Module 12: Child with Physiologic Alterations on Cognitive-Perception (Part 01) Flashcards
(181 cards)
1
Q
How do you assess a child with neurological disorders?
A
(A) Obtain the mother’s perinatal history
(B) Developmental milestones
(C) School performance
2
Q
What does cerebral function assessment include?
A
It includes assessing level of consciousness (LOC), orientation, intelligence, performance, mood, and general behavior.
3
Q
What are the 3 components of orientation in cerebral function assessment?
A
Person, place, and time.
4
Q
How is intellectual performance tested in children (ORIENTATION)?
A
Ask age-appropriate questions
5
Q
What is immediate recall and how is it assessed?
A
It’s the ability to retain a concept briefly; tested using number series.
6
Q
This memory lasts slightly longer than immediate recall.
A
Recent Memory
7
Q
This type of memory is characterized as the long term memory.
A
Remote Memory (For preschoolers, ask what they ate for breakfast)
8
Q
This can be measured by assessing language, sensory interpretation, and motor integration.
A
Specific Cerebral Function
9
Q
This is known as the ability to recognize an object.
A
Stereognosis
10
Q
What is graphesthesia and how is it assessed?
A
Recognizing a shape traced on the skin with eyes closed; trace a square or circle on the back of the hand.
11
Q
This is known as the ability to distinguish movement.
A
Kinesthesia
12
Q
How is kinesthesia tested among children or pediatric patients?
A
(A) Ask the child to close eyes and then extend her hands in front.
(B) Raise one of the fingers and ask whether it is up or down.
13
Q
How is motor integration assessed?
A
Ask the child to do a complex task like folding a paper and placing it in a tight envelope.
14
Q
What are the three types of cranial nerves?
A
Motor, sensory, and mixed nerves (Cranial nerve function depends on whether each nerve is composed of motor, sensory or mixed nerves, and also on the region where the nerve endings are located).
15
Q
What do motor cranial nerves do?
A
Carry signals from the brain (efferent) to muscles.
16
Q
What do sensory cranial nerves do?
A
Bring information to the brain (afferent), enabling movement, organ function, and sensations like pain, smell, taste, vision, hearing, and touch.
17
Q
What are the 12 Cranial Nerves?
A
(A) Olfactory (I) – Sense of smell
(B) Optic (II) – Vision
(C) Oculomotor (III) – Eye movement, pupil constriction
(D) Trochlear (IV) – Eye movement (superior oblique muscle)
(E) Trigeminal (V) – Facial sensation, chewing
(F) Abducens (VI) – Eye movement (lateral rectus muscle)
(G) Facial (VII) – Facial expression, taste (anterior 2/3 of tongue)
(H) Vestibulocochlear (VIII) – Hearing and balance
(I) Glossopharyngeal (IX) – Taste (posterior 1/3 of tongue), swallowing
(J) Vagus (X) – Autonomic control of the heart, lungs, digestive tract
(K) Accessory (XI) – Shoulder and neck movement (sternocleidomastoid and trapezius)
(L) Hypoglossal (XII) – Tongue movement
18
Q
What is needed to test cerebellar function?
A
Tests for balance and coordination
19
Q
How is cerebellar function tested in children?
A
Ask the child to stand on one foot and perform tandem walking.
20
Q
At what age can a child typically balance on one foot for 5 seconds?
A
As young as 4 years old.
21
Q
How is muscle size assessed in children?
A
Measure the circumference of the calves, thighs, upper and lower arms using a tape measure.
22
Q
What is evaluated when palpating the muscles?
A
Muscle tone.
23
Q
What does passive range of motion assess?
A
Symmetry, spasticity, and flaccidity of extremities bilaterally.
24
Q
What sensory perceptions should a child be able to distinguish?
A
Light touch, pain, vibration, hot, and cold.
25
How is light touch sensation tested in a child?
Ask the child to close eyes and point to the spot where they were touched.
26
How is vibration sensation tested?
By touching the child's bony prominences with a tuning fork.
27
What is included in reflex testing during neurologic assessment?
Deep tendon reflexes and newborn reflexes.
28
What functions constitute the neurologic examination?
(A) Cerebral Function
(B) Cerebellar Function
(C) Motor Nerve Function
(D) Sensory Function
(E) Reflex Function
29
What is a lumbar puncture?
A procedure where a needle is introduced into the subarachnoid space between L4 and L5 to withdraw cerebrospinal fluid (CSF).
30
What is the purpose of a lumbar puncture?
To diagnose CNS infections, hemorrhages, or obstruction of CSF flow.
31
What are contraindications for lumbar puncture?
Infected skin over the needle site and suspected elevated CSF pressure.
32
What medication can be used to reduce pain before lumbar puncture?
EMLA or lidocaine cream applied 1 hour before the procedure. Child may be sedated.
33
What are the post-operative care procedures for a child who has undergone a lumbar tap?
(A) After the procedure, encourage the child to lie down for at least 30 minutes and drink a glass of fluid to prevent cerebral irritation caused by air rising in the subarachnoid space.
(B) Analgesics may be given in case headache develops
(C) Observe the child after the procedure. Watch out for respiratory and cardiac difficulty due to medulla pressure.
(D) WOF signs of intracranial compression: Decrease PR and RR, change in LOC, pupillary changes, decreased in motor ability.
34
How is CSF obtained in a ventricular tap?
By tapping into a ventricle through the anterior fontanelle.
35
What does a flat skull x-ray evaluate in neurologic assessment?
(A) Increased inter-cranial pressure (ICP)
(B) Skull fractures
(C) Craniosynostosis (usually involves premature fusion of a single cranial suture)
36
This is an x-ray study of cerebral blood vessels using contrast medium injected into the femoral or carotid artery.
Cerebral Angiography
37
How is cerebral angiography performed?
Serial x-rays are taken as contrast dye flows through cerebral blood vessels.
38
This is an x-ray of the spinal cord after injecting contrast medium into CSF via lumbar puncture.
Myelography
39
What position should the patient be in after myelography and why?
Head elevated to prevent the contrast from reaching the brain’s meninges, which can cause irritation.
40
What is a CT scan used for in neurologic diagnosis?
To reveal brain tissue densities and detect tumors or encroaching lesions.
41
How does a CT scan work?
It uses x-rays to produce images of brain layers at multiple levels.
42
What is the main purpose of an MRI in neurologic assessment?
To provide detailed images of brain and spinal cord tissues using magnetic fields and radio waves.
43
How does Positron Emission Tomography (PET) imaging work?
By injecting positron-emitting radiopharmaceuticals into a vein that accumulate in diseased brain or spinal cord areas.
44
What is PET scan highly accurate in identifying?
Seizure foci.
45
This type of imaging is used to outline brain ventricles and monitor intra-ventricular hemorrhages in preterm infants.
Echoencephalography (Head and Spinal Ultrasound - It involves projection of ultrasound towards the child’s head or spinal cord).
46
What is the key disadvantages of Echoencephalography?
It is non-invasive and does not cause discomfort
47
What does electroencephalography (EEG)?
The electrical activity of the brain.
48
What condition is EEG helpful in diagnosing?
Absence seizures.
49
What are the different cognitive disorders?
(A) Mental Retardation
(B) Trisomy 21
(C) Autism
(D) Attention deficit Hyperactive Disorder
49
What are important nursing responsibilities before an EEG?
(A) Educate the family that the room will be darkened.
(B) Ensure the child stays still and quiet.
(C) Sedation may be required for uncooperative children.
50
This is commonly referred to as intellectual disability.
Mental Retardation (The intellectual functioning that is at least two standard deviations below the norm).
51
According to new definition by American Association on Mental Retardation (AAMR), an individual is considered to have mental retardation based on the following
criteria:
(A) Intellectual functioning level (IQ) is below 70-75
(B) Significant limitations exist in 2 or more adaptive skills areas;
(C) The condition is present from childhood (defined as age 18 or less).
52
What is the IQ range for mild intellectual disability?
50 to 70
53
What is the IQ range for moderate intellectual disability?
35 to 55
54
What is the IQ range for severe intellectual disability?
20 to 40
55
What is the IQ range for profound intellectual disability?
Below 20
56
This is the most common inherited cause of mental retardation (MR), caused by a break on the long arm of the X chromosome.
Fragile X Syndrome
57
Who is usually affected by Fragile X syndrome?
Males are usually affected, while females are carriers.
58
What therapies are used to manage Fragile X syndrome?
Speech therapy, occupational therapy, and physical therapy.
59
Name three physical features associated with Fragile X syndrome.
Enlarged ears, long face, and connective tissue problems.
60
Name behavioral signs of Fragile X syndrome.
Attention deficit, hand flapping or biting, poor eye contact, speech disturbances, sensory aversions to touch and noise.
61
What are some symptoms of Fragile X syndrome?
Intellectual disability, autism spectrum features, abnormal facial features, prominent forehead, large ears, and long face.
61
What is the IQ range for mild intellectual disability, and what are common traits?
IQ 50–70; can form (important) relationships, may learn to read and write, may travel independently with some help with money and organizing their daily life.
62
What is the IQ range for moderate intellectual disability, and what are common traits?
IQ 35–55; forms (important) relationships, uses some words, needs lifelong support for daily tasks.
63
What is the IQ range for severe and profound intellectual disability, and what are common traits?
IQ 20–40 or below 20; may form strong relationships with key people, little or no speech, needs lifelong help in most areas.
64
What are early signs of intellectual disability in infants and toddlers?
Delayed rolling over, sitting, crawling, or walking.
65
What language-related signs may indicate intellectual disability?
Talking late or having trouble speaking.
66
What self-care delays may be observed in intellectual disability?
Difficulty with potty training, dressing, and feeding.
67
What causes Down Syndrome?
An extra copy of chromosome 21 (Trisomy 21).
68
What is the incidence of Down Syndrome?
1 in every 700 newborns (Children with down syndrome have multiple malformations, medical conditions and cognitive impairments because of the presence of extra genetic material from chromosome 21).
69
Name facial or physical characteristics of a child with Down Syndrome.
(A) Hypotonia
(B) Small brachycephalic head
(C) Epicanthal folds
(D) Flat nasal bridge
(E) Upward- slanting palpebral fissures
(F) Small mouth
(G) Small low-set ears
(H) Excessive skin at the nape of the neck
(I) Brushfield spots
(J) Single transverse palmar crease
(K) Short gift finger with clinodactyly
(L) Wide spacing between the first and second toes (sandal gap toes)
70
What are "sandal gap toes"?
A wide spacing between the first and second toes—common in Down Syndrome.
71
What are brushfield spots?
White spots on the iris, commonly seen in Down Syndrome.
72
What is the range of IQ levels found in individuals with Down Syndrome?
Ranges from mild (IQ 50–70), moderate (IQ 35–50), to occasionally severe (IQ 20–35).
73
What is the most common genetic cause of Down Syndrome?
Full Trisomy 21 (95%).
74
What percentage of Down Syndrome cases are caused by translocation?
3% to 4%.
75
What percentage of Down Syndrome cases are due to mosaicism?
1% to 2%.
76
What is the risk of Down Syndrome in mothers aged 15–29?
1 in 1500.
77
What is the risk of Down Syndrome in mothers aged 30–34?
1 in 800.
78
What is the risk of Down Syndrome in mothers aged 35–39?
1 in 270.
79
What is the risk of Down Syndrome in mothers aged 40–44?
1 in 100.
80
What is the risk of Down Syndrome in mothers over 44 years old?
1 in 50.
81
When is Down Syndrome commonly diagnosed?
In the immediate newborn period after an apparently uneventful pregnancy.
82
What does first trimester screening for Down Syndrome include?
(A) Maternal Age
(B) Nuchal Translucency
(C) Measurement of hCG
(D) Measurement of pregnancy-associated plasma protein (PAPP-A)
83
What is the screening of trisomy 21 in the second trimester?
Quad screen
84
What are the components of the Quad Screen in the second trimester?
Maternal serum hCG, unconjugated estriol, alpha-fetoprotein (AFP), and inhibin A.
85
What is the detection rate of Down Syndrome using:
(A) First trimester screening
(B) Second trimester screening
(C) Combined (integrated) screening
(A) First trimester: 82–87%
(B) Second trimester: 80%
(C) Integrated screening: ~95%
86
What is the false-positive rate for Down Syndrome screening tests?
5%
87
When is blood drawn for screening?
16 to 20 weeks
88
What maternal serum marker is elevated in neural tube defects?
Alpha-fetoprotein (AFP).
89
What is the serum marker pattern for Down Syndrome (risk > 270)?
(A) AFP: Decreased
(B) hCG: Increased
(C) Estriol: Decreased
(D) Inhibin A: Increased
90
What is the serum marker pattern for Trisomy 18 (Edwards Syndrome)?
(A) AFP: Decreased
(B) hCG: Decreased
(C) pEstriol: Decreased
(D) Inhibin A: Not applicable
91
What are follow-up tests after an abnormal maternal serum screening?
Ultrasound and amniocentesis.
92
What is the role of chromosomal analysis (karyotyping)?
To confirm clinical diagnosis and aid in genetic counseling.
93
Why is cardiac assessment essential in newborns with Down Syndrome?
About 40% have congenital heart disease.
94
What is used to confirm the clinical diagnosis for trisomy 21?
Chromosomal analysis (karyotyping)
95
What cardiac anomalies are most common in Down Syndrome?
(A) Endocardial cushion defects
(B) Ventricular septal defects (VSD)
(C) Patent ductus arteriosus (PDA)
(D) Atrial septal defects (ASD)
96
Why is a full blood count important in infants with Down Syndrome?
Hematologic problems are common; up to 28% may have thrombocytopenia (<100,000).
97
What hematologic condition is common in infants with Down Syndrome?
POLYCYTHEMIA
98
What transient condition may occur in the newborn period that mimics leukemia?
Transient myeloproliferative disorder (leukemoid reaction).
99
When should thyroid function be checked in Down Syndrome newborns?
During newborn screening or if clinical signs (e.g., prolonged jaundice) are present.
99
How much more likely are infants with Trisomy 21 to develop leukemia?
10 to 20 times more likely.
100
What percentage of individuals with Down Syndrome will develop hypothyroidism?
About 15%.
101
List the subspecialists recommended for Down Syndrome management.
Pediatrician, Geneticist, Developmental Pediatrician, Ophthalmologist, ENT, Cardiologist, Endocrinologist, Rehabilitation Medicine.
102
What is the recurrence risk for nondisjunction type Down Syndrome?
1% or less.
103
What is the recurrence risk for de novo Robertsonian translocation?
2–3%.
104
What is the recurrence risk if the mother is a Robertsonian carrier (Dq;21q)?
10–11%.
105
What is the recurrence risk if the father is a Robertsonian carrier (Dq;21q)?
2.4%.
106
What is the recurrence risk if the mother is a Robertsonian carrier (21q;22q)?
14%.
107
What is the recurrence risk if the father is a Robertsonian carrier (21q;22q)?
1–2%.
108
Why might Down Syndrome be missed on prenatal ultrasound?
Ultrasound alone is not enough; some cases are missed. Blood tests, amniocentesis, and DNA analysis are more accurate.
109
Can newborn screening detect Down Syndrome?
No. It is not part of the panel. However, hypothyroidism (a common DS complication) may be detected.
110
What test confirms the diagnosis of Down Syndrome?
Chromosomal analysis (karyotyping).
111
What are the different types of Autism?
1. The Pervasive Developmental Disorder Autism Spectrum Disorder
(A) Autistic Disorder (Autism)
2. Non- Autistic PDDS
(A) Asperfer’s Syndrome
(B) Pdd, Nos
(C) Fragile X Syndrome
(D) Rett’s Syndrome
(E) Childhood Disintegrative Disorder
112
At what age does autism typically begin to manifest?
During the first 3 years of life.
113
What is the nature of the neurological disorder in autism?
It affects the functioning of the brain and is biologically based.
114
What is the common reason parents ask why ASD isn’t detected at birth?
Because it is not part of the Newborn Screening panel and symptoms manifest later.
115
What umbrella term is used when referring to all forms of autism disorders?
Autism Spectrum Disorder (ASD).
116
Name the classic autism diagnosis under Pervasive Developmental Disorders.
Autistic Disorder (Autism).
117
Name the non-autistic pervasive developmental disorders (PDDs).
Asperger’s Syndrome, PDD-NOS, Fragile X Syndrome, Rett’s Syndrome, Childhood Disintegrative Disorder.
118
Is the exact cause of autism known?
No, it remains unknown but is believed to be biologically and genetically based.
119
What genetic abnormality is associated with over 1% of autism cases in the US?
A rare mutation involving deletion or duplication of 25 genes on chromosome 16.
120
What is the estimated recurrence risk of ASD if one sibling has it?
5%–6% (range of 2%–8%).
121
What is the risk of ASD if there are already 2 children in the family with the condition?
The recurrence risk is even higher.
122
What is the concordance rate of ASD in identical twins?
60%–96%.
123
What is the concordance rate of ASD in non-identical twins?
0%–24%.
124
What percentage of children with ASD have an identifiable genetic, neurologic, or metabolic condition (Fragile X)?
About 10%.
125
Which major brain structures are implicated in autism?
Cerebellum, cerebral cortex, limbic system, corpus callosum, basal ganglia, brain stem.
126
Which neurotransmitters are involved in the neurobiology of autism?
Serotonin, dopamine, and epinephrine.
127
Which brain structures are involved in ASD?
Frontal lobe, cingulate gyrus, corpus callosum, midbrain, brainstem, limbic system, and cerebellum.
128
What is the noted white matter finding in ASD?
Diffuse white matter inflammation in the corpus callosum due to premature maturation.
129
What is the neuronal deficit seen in the temporal lobe of ASD individuals?
Decreased Purkinje cell population.
130
This suggests that abnormal brain development starts in the infant’s first months of life.
Growth Dysregulation hypothesis
130
What physical growth pattern in infancy may indicate early ASD?
Sudden, rapid head growth.
131
Are ASDs purely genetic in origin?
No, they are mainly genetic but environmental factors may affect expression.
132
What parental factors are associated with increased ASD risk?
Advanced paternal and maternal age.
132
What causes the genetic changes in older parents that may lead to ASD?
De novo spontaneous mutations and alterations in genetic imprinting.
133
How can environmental exposures during pregnancy influence ASD?
They may act as central nervous system teratogens during early gestation.
134
What is the overall cause of ASD
Multifactorial—genetic and, to a lesser extent, environmental factors.
135
What are the two stages in diagnosing ASD?
(A) Developmental screening during well-child check-ups
(B) Comprehensive evaluation by a multidisciplinary team
136
What diagnostic manual outlines criteria for ASD diagnosis?
DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition).
137
According to DSM-IV, how many symptoms and in what areas are needed for ASD diagnosis?
At least 6 of 12 symptoms across three areas: social interaction, communication, and behavior.
138
What are examples of autism-specific screening tools?
CARS (Childhood Autism Rating Scale), ADOS (Autism Diagnostic Observation Schedule), M-CHAT (Modified Checklist for Autism in Toddlers).
139
What types of additional testing are involved in a comprehensive ASD evaluation?
Cognitive testing and adaptive skills testing.
140
What is BAER testing used for in ASD evaluation?
To assess hearing (Brainstem Auditory Evoked Response).
141
What is the role of EEG in ASD assessment?
To rule out seizure activity or abnormal brain function.
142
Why is neuroimaging sometimes used in ASD?
To detect structural brain abnormalities.
143
What metabolic screenings are done for ASD evaluation?
Thyroid function and blood lead levels.
144
Why are chromosomal studies recommended in ASD evaluation?
To check for genetic syndromes like Fragile X.
145
What is EIBI and why is it recommended?
Early and Intensive Behavioral Intervention; recommended by the US Surgeon General for its effectiveness in ASD.
146
What is TEACCH?
Treatment and Education of Autistic and Related Communication-Handicapped Children; a structured teaching approach recommended by the National Research Council.
147
What is the role of risperidone (Risperdal) in ASD?
Used for problem behaviors when behavioral interventions are ineffective.
148
How many children were reported to have ever been diagnosed with ADHD in the U.S. as of 2016?
Approximately 6.1 million children (9.4%).
149
What age group had the highest number of ADHD diagnoses in 2016?
Children aged 12–17 years (3.3 million).
150
How many children aged 2–5 years were diagnosed with ADHD?
Around 388,000 children.
151
How many children aged 6–11 years were diagnosed with ADHD?
About 2.4 million children.
152
Which gender is more likely to be diagnosed with ADHD?
Boys are more likely (12.9%) compared to girls (5.6%).
153
What percentage of children are affected by ADHD?
8% to 10%.
154
What is the prevalence of ADHD among adolescents?
9.6%.
155
What percentage of adults have ADHD?
4.4%.
156
What proportion of children with ADHD may continue to have symptoms into adulthood?
Up to 65%.
157
What is the concordance rate of ADHD in monozygotic twins?
81–100%.
157
Name the misconceptions about ADHD.
ADHD is caused by poor parenting, high sugar intake, or laziness; it’s just "kulang sa pansin" or a phase that will be outgrown.
158
What is the risk of ADHD in offspring if a parent has it?
40–57%.
159
What genes are associated with ADHD?
DRD4*7 (most confirmed), DRD5, DAT1, Taq1, SNAP 25.
160
What brain regions show altered blood flow in ADHD?
Decreased in anterior cingulate; increased in the frontal lobe.
161
What role do neurotransmitters play in ADHD?
Dysfunction in dopamine and norepinephrine pathways.
162
Are there environmental contributions to ADHD?
Yes, environmental factors may increase risk, though genetics play a major role.
163
What are the three core symptoms of ADHD?
Inattention, impulsivity, and hyperactivity.
164
What are the key components in diagnosing ADHD?
History, interviews (parents, teachers, patient), rating scales, physical exam, DSM-IV TR or ICD-10 criteria, and assessment for comorbidity conditions.
165
Why is a multi-setting evaluation important in ADHD diagnosis?
Symptoms must occur in two or more settings (e.g., home, school, work) to confirm diagnosis.
166
How many symptoms must be present to meet DSM-IV TR criteria for ADHD?
6 or more symptoms of inattention and/or hyperactivity-impulsivity.
167
What is the required duration of symptoms for ADHD diagnosis?
Symptoms must last for more than 6 months.
168
At what age must symptoms of ADHD begin according to DSM-IV TR?
Before age 7.
169
What kind of impairment is required for ADHD diagnosis?
Significant impairment in social, academic, or occupational functioning.
170
What must be ruled out before diagnosing ADHD?
Other mental disorders.
171
How is the Inattentive Presentation (Restrictive) defined?
If Criterion A1 (inattention) is met, but no more than 2 symptoms from Criterion A2 (hyperactivity-impulsivity) are present in the past 6 months.
171
What are the 3 subtypes of ADHD?
Combined Presentation, Predominantly Inattentive Presentation, Predominantly Hyperactive/Impulsive Presentation.
172
How is the Predominantly Hyperactive/Impulsive Presentation defined?
If hyperactivity-impulsivity symptoms are more prominent than inattention.
172
What are the standard components of ADHD treatment?
Education, psychosocial interventions, and pharmacotherapy.
173
What remains one of the most effective treatments for children with ADHD?
Medication
