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Peds Exam 2 > Lecture 10: Neurology > Flashcards

Lecture 10: Neurology Flashcards

1
Q

4 classifications of headaches

which is most often benign and which is most worrisome

A
  1. Acute = mostly benign
  2. Acute Recurrent (Episodic)
  3. Chronic non-progressive
  4. Chronic progressive = most worrisome
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2
Q

What is the definition of Acute Recurrent (Episodic) HA

A

chronic daily headache > 15 days/month for 3 mo

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3
Q

What is a/w tension HA?

What is NOT a/w tension HA?

A

mild-mod pulsating press/tightness

NOT a/w: N/V or photo/phonophobia

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4
Q

2 challenges about Dx Migraines?

A
  1. Vomiting and vertigo more prominent Sxs (dont report HA)

2. Bilateral = more in kids but can be unilateral

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5
Q

Migraine w/OUT aura criteria:
How many migraines needed?

  1. how long do HA last:
  2. Two of following (4):
  3. one of following (2):
A

At least 5 migraines

  1. Lasts 1-72 hrs
  2. need at least 2:
    - unilateral
    - pulsing
    - mod-severe pain
    - aggravated by activity
  3. need at least 1:
    - Photophobia
    - N/V
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6
Q

Migraine w/aura criteria:
How many migraines needed?

  1. Aura w/one of following:
  2. when does migraine start:
A

least 2 migraines

  1. Aura w/one of following:
    - Visual Sxs or vision loss
    - Sensory Sxs (pins/needles, numb)
    - dyphasic speech disturbance
  2. Migragine = dura aura or w/in 60 min after
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7
Q

6 Red flags of HAs that are concerning for intracranial pressure

A
  1. Sleep related HA
  2. A/w cough/defecation
  3. Explosive/sudden onset
  4. Progessive
  5. Neuro Sxs
  6. Systemic sxs
    * Vomiting&raquo_space;»>nausea
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8
Q

What is the imaging modality of choice for eval HAs?

A

MRI (diffusion weighted)

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9
Q

When is eval NOT indicated for HAs?

When should it be considered (2)?

A
  1. NOT indicated if recurrent HA + normal PE
  2. Consider if abn exam, have seizures or both
  3. consider if recent onset of severe HA, change in HA type, neuro dysfxn
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10
Q

if suspect child has ICP what is imaging study done? what also must be done 1st?

A

ICP –> LP

  • MUST DO MRI first to r/o mass
  • if dont –> herniation w/LP
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11
Q

Nemonic for lifestyle management of HAs

A 
"SMART"
Sleep 
Meals (diet)
Activity
Relaxation 
Trigger avoidance
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12
Q

2 Tx options for Acute HA

When do you consider Triptans?

A
  1. OTC Tx
  2. add caffeine < 9 days/mo

Triptans if > 6 y/o

  • if NSAID use > 2-3x/wk
  • Acute Tx of Triptans or caffeine < 10 days/mo
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13
Q

When is preventative therapy considered for HAs?

Med?

A

when > 4 debilitating HAs/month

Topiramate

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14
Q

What types of seizures are more common in kids than adults

A

generalized seizures

vs focal - affects 1 side

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15
Q

Can a norm EEG r/o seizures?

When is the only time an abn EEG can Dx seizure?
- how are they useful?

(Main method of Dx seizures)

A

Norm EEG CANT r/o seizures

Abn EEG –> Dx of seizure if actual seizures recorded
- help classify type of epilespy

main method = Hx

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16
Q
  1. Weird baby movements
  2. Sleep myoclonus
  3. Syncope
  4. Breath holding spells
  5. Movement d/o
  6. Behavioral - daydream, temper tantrum, night terror
  7. Parasomnias
  8. Pseudo-seizures
A

Paroxysymal Non-epileptic Events (not seizures)

17
Q

What is a febrile seizure?

  • age range & peak?
  • 3 RFs (1/2 = no RFs)

Note: MC neuro d/o of infants + young kids

A

convulsion a/w temp > 38 C

  • age range: 3 mo - 6 yrs
  • peak = 12-18 mo

RFs

  1. FHx (1st deg relative)
  2. Neurodevelopmental delays
  3. incr exp to HSV-6
18
Q

3 differences b/t simple and focal febrile seizures

which is MC?

A

Simple = MC

  1. generalized
  2. shorter duration ( < 15 min)
  3. 1 in 24 hrs

Complex

  1. focal (one side of body)
  2. longer duration > 15 min
  3. 1+ in 24hrs
19
Q

Two abn things on PE for seizure that require further workup?

non-focal exam –> no Dx testing

A
  1. Meningmus

2. Bulging fontanelles

20
Q

3 reasons to do LP in workup of seizures? 3 for Neuroimaging?

What type of testing usu NOT recommended

A

LP

  1. < 12 mo
  2. meningitis or CNS infxn
  3. on ABX

Neuro-imaging

  1. macrocephayl
  2. persistent abn neuro exam
  3. incr ICP

EEG usu not recommended

21
Q

What is the Tx for recurrent or prolonged febrile seizure?

What does NOT help?

Why are daily ppx anti-epiletics NOT recommended

A
  1. Rectal Diazepam (short term)

Anti-pyretics NOT helpful

ppx anti-epiletics dont decr likelihood of progression (epilepsy, non-febrile)

22
Q

When is there a slightly higher risk of seizures progressing to epilepsy? (3)

A
  1. Complex febrile seizures
  2. FHx of epilepsy
  3. Neurodev abn
23
Q

Definition of status epilepticus (SE)?

How long til worry about long term damage?

What is the purpose of Broselow tape in SE

A

5+ min of continous seizure activity or intermittent convulsions w/out regaining consciousness

30+ min –> long term damage

Broselow tape = determine ht/wt –> dose meds

24
Q

Pt in ER has been having continous seizures that have gone on for 7 min. What 3 initial steps in managing this pt (3)?

A
  1. ABCs
  2. obtain IV access (can give meds IM, rectally too)
  3. check BG
25
Q

If pt in SE is HYPOglycemia what should be done?

A

give IV dextrose–> likely stops the seizure

26
Q

What type of meds are 1st line for SE? what drug specifically used MC?

Pt still seizing after 5 min what should be done? max dosing?

What if pt still seizing after max dosing?

A

BZs = 1st line tx
- Lorazepam

Give repeat dose of BZs –> max = 3 doses

give other meds

  1. phenytoin
  2. phenobarbital
27
Q

Definition of epilepsy

A

> 2 unprovoked Afebrile seizures

note: most kids w/ 1 unprovoked abef seizure never have another

28
Q

When give anti-epileptic drugs? for how long?

When is the greatest risk of recurrence?

A

Anti-epileptic drugs

  • Give after 2+ afebrile seizures
  • for least 2yrs after last seizure

greatest risk of recurrence = first 2 yrs after stop meds

29
Q

What should peds pts w/SE avoid?

Edu for teens/adults?

A

peds pts w/SE avoid:

  • contact sports
  • ride bike w/out helmet
  • swimming unsupervised

EtoH/drugs lower seizure threshold

30
Q

Med for tachy rhythms

Meds for brady rhythms

A

Tachy –> adenosine, vagal manuevers

Brady –> atropine, IV epi

31
Q

S/s of concussion/TBI

  1. main
  2. w/in mins - hrs:
  3. w/in hrs - days:
A
  1. main:
    - confusion + amnesia
    (+/- LOC before it)
  2. w/in mins - hrs:
    - HA, dizzy, lack awareness, N/V
  3. w/in hrs - days:
    - mood/cognitive/sleep disturbances
    - light/noise sensitivity
32
Q
  1. Orientation
  2. Immed memory
  3. Concentration
  4. Delayed recall
  5. Neuro screening
  6. Exertional Manuever

are components of:

A

SAC

- standardized assessment of concussion tool

33
Q

What is the PECARN rule in concussion assessment?

What type of imaging used in kids for TBI?

A

Findings a/w LOW risk of signif TBI –> no imaging recommended

CT

34
Q

Falls of what height in < 2 y/o = severe MOA? For > 2 y/o?

A

< 2 y/o = falls > 3 ft

> 2/o = falls > 5 ft

35
Q

Early vs late signs of basilar skull fractures?

A

Early signs

  • CSF rhino/otorrhea
  • Hemotypanum

Late signs

  • raccoon eyes
  • battle sign
36
Q

What is return to school protocol for concussion/TBI

A

must be able conc & tolerate visual/auditory stim for 30-45 min

37
Q

4 requirements for return to play protocol?

A
  1. return to school
  2. no meds
  3. normal neuro exam
  4. back at baseline fxning
38
Q

How do Zurich guidelines for return to play work?

A

Stages 0 - 5

- must pass all before returning to play

Peds Exam 2 (9 decks)

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