Neuro

Question 1

CP is a diagnosis of exclusion usually made around ________ of age and by a pediatric neurologist after observing the child for a while.

Answer 1

18mo

Question 2

Patients with CP may have severe _____ impairment but no ______ impairment

Answer 2

Physical
Cognitive.

Question 3

CP is/is not a progressive disease.

Answer 3

Is NOT. It just has s/s that appear or disappear as the child ages and neuron connections intensify.

Question 4

MD is/is not a progressive disease and usually occurs in ______

Answer 4

IS
Males (x-linked)

Question 5

Compare and contrast Duchenne and Becker MD

Answer 5

Duchenne - x-linked, shortened life span (20-30yrs), most common, age at onset 2-6yo, respiratory/cardiac impairment, scoliosis, intellectual impairment, contractures, Gower sign, lordic/waddling gait.
Becker - age of onset 2-16years, slower than Duchenne, survive to middle age,

Question 6

What is Gower sign?

Answer 6

Where a child has to use their hands to walk up their legs when they’re trying to stand up.

Question 7

Tx for MD?

Answer 7

Long term steroids, biologics/gene therapies , PT/OT, assistive devices, multiD team approach.

Question 8

Most common S/s of GBS in kids

Answer 8

Bilateral calf pain, refusal to walk, diffuse weakness.

Question 9

GBS follows a _____ or _____ illness after about ______

Answer 9

Respiratory or GI viral
10 days

Question 10

_____ lab elevation in GBS

Answer 10

CK

Question 11

Median age of GBS/BACM is _____

Answer 11

6.6yo

Question 12

Bell’s palsy can last for

Answer 12

1-9 weeks

Question 13

Consider _____ disease in Bell’s Palsy

Answer 13

Lyme Disease

Question 14

Epilepsy is _______

Answer 14

2 unprovoked seizures >24hrs apart

Question 15

Differentiate between infantile spasms and febrile seizure

Answer 15

Infantile spasm = <6mo
Febrile seizure = 6mo-5yrs

Question 16

Absence and tonic-clinic are types of ______

Answer 16

Generalized seizures

Question 17

MRI or CT scan is ______ indicated for seizure work up unless _____

Answer 17

NOT usually
Need to rule out stroke or tumor as cause of seizures.

Question 18

Febrile seizures usually occur early on in a viral illness (<24hrs). They can be Simple or complex. If first seizure happens >24hrs after start of illness, then consider ________

Answer 18

Bacterial cause

Question 19

Tx for febrile seizures:

Answer 19

Anti-pyretics have not been proven to decrease risk of recurrent febrile seizures, HOWEVER it may help child feel better to keep eating and drinking and make parents feel better that they are doing something - no harm.
Also possible to do Diazepam every 8 hours during illness may be considered.

Question 20

In what instances would you consider an LP to evaluate a febrile seizure?

Answer 20

If strong suspicion for bacterial illness (meningitis)
Or if 6-12mo and have NOT gotten Hib or pneumococcal vaccines yet.

Question 21

Infantile spasms or “west syndrome” is what 3 characteristics? Tx?

Answer 21

Epileptic spasms accompanied by developmental regression with EEG findings of hypsarrythmia. May be mistaken for startle reflex, hiccups , very brief “jack knife” occurring in clusters when tired.
Adrenocorticotropic hormone. (ACTH)

Question 22

Status epilepticus is a seizure that lasts _____

Answer 22

> 30mins with some interruption
20min without interruptions.

Question 23

The drug _______ can potentially worsens seizures especially this type _______

Answer 23

Carbamazepine
Absence or partial.

Question 24

Instead of aura with migraines, kids may have ________. Adults usually have unilateral migraine where as kids it is not uncommon to have bilateral behind the eyes (frontotemporal).

Answer 24

Change in mood/temprament, and appetite.

Question 25

Young kids can have _____ with migraines

Answer 25

Cyclical vomiting syndrome or Abdominal migraine

Question 26

Triptans (maxalt) are FDA approved for kids. ______

Answer 26

>6yo.

Question 27

Pseudotumor cerebrii - increase in ICP without MRI changes. Papilledema. LP for dx. Overweight females.

Question 28

Avoid ______ forms of contraception in adolescents with migraine.

Answer 28

estrogen component.

Question 29

Electrolyte used for migraine prophylaxis?

Answer 29

Mg

Question 30

Most common organisms casing fever under 2 months? Over 2 months?

Answer 30

GBS, E. Coli Strep pneumonia, GBS, meningitisis and h flu.

Question 31

How can you assess dysmetria in a child?

Answer 31

They’re unable to judge distance - they can’t pass the block - over pass or under pass.

Question 32

When do children grow out of their wide set ambling gait?

Answer 32

Around age 6 is when tandem walking should begin. They walk on heel to toe

Question 33

4 factors that influence a child’s likelihood to have a second seizure and 2 factors that do NOT

Answer 33

Family Hx, abnormal EEG, nocturnal seizures, complex seizure Age and duration of seizure do not influence.

Question 34

Sturge Webber - what is this?

Answer 34

Port wine stain on the face (much more concerning than stork bite - on back of head or neck). Neuro cutaneous disorder with angiomas. Residual embryonal blood vessels, Concerning if involving the upper part of the face over eye (V1 -ophthalmic branch) Choroidal angiomas grow under the skin on the vessels and cause damage to brain tissue around them Seizures, stroke like episodes and hemiparesis.