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Pediatrics > Exam 4 - Neuro > Flashcards

Exam 4 - Neuro Flashcards

1
Q

autoregulation is aka

A

self regulation

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2
Q

what occurs during autoregulation

A

cerebral arteries change in diameter in response to changes in cerebral perfusion pressure

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3
Q

s/sx of IICP in an infant

A

poor feeding
vomiting
irritable/restless/lethargy
bulging fontanel
high-pitched cry
increased head circumference
separation of cranial sutures
distended scalp veins
eyes deviated downward (sun-setting)
increase or decrease pain response

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4
Q

s/sx of IICP in a child

A

HA
diplopia
mood swings
slurred speech
papilledema (after 48 hours)
altered LOC
N/V, esp in the AM

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5
Q

Cushing’s triad

A

low HR
irregular respirations
HTN

wide PP

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6
Q

AAO; interacts with environment

A

full consciousness

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7
Q

lacks ability to think clearly and rapidly

A

confused

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8
Q

impairment of reality with hallucinations possible

A

delirious

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9
Q

lacks ability to recognize place or person

A

disoriented

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10
Q

sleeps, once aroused, has limited interactions with environment

ex: someone you gave pain medicine to

A

obtunded

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11
Q

requires stimulation to arouse

A

stupor

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12
Q

vigorous stimulation produces no response

A

coma

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13
Q

awakens easily but exhibits limited responsiveness

A

lethargic

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14
Q

congenital neural tube defect (NTD) classified by incomplete closure of the vertebrae

A

spina bifida

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15
Q

what are the 2 categories of spina bifida

A

occulta
cystica

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16
Q

what are the 2 types of spina bifida cystica

A

meningocele
myelomeninogocele

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17
Q

what is spina bifida occulta

A

defective closure of laminae without herniation of spinal cord or meninges

skin depression, dimple, or tuft of hair at site
no neuro deficits
later life: develop foot weakness, decreased sensation

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18
Q

describe spina bifida cystica: meningocele

A

meninges protrude producing a sac-like cyst filled with CSF

little or no nerve damage

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19
Q

describe spina bifida cystica: myemeningocele

A

meninges protrude producing a cyst filled with fluid and nerve tissue

permanent neuro deficits

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20
Q

spina bifida pts can later develop what kind of allergy

A

latex

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21
Q

what to do with a baby who is born with spina bifida cystica

A

keep a sterile moist dressing of the sac
do not want the sac to rupture

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22
Q

how to prevent spina bifida

A

0.4 mg folic acid daily during child bearing years

hx of: 4 mg folic acid starting 1 month prior to conception and during first trimester

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23
Q

how to dx spina bifida

A

US
CVS
AFP: 16-18 weeks ONLY (false + if too early or late)

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24
Q

neurologic deficits r/t spina bifida cystica: myelomeningocele

A

hydrocephalus
Arnold Chiari type 2 malformation
tethered spinal cord
neurogenic bladder
bowel incontinence
seizures

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25
Q

orthopedic problems r/t spina bifida cystica: myelomeningocele

A

kyphosis
scoliosis
hip dislocation
foot, ankle deformities (clubfoot)

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26
Q

talipes varus vs. talipes valgus clubfoot

A

varus: inversion/bending inward

valgus: eversion/bending outwart

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27
Q

when is spina bifida sx performed

A

within 24 hours

prevent infection, trauma of exposed tissue, and stretching of other nerve roots

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28
Q

spina bifida positioning preop and postop

A

pre: prone

post: prone or side-lying

hips to be maintained in moderate abduction while prone

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29
Q

how often to change the sterile moist dressing with spina bifida

A

q2-4 hours

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30
Q

when can you give a bottle after surgery

A

while awake with active bowel sounds

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31
Q

this results as an imbalance of production and absorption of CVF

A

hydrocephalus

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32
Q

treatment for hydrocephalus consists of what

A

ventriculoperitoneal shunt

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33
Q

besides being congenital, what else can cause hydrocephalus

A

cancer
tumor
meningitis

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34
Q

what is macewen sign

A

“cracked pot” sound on percussion of the head

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35
Q

how soon can hydrocephalus be detected on an US

A

14-15 weeks

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36
Q

infancy dx of hydrocephalus is dx when

A

head circumference crosses 1+ percentile lines on the chart within a period of 2-4 weeks; progressive neurological signs

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37
Q

what ma be required for older infants and children who are having at CT performed

A

mild sedation

38
Q

where to measure the head when hydrocephaus

A

largest point (occipitalfrontal circumference)

39
Q

complications of ventriculoper. shunt are r/t

A

mechanical obstruction
–often r/t tissue or exudate within the ventricles
displacement from growth
–will present with s/sx of IICP

40
Q

s/sx of ventriculoper. shunt infection

A

redness
tenderness
swelling
rubbing, pulling ears
fever
neck stiffness

41
Q

the most common physical disability of childhood

A

cerebral palsy

42
Q

chronic, nonprogressive disorder of posture and movement

damage to the motor centers and nerve pathways in the brain

A

cerebral palsy

43
Q

CP comorbities

A

cognitive impairment
hearing, speech impairment
visual impairment
seizures

44
Q

CP: every case is the same or different

A

different

45
Q

what are the 4 types of CP

A

spastic CP
dykinetic/athetoid
ataxic type
mixed type CP

46
Q

most common type of CP

A

spastic

47
Q

describe spastic CP

A

early: hypotonia
later: hypertonicity with poor control of posture, balance, motion; contracture and deformities may develop

48
Q

describe dyskinetic/athetoid CP

A

deposits of bilirubin in the basal ganglia

involuntary movement of extremities, trunk, facial muscles, tongue, drooling and speech probs; movements aggravated by stress

contratures are rare

49
Q

describe ataxic type CP

A

cerebral hypoplasia and severe neonatal hypoglycemia

wise-based, unsteady gait, disturbed coordination, rapid, repetitive movements performed poorly, hypotonic muscles

50
Q

what is mixed type CP

A

combo of spastic and dyskinetic

many are severely disabled

51
Q

CP is not usually dx until what age

A

2

52
Q

CP: what is used with ambulation before balance is established

A

posture control walkers

facilitates thoracic extension

53
Q

painful CP spasms are treated with ____

A

diazepam

54
Q

___ is Rx for severe spasticity that interferes with ADLs and ambulation without side effects

A

baclofen

55
Q

this can be injected in selected muscle groups to reduce CP spasticity

A

boxtox (botulinum A)

inhibits acetylcholine release

onset: 24-72 hours
duration: 3-6 months

56
Q

concussions are transient which means they are ___

A

reversible

57
Q

GSC for children

A

13-15: minor/mild. head injury
9-12: moderate
3-8: severe

58
Q

how is a spinal cord injury dx

A

MRI

59
Q

what med is given for spinal cord injury

A

solumedrol

60
Q

excessive uncontrolled electrical discharge of a group of neurons in the brain

A

seizure

61
Q

when is it considered epilepsy

A

seizures recur over a period of time in a discernible pattern

2+ unprovoked seizures

62
Q

what are the 3 phases of a seizure

A

prodromal
ictal
postictal

63
Q

what occurs during the prodromal phase of a seizure

A

right before occurence
aura
certain feeling or smell
behavior changes

64
Q

what is the ictal phase of a seizure

A

beginning to end of seizure

whomever is with must know the start and end time

65
Q

what is the postictal phase of a seizure

A

period immediately after

disoriented, confused, sleepy

66
Q

tonic clonic seizure is aka

A

grand mal seizure

67
Q

what occurs during a tonic clonic seizure

A

ctx of muscles
loss of consciousness
abrupt onset
1-2 minutes
certain cry during occurence
bite tongue
incontience

68
Q

atonic seizure

A

“fall out”
lose support
injuries can occur
often during the day

69
Q

myoclonic seizure

A

awake
can think during process
brief muscle ctx
do not have postical state

70
Q

absence seizure

A

common in school aged
“zoned out” appearance
may act confused, daydreaming

71
Q

focal seizure

A

one area of brain involved
involuntary movements of the mouth
usually drowsy afterwards

72
Q

what labs must be assess with anticonvulsants

A

CBC
liver enzymes
med levels

73
Q

what type of diet can help with seizures

A

ketogenic

low carb, high fat, high protein

74
Q

3 main types of meningitis

A

bacterial
viral, aseptic
tuberuclosis

75
Q

s/sx of meningitis in children > 2 y/o

A

high fever
HA (w/ poss vomiting)
nuchal rigidity
seizures
photophobia
change in LOC
Kernig, Brudzinski
opisthotonos
petechial, purpura rash (impending vascular collapse)

76
Q

how is meningitis dx

A

lumbar puncture: culture, gram stain

77
Q

meningitis precautions and for how long

A

droplet

at least 24 hours after abx

78
Q

how long is someone on IV abx for meningitis

A

7-10 days

79
Q

what is administered for meningitis besides abx

A

IV steriods

80
Q

what baseline should be established upon meningitis admission

A

neuro status
VS

81
Q

why should I&O be monitored with meningitis

A

possible development of DI or SIADH

82
Q

which vaccines will help prevent meningitis

A

Hib
meningococcal
pneumonccocal

83
Q

HOB for meningitis

A

15-30 degrees

84
Q

what opioids can be used to relieve meningitis pain

A

acetaminophen with codeine

85
Q

autoimmune neurologic disorder of the peripheral nervous system

A

Guillain-Barre syndrome

most common in males around 5 y/o

86
Q

what can lead to GBS

A

viral infection or reaction to the flu vaccine

87
Q

what is used to treat GBS

A

IVIG

88
Q

how long until spontaneous recovery with GBS

A

2-4 weeks

89
Q

4 neurological conditions that require critical care

A

encephalitis
Reye syndrome
botulism
tetanus (lockjaw)

90
Q

encephalitis method of dx and treatment

A

dx: LP
tx causative agent

91
Q

what occurs with Reye Syndrome

A

liver damage, increase ammonia levels

92
Q

how can one contract botulism

A

improper sterilization of canned food

Pediatrics (12 decks)

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