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Peds Exam 2 > Peds Neurology > Flashcards

Peds Neurology Flashcards

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1
Q

PE for neuro

A 
vitals
head circumference, fontanelles
general
skin, eyes, ears, extremities, midline
dev. exam
mental state
CN
motor
reflexes
sensory
station & gait
cerebellar
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2
Q

Cerebral palsy

A

motor impairment secondary to fetal or infantile brain injury

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3
Q

Etiologies of cerebral palsy

A 
hypoxia
trauma
premature birth
infections
toxins
structural abnormalities
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4
Q

Subtypes of cerebral palsy

A

spastic - most common
ataxic
dyskinetic
mixed

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5
Q

S/sx of cerebral palsy

A 
abnormal tone and/or posture
retained reflexes
NOT REACHING MILESTONES (sit by 8 mos, walk by 18 mos)
excessive irritability
poor feeding, drooling
poor visual attention
difficult to hold, cuddle
ASYM. TONIC NECK REFLEX (ATNR)
MORO REFLEX  - retained after 4 mo
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6
Q

Managment of cerebral palsy

A

early recognition and referral
parental support

symptomatic: OT, PT, bracing
anti-spasmodics
botulism toxin

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7
Q

Etiologies of congenital malformations

A 
infection
toxin
genetic
metabolic
vascular
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8
Q

Prognosis of congenital malformation

A

present in 40% of infants who die <1 YO

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9
Q

Chiari Type 1

A

cerebellar tonsils displaced caudally BELOW the foramen magnum

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10
Q

Chiari type 1 can be associated w/

A

syringomyelia = fluid filled cyst w/ in spinal cord

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11
Q

Sx of chiari type 1

A

appear as teen/adult
loss of abdominal reflex
neuro sx associated w/ syringomyelia –> h/a worse w/ increase pressure (sneeze, cough, valsalva)

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12
Q

Chiari type II (arnold-Chiari malformation)

A

type 1 + myelomeningocele

usually detected prenatally or at birth

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13
Q

S/sx of chiari type 2

A

HYDROCEPHALUS (CSF build up in head)
dysphagia
UE weakness
apneic spells and aspiration

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14
Q

Spina bifida occulta

A

incomplete closure of spinal canal (closed type)
no or mild signs

hair patch, dimple, dark spot, swelling on back at the site of the gap in the spine

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15
Q

Open types of spina bifida

A

meningocele

myelomeningocele

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16
Q

Meningocele

A

outpouching of spinal fluid and meninges through vertebral clef

mild problems w/ sac protrusion

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17
Q

Myelomeningocele

A

most severe form

spinal cord &/or nerves protrude from vertebral cleft

weakness, loss of bladder and/or bowel control, hydrocephalus, inability to walk
learning problems

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18
Q

Etiology of spina bifida

A

genetics
LOW FOLATE
medications during pregnancy
poorly managed DM

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19
Q

Management of spina bifida

A

early recognition (US, AFP)
prevention
neurosurgeon refer: surgery, shunt

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20
Q

Hydrocephalus

A

increased volume of CSF – causing ventricular dilation and increased ICP

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21
Q

types of hydrocephalus

A

obstructive - blocakge

non-obstructive - impaired absorption or rarely overproduction

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22
Q

Etiologies of hydrocephalus

A 
CNS malformation
infection
Intraventricular hemorrhage
genetic defects
trauma
tumor
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23
Q

S/sx of hydrocephalus

A 
asymptomatic
bradycardia, HTN, altered RR
h/a, n/v, behavior changes
papilledema
macrocephaly
spasticity
diplopia (compression of cranial nerves)
spinal abnormalities
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24
Q

Dx of hydrocephalus in newborns/infant

A

US

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25
Dx of hydrocephalus in infants/children
MRI or CT
26
Management of hydrocephalus
refer to neurosurgeon | shunt (to periotneal space)
27
Microcephaly is considered
head circumference >2 SD BELOW mean or <5th percentile
28
types of microcephaly
primary (congenital) - lack of brain dev or abnormal dev due to timing of insult secondary (postnatal) - injury or insult to previously normal brain
29
Etiology of microcephaly
``` genetic prenatal/perinatal injury CRANIOSYNOSTOSIS postnatal injury metabolic toxins ```
30
S/sx of microcephaly
delayed milestones seizures or spasticity fontanelle may close early and suture may be prominent
31
Macrocephaly is considered
head circumference >2 SD above mean or >95 percentile
32
Cause of macrocephaly
increase in size of any components of cranium (brain, CSF, blood or bone) rapid growth: increased ICP catch up growth: premature infants, neurologically intact normal growth rate: familial macrocephaly or megaloencephaly
33
management of micro and macrocephaly
Neuro referral - labs and imaging treat underlying cause
34
NF1 etiology
auto dominant
35
Clinical manifestation of NF1
``` neuro abnormalities: macrocephaly, seizures, cognitive deficit Cafe-au-lait spots (1st yr) axillary/inguinal freckles (3-5 yrs) lisch nodules optic glioma neurofibromas ```
36
Management of NF1
consult neuro, genetics, optho
37
PE for headaches
``` general vitals head circumference growth chart HEENT skin Neuro exam ```
38
Types of headaches
primary - migrane and tension | secondary- acute febrile illness
39
Migraine
location- FOCAL, unilateral or bilateral Duration 2-72 hrs Character- mod/severe intensity, PULSATILE/THROBBING worse w/ activity or reduced activity
40
Tension h/a
location: DIFFUSE, frontal or temporal duration: 30 min - 7days character: mild/mod, constant PRESSURE/NON-THROBBING not aggravated w/ activity
41
Worse w/ acivity
migraine
42
throbbing/pulsatile
migraine
43
diffuse
tension
44
management of h/a
track and avoid triggers | ibuprofen, tylenol, biofeedback, relaxation therapy
45
when to worry about h/a
- abnormal neuro or visual exam - severe upon awakening or awaken in middle of night - daily sx w/ progressive worsening - vomiting - acute onset w/o previous hx - increased w/ coughing or bending
46
Pseudotumor cerebri: what is it?
idiopathic intracranial HTN; increase ICP w/o mass or hydrocephalo
47
Pseudotumor cerebri typically seen in
obese teenage girls
48
S/sx of pseudotumor cerebri
``` HA* Papilledema* - hallmark visual sx visual field loss, acuity loss Pulsatile tinnitus* ```
49
Papilledema seen in
hydrocephalus | pseudotumor cerebri
50
Dx of pseudotumor
``` (mainly diagnosis of exclusion) neuro eval MRI - r/o other cause LP - elevated opening pressure Optho eval ```
51
Management of pseduo tumor
``` Acetazolamide* - reduces CSF production Topiramate - helps HA and reduce weight Furosemide- reduces fluid, reduced pressure weight loss shunting of fluid optic nerve fenestrations ```
52
main tx for pseudo
acetazolamide
53
Seizure
sudden, transient disturbance of brain function manifested by involuntary sensory, motor, autonomic sx w/ or w/o LOC
54
Epilepsy
>2 seizures occuring more than 24 hours apart
55
Types of seizures:
focal (partial): w/ or w/o awareness generalized unknown unclassified
56
Absence seizure sx
sudden impairment of consciousness w/o loss of tone (blank stare) provoked by hyperventilation genetic cause presents b/w age 4-10 and remits after puberty ARREST IN ACTIVITY, lasting 9-10 seconday, may occur 10x/day
57
Age of absence seizures go away
pubery
58
absence seizures start
4-10 YO
59
Dx of absence seizures
Hx PE, EEG | Hyperventilation test
60
Management of absence seizures
neuro refer | neurocognitigve testing
61
Pharm tx for absence seizures
Ethosuximide (anticonvulsant)
62
Tx for pseudotumor
Acetazolamide* Furosemide Topiramate
63
Febrile seizure features
convulsion w/ temp >38 C age 6 mo - 5 yo often associated w/ virus (roseola) + genetic predisposition
64
age for febrile seizures
6 mo - 5 YO
65
Types of febrile seizures
simple: most common, <15 min (no inc risk for more) Complex: focal, last >15 min or occur >1/24 hours (inc risk for more)
66
Dx of febrile seizure
hx and PE CNS infection - LP or neuro image EEG - only if at risk for future epilepsy
67
Management of febrile seizures
self-limiting | Sx >5 min -- IV benzodiazepines
68
Tx for febrile seizure
IV benzodiazepines (> 5 min seizures)
69
Guillian-Barre syndrome
acute immune-mediate polyneuropathy; preceded by illness (campylobacter)
70
Most common caue of acute flaccid paralysis in healthy infant/child
guillian-barre
71
main cause of guillian-barre
campylobacter infection
72
S/sx of guillian barre
ASCENDING symmetric weaknes neuropathic pain gait instability or refusal to walk absent reflexes
73
Dx of guillian-barre
EMG CSF analysis - increased protein w/ normal WBC Spinal . MRI w/ and w/o contrast -- enhance spinal nerve roots & cauda equina
74
Managment of guillian-barre
hospitilize and close monitor | IVIG or plasma exchange
75
Botulism is usually caused by
consuming honey or home canning
76
What does the botulinum toxin do
bind Ach receptors
77
Age of infants w/ botulism
90% are <6 mos
78
S/sx of Botulism
DESCENDING weakness constipation, poor feeding HYPOTONIA, loss of DTRs irritable, lethargic
79
Dx for botulism
stool sample | EMG
80
Management of botulism
hospitilize and close monitor botulism immune globulin (BIG-IV or BabyBIG)
81
Education on botulism
don't feed babies <1Yo honey
82
Duchenne Muscular Dystrophy (DMD) cause
X-linked recessive defect in dystrophin gene elevated muscle enzymes (CK, ALT, AST) more severe sx and earlier onset --> age 2-3 wheelchair bound by age 13 and mortality by 18-20
83
Sx of DMD
progressive weakness (proximal --> distal, LE --> UE) GOWER'S SIGN - use hands to get off floor PSEUDOHYPERTROPHY of calves growth delay (short) cognitive impairment
84
Associated conditions w/ DMD
cardiomyopathy (dilated ventricle) ortho complications (scoliosis) cognitive impairment
85
Dx for DMD
elevated muscle enzymes (CK >10-20 x) | Genetic testing
86
Management of DMD
Glucocorticoids (keeps sx worsening slower)
87
Becker Muscular Dystrophy (BMD)
later onset than DMD less severe than DMD CK (>5 x) cardiomyopathy more predominant*

Peds Exam 2 (3 decks)

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