ER. Mother describes what sounds like a generalized seizure that last for 5 minutes. Prior to this, she was fine until she developed a fever to 105F "rather rapidly". After the seizure, she felt cool again, but now has developed a rash. On exam, the child is awake and crying, is now afebrile, and RR, HR and BP are normal. He exam is completely normal. The child's birth hx and medical hx over the first year are unremarkable. Family hx is negative fore seizures or neurological problems. Mother states that this occurred once with an older sibling when the child was 18 months old. The next best step in management is to:
a. Perform LP
b. schedule EEG
c.Order MRI of the brain
d. Start the patient on phenobarbital
e. Perform no test and give no treatment
2. A 2 year old girl, who has been a well-child to this point has developed a seizure. the mother tells the pediatrician that her right arm was shaking and that she "passed out". This lasted about 3 or 3 minutes, whereupon the girl regained consciousness but seemed to be very sleepy. You are now examining her about one hour after the episode. She is is asleep in her mothers arms and is arousable but lethargic. She is breathing comfortably, is pink with oxygen saturation in room air of 99%. Her HR and BP are normal and her neurological exam is normal. Fundoscopic exam is normal. The best test to determine the possible etiology for this seizure is :
a. EEG
b.CT scan
c.MRI
d.CSF protein concentration
e. Blood for molecular analysis of a specific genetic defect.
3. A term infant is born through thick meconimum with a non-traumatic delivery. There are also later decelerations, and a cord pH of 7.15. The neonatology team is called to the delivery room to attend this delivery. The infant is born limp without respirations. He is is immediately intubated and suctioned with scant meconium below the cords. He is then ventilated through the ETT with a bag and 100%oxygen and the infant begins to breathe and become pink. Apgar scores are 2,5 and 6. The EET is removed and he continues to breathe well in room air. The infant is then raken to the NICU for observation. At 10 hours of age, he has multiple apneic events, hypotonia and eye blinking. He is re-intubated and placed on ventilator. Continous EEG monitoring shows seizure activity. The most likely cause of the seizures in this newborn is:
a.Meningitis
b.Hypocalcemia
c.Subarachnoid hemorrhage
d. Hypoxic-ischemic encephalopathy
e.An inborn error of metabolism