A 6-year-old complains of headachon arising in the morning for 2 months, with head tilt for 2 days. Physical exam shows past pointing and difficulty with rapid alternating hand movements. Fundi are hard to visualize. The next evaluation step should be

Correct Answer: C

Rationale: A CT scan is the next step for morning headaches, head tilt, ataxia (past pointing, dysdiadochokinesia), and obscured fundi, suggesting increased intracranial pressure (ICP) from a posterior fossa lesion (e.g., tumor). CT quickly identifimass effect or hydrocephalus, critical before lumbar puncture , which risks herniation with ICP. EEG targets seizures, not present here. A psychologist addressbehavior, not neurologic signs. Vision testing is secondary to imaging. CTs speed and ICP detection, per emergency protocols, make C the correct answer, prioritizing safety and diagnosis.

Correct Answer: C

Rationale: Rasmussen encephalitis featurepilepsia partialis continua , onset before 10 years , abnormal EEG , and possible CMV role , but not no sequelae . This chronic focal encephalitis causprogressive hemispheric atrophy, seizures, and deficits (e.g., hemiparesis), ensuring sequelae. No sequelae contradicts its destructive course, per neurology texts, making C the exception and correct answer.

Correct Answer: A

Rationale: Acetaminophen is the first-line treatment for mild, infrequent pediatric migraines, per AAP, due to safety and efficacy. Sumatriptan targets severe migraines, not mild, and is less studied in young children. Aspirin risks Reye syndrome in kids. Chlorpromazine and ergotamine are for acute severe attacks or adults. Acetaminophens tolerability makes A the correct answer.

Correct Answer: D

Rationale: Brain tumor evolvsubacutely over days to weeks, with symptoms like headache, seizures, or focal deficits progressing as mass effect or edema worsens, per neurology texts. Seizurare episodic, lasting minutes, not weeks. Stroke is acute, onset within hours. Epidural hemorrhage progressrapidly (hours) post-trauma. Hereditary neuropathi(original E) are chronic, spanning years. Tumors gradual growth, causing pressure or infiltration, fits the subacute timeline, distinguishing it from acute or chronic processes. Imaging often reveals mass with surrounding edema, supporting diagnosis over time. Thus, D is the correct answer, reflecting its insidious yet progressive nature.

Correct Answer: B

Rationale: The Babinski reflex disappears by 12-18 months , per pediatric norms, as corticospinal tracts myelinate, suppressing this primitive response. Present at birth, dorsiflexion and fanning indicate immature upper motor neurons; persistence beyond 18 months suggests pathology (e.g., CP). 6-12 months is early; 18-24 or later overestimatnormal range. Developmental neurology confirms 12-18 months as typical, making B the correct answer.