Neuro/Development Flashcards by Indy P

Lift head

2 months

same time as social smile

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Roll over

4 months

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Sit up

6 months 
(same time as stranger danger)

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Walk

1 years

same time as separation anxiety

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Root reflex

corner of mouth is touched –> baby turns head

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Sucking reflex

roof of babies mouth is touched –> baby begin to suck

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Moro reflex

aka “startle reflex” –> baby throws head back, extends out arms/legs –> cries –> then pulls arms/legs back in

lasts until 5/6 months of age

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Tonic Neck Reflex

babys head is turned to one side 
arm on that side extends 
opposite arm bends at the elbow 
"fencing position" 
lasts until 6/7 months of age

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Grasp reflex

stroke palmar side of hand –> baby closes fingers in a grasp
lasts until 5/6 months of age

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Babinski

stroke sole of foot (plantar) –> big toe bends backwards while rest of toes fan out

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Meningitis is most commonly caused by?

encapsulated organisms - invade through upper airways and get into subarachnoid space

Neonates: E. Coli, Group B strep

Children/Adults: S. Pneumoniae

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What is the treatment for meningitis in neonates?

Cefotaxime + Ampicillin

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What is the treatment for meningitis in Children?

ceftriaxone + Vancomycin

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Kernig sign

pt is supine, flexion of neck causes flexion of the hips
POSITIVE: flexion of the hips and the knees

K for Kick

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Brudzinski’s sign

pt is supine, knee and hip are flexed to 90 degrees and then an attempt to extend the knee is made
POSITIVE: pain in neck or back

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How can you tell if an infant has meningitis?

bulging fontanelles

toxic appearing

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LP for bacterial meningitis?

HIGH proteins
LOW glucose

be sure to do a CT before LP to prevent herniation

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What is the tx for meningitis?

ceftriaxone or cefotaxime x 10 days

for neonates: must give ampilicillin to cover listeria and group B strep x 2-3 weeks

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What defines a simple febrile seizure?

tonic clonic attack associated with fever than doesnt last for more than 15 minutes and doesnt recur within 24 hours

What defines a complex febrile seizure?

> 15 minutes, focal, or recurs within 24 hours (basically an atypical simple febrile seizure)

When are febrile seizures most common?

6-60months (less than 5 yo, RARE to have febrile seizures greater than 5 yo)
temps higher than 38C

What is the workup for febrile seizures?

for complex febrile seizures: CT scan, LP, +/-EEG

What is the first line treatment for absence seizures?

Ethosuximide

What is the cause of cerebral palsy?

perinatal injury to the nervous system that results in motor spasticity

What is the first line treatment for tics?

clonidine or BZs

What is the rule on concussions for kids playing sports?

after the 3rd concussion, they should terminate the season and return next season immediate tx: physical rest between 24-28 hours - then graduate return to play

What is the MC sx of concussion?

Turner syndrome

XO - absence of all or part of 2nd chromosome | nondisjunction (not inherited)

How do pts with Turner syndrome present?

``` webbed neck low set ears and lower hairline wide spaced nipples hip dysplacia horseshoe kidney short stature primary amenorrhea ```

What is the tx for Turner syndrome?

GH for short stature | Estrogen and progesterone for secondary sex characteristics

What is the most common syndromic for of obesity?

Prader-Willi Syndrome | caused by absence of expression of long arm of chromosome 15

How do pts with Prader-Willi Syndrome present?

prenatal: breech positioning, polyhramnios, reduced fetal activity neonate: poor suck, failure to thrive, cryptorchidism learning difficulties food-seeking behaviors (hence obesity association)

When do pts get tested for Prader-Willi Syndrome?

if they are between 2-6yo and have a hx of poor suck with global developmental delay

How do pts with fetal alcohol syndrome present?

``` growth deficiency (length, weight, and head circumference) facial abnormalities --> short palpebral fissure, epicanthal folds, maxillary hypoplasia, micrognathia, a thin smooth upper lip mental and developmental delays ```

Trisomy 21

Down's syndrome MC d/t nondisjunction (failure of one or more pairs of homologous chromosomes or sister chromatids to separate normally during nuclear division)

What is the MC chromosomal abnormality affecting children?

Down's Syndrome

Brushfield spots

speckling on the iris | seen in down's syndrome

What are some complications/associations to down's syndrome?

``` cardiac anomaly (tetraology of fallot) primary congenital hypothyroidism SNHL opthalmologic disorders late hip dislocations ```

What is neurofibromatosis?

mutation on NF1 on chromosome 17 neurocutaneous disorder MC in adolescence these pts are at increase risk for optic nerve glioma (schwannomas), and soft tissue sarcomas

What is Guillain Barre Syndrome?

post-infectious polyneuropathy MC associated with campylobacter jejuni, EBV, and CMV

How does Guillian Barre Syndrome present?

weakness in the LEs that ascends to the trunk | loss of tendon reflexes

What would an LP show on a pt with Guillain Barre Syndrome?

elevated protein level, typically 2x the upper limit of normal normal WBC

What is the treatment for Guillain Barre Syndrome?

plasmapheresis or IVIG

What is the path behind myasthenia gravis?

auto antibodies to acetylcholine receptors

What are the first clinical signs of MG?

ptosis or extraocular muscle weakness sxs usually increase throughout the day

What is the dx for MG?

Tensilon test - admin of edrophonium chloride causes immediate improvement of eye sxs in infants: neostigmine is used instead of edrophonium chloride d/t risk of cardiac dysrhythmias

How is MG tx?

cholinesterase inhibitors - pyridostigmine (first line) others: IVIG, plasmapheresis Thymectomy can be used in refractory cases