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From Flashcardlet > Peds Neuro > Flashcards

Peds Neuro Flashcards

1
Q

What is a common treatment for children that have seizures?

A

A ketogenic diet

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2
Q

How does a ketogenic diet help treat seizures?

A

Raises your seizure threshold

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3
Q

When is a child’s brain usually done growing?

A

7

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4
Q

How long do you measure head circumference?

A

36 months (measure just about the eyebrows and pinna)

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5
Q

Why is an infant better able to accommodate rising ICP?

A

Skull is more elastic and fontanels not yet closed

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6
Q

What are additional signs or symptoms of rising ICP in an infant?

A
  • High pitched cry
  • Bulging fontanel
  • Dilated scalp veins
  • Wide sutures (with palpation)
  • Irritability
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7
Q

What is the APVU scale used for?

A

Obtaining a measure of the level of consciousness

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8
Q

What will the pupils be like with an intracranial mass?

A

Unilateral dilated and reactive

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9
Q

What is a sign of impending brainstem herniation?

A

A fixed and dilated pupil

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10
Q

What is the sign of brainstem herniation from increased ICP?

A

Bilateral fixed and dilated pupils

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11
Q

What do you look for with Cushing Triad?

A
  • HTN
  • Widened pulse pressure
  • Bradycardia
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12
Q

How do you assess CN 2,4,6?

A

Doll’s eye

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13
Q

How do you assess CN 3,8?

A

Place ice water in inner canal and look for eyes to deviate to affected ear

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14
Q

How do you assess CN 5,7?

A

Corneal reflex

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15
Q

What does increased production, impaired absorption or block of CSF that results in excessive amounts of CSF within the cerebral ventricles cause?

A

Hydrocephalus

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16
Q

What is hydrocephalus often seen with?

A

Spina bifida

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17
Q

Is hydrocephalus usually communicating or non-communicating?

A

99% non-communicating

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18
Q

What is communicating hydrocephalus caused by?

A

Absorption of CSF in the subarachnoid space and arachnoid villi is impaired

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19
Q

What does non-comm?unicating hydrocephalus caused by

A

Results from an obstruction in the channels, pathways that impede the flow of CSF and prevent it from entering the subarachnoid space

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20
Q

What is the Monroe Kelly Law?

A

Brain is a closed space – 3 compartments CSF, Blood and Brain Tissue. An increase in one will have a decrease in another to compensate.

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21
Q

What is the predominant feature of hydrocephalus?

A

Rapidly increasing head circumference

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22
Q

What is the Macewen’s sign that is associated with hydrocephalus?

A

Hollow sound when the skull is percussed

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23
Q

What is the sunsetting sign that is associated with hydrocephalus?

A

Visible sclera above the iris

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24
Q

What is congenital herniation of the brainstem and lower cerebellum through the foramen magnum into the cervical vertebral canal?

A

Arnold-Chiari

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25
Q

Congenital brain malformation involving the cerebellum and the fluid filled spaces around it.

A

Dandy Walker Syndrome

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26
Q

When are shunts place for hydrocephalus?

A

Shunts are placed as soon as a diagnosis is made with modification to handle growth at regular planned intervals.

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27
Q

If the shunt malfunctions what signs will you see?

A

Signs of increased ICP

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28
Q

If overdrainage occurs with a shunt for hydrocephalus what signs will you see?

A
  • Low BP
  • Postural HS while sitting up
  • Decreased HR
  • Seizure
  • N/V
  • Lethargy
  • Irritability
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29
Q

When is infection most likely after surgery for hydrocephalus?

A

1-2 months

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30
Q

How should the bed be positioned after a shunt is placed?

A

Flat or no more than 30 degrees on unoperative side

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31
Q

If fluid is drained to quickly from a shunt what does it increase the risk for?

A

Subdural hematoma

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32
Q

What it is important to note after a shunt is placed?

A

Every change (feeding, behavior, alertness)

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33
Q

What is the occurrence of meningitis in children?

A

90% under age 5 (if under 5 you will often see learning difficulty and hearing loss)

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34
Q

What are some signs/symptoms of meningitis?

A
  • Poor feeder
  • Irritable
  • Fever
  • Seizures
  • SIADH or DI
  • Bulging fontanel
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35
Q

What are the main 3 signs of meningitis?

A
  • Fever
  • Stiff neck
  • Change in LOC
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36
Q

Is bacterial or viral meningitis worse?

A

Bacterial

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37
Q

Is bacterial or viral meningitis more common?

A

Viral is more common

38
Q

What type of meningitis are infants at the greatest risk for?

A

Bacterial (Group B)

39
Q

What position do infants use to relieve discomfort with meningitis?

A

Opisthotonic position (reduces pressure on the meninges)

40
Q

What position is the taken in the Opisthotonic position?

A

Head and neck hyperextended

41
Q

How long will a child with bacterial meningitis be on isolation?

A

24 hours after antibiotic is administered

42
Q

What is inflammation of meninges?

A

Meningitis

43
Q

What is inflammation of the brain itself?

A

Encephalitis

44
Q

What can cause encephalitis?

A

Tick or Mosquito bite

45
Q

What are the long term effects of meningitis and encephalitis?

A
  • Hearing loss
  • Optic nerve swelling
  • Necrotic limbs
  • Headaches
  • Fatigue
  • Poor concentration
  • Brain scarring
46
Q

When do neural tube defects develop?

A

First 28 days of gestation

47
Q

How do you diagnose a neural tube defect?

A

AFP and Ultrasound

48
Q

What is common in children with neural tube defects?

A

Folic Acid Deficiency and Lates allergies

49
Q

What is the prescribed dose of folic acid the mother takes before conception?

A

0.4 mg one month prior to conception (with family history up to 4.0 mg)

50
Q

Is increasing folic acid in the diet just as good as the supplement?

A

NO

51
Q

What is failure of the posterior vertebral arches to fuse?

A

Spinal Bifida Occulta

52
Q

What is a sign of spinal bifida occulta?

A

Dimple or small depression (no herniation)

53
Q

When spinal bifida occulta is detected in a toddler what is a normal sign?

A

Gait abnormality

54
Q

What is an encephalocele?

A

Brain and meninges herniate through defect in skull and into a sac

55
Q

How do you repair an encephalocele?

A

Surgical repair in stages

56
Q

What is a meningocele?

A

A sac on the spine that does contain meninges and CSF, but not spinal cord

57
Q

What is a meningomyelocele?

A

A sac on the spine that contains meninges, CSF, and a portion of the spinal cord or nerve roots

58
Q

What do we usually use the term spinal bifida for?

A

Meningomyelocele

59
Q

What percent of children with a meningomyelocele will also have hydrocephalus?

A

90%

60
Q

Where do you keep a child with a meningomyelocele?

A

Keep them prone and in a warmer

61
Q

What is the pre-surgery care for a child with a meningomyelocele?

A
  • Prevent infection
  • Prone positioning
  • Moisture control
  • Isolette for temp
62
Q

When should a child with a meningomyelocele have surgery?

A

In the first 24-48 hours

63
Q

What is a chronic, non-progressive motor dysfunction caused by damage to the motor areas of the brain?

A

Cerebral Palsy

64
Q

What symptoms will you see with Cerebral Palsy?

A

Abnormal muscle tone and movement and lack of coordination with spasticity found in the majority of cases

65
Q

What are some maternal causes of Cerebral Palsy?

A

Drug use and malnutrition

66
Q

When are most people with cerebral palsy diagnosed?

A

Age 3

67
Q

What is the main goal of treatment for cerebral palsy?

A

Get them to the best level of functioning possible so they can be independent

68
Q

What is the most common cause of cerebral palsy?

A

Premature birth or very low birth weight

69
Q

If a 2 year old is still not able to sit up what is the likelihood that the child will walk?

A

Unlikely

70
Q

Do children with cerebral palsy have normal intelligence?

A

About 70% do

71
Q

How do you manage muscle contractures with cerebral palsy?

A

Lengthen achillies and use muscle relaxer

72
Q

Why do you use botulinum toxin to treat cerebral palsy?

A

Manage spasicity

73
Q

What is a baclofen pump used for with cerebral palsy?

A

Decrease muscle tone and vasospasms

74
Q

How long do baclofen pumps stay in before they are changed?

A

3-5 years

75
Q

What is an autosomal recessive disorder that causes tumors to grow along the nerves?

A

Neurofibromatosis

76
Q

What skin changes will you see with neurofibromatosis?

A

Six or more cafe au lait spots

77
Q

What bone changes can you see with neurofibromatosis?

A

Scoliosis and bowing tibia

78
Q

What endocrine changes will you see with neurofibromatosis?

A

Precocious puberty

79
Q

What disease has sudden (acute) brain damage (encephalopathy) and liver function problems of unknown cause?

A

Reyes Syndrome

80
Q

What do we not give to children because it causes Reyes Syndrome?

A

Aspirin and Pepto

81
Q

Does Reyes Syndrome come gradually or suddenly?

A

Suddenly

82
Q

What does Reyes Syndrome usually follow?

A

Upper Respiratory Infection or Chickenpox

83
Q

How does Reyes Syndrome progress?

A
  • Vomiting that lasts hours
  • Then irritable and aggressive
  • Then unable to stay awake or alert
84
Q

What are the symptoms of Reyes Syndrome?

A
  • Confusion
  • Lethargy
  • Loss of consciousness or coma
  • Mental changes
  • Nausea and vomiting
  • Seizures
  • Unusual placement of arms and legs (decerebrate posture)
85
Q

What is it called when the mother uses drugs during pregnancy which causes the baby to have withdraws?

A

Neonatal Abstinence Syndrome

86
Q

What is the most common cause of death from child physical abuse?

A

Abusive Head Trauma (AHT)

87
Q

If AHT is on the same side as injury what is it called?

A

Contracoup

88
Q

If AHT is on the opposite side of injury what is it called?

A

Coup

89
Q

When does AHT tend to occur?(

A

2-4 months (when they start crying more)

90
Q

What are the most common fractures with AHT?

A
  • Skull
  • Rib
  • Classic Metaphyseal Lesions (CML)
91
Q

What fracture is pathognomonic for child abuse?

A

Classic Metaphyseal Lesion

From Flashcardlet (107 decks)

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