pediatrics Flashcards by sophia carrasco

when does the nervous system first appear

about 21 days of gestation

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when does neural tube closer occurs

at 23-25 days from anterior to posteior

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what are the 3 primary brain vesicles from

-prosencephalon
-mesencephalon
- phrobencephalon

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by week ___ there are 5 vesicles

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what is another word for neural tube defects

dysraphism

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what is the diagnosis and prevention for dysraphism (neural tube deficits)

Diagnosis: ultrasound, alpha-fetal protein
* Prevention: Folate

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is the dysraphism

disorders of neural tube closure

anterior neurpore open > cranial dysraphism

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what is fatal , absent brain with associated skull defects like dysraphism

anencephaly

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what is spinal dysraphism

spina bifida

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what are the 3 different spina bifida

-occulta
-meningocele
- myelomeningocele

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what type of spina bifida is
- vertebral arch defect only, up to 10% of population

-Dura and arachnoid herniation through vertebral defect

-herniation of spinal cord and meninges through defect

occulta

meingocele
myelomeningocele

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if a pateint has a turf of hair on their low back what can we maybe suspect

spina bifida occulta

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what are the symptoms for spina bifida occulta and where is it most common

usually asymptomatic
common at L5-S1
skin abnormality may be present over defect

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what kind of deficits foes myelomeningocele have

myelopathy and/or radiculopathic

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what is usually associated with myelomeningocele and what is there a later risk for

associated with hydrocephalus and later risk fro tethered cord syndrome

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what is a prevention of normal cephalad movement of conus medullaris , child or adult develops progressive neurologic dysfunction due to traction on cord and/or nerve roots and is most common is unilateral lower motor neuron dysfucntion in one leg

tethered cord

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what symptoms is most common in tethered cord

unilateral lower motor neuron dysfucntion in one leg

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what can you see in the arnold chiari malformation on the CT/MRI scan

you can see the cerebellum going below the skull

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what is a Congenital anomaly of hindbrain, downward elongation of brainstem and cerebellum into cervical portion of spinal cord

arnold chiari malformation

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what is type 1 , 2 and 3 arnold chiari malformation

o Type I: cerebellar tonsils displaced > 6mm
o Type II: associated myelomeningocele.
o Type III: associated encephalocele

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what are the symptoms for arnold chiari malformation

early hydrocephalus
-later with cerebellar , medullary or CN signs

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what is the treatment of arnold chiari malformation

closure of myelomeningocele and placement of shunt to relieve hydrocephalus

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– Cerebellar vermis developmental anomaly with** large cyst** in posterior fossa
– 50% with associated mental retardation
– Hydrocephalus common
– Spastic diplegia from associated malformations

what is this

dandy walker malformation

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dandy walker malformation .. there is 50% associate with what

associated mental retardation

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what is common with dandy walker malformation

hydrocephalus

Ventriculo-peritoneal shunt for Treatment of _____

Hydrocephalus

what is microcephaly

small size of head (idiopathic, chromosomal, toxic)

what is Macrocephaly

Large head (hyrdrocephalus, genetic, gigantism)

what is Craniostenosis

skull sutures fuse early, altering the shape of the head

what are domains for the developmental domains

– Gross Motor – Fine Motor – Expressive Language – Receptive Language – Socialization/Adaptive Behaviors

what is the developmental quotient

developmental age/chronological age

what is global developmental delay

Delay in 2 or more domains

by **12 months** waht shoudl a baby be doing

walking and first words

when should a baby be able to sit unsupported

6 month

when shoudl a baby be able to put words together and ride a tricycle

2 years and 3 years

what is the **denver 2 scale** used for

check milestone in kids

what is considered a vital sign for babies and is very important for measure of brain growth

head growth

what are the 5 normal primitive reflexes for a bay

- moro reflex (baby puts hands out if pretend like dropping them) -tonic neck reflex (baby will turn head to side of stretched out arm) - step reflex (baby will act like stepping when held up) -crawl reflex (baby will try to crawl when places on tummy - grasp reflex (baby will grasp ur finger if placed in palm)

what are first 7 red flags for a baby

- * Head size crossing two percentiles * Failure to respond to sounds * Fisting beyond **3 months** * Rolling **before** 3 months * Persistent MORO** >6months** * Persistent asymmetric tonic neck reflex, not rolling > 7 months * Not sitting>9months

6, red flags continued ….

* Delayed smiling (>1 mo.), laughing (>2-3 mo.), cooing (>3-4 mo.), first words (>12 mo.) * Handedness below 12 months * No words by 2years * Persistent echolalia >3yrs. * Noticeable stutter after 4 years * At any age: decline in speech ability or vocabulary

what does IDEA define this as “significantly sub-average general intellectual functioning, existing concurrently with deficits in adaptive behavior and manifested during the developmental period, that adversely affects a child's educational performance."

intellectual disability

is delay or regression worse and why

regression bc that is saying u learned something and then regressed backwards and loss the milestone

what are causes of predominant speech delay

– Multilingual family – Hearing loss – Infantile Autism

what are causes of Predominant Motor Delay:

– Ataxia – Hemiplegia – Hypotonia – Paraplegia

if a kid has 3 copes of trisomy 21 what syndrome do they have

down syndrome

* 1:700 live births; Male to Female ratio 3:2 * Risk increases sharply with advanced maternal age (>age 35) * 2% risk of recurrence * Associated with: – Typical facial features – skeletal anomalies – infantile **hypotonia** – Intellectual disability – Seizures – congenital cardiac defects – GI structural defects what is this

down syndrome : trisomy 21

what is down syndrome associated with

- typical facial features - skeletal anomalies -hypotonia - intellectual disability -seizures -cardiac defects -GI defects

if a kid presents with a shirt stature , stubby finger and toes , increased space between 1st adn 2nd toes, small pelvis , inward curvature of 5th finger and antlatoaxial instability (AAI) of cervical spine what can we seuspect

down syndrome

what is the most common chromosomal cause of intellectual disability and is MOST common in MALES

fragile x syndrome

what is Caused by tri-nucleotide repeat expansion in the FMR1 gene and Clinical: – IQ 40-55, Attention deficit and hyperactivity, seizures – Long face, enlarged ears, macro-orchidism, hyperextensible joints, low muscle town, high arched palate

fragile x syndrome

what is Toxic Cause Developmental Delay:

fetal alcohol syndrome

what are infectious causes of developmental delay : intrauterine infections

TORCH(S) – Toxoplasmosis – Other (Zika) – Rubella – Cytomegalovirus – Herpes Simplex, HIV – Syphilis

what does Congenital Toxoplasmosis causes

calcification in the brain adn eye

what is the most important intervention from developmental delay

referral to specialist if under 3

– MRI – Karyotype (± FISH) – AST, ALT, NH3, lactate, CBC, Chem 20 – Serum amino acids, urine organic acids what are these

usualt test for developmental delay

• A group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to NON PROGRESSIVE disturbances occurring in the developing fetal or infant brain. • Often accompanied by disturbances of sensation, perception, cognition, communication and behavior, by epilepsy and by secondary musculoskeletal problems

cerebral palsy

is CP a progressive or non progressive disturbances occurring in the developing fetal or infant brain

non

those who are born 28 was gestation have higher risk of what

what are the causes of CP

any disturbance of developing a brain in utero or around the time of delivery hypoxia is 10%

what are risk factors of antenatal for development of CP

- pre mature -infections -multiple gestation -complications

what are risk factors of perinatal for development of CP

-birth asphyxia - complication

what are risk factors of postnatal for development of CP

- non accidental injury (child abuse) -head trauma -meningitis/ encephalitis - cardio arrest

what are the 4 classifications of CP

-spastic (most common) -dyskinetic -ataxic mixed

how would u classify spastic CP

-unilateral or bilateral -velocity dependent increased tone - hyperreflexia - UMN signs

how would u classify dyskinetic CP

-recurrent uncontrolled/incoluntary movement -tone may be abnormal -dystonic - choreoathletotic

how would u classify ataxic CP

– Hypotonic – Loss of coordination

what is the most common mixed CP

Most commonly spastic with dyskinesias

where is the lesion for spastic hemiparesis

lesionin the CORTICOSPINAL system of ONE cerebral hemisphere

what is the most common causes of spastic hemiparesis

intrauterine stroke affecting middle cerebral artery

does spastic hemiparesis affect the arm or leg more an when may it be apparent

arm and when child developed handedness before 18 months

if a pt presents with a lesion in the corticopsinal system from an intrauterine stroke affecting the middle cerebral artery and affecting the arms more then the legs so the pt can work and is apparent in a 12 month old what do we think

spastic hemiparesis

how will a patient with spastic diplegia present

spasticity and weakness in their legs

what is spastic diplegia casued by

-prematurity with bilateral hemorrhages or - peri ventricular white matter disease - perinatal ischemia in border zone of ACA and PCA

what kind of gait will a pt with spastic diplegia presents with

scissoring gait bc of adductor spams

if a patient presents with spasticity and weakness in the left and presents with a SCISSORING gait w normal intelligence what so we suspect

spastic diplegia

what is the most severe spastic variant of CP

spastic quadriplegia

what is wrong with teh brain in spastic quadriplegia , what is it associated with and what is frequent

diffuse malformation associated with mod-serve intellectual disability frequent seizures

what are casues of spastic quadriplegia

hypoxia -ischemia , infection , CNS malformation

where is the lesion for dyskinetic CP and whar does it present with

BG lesions leading to chorea , dystonia and athetosis

what kind of CP does neonatal hyperbilirubinemia (kernicterus) and severe anoxia cause

dyskinetic CP

can children walk with dyskinetic CP n

naur

kids with dyskinetic CP will present with ____ in infancy , abnormal movements will begin at 1 year old

hypotonia

what is the rarest form of CP and is the abnormal development of cerebellum or its pathways

ataxia CP

what kind of ataxia does ataxic CP present with

truncal and gait

do drugs help ataxic CP

NAURRR may improve with age tho

what are the oral medication for CP spasticity

• baclofen • Diazepma • tizanidine Others: trihexyphenidyl, gabapentin, tetrabenazine)

• baclofen • Diazepma • tizanidine, • Others: trihexyphenidyl, gabapentin, tetrabenazine) what are these medications for

CP spasticity

what is the injection for CP spasticity

botulinum A

what is the sx for CP spasticity

• Intrathecal baclofen • selective dorsal rhizotomy • DBS

what is the prognosis for mild to moderate CP

normal life

pediatrics Flashcards

(90 cards)