Peds - Neuro

Question 1

Mechanisms of headache pain (4)

Answer 1

o VASCULAR dilation - migraine, fever
o MUSCULAR contraction - tension
o TRACTION - space-occupying lesion - tumor, hematoma, ICP
o INFLAMMATION - infection

Question 2

OLD CARTS

Answer 2

Onset
Location
Duration
Characteristics
Aggravating
Relieving
Treatment
Severity

Question 3

Diagnostic testing for headache with fever

when meningitis is suspected

Answer 3

Lumbar puncture –> CSF analysis

Question 4

CSF findings in meningitis (4)

Answer 4

o cloudy
o WBCs present
o increased protein – bacteria are protein
o decreased glucose – bacteria eat sugar

Question 5

Differential for headache which is worst in the morning followed by vomiting, usually increasing in frequency.

Answer 5

brain tumor

Question 6

Caution when considering lumbar puncture.

Answer 6

Do not perform if any suspicion of ICP. May cause brain herniation. :-(

Question 7

Which type of migraine has an aura?

Answer 7

classic

Question 8

Which type of migraine has NO aura?

Answer 8

common

Question 9

Is migraine unilateral or bilateral?

Answer 9

unilateral and localized

Question 10

What age does classic (w/ aura) migraine usually occur?

Answer 10

> 10 years old

Question 11

When should prophylactic therapy be used for migraine?

Answer 11

when occurring more than 3-4 times per month or are interfering with work or school

Question 12

Typical age range for bacterial meningitis?

Answer 12

1 month to 5 years

Question 13

Typical age range for brain tumor in children?

Answer 13

4 to 11 years

Question 14

Typical location for brain tumor in children?

Answer 14

infratentorial, brain stem tumors

lots of space to grow undetected

Question 15

Migraine baseline studies

4 bw + 1 imaging

Answer 15

For exclusion of other causes --
CMP - complete metabolic panel
CBC - complete blood count (r/o anemia)
VDRL - venereal disease research (r/o syphilis)
ESR - erythrocyte sedimentation rate
CT - cat scan

Question 16

Agents used for prophylaxis of migraine (5)

Answer 16

o  NSAIDS - chronic low dose
o  propanalol (Inderal) -- beta blocker
o  amatriptyline (Elavil) -- antidepressant
o  imipramine (Tofranil) -- antidepressant
o  topiramate (Topamax) -- antiepileptic
o  verapamil (Calan) -- calcium channel blocker

Question 17

Management of acute migraine

Answer 17

o NSAIDS

o -triptans

Question 18

These drugs are examples of what class?

Imitrex
Maxalt
Axert
Zomig

Answer 18

TRIPTANS

almotriptan
rizatriptan
sumatriptan
zolmitriptan

Question 19

Caution for use of triptans?

Answer 19

avoid in children at risk for HEART DISEASE because they can cause heart block

Question 20

A transient disturbance of cerebral function due to abnormal paroxysmal neuronal discharge in the brain.

Answer 20

Seizure disorder

Question 21

Which type of seizure occurs in only one hemisphere?

Answer 21

partial seizures

Question 22

Variant syndromes of migraine in children usually involve what?

Answer 22

The abdomen - nausea, vomiting

Question 23

Which triptan is limited to those age 12 and up?

Answer 23

almotriptan (Axert)

Question 24

Which triptan is available as a nasal spray?

Answer 24

zolmitriptan (Zomig)

Question 25

When should triptans be taken?

Answer 25

At the first sign of headache

Question 26

What are the two overarching categories of seizures?

Answer 26

Partial | Generalized

Question 27

What are the two types of partial seizures?

Answer 27

simple partial | complex partial

Question 28

Which type of partial seizure involves the loss of consciousness?

Answer 28

complex partial

Question 29

What are the four types of generalized seizures?

Answer 29

Absence Tonic Tonic-clonic Atonic

Question 30

Which category of seizures involves both hemispheres of the brain?

Answer 30

generalized seizures

Question 31

What are some potential causes of seizures? (6)

Answer 31

``` o congenital o metabolic o trauma o tumor o infectious o fever ```

Question 32

What are some symptoms of a simple partial seizure?

Answer 32

motor autonomic sensory ** NO loss of consciousness **

Question 33

Which seizure exhibits a sudden increase in muscle tone producing a number of characteristic postures?

Answer 33

Tonic

Question 34

Is consciousness lost during a TONIC seizure?

Answer 34

It may or may not be

Question 35

Which seizure is characterized by a sudden loss of consciousness, arrested respirations, and increased muscle tone followed by bilateral rhythmic jerks?

Answer 35

Tonic-clonic

Question 36

Which type of seizure is characterized by sudden loss of muscle tone, often resulting in head drop or fall to the ground?

Answer 36

Atonic

Question 37

What drug class is used to stop convulsive seizures?

Answer 37

benzodiazepines ``` o lorazepam (Ativan) o diazepam (Valium) ```

Question 38

Peak incidence of febrile seizure?

Answer 38

1 to 3 years

Question 39

When is an-illness related seizure more likely due to infection than fever?

Answer 39

> 24 hours after the onset of the fever

Question 40

A progressive, autosomal dominant, neuro-cutaneous syndrome characterized by numerous cafe au lait spots and nerve tumors

Answer 40

Neurofibromatosis / von recklinghausen disease

Question 41

Neuro-fibromatosis -- | Typical signs and symptoms (6)

Answer 41

``` o multiple cafe au lait spots o seizures o neurofibromatomas o axillary or inguinal freckling o lisch nodules o distinctive osseous lesions ```

Question 42

Medications which may be associated with tics. (3)

Answer 42

o methylphenidate o pemoline o amphetamines

Question 43

Distinction of complex from simple motor tics

Answer 43

complex include VOCAL tics

Question 44

The most common type of headache with onset in adolescence is:

Answer 44

tension