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PEDS II final > Neurology > Flashcards

Neurology Flashcards

(74 cards)

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1
Q

Define Macrocephaly

A
  • > 95th percentile or > 2 percentile lines above height/weight
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2
Q

define microcephaly

A
  • < 5th percentile or < 2 percentile lines below height/weight
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3
Q

posterior fontanelle closes when

A
  • 2-3 months
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4
Q

anterior fontanelle closes when

A

1-3 years

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5
Q

How can you test CN III, IV and VI in a pediatric patient

A
  • following objects
  • fixating
  • EOMs
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6
Q

how can you test for CN V in infant

A
  • sucking, swallowing
  • light touch to face
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7
Q

How can you test for CN IX and X in infant

A
  • IX: glossopharyngeal: salivation
  • X: vagus
    • both: gag reflex
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8
Q

List some neonatal primitive reflexes. These should disappear at ?

A
  • Moro: when head is extended, arms and legs both flex
  • Grasp
  • Rooting: tactile stimulus near mouth, mouth pursues stimulus
  • Placing
  • Trunk incurvation: reflex occurs the side of the infant’s spine is stroked or tapped while the infant lies on the stomach. The infant will twitch his or her hips toward the touch
  • disappear at 4-6 months
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9
Q

gait is usually wide based and unstead until what age

A

6 yo

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10
Q

Static evolution of neurologic symptoms

A
  • seen in first few months and do not change over time
    • congenital abnormalities or brain injury
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11
Q

Progressive evolution of neurologic symptoms

A

degenerative disease or neoplasm

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12
Q

Intermittent and brief evolution of neurologic symptoms

A

epileptic or migraine syndromes

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13
Q

Saltatory evolution of neurologic symptoms

A
  • bursts of symptoms followed by partial recovery
    • demyelinating and vascular diseases
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14
Q

What is considered developmental delay

A
  • not reaching a milestone 2 standard deviations below the norm
  • disability: permanent delay
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15
Q

List the 4 developmental milestone categories

A
  1. gross motor
  2. fine motor
  3. cognitive language
  4. social
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16
Q

Intellectual disability can be broken down into what 2 categories

A
  1. adaptive behavior: limitations in conceptual, social, and/or practical skills
  2. intellectual functioning: limitations in general mental capacity including learning, reasoning, problem solving, etc
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17
Q

Which atypical movement describes the inability to make voluntary smooth, accurate, and coordinated movements - cerebellum

A

Ataxia

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18
Q

which atypical movement describes the extreme slowness and stiffness of voluntary movement

A

bradykinesia

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19
Q

which atypical movement describes the syndrome of continous involuntary random movements that usually occur at rest and may appear to be fidgety, dancing, or writhing

A

chorea

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20
Q

which atypical movement describes the syndrome of abnormal muscle contractions that lead to twisting, jerking, spasms, or stiffness at rest of during attempts at movement

A

Dystonia

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21
Q

which atypical movement describes the condition of very rapid and brief shock-like jerks

A

Myoclonus

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22
Q

which atypical movement describes the increase in muscle stiffness that worsens with rapid movement and may be associated with increased reflexes and weakness

A

spasticity

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23
Q

which atypical movement describes the repetitive, stereotyped and sometimes complex involuntary movements or sounds that may appear similar to purposeful actions

A

Tics

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24
Q

What is Cerebral palsy

A
  • motor impairment resulting from brain damage
  • 70% caused during prenatal period
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25
List the 4 different types of Cerebral palsy
1. **spastic**: 70-80% 2. athetoid/dyskinetic: writhing 3. ataxic: imbalance 4. atonic: flaccid * many have normal or above normal intellect
26
is cerebral palsy hereditary?
No
27
Cerebral palsy treatment
* early recognitition and intervention * anti-spasmodics * botulinum toxin
28
what is the most common cause of recurrent HA in children
Migraine
29
in a Migraine, pain is usually bi- or unilateral in children? In teens?
* bilateral in children * unilateral in teens
30
tx of migraine
eliminate triggers
31
Tonic convulsion
sustained contraction
32
clonic convulsion
contraction alternating with relaxation
33
myoclonic convulsion
spasm of a muscle or group of muscles
34
atonic convulsion
sustained relaxation of muscles
35
if ictus phase (Acute seizure) affect both sides of brain, then patient will be
unconscious
36
post ictal phase
* aleration of consciousness following most seizures * HA, irritable
37
partial seizures can be broken down into
* simple partial: conscious * complex partial: impaired consciousness
38
febrile are extremely common in what age groups
3 months to 5 years
39
febrile seizure characteritistics
* 85% are simple seizures * associated with sudden spike in temperature * usually lasts \<15 minutes * often + FH * **\< 5% will later have epilepsy**
40
what med is given if febrile sz lasts longer than 10-15 min
benzodiazepines
41
absence seizure most commonly affects what patient population
* female * 4-6 years of age onset
42
what is an absence seizure
* brief loss of environmental awareness accompanied by simple automatisms * usually hx "starring into space" * not responsive during episode * no memory of even * no postictal confusion
43
absence seizure can be provoked by
* hyperventilation * flashing lights
44
What is status epilepticus
* prolonged seizure lasting longer than 20-30 minutes
45
tx of status epilepticus
* ABCs * Benzodiazepine (valium/ativan)
46
West syndrome
* epilepsy syndrome of infancy and childhood * characterized by infantile spasms, developmental regression and a specific pattern on EEG testing called **hypsarrhythmia (chaotic brain waves)**
47
What are infantile spasms? When do they usually start in an infant?
* onset usually 3-7 months old * the seizures primarily consist of a sudden bending forward of the body with stiffening of arms and legs; some children arch their backs as they extend their arms and legs * happen in clusters
48
when do infantile spasms occur during the day
* just before sleep * upon awakening
49
what EEG pattern is consistent with infantile spasms
hypsarrthymia pattern
50
tx of infantile spasms
* ACTH * vigabatrin * Ketogenic diet * poor prognosis
51
What is the most frequent permanently disabling birth defect
* spina bifida
52
what is spina bifida
* defective closure of the neural tube at end of week 4 * anomalies of L/S vertebrae (most common) or spinal cord
53
how is spina bifida prevented
folic acid
54
spina bifida is associated with hydrocephalus and **Arnold-Chiari malformations** which are
* cerebellum herniating through foramen magnum * sx: occipital HA that radiates upward and worsens with valsalva
55
patients with spina bifida have a high incidence of allergy to
latex
56
What is Dandy walker syndrome
* posterior fossa cyst that causes **enlargement of 4th ventricle** * see **hydrocephalus** in 90% of patients
57
what is hydrocephalus
* slowly evolving accumulation of CSF over weeks to months * due to obstruction vs overproduction of CSF * increases ICP and causes ventricular distention
58
treatment of hydrocephalus
* temporary: loop diuretic, acetazolamide * surgical: shunt-VP most common
59
Most common hereditary neuromuscular disease
Duchenne muscular dystrophy
60
how is Duchenne muscular dystrophy inherited
* X-linked recessive (Xp21.2)
61
50-80% of patients with Duchenne muscular dystrophy have what heart condition
cardiomyopathy
62
prognosis of Duchenne muscular dystrophy
* onset age 3 yo * wheelchair bound age 10 yo * death by 18-20 yo * \*Proximal progressive weakness and calf hypertrophy
63
Patients with Duchenne muscular dystrophy exhibit Gower's sign which is
using hands to push up from floor to standing
64
how is Duchenne muscular dystrophy diagnosed
* muscle biopsy * absence of dystrophin * EMG * serum CPK levels elevated
65
What is Emery-Dreifuss musclar dystrophy and when does it present
* group of myopathies that primarily affects muscles of hip and shoulder * middle to late childhood and early adult * wheelchair by age 30
66
how is Limb-girdle musclar dystrophy inherited
* x-linked recessive long arm Xq28
67
Limb-girdle musclar dystrophy is associated with what heart problem
severe cardiomyopathy
68
List the 2 types of neurofibromatosis
* type 1: autosomal dominant (chromosome 17) * peripheral type * type 2: autosomal dominant (chromosome 22) * central type
69
clinical presentation * cafe-au-lait spots * axillary, groin freckling * greater incidence of CNS tumors * essential HTN
Neurofibromatosis
70
hallmark of guillain barre syndrome is
* symmetric **ascending** loss of motor strength
71
majority of guillain barre syndrome is caused by
campylobacter jejuni
72
cause of myasthenia gravis
* rare autoimmune disorder where **antibodies form against Ach nicotinic receptors** at neuromuscular junction
73
how is Spinal musclar atrophy syndrome inherited? What is it
* autosomal recessive * defect on chromosome 5 * progressive weakness of LMN due to degeneration of anterior horn cells
74
Spinal musclar atrophy syndrome symptoms
* progressive flaccid weakness * symmetric * lower extremity -\> upper extremity * remember: normal cognitive, social, and language development

PEDS II final (3 decks)

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