Week 9

Question 1

Variations in Pediatric Anatomy and Physiology first 3-4 weeks’ gestation

Answer 1

Infection, trauma, teratogens, and malnutrition can cause physical defects and may affect normal CNS development

Question 2

Variations in Pediatric Anatomy and Physiology: birth

Answer 2

Cranial bones not well developed or fused: increased risk for fracture
Brain is highly vascular: increased risk for hemorrhage

Question 3

Variations in Pediatric Anatomy and Physiology: child

Answer 3

Spine is mobile: high risk for cervical spine injury

Question 4

clinical manifestations for Infant with ^ICP

Answer 4

Irritability, poor feeding
Macewen sign
High-pitched cry,
bulging fontanels
Separated cranial sutures
Sunsetting sign
Distended scalp veins
Increased frontooccipital circumference

Question 5

clinical manifestations for child with ^ICP

Answer 5

Headache
Forceful vomiting
Seizures
blurred vision
drowsiness
increased sleep
Lethargy
Inability to follow simple commands

Question 6

late signs of ^ ICP

Answer 6

Bradycardia
Decreased motor response to command; decreased sensory response to painful stimuli
Alterations in pupil size and reactivity
Cheyne -Stokes respirations
Decreased consciousness
Coma

Question 7

Respiratory Care

Answer 7

Airway management is the primary concern.
Cerebral hypoxia lasting more than 4 minutes may cause irreversible brain damage.
The child may have minimal gag and cough reflexes.

Question 8

Hydrocephalus Infancy (early)

Answer 8

Abnormally rapid head growth
Bulging fontanels (especially anterior)
Nonpulsatile
Dilated scalp veins
Separated sutures
Macewen sign
Thinning of skull bones

Question 9

Hydrocephalus Infancy (General)

Answer 9

Irritability
Lethargy
Early infantile reflex acts may persist
Normally expected responses failing to appear
Change in level of consciousness
Opisthotonos (often extreme)
Lower extremity spasticity
Vomiting

Advanced cases: Difficulty in sucking and feeding Shrill, brief, high-pitched cry
Cardiopulmonary compromise

Question 10

Hydrocephalus Infancy (Later)

Answer 10

Frontal enlargement, or bossing
Depressed eyes
Setting-sun sign (sclera visible above the iris)
Pupils sluggish, with unequal response to light

Question 11

Hydrocephalus Childhood

Answer 11

Headache on awakening
Papilledema
Strabismus
Irritability
Lethargy
Apathy
Confusion
Incoherence
Vomiting

Question 12

Shunt Treatment for Hydrocephalus

Answer 12

Period of greatest risk is 1 to 2 months after placement
Infections:
Septicemia
Bacterial endocarditis
Wound infection
Shunt nephritis
Meningitis
Ventriculitis
Antibiotics or shunt removal

Question 13

Seizure Disorders

Answer 13

Caused by excessive and disorderly neuronal discharges in the brain
Determined by site of origin
Most common treatable neurological disorder in children
Occur with wide variety of CNS conditions

Question 14

Epilepsy

Answer 14

Two or more unprovoked seizures
Caused by a variety of pathological processes in the brain
Optimal treatment and prognosis require an accurate diagnosis and determination of cause.

Question 15

Etiology of Seizures

Answer 15

Acute symptomatic
Associated with head trauma or meningitis
Remote symptomatic
Prior brain injury such as encephalitis, meningitis, or stroke
Cryptogenic
No clear cause
Idiopathic
Genetic in origin

Question 16

Partial Seizures

Answer 16

Local onset and involves a relatively small location of the brain

Question 17

Generalized Seizures

Answer 17

Involves both hemispheres without local onset

Question 18

tonic phase of tonic-clonic

Answer 18

Lasts about 10 to 20 seconds
Eyes roll upward
Immediate loss of consciousness
Entire body musculature stiffens in symmetrical tonic contraction
Legs, head, and neck extended and person may utter a peculiar cry
Increased salivation and loss of swallowing reflex

Question 19

clonic phase of tonic-clonic

Answer 19

Lasts about 30 seconds but can last up to 30 minutes
Violent jerking movements
May foam at mouth
May be incontinent of urine and feces

Question 20

Absence Seizures

Answer 20

Brief loss of consciousness
Minimum or no alteration in muscle tone
Almost always appear in childhood (4 to 12 years old)
More common in girls than in boys
Usually cease at puberty

Question 21

Atonic and Akinetic Seizures

Answer 21

Sudden momentary loss of muscle tone and postural control
Onset usually at ages 2 to 5
May or may not have loss of consciousness
Sudden fall to ground, often on face; may incur facial, head, or shoulder injury

Question 22

Myoclonic Seizures

Answer 22

Sudden brief contractions of a muscle or group of muscles
May be single or repetitive
May or may not include loss of consciousness
No postictal state
May or may not be symmetrical

Question 23

Infantile Spasms

Answer 23

Onset in first 6 to 8 months of life
Twice as common in boys than in girls
Poor outlook for normal intelligence
Possibly caused by disturbance of central neurotransmitter regulator at specific phase of brain development

Question 24

Febrile Seizures

Answer 24

Transient disorder of childhood
Affect approximately 2 to 5% of children
Usually occur between ages 6 and 60 months
Cause is uncertain
Tepid sponge baths are not recommended.
Simple febrile seizures are benign.

Question 25

Cranial Asymmetry

Answer 25

Increased frequency since recommendation that infants be put in supine position to sleep Unilateral flattening of the occiput Teach parents to position infant’s head to the side when lying in the supine position Prone position when awake; tummy time at least 10 to 15 minutes TID

Question 26

variation in pediatric Anatomy and physiology spine

Answer 26

Spinal cord more mobile than in adult Myelination incomplete at birth; reaches maturity by age 2 years Present and mature at birth: Full range of motion Deep tendon reflexes Muscle tone

Question 27

Cerebral Palsy

Answer 27

A group of permanent disorders of the development of movement and postures, causing activity limitations attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain

Question 28

Early Warning Signs of CP

Answer 28

Poor head control and clenched fists after age 3 months Stiff or rigid limbs Floppy tone Unable to sit without support at 8 months Failure to smile by 3 months Primitive reflexes Feeding Difficulties

Question 29

Neural Tube Defects

Answer 29

Failure of the neural tube to close during the embryo’s early development (3 to 5 weeks) Multifactorial etiology

Question 30

Exencephaly and anencephaly

Answer 30

The fetus is usually aborted If the fetus survives, degeneration of the brain to a spongiform mass occurs Incompatible with life beyond a few days

Question 31

Spina Bifida

Answer 31

Failure of osseous spine to close Two types Spina bifida occulta Not visible externally Spina bifida cystica Visible defect

Question 32

Myelomeningocele

Answer 32

Neural tube fails to close May be anywhere along the spinal column May be diagnosed prenatally or at birth Sac contains meninges, spinal fluid, and nerves Varying and serious high incidence of latex allergy **

Question 33

Duchenne Muscular Dystrophy

Answer 33

pseudohypertrophic muscular dystrophy Most severe and most common Progressive muscle weakness, wasting, and contractures Death from respiratory or cardiac failure Early onset, usually between 3 and 5 years of age

Question 34

Symptoms of Duchenne Muscular Dystrophy

Answer 34

Waddling gait, frequent falls, Gower sign Lordosis Enlarged muscles, especially of thighs and upper arms Profound muscular atrophy

Question 35

Spinal Muscular Atrophy

Answer 35

Group of inherited genetic muscle-wasting disorders affecting motor neurons Four types Type I (severe) – also known as infantile-onset or Werdnig-Hoffman disease Type II (intermediate) Type III (mild) – also known as Kugelberg-Welander disease Type IV – also known as adult SMA

Question 36

SMA type 1

Answer 36

Manifests within first few months of life Infant lies in frog position, has weak cry, cough, generalized weakness Active movement usually limited to fingers and toes Normal sensation and intellect Palliative care Death usually by age 2 years

Question 37

SMA type 2

Answer 37

Onset between 2 and 12 months of age First have weakness of arms and legs, later generalized weakness Prominent pectus excavatum Movements absent during relaxation and sleep Lifespan is 7 months to 7 years

Question 38

SMA type 3

Answer 38

Onset late childhood or adolescence Normal head control, can sit by age 6 to 8 months Thigh and hip muscles weak Some will learn to walk Scoliosis common Slowly progressive course Normal life expectancy

Question 39

Spinal Cord Injury

Answer 39

Generally the result of indirect trauma Especially in motor vehicle collision without child restraints Vertebral compression from blows to the head or buttocks Levels of spinal cord injuries Higher injury: more extensive damage Paraplegia Tetraplegia

Question 40

Down Syndrome

Answer 40

Also known as nonfamilial trisomy 21 Extra chromosome 21 in 95% of cases Translocation of chromosomes 15 and 21 or 22 in 3 to 4% of cases Mosaicism, a mixture of abnormal and normal cells in 1 to 2% of cases Maternal age Age 35—risk is 1 in 400 births Age 40—risk is 1 in 110 births

Question 41

Fragile X Syndrome

Answer 41

Most common inherited cause of CI and second most common genetic cause of CI after Down syndrome Abnormal gene on the lower end of long arm of the X chromosome

Question 42

Autism Spectrum Disorders

Answer 42

Complex neurodevelopmental disorder accompanied by intellectual and social defects Change in DSM-5 classification, all under ASD (e.g., Asperger disorder is under ASD) Risk: 1 in 166 children Four times more common in males