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Pediatrics > Exam 4 - Neuro > Flashcards

Exam 4 - Neuro Flashcards

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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
orthopedic problems r/t spina bifida cystica: myelomeningocele
kyphosis scoliosis hip dislocation foot, ankle deformities (clubfoot)
26
talipes varus vs. talipes valgus clubfoot
varus: inversion/bending inward valgus: eversion/bending outwart
27
when is spina bifida sx performed
within 24 hours prevent infection, trauma of exposed tissue, and stretching of other nerve roots
28
spina bifida positioning preop and postop
pre: prone post: prone or side-lying hips to be maintained in moderate abduction while prone
29
how often to change the sterile moist dressing with spina bifida
q2-4 hours
30
when can you give a bottle after surgery
while awake with active bowel sounds
31
this results as an imbalance of production and absorption of CVF
hydrocephalus
32
treatment for hydrocephalus consists of what
ventriculoperitoneal shunt
33
besides being congenital, what else can cause hydrocephalus
cancer tumor meningitis
34
what is macewen sign
"cracked pot" sound on percussion of the head
35
how soon can hydrocephalus be detected on an US
14-15 weeks
36
infancy dx of hydrocephalus is dx when
head circumference crosses 1+ percentile lines on the chart within a period of 2-4 weeks; progressive neurological signs
37
what ma be required for older infants and children who are having at CT performed
mild sedation
38
where to measure the head when hydrocephaus
largest point (occipitalfrontal circumference)
39
complications of ventriculoper. shunt are r/t
mechanical obstruction --often r/t tissue or exudate within the ventricles displacement from growth --will present with s/sx of IICP
40
s/sx of ventriculoper. shunt infection
redness tenderness swelling rubbing, pulling ears fever neck stiffness
41
the most common physical disability of childhood
cerebral palsy
42
chronic, nonprogressive disorder of posture and movement damage to the motor centers and nerve pathways in the brain
cerebral palsy
43
CP comorbities
cognitive impairment hearing, speech impairment visual impairment seizures
44
CP: every case is the same or different
different
45
what are the 4 types of CP
spastic CP dykinetic/athetoid ataxic type mixed type CP
46
most common type of CP
spastic
47
describe spastic CP
early: hypotonia later: hypertonicity with poor control of posture, balance, motion; contracture and deformities may develop
48
describe dyskinetic/athetoid CP
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
describe ataxic type CP
cerebral hypoplasia and severe neonatal hypoglycemia wise-based, unsteady gait, disturbed coordination, rapid, repetitive movements performed poorly, hypotonic muscles
50
what is mixed type CP
combo of spastic and dyskinetic many are severely disabled
51
CP is not usually dx until what age
2
52
CP: what is used with ambulation before balance is established
posture control walkers facilitates thoracic extension
53
painful CP spasms are treated with ____
diazepam
54
___ is Rx for severe spasticity that interferes with ADLs and ambulation without side effects
baclofen
55
this can be injected in selected muscle groups to reduce CP spasticity
boxtox (botulinum A) inhibits acetylcholine release onset: 24-72 hours duration: 3-6 months
56
concussions are transient which means they are ___
reversible
57
GSC for children
13-15: minor/mild. head injury 9-12: moderate 3-8: severe
58
how is a spinal cord injury dx
MRI
59
what med is given for spinal cord injury
solumedrol
60
excessive uncontrolled electrical discharge of a group of neurons in the brain
seizure
61
when is it considered epilepsy
seizures recur over a period of time in a discernible pattern 2+ unprovoked seizures
62
what are the 3 phases of a seizure
prodromal ictal postictal
63
what occurs during the prodromal phase of a seizure
right before occurence aura certain feeling or smell behavior changes
64
what is the ictal phase of a seizure
beginning to end of seizure whomever is with must know the start and end time
65
what is the postictal phase of a seizure
period immediately after disoriented, confused, sleepy
66
tonic clonic seizure is aka
grand mal seizure
67
what occurs during a tonic clonic seizure
ctx of muscles loss of consciousness abrupt onset 1-2 minutes certain cry during occurence bite tongue incontience
68
atonic seizure
"fall out" lose support injuries can occur often during the day
69
myoclonic seizure
awake can think during process brief muscle ctx do not have postical state
70
absence seizure
common in school aged "zoned out" appearance may act confused, daydreaming
71
focal seizure
one area of brain involved involuntary movements of the mouth usually drowsy afterwards
72
what labs must be assess with anticonvulsants
CBC liver enzymes med levels
73
what type of diet can help with seizures
ketogenic low carb, high fat, high protein
74
3 main types of meningitis
bacterial viral, aseptic tuberuclosis
75
s/sx of meningitis in children > 2 y/o
high fever HA (w/ poss vomiting) nuchal rigidity seizures photophobia change in LOC Kernig, Brudzinski opisthotonos petechial, purpura rash (impending vascular collapse)
76
how is meningitis dx
lumbar puncture: culture, gram stain
77
meningitis precautions and for how long
droplet at least 24 hours after abx
78
how long is someone on IV abx for meningitis
7-10 days
79
what is administered for meningitis besides abx
IV steriods
80
what baseline should be established upon meningitis admission
neuro status VS
81
why should I&O be monitored with meningitis
possible development of DI or SIADH
82
which vaccines will help prevent meningitis
Hib meningococcal pneumonccocal
83
HOB for meningitis
15-30 degrees
84
what opioids can be used to relieve meningitis pain
acetaminophen with codeine
85
autoimmune neurologic disorder of the peripheral nervous system
Guillain-Barre syndrome most common in males around 5 y/o
86
what can lead to GBS
viral infection or reaction to the flu vaccine
87
what is used to treat GBS
IVIG
88
how long until spontaneous recovery with GBS
2-4 weeks
89
4 neurological conditions that require critical care
encephalitis Reye syndrome botulism tetanus (lockjaw)
90
encephalitis method of dx and treatment
dx: LP tx causative agent
91
what occurs with Reye Syndrome
liver damage, increase ammonia levels
92
how can one contract botulism
improper sterilization of canned food

Pediatrics (12 decks)

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