Exam 3- Neuro Flashcards
(124 cards)
1
Q
At 6 months in the supine position, what would be an atypical finding?
A
Visually interested in toy but unable to reach, grasp, or play
2
Q
What is a developmental delay?
A
Impairment in learning, language, behavior, and/or motor skill
3
Q
What disease is characterized as a non-progressive motor impairment secondary to fetal or infantile brain injury?
A
Cerebral palsy
4
Q
What is the most common subtype of cerebral palsy?
A
Spastic (muscles appear stiff and tight. Arises from motor cortex damage)
5
Q
What are the 4 subtypes of cerebral palsy?
A
Spastic, ataxic, dyskinetic, mixed
6
Q
Pt presents with abn tone and/or posture, retained primitive reflexes, not reaching milestones, excessive irritability, poor feeding/ drooling, and/ or poor visual attention. What should you be concerned for?
A
Cerebral palsy
7
Q
Is cerebral palsy reversible?
A
No
8
Q
What is the management for CP?
A
early recognition, referral, intervention (parental support, sx. management)
9
Q
What condition is defined as increased volume of CSF causing ventricular dilation and increased ICP?
A
Hydrocephalus
10
Q
What are the two types of hydrocephalus?
A
Obstructive (due to blockage), non-obstructive (impaired absorption or overproduction of CSF)
11
Q
Pt presents with macrocephaly, HAs, and papilledema. What should you be concerned for?
A
Hydrocephalus
12
Q
What is imagining test of choice for newborn/infant w/ suspected hydrocephalus?
A
US
13
Q
What is the appropriate management for hydrocephaly?
A
Refer to neurosurgeon for shunt
14
Q
What is imagining test of choice for older infant/children w/ suspected hydrocephalus?
A
MRI or CT
15
Q
When must you measure the occipitofrontal circumference?
A
Each well child visit between birth- 3 years and any child with neurologic sxs or developmental complaints?
16
Q
What is the relationship b/w occipitofrontal circumerence and brain growth?
A
Directly proportional
17
Q
What head circumference is associated with microcephaly?
A
≥ 2 SDs below mean or < 5th percentile
18
Q
Lack of brain development or abn development due to timing of insult is a 1˚ or 2˚ cause of microcephaly?
A
1˚ (primary)
19
Q
Injury or insult to previously normal brain is primary or secondary pathogenesis for microcephaly?
A
Secondary (postnatal)
20
Q
If microcephaly is symptomatic, what might you expect to see? (3)
A
Delayed milestones, seizures/ spacticity, fontanelle may close early and sutures may be prominent
21
Q
What head circumference is associated with macrocephaly?
A
≥ 2 SD above mean or ≥ 97th percentile
22
Q
What type of macrocephaly associated growth is suggestive of increased intracranial pressure?
A
Rapid growth
23
Q
What type of macrocephaly associated growth is seen in premature infants, neurologically intact?
A
Catch-up growth
24
Q
What type of macrocephaly associated growth is seen with familial macrocephaly or megaloencephaly?
A
Normal growth rate
25
What will result due to increased size in any component of cranium (brain, CSF, blood, or bone)?
Macrocephaly
26
As a PA what is our role in the tx and managment of macrocephaly?
Refer to neurology for labs and imaging. TX underlying cause
27
What are the 2 types of congenital malformations of CNS?
Chiari malformations and spinal dysraphisms
28
The type of cranial malformation is dependent on what?
Gestational period the insult occurs
29
When measuing occipitofrontal circumerfernce of a 9 mos old and you note a 2 cm increase in grwoth since their last visit one month ago, what should you do first?
Remeasure
30
What is the normal rate of head growth for a 1-3 mos old?
2 cm/month
31
What is the normal rate of head growth for a 4-6 mos old?
1 cm/month
32
What is the normal rate of head growth for a 6-12 mos old?
0.5 cm/month
33
What condition is defined as cerebellar tonsils abnormally shaped and displaced caudally below the foramen magnum?
Chiari malformation- type I
34
What is Chiari malformation- type I sometimes associated with?
Syringomyelia (fluid filled cyst within spinal cord)
35
Sleep apnea, syringomyelia sx (Cape like sensory loss, loss of abdominal reflex) and HA that are exacerbated by cough (sneeze, valsalva) are concerning for what disease?
Chiari malformation type I
36
When do sxs often present with a Chiari malformation- type I?
Not present until teen or adult
37
Type II Chiari malformation is aka Arnold-Chiari malformation and is a combination of what 2 conditions?
Type I Chiari + myelomeningocele
38
Dysphagia, apneic spells/aspiration and UE weakness are concerning for what disease?
Chiari malformation- type II
39
Which type of Chiara malformation often present with hydrocephalus and are usually detected prenatally or at birth?
Tyle II
40
What is the test of choice for diagnosis of Chiari malformations?
MRI (≥5 mm below foramen magnum)
41
What is the tx for chiari type II
Neurosurgical referal. Surgical management (fetal surgery or post-natal)
42
What is the tx for asymptomatic chiari type I?
Neurosurgical referal. Conservative managments
43
What are the 2 types of spina bifida/ spina dysraphism?
Closed (spina bifida occulta) and open (meningocele, myelomeningocele)
44
Low folate, genetics, fever/ hyperthermia, poorly managed pre-gestational DM and obesity are etiologies/ RF's for what condition?
Spina bifida
45
What is spinal bifida occulta?
Incomplete closure of the spinal cord
46
If you note a hairy patch, dimple, dark spot, or swelling on the back at the site of the gap in the spine (typically lower back/ ~L5), what should you be concerned for?
Closed spinda bifida (spina bifida occulta)
47
Will a menigocele and myelomeningocele be above or below the area of defect?
Below
48
What is an outpouching of spinal fluid and meninges through the vertebral cleft?
Meningocele
49
Meninges and spinal cord protruding from the vertebral cleft w/ sensory loss (paralysis, loss of bowel or bladder control) is concerning for what?
Myelomeningocele
50
Pt w/ a myelomeningocele often have what 2 diseases?
Chaiari II malformation & hydrocephalus
51
What is used for the diagnosis of spina bifida?
MRI
52
What is the management/ treatment for spina bifida? (3)
Prevention, early recognition, neurosurgeon consult (surgery/ shunt)
53
What condition is autosomal dominant and can be associated with neurologic abnormalities such as macrocephaly, seizures, and cognitive deficits?
Neurofibromatosis (NF1)
54
What is the most common form of neurofibromatosis?
NF1
55
What are the 4 most common clinical manifestations of NF1?
Cafe-au-lait macules (appear 1st yr), neurofibromas, axillary/ inguinal freckling (3-5 yrs), Lisch nodules (also optic pathway glioma)
56
In what time frame will cafe-au-lait macules appear in pt w/ NF1?
Appear in 1st year
57
What are the 2 most common primary headaches?
Migraine, tension HA
58
What is the most common cause of a secondary HA?
acute febrile illness
59
What is the location of a migraine HA?
Focal (uni or bilateral)
60
What is the location of a tension HA?
Diffuse
61
What is the character of a migraine HA?
Pulsatile/ throbbing (mod to severe intensity)
62
What is the character of a tension HA?
Pressure/ non-throbbing/ tightness (mild to mod intensity, constant)
63
Pt presents with hx of HAs that are 2-72 hrs, aggravated w activity or have hx of reduced activity, and are having sxs of N/V, photo/ phonophobia +/- aura. What type of HA are you concerned for?
Migraine HA
64
What do you want to avoid Ibuprofen & Tylenol as chronic tx for HA?
Can cause rebound HA
65
When do you refer HA to specialist? (6)
ABN neurologic or visual exam, severe HA upon waking/in the middle of the night, daily sx w/ progressive worsening, persistent vomiting, acut onset w/o previous hx, exacerbated sx w/ coughing or bending
66
Pt presents with hx of HAs that are 30min- 7 days, not aggravated w activity, and +/- sxs of photo OR phonophobia. WHat type of HA are you concerned for?
Tension HA
67
What condition is defined as increased ICP without mass or hydrocephalus and typically seen in obese teenage girls?
Pseudotumor cerebri
68
What is the hallmark sx for pseudotumor cerebri?
Papilledema. Other: HA, visual disturbance, pulsatile tinnitus, neck stiffness, back pain)
69
How is pseudotumor cerebri diagnosed?
Dx of inclusion, but neuro eval (MRI/ lumbar puncture), ophtho eval
70
How is pseudotumor cerebri managed? (3)
Manage sxs, preserve vision, weight loss
71
What drug is used to reduce rate of CSF production in pts with pseudotumor cerebri?
Acetazolamide
72
What is a sudden, transient disturbance of brain function w/ or w/o LOC?
Seizure
73
How is epilepsy dx?
≥ 2 unprovoked seizures occuring more than 24 hrs apart
74
What are the 3 phases of a seizure?
Aura, ictal, post-ictal
75
What phase of a seizure is defined as a sense of physical or emotional warning of imminent seizure?
Aura
76
What phase of a seizure is defined as the active seizure?
Ictal
77
What phase of a seizure is defined as the recovery period following a seizure (confusion, sleepiness, neuro abns)?
Post-ictal
78
What is a seizure localized to a region of the brain w/o LOC?
Simple focal seziure
79
How long does a simple focal seizure last?
seconds to minutes
80
How long does a complex focal seizure last? Does it impact awareness?
Lasts < 3 miuntes. Will impair awareness
81
What seizure is provked by hyperventilation and presumed to be genetic?
Absence seizure
82
How would you classify the following seizure? Sudden impairment of consciousness w/o loss of tone and arrest in activity lasting 9-10 secs that occurs 10x/day
Absence seizure
83
What type of seizure is defined as abnormal electrical charges in both hemispheres simultaneously?
Generalized seizures
84
Loss of consciousness or awareness and varying post-ictal state is associated with what type of seizure?
Generalized seizure
85
Blank stare and automatisms is indicative of what generalized seizure presentation?
Absence
86
Sudden, brief muscle contractions is indicative of what generalized seizure presentation?
Myoclonic
87
Rigidity is indicative of what generalized seizure presentation?
Tonic
88
Rhythmic jerking is indicative of what generalized seizure presentation?
Clonic
89
Sudden loss of muscle control is indicative of what generalized seizure presentation?
Atonic
90
What is the most common generalized seizure?
Tonic/ clonic
91
By what age will absence seizure spontaneously resolve?
By puberty
92
How is an absence seizure diagnosed?
EEG (also hx and PE)
93
What is the management (non-pharmacologic) for absence seizures?
Refer to neuro, neurocognitive testing
94
What is the 1st line med for absence seizures?
Ethosuximide
95
Are febrile seizures provoked or unprovoked?
Provoked (by fever)
96
A febrile seizure will occur at thwat body temp?
> 38 (100.4)
97
A simple febrile seizure is more common, how long will it last?
<15 min
98
A complex febrile seizure is focal to one area of the body, how long will it last?
> 15 min or occur > 1/24 hrs
99
Febrile seizures are typically dx's with history and PE. If there is concern for CNS infection, what might be needed?
Lumbar puncture and/ or neuroimaging
100
Is an EEG typically indicated for febrile seizures?
No
101
Although generally self-limiting, what is the management for febrile seizures if sxs last > 5 min?
IV benzodiazepines
102
Once a pt's fever has gone down, will they continue to have febrile seizures?
No
103
Are febrile seizures genetic?
Yes
104
What is defined as an acute immune-mediated polyneuropathy?
Guillian-Barre syndrome
105
What typically precedes Guillian-Barre syndrome?
Illness (most common Campylobacter jejuni)
106
What is the most common cause of acute flaccid paralysis in a healthy infant/ child?
Guillian-Barre syndrome
107
Pt presents with ascending symmetric weakness, neuropathic pain, gait instability or refusal to walk, and absent reflexes. What should you be concerned for?
Guillian-Barre syndrome
108
What tests a dx for Gillian-Barre?
Electrodiagnostic studies (EMG, NCV)
109
What will CSF show for pt w/ Gillian-Barre?
Increased protein w/ normal CBC
110
MRI shows enhancement of spinal nerve roots and cauda equina. What syndrome should you be concerned about?
Gillian-Barre
111
How are Gillian-Barre pts treated?
Hospitilzation for close monitoring. Tx w/ IVIG or plasma exhange
112
Where are clostridium botulinum spores found?
Soil, honey, home canning
113
Botulism is a neurotoxin that binds to what? What does this result in?
Binds to ACh receptors. Results in weakness
114
Pt presents with descending weakness, hypotonia, loss of DTRs and lethary. What disease should you be concerned about?
Botulism
115
What diagnostics are used for botulism? (2)
Stool sample, EMG/ NCV
116
How is botulism managed? (2)
Hospitalization/ close monitoring, botulism immune globulin (BIG-IV or BabyBIG)
117
What disease is an X-linked recessive disorder that results in a defect in muscle function?
Duchenne muscular dystrophy
118
PT with onset of DMD by age 2-3 will have more severe sx. By what age will they be wheelchair bound? What is their prognisis?
Wheelchair bound by 13. Mortaility by 18-20
119
Pt presents with progressive weakness, proximal before distal and LE before UE, as well as pseudohypertrophy of calves. What condition are you concerned for?
Duchenne muscular dystrophy
120
Pt presents with Gower's sign. What is this and what condition are you concerned for?
Use hands to push up from floor, concerned for Duchenne muscular dystrophy
121
Dilated cardiomyopathy, orthopedic complications (scoliosis, fxs from falls), growth delay, and cognitive impairment are associated conditions of what?
Duchenne muscular dystrophy
122
Elevated muscle enzymes, (CK ≥ 10-20x) is dx for what disese?
DMD (CK levels will fall as muscle is replaced)
123
What is the tx for DMD?
glucocorticoids, multi-disciplinary apprach
124
Compared to DMD, what condition typically has later sx onset, less severe muscle involvement, CK elevated (≥5x) and more predominant cardiomyopathy?
Becker Muscular Dystrophy (BMD)
