Peds NEURO 1 - PE

Question 1

Sx seen in 1st few months & DO NOT CHANGE over time

Congenital abnormalities or brain injury (cerebral palsy)

What type of sx?

Answer 1

STATIC

Question 2

Sx due to degenerative disease or neoplasm

What type of sx?

Answer 2

Progressive

Question 3

Epileptic or migraine syndromes

What type of sx?

Answer 3

INTERMITTENT

Question 4

Bursts of symptoms followed by partial recovery

Vascular, demyelinating d/o

What type of Sx?

Answer 4

SALTATORY

Question 5

What 6 components of the PE do you perform for pt with neuro sx?

Answer 5

1. Hair, skin, teeth, nails
2. Head circumference
3. Fontanelles
4. Ears, eyes
5. Hands, feet
6. Midline defects

“Has Harry Found Every Happy Moment?”

Question 6

PE: Hair, skin, teeth, nails

_______&_______ have same embryonic origin

Answer 6

Brain & Skin have same embryonic origin

Question 7

What do you monitor for during a head circumference check?

Answer 7

microcephaly/macrocephaly

Question 8

T/F: You plot head circumference on a growth curve

Answer 8

TRUE

Question 9

What does an accelerating pattern on a growth curve indicate?

Answer 9

possible hydrocephalus

Question 10

What does a decelerating pattern on a growth curve for head circumference indicate?

Answer 10

possible degenerative neurologic d/o

Question 11

Define craniosynostosis

Answer 11

abnormal shape of the skull due to premature suture closure

Question 12

Is this a normal or abnormal fonatanelle?

+/- slightly depressed and pulsatile

may slightly bulge when crying, vomiting

Answer 12

NORMAL

Question 13

Is this a normal or abnormal fonatanelle? Where would you see this PE finding?

contstant bulging

Answer 13

infection or inc. ICP

Question 14

Age of anterior and posterior fontanelle closure?

Answer 14

anterior: 2 yrs
posterior: 2 mos

Question 15

What are the following cranial nerves responsible for?

CN I

CN II

Answer 15

CN I: smell

CN II: pupillary light reflex, visual acuity

_**ALWAYS CHECK RED REFLEX**_

WILL BE ON TEST

Question 16

What are the following cranial nerves responsible for?

CN III, IV, VI (3, 4, 6)

Answer 16

Following objects, fixating, oculocephalic reflex, EOMs

Question 17

CN V?

Answer 17

Sucking/swallowing, light touch

Question 18

CN VII?

Answer 18

Observe face at rest, crying/blinking

Question 19

CN VIII

Answer 19

HEARING

Question 20

CN IX, X

Answer 20

gag reflex, sucking, salivation

Question 21

CN XI

Answer 21

posture, spontaneous movement

Question 22

CN XII

Answer 22

tongue movement

Question 23

What 2 things should you look for on the hands during PE?

Answer 23

single crease in down syndrome

polydactyly

Question 24

What 4 primitive reflexes must be present in normal child development?

Answer 24

Moro: startle reflex

Grasp: put finger in hand, will grasp around finger

Rooting: tactile stimulation around mouth- will search for stimulus

Tonic neck

“My grandchild runs too”

Question 25

When do **primitive reflexes** usually disappear?

Answer 25

**4-6 mos** = normal maturation

Question 26

**Asymmetry of primitive reflexes** may indicate What 2 possibilities?

Answer 26

**focal brain or PNS lesions**

Question 27

Origination & termination of **upper motor neurons**?

Answer 27

**Origin:** motor region of cerebral cortex or brainstem **Termination:** brainstem & spinal cord

Question 28

Origination & termination of **lower motor neurons**?

Answer 28

**Origin:** brainstem & spinal cord **Termination:** skeletal muscle fibers

Question 29

**Flaccid** paralysis Decreased tone **Absent DTRs** Profound muscle atrophy **Fasciculations present** May have sensory disturbances **_Sx of lower or upper motor lesion?_**

Answer 29

**Lower motor** neuron lesion

Question 30

**Spastic** paralysis •Increased tone **Increased DTRs**/+Babinski (in older children, normal in infants); usually with clonus Minimal muscle atrophy/strength loss **Fasciculations absent** May have sensory disturbances **_Sx of lower or upper motor lesion?_**

Answer 30

**Upper motor** neuron lesion

Question 31

The following **midline defects** may indicate which condition? **Tufts of hair, lipomas, dimpling**

Answer 31

**spina bifida**

Question 32

What are the **indications of normal strength** in **infants & toddlers**? What are **abnormalities**?

Answer 32

**Infants:** symmetrical movements in supine position **Toddlers:** reach high, run, walk, hop, climb stairs \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Abnormalities: **LMN** lesions: **weakness** **UMN** lesions: **stiffness**

Question 33

What are the **normal passive & active movements seen in tone (in infants)?** **What are abnormalities?**

Answer 33

Passive: some **resistance to stretch** normal Active: **posture adopted** when placed in particular position \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Abnormalities: LMN lesions: **_decreased_** passive tone UMN lesions: i**_ncreased_** passive tone

Question 34

What **3 components** are part of the **motor evaluation** of the PE?

Answer 34

**Gait** **Cerebellar function/coordination** **Reflexes**

Question 35

What are the normal **gait findings** in **infants & toddlers?**

Answer 35

**infants:** crawling **toddler**: wide-based & unsteady; gradually closes until 6yrs

Question 36

What are normal **Cerebellar Function/Coordination** findings?

Answer 36

## Footnote **Finger to nose, rapid alternating movements, heel to shin** **Heel toe walking** **Exchange objects**

Question 37

What are normal **reflex** findings?

Answer 37

Can elicit **DTRs at almost any age** **_Babinski reflex:_** **Neonates**- variable response **Older children**- toes down is normal after 18 months

Question 38

What are the **PE findings during the sensory evaluation of _infants_**?

Answer 38

**Light touch vs. pinprick** **Stimulation = withdrawal of limb**

Question 39

What are the **PE findings during the sensory evaluation of _older children_**?

Answer 39

**Proprioception/vibration** **Graphesthesia** **Stereognosis** **2-point discrimination**