Musculoskeletal Disorders Flashcards
(131 cards)
1
Q
Musculoskeletal disorders
Infammatory DIsorders: Two types
A
1) Osgood- Schlatter disease
2) Toxic synovitis
2
Q
Inflammation of the tibial tubercle as a result of repetitive stressors (e.g.g, avulsion injury) in a patient with immature skeletal development
- Peak ages: 11 to 14 years
2) Associated with a rapid growth spurt
A
Osgood- Schlatter Disease
3
Q
Signs and symptoms include of ________:
a) Pain and tenderness at tibial tubercle
b) Point tenderness
c) Enlargement compared to the unaffected side
A
Osgood- Schlatter Disease
4
Q
Laboratory/ Diagnostics for Osgood- Schlatter disease:
1) ______; typically, this is a diagnosis that is made clinically.
2) Radiographs to rule out more serious causes of pain
A
1) none
5
Q
Self-limiting inflammation of the hip, most likely due to a viral or immune cause
1) Occurs most often in children between the ages for two and six, but can occur for age 1 to 15 years
2) Affects males more than females
A
Toxic Synovitis
6
Q
Signs and symptoms of Toxic Synovitis include:
1) _____ limp
2) Unilateral involvement
3) Insidious onset
4) Internal rotation of hip causes spasm
5) No obvious signs of infection on inspection /palpation
A
1) Painful
7
Q
Laboratory/ Diagnostics of Toxic Synovitis include:
a) Normal radiographs
b) Normal joint fluid _______
A
b) aspiration
8
Q
Management of Toxic Synovitis include:
a) _______
b) bed rest as needed
c) typically benign and self-limiting
d) hospitalization should be considered if the patient has a high fever or septic arthritis is suspected
A
a) analgesics
9
Q
Noninflammatory disorders include:
a) Legg- Calce- Perthes Disease
b) Slipped capital femoral epiphysis (SCFE)
c) ___ _____
d) Septic arthritis
A
Juvenile arthritis
10
Q
_____ ___ ___ _____ (____):
Aseptic or avascular necrosis of the femoral head
A
Legg-Calve-Perthes Disease (LCPD)
11
Q
Etiology/Incidence of Legg-Calve-Perthes Disease (LCPD):
1. Unknown etiology, possibly due to vascular disruption
2. Slightly shorter stature or delayed bone age
compared to peers
3. Most common in ____ ____, ages four to nine
A
Caucasian boys
12
Q
Signs/Symptoms of this include:
- Insidious onset of limp with knee pain; pain may also migrate to groin/lateral hip
- Painless acute and severe than transient synovitis or septic arthritis
- Afebrile
A
Legg-Calve-Perthes Disease (LCPD)
13
Q
Physical Findings of Legg-Calve-Perthes Disease (LCPD):
- Limited passive internal rotation (PIR) and abduction of the hip joint
- Maybe resisted by ____ ___ or guarding
- Hip flexion contracture and leg muscle atrophy occur in long-standing cases
A
- mild spasm
14
Q
Laboratory/Diagnostics of Legg-Calve-Perthes Disease (LCPD):
- Radiograph studies
- ___ ____ necessary
A
- No labs
15
Q
Management/Treatment of Legg-Calve-Perthes Disease (LCPD):
1. Goal: To restore range of motion (ROM) while maintaining femoral head within the acetabulum
- Observation only if:
a. The full range of motion (FROM) is preserved
b. Less than ___ years of age
c. Involvement of less than one-half of the femoral head - Aggressive treatment
a. Indicated when more than the __-___ femoral head is involved and in children older than six years
b. Refer to orthopedics
A
- six
3. one-half
16
Q
Spontaneous dislocation of the femoral head (capital epiphysis) both downward and backward
relative to the femoral neck and secondary to disruption of the epiphyseal plate
A
Slipped Capital Femoral Epiphysis (SCFE)
17
Q
Etiology, /Incidence of Slipped Capital Femoral Epiphysis (SCFE):
1. Etiology: Unknown; perhaps precipitated by puberty-related hormone changes
- Generally occurs without severe, sudden force or trauma
- Typical during a growth spurt and prior to menarche in girls
- Rare: 1-8: 100,000
- More common in males and ___ ____ adolescents
- Incidence is greater among obese adolescents with sedentary lifestyles
A
- African American
18
Q
Signs/Symptoms of Slipped Capital Femoral Epiphysis (SCFE):
- Pain in the ____ and often referred to the thigh and/or knee
- When acute onset, the pain will be severe with the inability to ambulate or move the hip
- Physical findings
a. Unable to properly flex __ as femur abducts/rotate
externally
b. May observe limb shortening, resulting from the
proximal displacement of the metaphysis
A
- groin
3. a. hip
19
Q
Laboratory/Diagnostics of Slipped Capital Femoral Epiphysis (SCFE):
1. ___ _____combined with knowledge of etiological factors
- Radiographs
- Laboratory studies - typically none
A
- Accurate history
20
Q
Management/Treatment of Slipped Capital Femoral Epiphysis (SCFE):
- Immediate referral to an _______
- No ambulation permitted
- Monitor other hips for the same problem
A
- orthopedist
21
Q
All these are structural ______?
- Genu varum
- Genu valgum
- Scoliosis
- Hip dysplasia
A
Disorders
22
Q
Lateral bowing of the tibia, often due to joint laxity; considered a normal variant until age two
(toddler most common)
A
Genu Varum (Bowleg)
23
Q
Signs/Symptoms
- It is acceptable for bowing that does not increase after walking
- Retains full range of motion
A
Genu Varum (Bowleg)
24
Q
Laboratory/Diagnostics of Genu Varum (Bowleg):
1. ___ ____
A
None indicated
25
Management of Genu Varum (Bowleg):
1. None necessary under age two if appears as a normal
variant
2. Refer to orthopedics
a. Continues after age ____
b. Unilateral
c. Becomes progressively worse after the first year
2. a. two
26
```
____ _____ (___-___):
Knees are abnom~ally close and ankle space is increased; typically evolves to normal alignment by seven years of age (preschool most common)
```
Genu Valgum (Knock-Knee)
27
Signs/Symptoms of ____ ___?
1. Knees close together
2. Distance between medial malleoli (ankles) is more than three inches.
3. No pain
4. Full range of motion
5. Walk or nm may be awkward
Genu Valgum (Knock-Knee)
28
Laboratory/Diagnostics for Genu Valgum (Knock-Knee):
1. ______ necessary
2. Radiographs if over age seven or if unilateral involvement is present.
None
29
Management for Genu Valgum (Knock-Knee):
1. ___ _____
2. Older children need a referral to orthopedics.
1. None necessary
30
1. Lateral curvature of the spine that is idiopathic and most common in adolescence
2. Other types are congenital (e.g., infancy) or neuromuscular (associated with conditions)
3. Occurs more often in females with an 8:1 ratio; familial in 70% of cases
Scoliosis
31
Signs/Symptoms of Scoliosis:
1. May occur any age
2. Rarely painful
3. _____ of shoulder, ribs, hips, and waistline (Adam's Forward Bend Test
3. Asymmetry
32
Laboratory/Diagnostics for Scoliosis:
| 1. _____ for further evaluation
1. Radiographs
33
Management for Scoliosis:
1. Further evaluation in any degree if pain occurs
2. Observe if no pain exists and if less than ___ degrees curvature
3. Refer if painful or greater than ___ degrees curvature
2. 25 degrees
| 3. 25 degrees
34
```
___ ___ ___ ___ ___ (__ )
Abnormal dislocation (luxation or subluxation) of the hip in which the femoral head is partially or completely displaced from the acetabulum
```
Developmental Dysplasia of the Hip (DDH)
35
Signs/Symptoms of Developmental Dysplasia of the Hip (DDH):
Physical examination
a. ______ sign,
i. Compare knee height with infant supine, hips mad
knees flexed
ii. Asymmetry suggests DDH
iii. Not helpful if DDH is bilateral
b. Barlow until six months of age and Ortolani until one-year-old
c. Painless
May not be detected in the newborn/infant period
May present as a limp when the child begins to walk
Decreased hip abduction in older children
a. Galeazzi's
36
Laboratory/Diagnostics for Dysplasia of the Hip (DDH):
| 1. Radiographs and/or _____
ultrasound
37
Management for Dysplasia of the Hip (DDH):
| 1. Referral to ______
orthopedics
38
Chronic Progressive Disorder is known as what?
Muscular Dystrophy
39
_____ ______
Progressive genetic disorder beginning in the lower extremities and progressing to the upper extremities and torso
1. The most common inherited neuromuscular disease in children
2. Affects 1:3, 500 males
3. The average age of diagnosis is three to five years.
Muscular Dystrophy
40
Signs/Symptoms Muscular Dystrophy:
1. Abnormalities of gait and posture
2. Developmental clumsiness
3. Cannot keep up with developing peers
4. ______ maneuver
a. Child "walks" hands up legs to attain standing
position when getting up
b. Suggests pelvic girdle weakness
5. Firm, large, woody calves (healthy muscle replaced by degenerative tissue)
6. Decreased proximal muscle strength
7. Wheelchair dependent by age ___ years
8. Eventual death from cardiopulmonary failure
4. Gower's
| 7. 12 years
41
Laboratory/Diagnostics for Muscular Dystrophy:
1. Creatine kinase: Markedly ____ in affected males (15,000 to 35,000 IU/L)
2. Electromyography (EMG): _____
3. Electrocardiogram (ECG): ______
4. Muscle biopsy: ______degenerating fibers
5. The DNA analysis of gene
1. elevated
2. Myopathy
3. Abnormal
4. Necrotic
42
Management for Muscular Dystrophy:
1. Symptomatic care to ___ progression and maintain strength and mobility
2. Genetic testing
1. delay
43
Stretching and/or tearing of the ligaments around the ankle, typically involving the lateral ligament complex
1. Most common sports injury
2. Most common musculoskeletal injury
3. Usually a forced inversion (lateral ankle) or eversion (medial ankle)
Ankle Sprain
44
Signs/Symptoms of Ankle Sprain:
1. Grade ___: Stretching but no tearing of ligament; no joint instability
a. Local tenderness
b. Minimal edema
c. Ecchymoses typically insignificant or absent
d. Full range of motion remains although maybe
uncomfortable
e. The patient retains the weight-bearing ability
1
45
Signs/Symptoms of Ankle Sprain:
2. Grade ___: Partial (incomplete) tearing of ligament; some joint instability but definite endpoint to laxity
a. Pain immediately upon injury
b. Localized edema and ecchymosis
c. Significant pain with weight-bearing
d. The range of motion is limited.
2
46
Signs/Symptoms of Ankle Sprain:
3. Grade ___: Complete ligamentous tearing; joint unstable with no definite endpoint to ligamentous stressing
a. Severe pain immediately upon injury
b. Significant edema along the foot and ankle
c. Profound ecchymoses due to hemorrhage; worsens
over several days
d. Patient cannot weight bear
e. No range of motion to the ankle
3
47
Laboratory/Diagnostic of Ankle Sprain:
1. The radiograph is indicated according to ____ ___ ___ if:
a. There is pain near the malleoli and
b. Bone tenderness is present at the posterior edge of
the distal six cm or the tip of either malleolus or
c. The patient is unable to bear weight for at least four
steps at the time of injury and evaluation.
2. Otherwise, diagnostic studies are not indicated.
1. Ottawa Ankle Rule
48
Management of Ankle Sprain:
1. RICE: All grades including 3 (unless severe grade 3) respond well to rest, ice, compression, and elevation (RICE)
a. ___: Weight beming should be avoided for the first several days.
b. ____: Should be applied on top of the compression dressing as quickly as possible following injury, 30 minutes on and off alternately
c. _______: Immediate secure compression will minimize edema and support stability of the ankled.
d. _______: For several days following injury reduces pain and swelling and promotes recovery
2. Nonsteroidal anti-inflammatory drugs (NSAIDs) for pharmacologic relief
a. Rest
b. Ice
c. Compression
d. Elevation
49
Often associated with injuries resulting from straight, outstretched arm falls
Elbow Fracture
50
Signs/Symptoms
1. ___ ___signs: Elbow Fracture
a. No fracture is visible on X-ray.
b. The lateral view demonstrates the elevation of the
anterior and posterior fat pads.
c. Even if fracture cannot be visualized on a radiograph,
the fat-pad sign suggests the presence of an occult
fracture.
Fat pad
51
Laboratory/Diagnostics: Elbow Fracture
| 1. Follow up radiographs with an ____ view
oblique
52
Management: Elbow Fracture
| 1. Refer to ______ to be treated as a fracture
orthopedics
53
____ ______
| A common injury in a young child resulting from swinging or pulling child's arm; radial head subluxation
Nursemaid Elbow
54
Signs/Symptoms: Nursemaid Elbow
1. Inability/refusal to use affected arm
2. Pain with ______
3. Holds arm across the body with thumb up
4. Significant swelling and bruising justifies X-Ray
supination
55
Laboratory/Diagnostics: Nursemaid Elbow
| 1. X-ray will be read as ____ and are usually not done
normal
56
Management: Nursemaid Elbow
| 1. Supportive care at home with _____
NSAIDs
57
a) CN 1 is what?
b) The major function is?
c) Is this a sensory or motor neuron?
a) Olfactory
b) Smell
c) Sensory
58
a) CN 2 is what?
b) The major function is?
c) Is this a sensory or motor neuron?
a) Optic
b) Vision
c) Sensory
59
a) CN 3 is what?
b) The major function is?
c) Is this a sensory or motor neuron?
a) Oculomotor
b) Most EOMs, opening eyelids, papillary constriction
c) Motor
60
a) CN 4 is what?
b) The major function is?
c) Is this a sensory or motor neuron?
a) Trochlear
b) Down and inward eye movement
c) Motor
61
a) CN 5 is what?
b) The major function is?
c) Is this a sensory or motor neuron?
a) Trigeminal
b) Muscle and mastication, the sensation of the face, scalp, cornea, mucus membranes, and nose
c) Both
62
a) CN 6 is what?
b) The major function is?
c) Is this a sensory or motor neuron?
a) Abducens
b) Lateral eye movements
c) Motor
63
a) CN 7 is what?
b) The major function is?
c) Is this a sensory or motor neuron?
a) Facial
b) Move face, close moth andy eyes, taste (anterior 2/3), saliva and test secretion
c) both
64
a) CN 8 is what?
b) The major function is?
c) Is this a sensory or motor neuron?
a) Acoustic
b) Hearing and equilibrium
c) sensory
65
a) CN 9 is what?
b) The major function is?
c) Is this a sensory or motor neuron?
a) Glossopharyngeal
b) Phonation, ( one-third), gag reflex, carotid reflex swallowing, taste (posterior)
c) both
66
a) CN 10 is what?
b) The major function is?
c) Is this a sensory or motor neuron?
a) Vagus
b) Talking, swallowing, the general sensation from the carotid body, carotid reflex
c) both
67
a) CN 11 is what?
b) The major function is?
c) Is this a sensory or motor neuron?
a) Spinal accessory
b) Movement of the trapezius and sternomastoid muscle (shrug shoulders)
c) motor
68
a) CN 12 is what?
b) The major function is?
c) Is this a sensory or motor neuron?
a) Hypoglossal
b) Move the tongue
c) motor
69
Eye movement by what nerves?
3, 4, 6
70
Facial (Bell's Palsy) by what nerve is this affected?
7
71
Tongue by what nerve is affected?
12
72
_____ may present for a multitude of reasons and can be difficult to evaluate. Proper evaluation of the history of the headache, and associated symptoms, are essential to making an accurate diagnosis.
Headache
73
____ _____: cranial artery distension (e.g. migraine, fever, vasodilator drugs, metabolic disturbance, systemic infection)
Vascular dilation:
74
____ _____: head and neck muscle contraction (e.g. tension or psychogenic headache)
Muscular contraction
75
____: space-occupying lesion (e.g. brain tumors, mass lesions, abscess, hematoma, increased intracranial pressure (ICP))
Traction
76
____: infection (e.g. meninges, sinuses, and teeth)
Inflammation
77
Febrile Patient
1) ______: bacterial, bacterial, viral, tuberculous, aseptic
2) A brain abscess or other intracranial infection
3) Encephalitis
4) Sinusitis
5) Associated infection: Strep throat, influenza, mono,
rubeola
1) Meningitis
78
Viral meningitis is more common in ______
infants
79
Bacterial meningitis occurs only in up to 2%
a. Temperatures higher than ___ °F (38.8 °C)
b. Causative agents include: Group B. streptococcus', S.
pneumoniae, H. influenzae, Salmonella, N. meningitis,
protozoa, and E. coli
c. Infants between six to ___ months are at the highest
risk.
d. 90% of cases occur in children ages one month to five
years
a. 101.8 °F
| c. 12 months
80
```
Signs/Symptoms of meningitis:
Most are behavioral responses
1. Newborns and young infants
a. Mimics septicemia
b. Temperature instability
c. Irritability, lethargy
d. Poor _____
e. Volniting
f. Bulging fontanel
g. No stiff neck
```
d. feeding
81
Older infants and children of meningitis:
a) Nausea and vomiting
b) Irritability, confusion
c) Headaches, back pain, nuchal rigidity
d) Hyperesthesia, cranial nerve palsy, ataxia
e) __________
f) Positive Kernig's sign
i. Flexion of the hip at 90 degrees
ii. Pain on the extension of the leg
g. Positive Bmdzinski's sign
i. Involuntary flexion of legs when the neck is flexed.
Photophobia
82
Diagnostic Tests
1. Cerebrospinal fluid (CSF) analysis via lumbar puncture
a. Cloudy
b. _____ present
c. Increased protein
d. Decreased glucose
b. WBCs
83
_____ Patient
1. Subarachnoid hemorrhage
2. Intraparenchymal hemorrhage
3. Postictal headache
4. Cerebral ischemia
5. Severe hypertension
6. Space-occupying condition (examples: a brain tumor,
hydrocephalies) Acute dental disease
7. Acute glaucoma, inflammatory disease of the eye/orbit
Afebrile
84
___ Tumors
1. Etiology is unknown.
2. Infratentorial, brainstem tumors predominate: Most common ages 4 to 11 years
Brain
85
Signs/Symptoms: Brain tumor
1. Infants
a. Increased head circumference, tense bulging
fontanel
b. _______
c. Head tilt
d. Loss of developmental milestones
b. Irritability
86
Signs/ symptoms: Brain tumor
Older Children
a. Headache
1. Worst in the morning followed by ____
2. Usually increases in frequency
b. Abnormal neurologic or ocular findings
1. Ataxia, hemiparesis, cranial nerve palsies
2. Somnolence
3. _______
4. Head tilt, failure to thrive (FTT), diabetes insipidus
5. Papilledema
6. Loss of fine motor control
7. Positive Babinski's sign
8. Behavioral changes
a) 1) vomiting
| b) 3) Seizures
87
Diagnostic Tests: Brain Tumor
1. Computed axial tomography (CT scan)
2. ___ ____ ___ (__)
3. Lumbar puncture (LP): Approach with caution
2. Magnetic resonance imaging (MRI)
88
Causes/Incidence: Brain Tumor
1. Common migraine (no aura) ____years of age at onset
2. Classic migraine onset (with aura) ___years of age
3. Often, there is a family history.
4. _______more often affected
5. A variety of "triggers" are associated with migraine
1. < 10
2. > 10
4. Females
89
A variety of "triggers" are associated with migraine (e.g. emotional or physical stress, lack or excess ____, missed meals, nitrate-containing foods, alcoholic beverages, menstruation, use of oral contraceptives).
sleep
90
Symptoms: Migraine
1. Unilateral, lateralized dull or throbbing headache that occurs episodically
2. ______ onset
3. Focal neurologic disturbances may precede or accompany classic migraines (e.g. field defects, luminous visual hallucinations
4. Aphasia, numbness, tingling, clumsiness or weakness may occur
5. Nausea and vomiting
6. Photophobia and phonophobia
2. Insidious onset
91
Variant Migraine Syndromes:
1) _______migraine
2) Abdominal migraine
1) Confusional
92
_______migraine: More common in younger children; period of confusion and disorientation followed by vomiting and deep sleep, waking feeling well; a headache may not be described
Confusional
93
_______ migraine: Episodic abdominal pain with nausea, vomiting followed or accompanied by headache
Abdominal
94
Laboratory/Diagnostics: Migraine
1. Baseline studies
a. Blood chemistries, basic metabolic panel (CMP)
b. ___ ____ ____ ____ (____)
c. Venereal Disease Research Laboratory test (VDRL)
d. Erythrocyte sedimentation rate (ESR)
e. CT scan of the head
f. Other studies as indicated by the history and physical
exam
b. Complete blood count test (CBC)
95
Management of Migraines:
1. Avoidance of trigger factors is very important; have the patient keep a headache diary
2. Improve general health: Balanced diet, aerobic exercise, regular sleep
3. Relaxation/stress management techniques (e.g., counseling, biofeedback)
4. Eliminate monosodium glutamate (MSG) and nitrates or nitrites from the diet
5. Stabilize or wean caffeine intake
6. Prophylactic therapy if attacks occur more than three to four times per month, or if migraines interfere with daily functioning or school; for example
a. Non-steroidal anti-inflammatory drugs (NSAIDs) in chronic, low doses daily b. Other agents:
i. _______ (Inderal):
ii. Amitriptyline (Elavil):
iii. Topiramate (Topamax):
iv. Imipramine (Tofranil): Ten to 150 mg daily
v. Verapamil (Calan): Fifteen to 30 mg/kg/24 hour by
mouth twice a day
i. Propanolol
| v. Verapamil
96
Management of an acute attack/ Migraine
a. Rest in a ____, quiet room
b. A simple analgesic such as Tylenol or ibuprofen (preferred) taken right away may provide some relief
i. Ibuprofen _____ mg/kg dose in younger children
ii. May use up to 800 mg/dose in older teens
c. Antiemetics
d. When OTC analgesics, not enough use triptans
i. Almotriptan (Axert) 6.25 mg (approved for children 12
years and older)
ii. Rizatriptan (Maxalt) 5 mg
iii. Sumatriptan (Imitrex):
1. Nasal 5 mg
2. Tablets - (less expensive; may not work as well
due to slower absorption)
iv. Zolmitriptan (Zomig) nasal 5 mg
v. Most evidence in adolescence - all triptans noted
above
vi. Most evidence for ages 6 to 11 years: Maxalt 5 mg or
Imitrex nasal 5 mg vii.
vii. May take at first sign of a headache, then repeat in
two hours if needed viii.
viii. Avoid in children at risk for heart disease
a. dark
| b. i. 7.5 - 10
97
A transient disturbance of cerebral function due to an abnormal paroxysmal neuronal discharge in the brain
Seizure Disorder
98
Causes/Incidence: Seizure Disorder
| 1. ______ abnormalities and perinatal injuries may result in seizures presenting in infancy and early childhood
Congenital
99
Causes/Incidence: Seizure Disorder
| 2. _______ disorders: hypocalcemia, hypoglycemia, pyridoxine deficiency, renal failure, acidosis, and others
Metabolic
100
Causes/Incidence: Seizure Disorder
| 3. ____ is an important cause in adolescents.
Trauma
101
Causes/Incidence: Seizure Disorder
| 4. _____ and other space-occupying lesions
Tumors
102
Causes/Incidence: Seizure Disorder
| 5. ______diseases: Bacterial meningitis, herpes encephalitis, neurosyphilis
Infectious
103
Causes/Incidence: Seizure Disorder
| 6. The seizure threshold is lowered with _____ (easier for them to have a seizure if febrile).
fever
104
_____Seizures
| Focal origin: One hemisphere
Partial
105
___ ____ seizures
a. No loss of consciousness
b. A variety of other symptoms (e.g. motor, autonomic, and sensory)
Simple partial
106
_____ partial seizures
| a. Impaired consciousness: Stating > ___ seconds before, during or after the symptoms described above
Complex
| 20 seconds
107
______ Seizures
| Bilateral, involving both hemispheres
Generalized
108
```
___ ______:
Absence (petit-mal)
a. Brief "staring" episodes (10 to 20 seconds)
b. Onset and termination are very brief
c. Almost always begin in childhood
```
Generalized Seizures
109
_____ seizure
a. A sudden increase in muscle tone producing a number of characteristic postures
b. Consciousness is usu~dly partially or completely 10st
c. Postictal alteration of consciousness is usually brief; may last several minutes
Tonic
110
_____ ____ seizure
a. Sudden loss of consciousness with arrested respirations
b. The clonic phase involves increased muscle tone followed by bilateral rhythmic jerks lasting two to three minutes, followed by flaccid coma
c. Urinary and or fecal incontinence may occur
d. The postictal state is characterized by deep sleep for up to an hour, headache, disorientation, muscle discomfort and nausea; can last minutes to hours
Tonic-clonic (grand mal)
111
_____ seizure
a. Sudden loss of muscle tone
b. May result in head drop or falling to the ground
An eyewitness account is extremely helpful
Atonic
112
Management: Acute Attack
1. Initial management is supportive as most seizures are self-limiting
a. Maintain open airway
b. Protect patients from injuries
c. Administer oxygen if the patient is cyanotic.
2. Do not force artificial airways or objects between teeth
3. Parenteral anticonvulsants are used to stop convulsive
seizures
a. ______ (Ativan) or
b. Benzodiazepines (Valium)
4. Consider referral if:
a. Seizures continue despite therapeutic monitoring
through anticonvulsant levels
b. Regression of developmental skills occurs
c. Regression of cognitive function occurs
d. Side effect profile is unacceptable
5. Primary care follow-up
3.a. Lorazepam
113
____ Seizures
| Seizures occurring during the course of and as a result of fever
Febrile Seizures
114
______ Seizures
| Occur in 5% of children, peak incidence between 1 and 3 years of age
Febrile Seizures
115
Febrile Seizures:
Risk factors include a family history of seizure disorder, ____ use by mother during pregnancy, prematurity, neonatal hospitalization > 28 days, and/or frequent infections in the first year.
tobacco
116
Febrile Seizures:
| If a seizure occurs > ___ hours after fever onset, it is likely due to infection.
24
117
Signs and symptoms: Febrile Seizures
1. The majority are ___ _____
2. Most episodes last < five minutes
3. Physical exam to rule out the infectious cause of seizure
4. Rule out meningitis
tonic-clonic
118
Laboratory/Diagnostics/ Febrile Seizure
1. ______ puncture if meningitis is suspected.
2. EEG, chemistries, and serologies are not indicated.
Lumbar
119
Management/ Febrile Seizures
1. ___ ___; place in the side-lying position
2. Cooling measures
3. Acetaminophen
Protect airway
120
A ____ ______characterized by numerous cafe-au-lait spots on the body, and nerve tumors on the skin and in the body
neurocutaneous syndrome
121
Signs/Symptoms
1. Multiple cafe-au-lait (CLS) spots
2. Seizures
3. Diagnostic criteria: Must have at least two
a. Six or more CLS spots > 5 mm in the prepubertal
child or > 15 mm postpubertal
b. Two or more cutaneous neurofibromas
c. Axillary or inguinal freckling
d. Two or more iris Lisch nodules
e. Distinctive osseous lesions
f. Autosomal dominant; present in a first-degree relative
Neurofibromatosis (von Recklinghausen Disease)
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Management of Neurofibromatosis (von Recklinghausen Disease)?
1. Refer to ______
1. neurology
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_____ _____
| Brief, abrupt, non-purposeful movements or utterances
Tic Disorders
124
1. The most common is Tourette syndrome.
2. Movements usually involve the face, neck, or shoulders and sometimes, muscles of the limbs or other parts of the body.
3. Other psychobehavioral problems (e.g. attention deficit hyperactivity disorder (ADHD), obsessive-compulsive behaviors)
Tic disorder
125
Etiology and incidence; Tic Disorders
1. Frequently unrecognized as a movement disorder in children
2. Onset is between ___ to ___ years of age.
3. The cause is unknown.
4. Family predisposition
5. Associated with medications (methylphenidate, pemoline, amphetamines)
2. 6 and 12 years
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Vocal tics
1. Oropharyngeal, nasopharyngeal or laryngeal sounds
2. Consonants or syllables
3. Meaningful or nonsense words or phrases
4. ______ (obscene speech)
Coprolalia
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obscene gestures
Copropraxia
128
obscene writing
coprographia
129
repeating one's own words
Palilalia
130
repeating another's words
echolalia
131
Tic Disorder is management is done with collaboration with _______?
Neurology
