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Neuro Pedia Flashcards

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1
Q

What is the cornerstone of neurologic assessment?

A

A detailed history

Includes primary informants such as parents/guardians.

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2
Q

What are the components of the neurologic evaluation history?

A
  • Chief complaint
  • History of present illness
  • Birth history
  • Developmental history
  • Family history
  • Social history
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3
Q

What is monitored to detect hydrocephalus or microcephaly?

A

Head circumference

Serial monitoring should occur at every clinic visit for children under 3 years old.

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4
Q

When does the anterior fontanelle typically close?

A

9-18 months

It is diamond-shaped and about 2x2 cm.

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5
Q

What is the GCS score for a patient with E3V4M5?

A

12 points

E3 (eye opening to voice) = 3, V4 (confused verbalization) = 4, M5 (localizes to pain) = 5.

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6
Q

What are the signs to check for in a general motor examination?

A
  • Atrophy
  • Hypertrophy
  • Abnormal movements (Tics, Fasciculations, Dystonia, Chorea, Athetosis)
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7
Q

What does the disappearance of primitive reflexes indicate?

A

Maturation of the cerebral hemisphere

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8
Q

What is the normal opening pressure for a newborn during a lumbar puncture?

A

90-120 mmH2O

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9
Q

What are the normal CSF analysis values for a child beyond the neonatal period?

A
  • Pressure: 50-80 mmH2O
  • Protein: 20-45 mg/dL
  • Glucose: >75 mg/dL of serum glucose
  • Leukocytes: <5 mm3 (75% lymphocytes)
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10
Q

What is the embryonic origin of the nervous system?

A

Ectoderm

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11
Q

What is the etiology of spinal cord malformation?

A

Failure of the neural tube to close between the 3rd and 4th week of in utero development

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12
Q

What is the most severe form of dysraphism?

A

Myelomeningocele

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13
Q

What imaging method is diagnostic of choice for all ages regarding spinal cord conditions?

A

MRI

It is expensive and often requires sedation.

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14
Q

What is the primary prevention method for neural tube defects?

A

Maternal periconceptual use of folic acid (4 mg OD)

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15
Q

What are the indications for imaging in suspected spinal dysraphism?

A
  • Uncertain clinical findings
  • Subcutaneous mass or lipoma
  • Hairy patch
  • Atypical dimples
  • Vascular lesions like hemangioma
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16
Q

What are the common gait abnormalities and their descriptions?

A
  • Spastic gait: Stiff-legged
  • Hemiparetic gait: Spasticity and circumduction
  • Cerebellar ataxia: Wide-based, reeling
  • Sensory ataxia: Steppage gait
  • Myopathic gait: Waddling
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17
Q

Fill in the blank: The method of choice for detecting hemorrhage in infants is _______.

A

Cranial Ultrasonography

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18
Q

What is the prognosis for children with aggressive treatment for neural tube defects?

A

10-15% mortality

70% of survivors have significant disabilities.

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19
Q

What is the incidence period for conditions that started before conception?

A

Before conception until at least the 12th week of gestation when neurulation is complete.

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20
Q

What is the immediate surgical indication for CSF leaks?

A

Immediate surgery is indicated to prevent complications.

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21
Q

What are the surgical procedures indicated for myelomeningocele?

A

Repair of myelomeningocele and shunting procedure for hydrocephalus.

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22
Q

What is the prognosis for survivors with aggressive treatment?

A

10-15% mortality; 70% of survivors have normal intelligence.

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23
Q

Where is cerebrospinal fluid (CSF) produced?

A

In the choroid plexus epithelium within the cerebral ventricles.

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24
Q

How is CSF reabsorbed into the bloodstream?

A

CSF is reabsorbed in the arachnoid villus cells and returned to the bloodstream via pinocytosis.

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25
What is the mnemonic for CSF flow?
CARS LINE for Monroe @ 3rd Avenue Sylvia & 4th for Lucy and Maggie in Subway.
26
List the sequence of CSF flow through the brain.
* Choroid plexus * Lateral ventricle * Foramen of Monroe * 3rd ventricle * Aqueduct of Sylvius * 4th ventricle * Luschka and Magendie * Subarachnoid space
27
Define hydrocephalus.
A condition characterized by an abnormal accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain.
28
What are the two main types of hydrocephalus?
* Communicating * Non-communicating (Obstructive and Non-Obstructive)
29
What causes non- obstructive hydrocephalus?
Obliteration of subarachnoid cisterns and/or malformation of arachnoid villi.
30
What are some etiologies of hydrocephalus?
* Achondroplasia * Aqueductal stenosis * Basilar Impression * Mitochondrial disorders * Chiari malformations * Dandy-Walker malformations * Meningitis
31
What is the triad of Dandy-Walker malformation?
* Agenesis of cerebellar vermis * Cystic dilatation of the 4th ventricle * Enlargement of the posterior fossa.
32
What are the signs of hydrocephalus in infants?
* Accelerated rate of head enlargement * Wide and bulging fontanelles (anterior)
33
What is the 'sun-setting sign' in hydrocephalus?
Eyes may deviate downward due to impingement of the dilated suprapineal recess on the tectum.
34
What is the MacEwen sign?
Percussion of the skull produces a 'cracked pot' sensation.
35
What imaging studies are crucial for diagnosing hydrocephalus?
* CT scan * MRI * Ultrasonography
36
What is the most common complication of shunts in hydrocephalus management?
Staphylococcus epidermidis infection.
37
What are the two main types of headaches?
* Primary headache * Secondary headache
38
What characterizes tension-type headache?
* Mild to moderate severity * Diffuse location * Non-throbbing character
39
What characterizes migraine headache?
* Moderate to severe severity * Focal location * Throbbing and pounding character
40
True or False: Auras are frequently associated with tension-type headaches.
False.
41
What are the symptoms typically associated with migraines?
* Nausea * Photophobia * Phonophobia * Vomiting
42
What is metamorphopsia?
Distortions of visual perceptions with changes in size, color, and movement.
43
What are the indications for neuroimaging in headaches?
* Abnormal neurologic examination * Abnormal or focal neurologic signs * Seizures or very brief auras (<5 mins) * Unusual headache in children. Brief cough headache. Headache after awakening. Migranous headache - no fam hist
44
What are red flags for headache in children?
SNOOPY S: systemic signs symotoms. N:neurologic . O:onset O: occiptal ( child) older age ( adult) P: previous headache, progressive/persistent, pressure, postural, pregnancy. Y: yonger age <2 - 3 yr old.
45
What are the components of migraine management?
* Acute treatment * Preventive treatment * Biobehavioral therapy
46
What pharmacologic options are available for migraine treatment?
* NSAIDs ( mild to moderate)*not more than 2-3 per week. Repeated Q3-q4 Triptans ( moderate to severe of nsaid fail) q2hr. Fluid hydration.
47
What is the pharmacologic option for migraine that should not be used more than 2-3 times per week?
NSAIDs ## Footnote To avoid medication overuse headache.
48
What is the maximum dose of Paracetamol for children?
90mg/kg/24h ## Footnote Administered at 15mg/kg/dose every 4-6 hours.
49
Which drugs are considered Triptans for uncontrolled migraine attacks?
* Almotriptan * Rizatriptan ## Footnote Side effects include tightness of jaw, chest, fingers due to vascular constriction. Grogginess, fatigue due to central sertonin effect
50
What are the two types of seizures?
* Generalized seizures * Focal seizures ## Footnote Generalized seizures involve both hemispheres, while focal seizures are limited to one hemisphere.
51
What characterizes a generalized seizure?
Upward gaze and generalized tonic-clonic movement of the extremities ## Footnote Indicates involvement of both cerebral hemispheres.
52
What is the definition of seizures?
Paroxysmal, time-limited changes in motor activity and/or behavior due to abnormal electrical activity of the brain. ## Footnote Includes transient occurrences of signs/symptoms resulting from excessive or synchronous neuronal activity.
53
What is epilepsy?
A brain disorder characterized by prolonged predisposition to generate seizures and by neurologic, cognitive, psychological, and social consequences. ## Footnote Defined as having ≥ 2 unprovoked seizures occurring in a time frame of > 24 hours.
54
What is a breakthrough seizure?
Occurs in patients already being treated with anti-epileptic drugs but has achieved low drug levels. ## Footnote Indicates inadequate seizure control despite ongoing treatment.
55
What is the initial drug therapy of choice for focal seizures?
Oxcarbazepine or carbamazepine ## Footnote These medications are often preferred for managing focal seizures.
56
What is the most common type of seizure disorder in childhood?
Febrile seizure ## Footnote Typically occurs in children aged 6-60 months with a temperature > 38 degrees Celsius.
57
What differentiates a simple febrile seizure from a complex febrile seizure?
Simple febrile seizures last ≤ 15 minutes and have no focal neurologic deficits; complex febrile seizures last ≥ 15 minutes and may have focal deficits. ## Footnote Complex febrile seizures may also present with focal seizure activity.
58
What is the management approach for febrile seizures?
* Counseling and education * Antipyretics for fever ( does not reduce recurrence) * Anticonvulsants may reduce recurrence but are not routinely recommended ## Footnote Emotional support is crucial for parents.
59
What are the major risk factors for developing epilepsy after a febrile seizure?
* Neurodevelopmental abnormalities * Complex febrile seizure * Family history of epilepsy ## Footnote A history of febrile seizures increases risk but varies based on individual factors.
60
What is the most common type of generalized seizure?
Generalized tonic-clonic seizure ## Footnote It can be primary or secondary generalized and includes tonic and clonic phases.
61
What is the typical presentation of an absence seizure?
Sudden cessation of motor activity or speech with a blank facial expression. ## Footnote Rarely associated with aura or postictal state.
62
What is the definition of postictal state?
The period following a seizure characterized by confusion, drowsiness, and sometimes incontinence. ## Footnote Symptoms can vary based on the type of seizure.
63
What is the purpose of a lumbar puncture in seizure management?
To evaluate for infection in infants with fever and seizure or if the child is ill-appearing. ## Footnote Recommended for all infants < 6 months with a first febrile seizure.
64
What is the site of greatest involvement in cerebral cortex infarction?
Brainstem ## Footnote Affects Cranial Nerves III, VI, VII.
65
What condition can exudates cause by interfering with the flow of CSF?
Communicating hydrocephalus ## Footnote Most common in children aged 6 months to 4 years.
66
In what percentage of cases is miliary tuberculosis present?
50% ## Footnote Miliary tuberculosis can be a complicating factor.
67
What are the non-specific signs and symptoms in the first stage of meningitis?
* Fever * Headache * Irritability * Drowsiness * Malaise ## Footnote Infants may show loss of developmental milestones.
68
What focal neurologic signs can occur in the second stage of meningitis?
* Nuchal rigidity * Seizures * Positive Kernig and Brudzinski signs * Hypertonia * Cranial nerve palsies ## Footnote May also present with hydrocephalus, increased ICP, and signs of encephalitis.
69
What are the potential outcomes in the third stage of meningitis?
* Coma * Hemiplegia * Hypertension * Deterioration of vital signs * Death ## Footnote Indicates severe progression of the disease.
70
What is the appearance of CSF in cases of tb meningitis?
Ground glass appearance ## Footnote Forms a pellicle when spun.
71
What are the ancillary tests used in diagnosing tb meningitis?
* PCR * ELISA * Latex agglutination ## Footnote These tests help identify specific infectious agents.
72
What cranial imaging findings might indicate meningitis?
* Basilar enhancement * Communicating hydrocephalus * Cerebral edema * Focal ischemia ## Footnote Important for assessing the extent of infection.
73
What is the treatment regimen for newly diagnosed tuberculosis?
2HRZE + 10HR ## Footnote This is a standard anti-Kochs regimen.
74
Which virus is the most common cause of meningoencephalitis?
Enterovirus ## Footnote Ranges from mild to severe illness.
75
What is the most common manifestation of CNS involvement in Varicella Zoster Virus?
Cerebellar ataxia ## Footnote Often occurs in relation to chickenpox.
76
What is the diagnostic procedure for suspected bacterial meningitis?
Lumbar puncture ## Footnote CSF analysis can show the organism on gram stain and culture.
77
What are common etiologic agents for bacterial meningitis in the first two months of life?
* Group B streptococcus * Gram-negative enteric bacilli * L. Monocytogenes ## Footnote These organisms are significant causes in this age group.
78
What are the signs of meningitis in older infants (12-18 months)?
Brudzinski and Kernig signs are consistently NOT PRESENT ## Footnote Indicates a difference in presentation compared to older children and adults.
79
What type of antibiotics are used for empiric treatment of bacterial meningitis?
* Ceftriaxone * Cefotaxime * Vancomycin if penicillin resistant ## Footnote Treatment choice may vary based on age and suspected organism.
80
What is the most reliable method for diagnosing a brain abscess?
Cranial CT scan and MRI ## Footnote These imaging techniques provide detailed information about the abscess.
81
What are potential long-term sequelae of brain abscess?
* Developmental problems * Delay in learning and behavior * Hydrocephalus * Seizures * Hemiparesis ## Footnote High mortality is associated with multiple abscesses and coma.
82
MIGRANE
recurrent headache • with or without aura • lasts 4 to 72 hours (2 to 72 hours in children) • unilateral , pulsating . • of moderate or severe intensity, • aggravated by routine physical activity.
83
MIGRANE
recurrent headache • with or without aura • lasts 4 to 72 hours (2 to 72 hours in children) • unilateral , pulsating . • of moderate or severe intensity, • aggravated by routine physical activity.
84
N. Meningiditis
PEN G IV 5 TO 7 DAYS. MEROPENEM OR VANCOMYCIN IF ALLERGIC TO PEN G.
85
N. Meningiditis
PEN G IV 5 TO 7 DAYS. MEROPENEM OR VANCOMYCIN IF ALLERGIC TO PEN G.
86
S. Pneumoniae
Vancomycin+ 3rd gen cephalosporin or pencillin iv 10-14days. Vancomycin may be added due to presumed resistance.
87
S. Pneumoniae
Vancomycin+ 3rd gen cephalosporin or pencillin iv 10-14days. Vancomycin may be added due to presumed resistance.
88
L. Monocytogenes
Ampicillin or iv cotrimoxazole
89
Hib
Ampicillin for 7-10 days
90
E. Coli
Cefotaxime or ceftriaxone for 21 days or atleast 2 weeks of sterlisation.
91
P. Aeroginosa
Ceftazidime for 21 days or atleast 2 weeks of sterlization.

Pediatrics (2 decks)

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