Question . 1. To be effective for preventing myelomeningocele, administration of

folic acid needs to begin:

By 3 months of gestation

At the first missed period

Before conception

Explanation: Folic acid supplementation has been a major

public health success in reducing the incidence of neural tube

defects in the United States. Supplementation also reduces the

recurrence rate of neural tube defects in families with a

previously affected child. (See Chapter 585 in Nelson Textbook

of Pediatrics, 17th ed.)

By 30 days of gestation

At 3 months prior to delivery

Question . 2. A newborn with myelomeningocele is being evaluated, and the

parents ask about the likelihood of the development of hydrocephalus. Which of the

following best describes the risk of hydrocephalus in this situation?

The risk increases with higher spine lesions

Explanation: Hydrocephalus is quite common in children with

a myelomeningocele and must be evaluated with a head

ultrasound study or CT. (See Chapter 585 in Nelson Textbook

of Pediatrics, 17th ed.)

The risk decreases with higher spine lesions

The risk is unknown at birth

The risk is less than 25%

The risk is related to the cause of the malformation

Question . 3. A 4-yr-old boy is evaluated for his first generalized tonic-clonic

seizure, which lasted 10 min. There is no history of illness or fever, and findings on

examination an hour after the seizure are completely normal. The most appropriate

management is:

Begin therapy with carbamazepine

Order an EEG

Explanation: An EEG will help define the presence of a

seizure focus and if there is a specific seizure type. A normal

EEG may help the pediatric neurologist determine if

anticonvulsant therapy is needed. (See Chapter 586 in Nelson

Textbook of Pediatrics, 17th ed.)

Order a CT scan of the brain

Order an MRI study of the brain

Order psychometric testing

Question . 4. A 15-mo-old girl is evaluated for a 10-min-long generalized seizure

associated with a temperature of 40oC. Which of the following factors in the history

is most likely to increase the risk of future seizures?

APGAR score of 3 at 5 min

Family history of epilepsy

Explanation: Future nonfebrile seizures can be predicted

when there is a family history of seizures. Up to 30% of children

with febrile seizures have a recurrence when they become

febrile; these are often unpredictable. (See Chapter 586 in

Nelson Textbook of Pediatrics, 17th ed.)

Clinical evidence of roseola

Female gender

Presence of 2 café-au-lait spots