Child neurologic exam

Question 1

What are neurological soft signs

Answer 1

nonfocal, functional neurologic findings

Subtle cue underlying CNS deficit (neurological maturation delay)

Question 2

Example of soft sign finding in walking/running gait

Answer 2

stiff-legged with a foot slapping quality - unusual posturing of arms

should disappear in gait by 3 years

Question 3

Soft sign finding in motor stance

Answer 3

difficulty maintaining stance (arm extended in front, feet together, eyes closed)

should disappear by 3 years

Question 4

soft sign finding one foot standing

Answer 4

unable to stand on one foot longer than 5-10 sec

should disappear 5 years

Question 5

soft sign finding visual tracking

Answer 5

difficulty following object with eyes - nystagmus

should disappear 5 years

Question 6

Soft sign finding stereognosis

Answer 6

unable to identify common objects placed in own hand

should disappear by 5 years

Question 7

soft sign finding right-left discrimination

Answer 7

unable to identify right and left on own body

should disappear 5 years

Question 8

soft sign finding hopping in place

Answer 8

unable to hope rhythmically on each foot

should disappear 6 years

Question 9

soft sign finding two point discrimination

Answer 9

difficulty localizing discriminating when touched in one or two places

should disappear 6 years

Question 10

soft sign finding heel walking

Answer 10

difficulty remaining on heels for distance of 10 ft

should disappear 7 years

Question 11

soft sign finding tip toe walking

Answer 11

difficulty remaining on toes for a distacne of 10 ft

should disappear by 7 years

Question 12

soft sign finding tandem gait

Answer 12

difficulty walking heel to toe unusual posturing of arms

should disappear by 7 years

Question 13

soft sign finding finger nose test

Answer 13

unable to alternately touch examiner’s finger and own nose consecutively

should disappear 7 years

Question 14

soft sign finding graphestesia

Answer 14

unable to identify geometric shapes you draw in child’s open hand

should disappear 8 years

Question 15

soft sign finding rapid thumb to finger

Answer 15

rapid touching thumb to fingers in sequence is uncoordinated

unable to suppress mirror movements in contralateral hand

should disappear 8 years

Question 16

Soft sign finding rapid alternating movements of hands

Answer 16

irregular speed and rhythm with pronation and supination of hands patting the knees

should disappear 10 years

Question 17

What does shaken baby syndrome cause?

Answer 17

brain to move around

stretches and tears nerve tissue and blood vessels

Question 18

S/S shaken baby syndrome

Answer 18

Fever, irritability, apnea, seizure, retinal hemorrhage, lethargy

Question 19

True or false; shaken baby syndrome commonly has an absence of visible trauma to the head or visible bruises

Answer 19

true

Question 20

True or false; like adults infants with meningitis commonly have nuchal rigidity

Answer 20

false; this doesn’t typically occur until 6-9 months of age

Question 21

S/S of meningitis in young infant

Answer 21

very irritable 
fever
diarrhea
poor appetite
toxic appearance 
bulging fontanelle

Question 22

True or false; cerebral palsy is a permanent disorder and non progressive (static)

Answer 22

true

Question 23

What causes cerebral palsy

Answer 23

injury to immature periventricular white matter (damage could be caused by number of things including infection, prematurity, genetic factors)

Question 24

S/S cerebral palsy

Answer 24

Delayed gross motor development, mental/learning, hearing, speech,

feeding difficulties, seizures

Persistent primitive reflexes (exaggerated DTR’s)

Intention tremors

Question 25

Contrast Spastic Cerebral palsy with Dyskinetic and ataxic

Answer 25

Spastic - hypertonic, tremors, scissor gait, toe walking

Dyskinetic - slow writhing movements, tremors sometimes

Ataxic - abnormalities of movement - balance and position of trunk and extremities issues

Question 26

When is the peak occurrence of SOLs

Answer 26

3-12 years and 50-70 years

Question 27

True or false; you should use the same technique and grading scale on reflexes as you do adults

Answer 27

true