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Pediatric Rounds Review Questions

Fever and Seizure Activity in a 10-Month-Old Boy

Win Boon, MD, and Amy Fleming, MD

Dr. Boon is a pediatric house officer, Department of Pediatrics, University of Michigan Health System, C.S. Mott Children’s Hospital, Ann Arbor, MI. Dr. Fleming is an assistant professor and pediatric hospitalist, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN..

The questions below are based on the December 2007 Pediatric Rounds article, “Fever and Seizure Activity in a 10-Month-Old Boy”.


Choose the single best answer for each question.

1. A previously healthy 20-month-old girl presents with high fever, mental status changes, and new-onset seizure activity. The initial physical examination is significant for focal neurologic findings. Of the following options, which would routinely be recommended first in the management of this patient?
  1. Computed tomography of the head
  2. Intravenous antibiotics
  3. Lumbar puncture
  4. Magnetic resonance imaging of the head
  5. Steroids
Click here to compare your answer.

2. What is an appropriate initial antibiotic regimen for the patient described in question 1?

  1. Cefotaxime and rifampin
  2. Ceftriaxone and rifampin
  3. Ceftriaxone and vancomycin
  4. Vancomycin alone
  5. Vancomycin and rifampin
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3. Which of the following is the most common long-term neurologic sequela associated with bacterial meningitis in children?
  1. Hearing loss
  2. Mental retardation
  3. Paresis
  4. Seizures
  5. Spasticity
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4. All of the following statements regarding the use of dexamethasone in children are true EXCEPT

  1. Dexamethasone is not routinely recommended in suspected cases of pneumococcal meningitis
  2. Dexamethasone has been associated with a decrease in neurologic sequelae in bacterial meningitis
  3. Dexamethasone should be administered before or with the initiation of antibiotics
  4. Dexamethasone works in part by enhancing the efficacy of antibiotics
  5. If initiated, dexamethasone should be given for 2 to 4 days
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