CNS Disorders in Children (Seizures, Hydrocephalus, Meningitis) MCQs

Pediatrics · 71 free questions with answers & explanations.

  1. A 2-year-old child has a first episode of generalized tonic-clonic seizure lasting 3 minutes during a febrile illness (temperature 39.2°C). Neurological examination is normal. There is no family history of epilepsy. What is the MOST appropriate management?
  2. A 3-month-old infant is brought with increasing head circumference (above 99th percentile), bulging anterior fontanelle, and setting-sun sign. CT scan shows dilatation of lateral and third ventricles with a normal fourth ventricle. What is the MOST likely type of hydrocephalus?
  3. A 7-year-old child has a 2-year history of staring episodes lasting 5–15 seconds with eye fluttering, occurring multiple times daily. EEG shows 3-Hz spike-and-wave discharges on hyperventilation. The child has normal intelligence and no structural brain lesion. Which of the following statements about the FIRST-LINE drug for this condition is CORRECT?
  4. A 6-month-old infant presents with bulging anterior fontanelle, irritability, sunset sign, and rapidly increasing head circumference crossing two centile lines. MRI shows aqueductal stenosis causing triventricular hydrocephalus. The PREFERRED surgical treatment in this case is:
  5. A 6-year-old child presents with daily episodes of sudden brief staring, with eye blinking and lip smacking lasting 5-10 seconds. The child is unaware of these episodes, which resolve spontaneously. EEG shows 3 Hz spike-and-wave complexes. Which of the following antiepileptic drugs is considered first-line for childhood absence epilepsy?
  6. A 3-month-old infant presents with bulging anterior fontanelle, setting-sun sign, irritability, and increasing head circumference crossing percentiles. Ultrasound shows dilated lateral ventricles. The infant was born at 28 weeks with a history of Grade III intraventricular hemorrhage. Which type of hydrocephalus is most likely?
  7. A 7-year-old child has absence seizures occurring 20–30 times a day. EEG shows 3 Hz generalised spike-wave discharges. Neurological examination is normal. The first-line antiepileptic drug of choice is:
  8. A 6-week-old infant presents with macrocephaly, bulging anterior fontanelle, and 'setting sun sign'. Head circumference has crossed 2 centile lines upward in 2 weeks. CT brain shows dilated lateral ventricles with cortical mantle preserved. The communicating hydrocephalus in this neonate most likely results from:
  9. A 4-month-old infant presents with fever, irritability, and a full fontanelle. CSF analysis: glucose 15 mg/dL (blood glucose 80 mg/dL), protein 280 mg/dL, WBC 1200 cells/mm³ (95% neutrophils). Gram stain shows Gram-negative diplococci. The most appropriate empirical antibiotic regimen while awaiting sensitivity is:
  10. A 6-month-old child presents with infantile spasms (brief flexion-extension jerks occurring in clusters on awakening). EEG shows hypsarrhythmia. MRI brain is normal. Which treatment has the BEST evidence for improving BOTH seizure control AND neurodevelopmental outcome in cryptogenic infantile spasms?
  11. A 2-year-old child develops fever, seizures, and encephalopathy. CSF analysis shows: glucose 15 mg/dL (blood glucose 90 mg/dL), protein 200 mg/dL, and 400 cells/µL predominantly lymphocytes. India ink stain is negative. What is the MOST appropriate empirical treatment?
  12. An 8-month-old child is brought with rapidly increasing head circumference, full fontanelle, 'setting sun' sign, and irritability. Cranial ultrasound reveals dilated lateral and third ventricles with a normal fourth ventricle. What is the ANATOMICAL site of obstruction?
  13. A 6-year-old child with childhood absence epilepsy (CAE) has been having multiple absence seizures per day. First-line treatment is started. Which EEG pattern is pathognomonic of CAE, and which drug combination is currently considered MOST effective based on the 2010 NIH-funded CHILDHOOD ABSENCE EPILEPSY study?
  14. A 5-month-old infant has rapidly increasing head circumference (+3 cm in 1 month), bulging anterior fontanelle, and sunsetting sign. MRI shows obstructive hydrocephalus with aqueduct stenosis. Which genetic condition has X-linked recessive inheritance and aqueductal stenosis as its primary feature causing congenital hydrocephalus?
  15. A 3-year-old child with suspected bacterial meningitis is being prepared for lumbar puncture. The child has no focal neurological signs, no papilledema, and GCS is 14. Cerebrospinal fluid shows WBC 1200 cells/μL (95% neutrophils), protein 180 mg/dL, and glucose 18 mg/dL (simultaneous blood glucose 90 mg/dL). Which ancillary investigation on CSF would BEST help predict bacterial etiology when Gram stain is negative?
  16. A 9-month-old infant has episodes of sudden flexion of the neck and trunk with arm extension lasting 2 seconds, occurring in clusters of 20–30 upon waking. EEG shows hypsarrhythmia (chaotic high-voltage disorganised pattern). MRI brain is normal. Which treatment has evidence for both seizure control AND improved developmental outcome?
  17. A 4-year-old child with obstructive hydrocephalus undergoes ventriculoperitoneal (VP) shunt placement. Three months later he presents with fever, headache, vomiting, and abdominal pain. CSF from the shunt reservoir shows WBC 800 (neutrophils 85%), glucose 30 mg/dL (serum 90 mg/dL), protein 180 mg/dL. The MOST common causative organism and appropriate management are:
  18. A 5-year-old boy has recurrent episodes of brief staring spells lasting 5–10 seconds, with subtle eye blinking and no postictal confusion. EEG shows 3 Hz generalized spike-and-wave discharges on hyperventilation. Family history reveals his older sister has childhood absence epilepsy. What is the drug of CHOICE for this condition?
  19. A 6-month-old infant presents with increasing head circumference (>95th centile) crossing two percentile lines over 2 months, sunset sign, and bulging anterior fontanelle. CT scan shows dilated lateral and third ventricles with normal-sized fourth ventricle. What does this suggest, and what is the next diagnostic step?
  20. A 6-year-old develops acute bacterial meningitis. CSF shows glucose 18 mg/dL (blood glucose 95 mg/dL), protein 280 mg/dL, WBC 800/µL (90% PMN), and Gram stain shows gram-negative diplococcus. Ceftriaxone is started. Dexamethasone is given 15 minutes before the first antibiotic dose. For which organism is dexamethasone adjunctive therapy MOST evidence-based in pediatric bacterial meningitis?
  21. A 3-year-old child develops a febrile seizure lasting 25 minutes (prolonged), involving the left arm only (focal), during a fever of 38.5°C. This is the second febrile seizure this year; the first was a brief generalized one. The risk factor most strongly associated with subsequent epilepsy in this child is:
  22. A 4-month-old infant presents with bulging fontanelle, sunset sign (downward gaze paresis), irritability, and increasing head circumference crossing two percentile lines over 6 weeks. MRI shows massive dilatation of lateral and third ventricles with normal fourth ventricle size and no evidence of aqueductal CSF flow. The primary anatomical site of obstruction is:
  23. A 6-year-old child with bacterial meningitis (CSF: WBC 2000/mm³, 92% neutrophils, protein 220 mg/dL, glucose 18 mg/dL vs blood 90 mg/dL) has been started on IV ceftriaxone. Dexamethasone is given as adjunctive therapy. The primary mechanism by which dexamethasone reduces meningitis-associated hearing loss is:
  24. A 3-year-old child has a 4-minute focal clonic seizure of the left arm associated with a fever of 39.8°C. He had a prior febrile seizure at age 2. His EEG between episodes is normal. Which feature MOST RELIABLY distinguishes a complex febrile seizure from simple febrile seizure in this child?
  25. A 2-month-old infant is noted to have a rapidly enlarging head circumference crossing two centile lines over 8 weeks, bulging anterior fontanelle, and sun-setting sign. CT scan shows enlarged lateral and third ventricles with normal fourth ventricle and cerebral aqueduct. Which is the MOST LIKELY anatomical site of CSF obstruction?
  26. A 6-month-old infant is brought with fever, irritability, bulging fontanelle, and reduced feeding for 24 hours. CSF analysis shows: glucose 18 mg/dL (blood glucose 90 mg/dL), protein 280 mg/dL, TLC 1800 cells/mm³ (90% neutrophils), and gram-negative coccobacilli on Gram stain. Which empirical antibiotic regimen is MOST APPROPRIATE for this age group?
  27. A 3-year-old child presents with complex febrile seizures lasting 20 minutes on three occasions in the same febrile illness. MRI later shows hippocampal sclerosis. Which of the following is the most significant long-term risk associated with prolonged/complex febrile seizures?
  28. A 6-month-old infant has a bulging anterior fontanelle, enlarged head circumference (head circumference >97th centile), sunset sign, and irritability. CT head shows triventricular hydrocephalus with dilated lateral and third ventricles and a normal fourth ventricle. What is the most likely site of obstruction?
  29. A 7-year-old has absence seizures characterized by brief (5-10 second) staring spells with eyelid flickering occurring 15-20 times daily, triggered by hyperventilation. EEG shows 3 Hz spike-and-wave discharges. The antiepileptic drug of choice for this specific syndrome is:
  30. An 18-month-old has a head circumference at the 98th centile with a bulging anterior fontanelle and setting-sun sign. CT head shows dilated lateral and third ventricles with a normal fourth ventricle. The most likely etiology of hydrocephalus in this child is:
  31. A 14-month-old child develops a generalized tonic-clonic seizure lasting 5 minutes during a febrile illness (temperature 39°C). The seizure stops spontaneously. Neurological examination is normal. The MOST accurate statement regarding this event is:
  32. An 8-year-old child with bacterial meningitis receives dexamethasone as adjunctive therapy. The primary mechanism by which dexamethasone reduces morbidity in bacterial meningitis is:
  33. An 18-month-old child develops a 3-minute generalised tonic-clonic seizure during a febrile illness (temperature 39.2°C). He returns to normal neurological baseline after the seizure. This is his first seizure. EEG is normal. What is the risk of recurrence and appropriate management?
  34. A 6-month-old infant has rapidly enlarging head circumference (99th centile) with sunset sign, prominent scalp veins, and irritability. CT brain shows dilated lateral and third ventricles with a normal fourth ventricle. This pattern of hydrocephalus is caused by obstruction at which site?
  35. A 2-year-old presents with fever 39.8°C and a 3-minute generalized tonic-clonic seizure, now fully conscious. This is his first febrile seizure. He recovers completely. Which of the following is the BEST predictor of RECURRENCE of febrile seizures?
  36. A 6-month-old infant presents with increasing head circumference (crossing two centile lines over 2 months), bulging anterior fontanelle, 'setting sun' sign, and prominent scalp veins. CT brain shows markedly enlarged lateral and third ventricles with a small posterior fossa. Which type of hydrocephalus does 'setting sun' sign indicate and what is its mechanism?
  37. A 5-year-old presents with 5 days of fever, severe headache, photophobia, and neck stiffness. CSF analysis: WBC 1200/mm3 (95% lymphocytes), glucose 25 mg/dL (blood glucose 90 mg/dL), protein 180 mg/dL. Gram stain negative. Which diagnosis and empirical treatment is appropriate while awaiting further investigations?
  38. A 5-year-old with known epilepsy presents with absence seizures characterized by brief (5–30 second) episodes of staring with eye blinking, abrupt onset and termination, and no postictal confusion. The EEG finding MOST characteristic of this seizure type is:
  39. A 3-month-old infant presents with progressive head enlargement (head circumference crossing centiles), bulging anterior fontanelle, and dilated scalp veins. Transillumination of the skull is positive. CT head shows massive dilation of all four ventricles. The MOST likely etiology of communicating hydrocephalus in this age group is:
  40. A 9-month-old infant is brought to the emergency department with high-grade fever for 18 hours, bulging fontanelle, neck stiffness, and a petechial/purpuric rash. Blood culture is sent. What is the FIRST priority intervention?
  41. A 4-week-old male infant presents with progressive non-bilious projectile vomiting after every feed for the past week. The baby appears hungry after vomiting. Examination reveals visible gastric peristalsis from left to right and an olive-shaped mass in the epigastrium. What is the INVESTIGATION OF CHOICE to confirm the diagnosis?
  42. A 3-week-old male infant presents with projectile non-bilious vomiting immediately after feeds, with visible peristalsis from left to right in the epigastrium. The infant appears hungry after vomiting. Electrolytes show Na 130 mEq/L, K 2.8 mEq/L, Cl 82 mEq/L, bicarbonate 32 mEq/L, pH 7.52. The PATHOLOGICAL metabolic abnormality and its MECHANISM are BEST described as:
  43. A 2-year-old child presents with sudden onset bilious vomiting, severe colicky abdominal pain, and passage of 'redcurrant jelly' stools. On examination, a sausage-shaped mass is palpable in the right iliac fossa. Which of the following is the investigation of choice for both diagnosis AND initial treatment?
  44. A 3-week-old male infant presents with progressive non-bilious projectile vomiting after each feed for the past 5 days. He is hungry after vomiting. On examination, an olive-shaped mass is palpable in the right epigastrium after a test feed. Bloods show: Na 128, K 3.0, Cl 85, pH 7.52, HCO3 32 mEq/L. Which of the following is the most important pre-operative measure?
  45. A 9-month-old infant presents with sudden-onset colicky pain, drawing up of knees, and passage of 'redcurrant jelly' stools. Ultrasound shows a target sign in the right upper quadrant. After successful pneumatic air enema reduction, the child should be observed for at least:
  46. A 3-week-old male infant presents with projectile non-bilious vomiting after feeds for the past 7 days. He appears hungry after vomiting. On examination, a hard olive-shaped mass is palpable in the right epigastrium. Blood gases show: pH 7.55, pCO2 48 mmHg, bicarbonate 38 mEq/L, chloride 85 mEq/L, potassium 2.8 mEq/L. What is the CORRECT management sequence?
  47. A 9-month-old infant presents with sudden onset colicky abdominal pain (paroxysmal episodes of crying, drawing up knees), vomiting, and passing 'red currant jelly' stools. Ultrasound shows a 'target sign' in the right iliac fossa. What is the initial treatment of choice?
  48. A 5-week-old male infant presents with non-bilious, projectile vomiting after every feed for 1 week. The vomiting has worsened progressively. The infant is hungry after vomiting. On examination there is visible peristalsis and a palpable olive-shaped mass in the epigastrium. Serum electrolytes show Na 128 mEq/L, K 2.9 mEq/L, Cl 72 mEq/L, bicarbonate 34 mEq/L. Which electrolyte/acid-base pattern and surgical technique are MOST appropriate?
  49. A 3-year-old child passes a large quantity of bright red blood per rectum painlessly. He has no abdominal pain, no fever, and is hemodynamically stable. Physical examination is unremarkable. The MOST appropriate diagnostic test to confirm the most likely diagnosis is:
  50. A 3-week-old male infant presents with progressive projectile (forceful, non-bilious) vomiting after every feed for 5 days. He is hungry after vomiting and demands immediate re-feeding. Examination shows visible peristaltic waves from left to right across the epigastrium and an olive-shaped mass palpable in the right hypochondrium. Blood gas shows pH 7.55, HCO3 38 mEq/L, K 2.8 mEq/L, Cl 88 mEq/L. What is the correct sequence of management?
  51. A 3-month-old infant has a history of bilious vomiting since birth, with intermittent episodes of abdominal distension. He passes meconium late and has ribbon-like stools. X-ray shows multiple air-fluid levels. Contrast enema shows a transition zone in the sigmoid colon with normal ganglion cells proximal to the zone. Rectal biopsy shows absence of ganglion cells. Acetylcholinesterase staining of the aganglionic segment would show:
  52. A 6-week-old male infant presents with projectile, non-bilious vomiting after every feed for the past 2 weeks. He has a palpable olive-shaped mass in the right hypochondrium after vomiting. Lab shows metabolic alkalosis with hypokalemia and hypochloremia. What electrolyte and acid-base profile is MOST characteristic, and what is the mechanism?
  53. A 9-month-old infant suddenly develops paroxysmal episodes of drawing up both knees to the chest, crying inconsolably for 20 seconds, then appearing completely well. These occur every 15–20 minutes. A 'sausage-shaped' mass is palpated in the right hypochondrium. Ultrasound shows a 'target sign' in the right upper quadrant. What is the INITIAL management?
  54. A 3-week-old male infant presents with progressive projectile non-bilious vomiting after every feed for 5 days. On examination, an olive-shaped mass is palpable in the right epigastrium. Serum electrolytes: Na 138, Cl 88, K 3.0, HCO3 32 mEq/L. The metabolic derangement present is:
  55. A 9-month-old infant presents with sudden onset of paroxysmal crying, drawing up of knees, and current jelly stools. Abdominal ultrasound shows a target sign (donut sign) in the right lower abdomen. What is the initial treatment of choice for this stable, hemodynamically normal child?
  56. A 6-week-old male infant presents with non-bilious projectile vomiting after every feed since age 3 weeks. He is hungry after vomiting. Examination reveals visible peristaltic waves from left to right in the epigastrium, and an olive-shaped mass palpable to the right of the umbilicus. Serum electrolytes show Na 132 mEq/L, K 2.9 mEq/L, Cl 88 mEq/L, HCO3 32 mEq/L. What is the CORRECT metabolic abnormality and the REASON surgery must not be performed immediately?
  57. A 9-month-old infant presents with sudden onset inconsolable crying, drawing up of knees to the chest, and passage of a 'redcurrant jelly' stool. An abdominal mass is palpable in the right upper quadrant. Ultrasound shows a 'target sign' (pseudo-kidney sign) in the right upper quadrant. What is the INITIAL treatment of choice if the infant is hemodynamically stable with no perforation or peritonitis?
  58. A 3-week-old firstborn male infant presents with 1 week of non-bilious projectile vomiting after feeds. He is hungry immediately after vomiting. Examination shows mild dehydration and an olive-shaped mass in the right upper quadrant. Blood gases show pH 7.52, bicarbonate 34 mEq/L, serum chloride 88 mEq/L, serum potassium 3.1 mEq/L. What is the correct pre-operative electrolyte management?
  59. A 3-week-old male infant presents with progressively worsening non-bilious projectile vomiting after every feed for 10 days. Examination reveals visible gastric peristalsis and an olive-shaped mass in the right upper abdomen. Electrolytes show: Na 133, K 2.8, Cl 85, HCO3 32 mEq/L. What is the metabolic derangement and its cause?
  60. A 4-week-old male infant presents with projectile non-bilious vomiting, olive-shaped palpable epigastric mass, visible peristalsis, and hypochloremic hypokalemic metabolic alkalosis. The most appropriate immediate investigation is:
  61. A 2-month-old infant presents with bilious vomiting and abdominal distension from day 2 of life. Plain abdominal X-ray shows a 'double bubble' sign with absent distal bowel gas. What is the most likely diagnosis and associated syndrome?
  62. A 4-week-old male infant presents with projectile non-bilious vomiting after every feed for the past week. On examination, an olive-shaped mass is palpable in the epigastrium. Abdominal ultrasound shows pyloric muscle thickness of 4.5 mm and pyloric channel length of 18 mm. What are the METABOLIC ABNORMALITIES expected in this condition and what is the definitive treatment?
  63. A 6-week-old male infant presents with non-bilious, projectile vomiting after every feed for the past 2 weeks. The vomiting occurs immediately after feeding and the infant is always hungry. Examination reveals a palpable olive-shaped mass in the right hypochondrium. Which investigation BEST confirms the diagnosis?
  64. A 9-month-old infant develops sudden, severe, colicky abdominal pain with drawing up of legs, currant jelly stools, and a sausage-shaped mass in the right hypochondrium. The FIRST-LINE treatment in a hemodynamically stable child without peritoneal signs is:
  65. A 6-year-old girl has 10–20 brief (5–10 second) staring spells daily. During an episode, she has subtle eyelid fluttering and does not respond. She recovers immediately with no postictal confusion. EEG shows 3 Hz generalized spike-and-wave discharges. Which drug is CONTRAINDICATED in this type of epilepsy?
  66. A 2-year-old child with myelomeningocele develops worsening headache, irritability, and upgaze palsy (Parinaud's sign) with dilated scalp veins. Head circumference has increased 3 cm over 2 months. Which type of hydrocephalus is present and its MOST common cause in this condition?
  67. A 4-year-old unvaccinated child presents with high fever (40°C), neck stiffness, Kernig's and Brudzinski's signs, and petechial rash. CSF: WBC 1200/mm³ (90% PMN), protein 280 mg/dL, glucose 18 mg/dL (blood glucose 90 mg/dL). Gram stain shows Gram-negative diplococci. What is the most likely organism and the drug of choice?
  68. A 3-year-old child with bacterial meningitis develops papilledema, bulging fontanelle, and herniation signs. Lumbar puncture was deferred. CT head is done first. In which scenario should dexamethasone be given and when is the timing critical?
  69. A 1-year-old child with progressive head growth and irritability has non-communicating hydrocephalus on MRI due to aqueductal stenosis. The preferred surgical treatment is:
  70. A 2-year-old girl develops a seizure (lasting 4 minutes, generalized tonic-clonic) during a febrile illness with temperature of 39.5°C. She is neurologically normal post-ictally. EEG and neuroimaging are not performed. Which statement is MOST accurate regarding her risk of future epilepsy?
  71. A 9-month-old infant with rapidly enlarging head circumference (crossing centiles), bulging fontanelle, sunset sign (downward gaze deviation), and scalp vein prominence is diagnosed with communicating hydrocephalus. MRI shows dilation of all four ventricles. Which is the most likely etiology in this age group?
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