11-08 Pedi Neuro Eval

Question 1

unique aspects of history (things you wouldn’t think of ask in adult medicine)

Answer 1

A. Pregnancy, labor, and delivery
C. Perinatal events
D. Developmental profile (akin to Mental Status exam)

Question 2

Developmental Milestones: Neonate

Answer 2

tracks objects to 45 degrees

**Developed from Denver Development Scale

Question 3

Developmental Milestones: 3-4 months

Answer 3

tracks fully//minimal head lag//bears weight//coos

Question 4

Developmental Milestones: 5-8 months

Answer 4

rolls, sits when placed//peek-a-boo//babbles

Question 5

Developmental Milestones: 9-11 months

Answer 5

pulls to stand, cruises//pincer grasp//babbles, +/-words stranger anxiety

Question 6

Developmental Milestones: 11-18 months

Answer 6

walks//3-15 words

Question 7

Developmental Milestones: 18 months

Answer 7

points to body parts

Question 8

Developmental Milestones: 24 months

Answer 8

2-3 word phrases//scribbles

Question 9

Developmental Milestones: 3 y/o

Answer 9

knows if boy or girl, age//draws a circle

Question 10

Developmental Milestones: 4 y/o

Answer 10

counts to 5, tells stories, copies cross and square

Question 11

Developmental Milestones: 5 y/o

Answer 11

counts to 10 or higher//knows colors//copies triangle//may write name

Question 12

Developmental Milestones: 6+ y/o

Answer 12

can read appropriate Grey scale//write alphabet//do simple addition.

Question 13

unique findings on CN II exam

Answer 13

—if <30 weeks gestation at birth (10 wks premature) pupils may not be reactive to light
—Fundi may reflect disorders of formation (optic nerve hypoplasia as may be seen in septo-optic dysplasia)
——injury (optic nerve pallor 2° to chronic pressure or demyelination)
——papilledema w/ incr ICP
—Many neurocutaneous d/o also have abnormalities of the optic nerve

Question 14

Bell’s Palsy vs. Central CN VII palsy

Answer 14

—Bell’s palsy INVOLVES THE FOREHEAD

—“central” VII (supranuclear) SPARES THE FOREHEAD

Question 15

Pedi CN IX, X exam

Answer 15

gag, swallow, cry, suck reflex in a baby

Question 16

worms-in-a-bag fasiculations on lateral tongue

Answer 16

a pathognomonic sign in infantile spinal muscular atrophy

Question 17

strength testing in babies?

Answer 17

assess tone

Question 18

Positive Babinski

Answer 18

seen normally in a newborn until sometime between 6-18 months (usually changes to downgoing by the time child is walking)

Question 19

Moro Reflex

Answer 19

(“startle reflex”): arm extension, finger flaring and eye opening followed by arm adduction, finger grasping, leg flexion.
—flex neck slightly while supine, then quickly let head fall back onto the bed.
—should disappear by about 4 months.
—Persistence indicates an upper motor neuron injury; common early finding in CP

Question 20

assessing coordination

Answer 20

child at play, stacking blocks, stringing beads, or writing

Question 21

neurofibromatosis

Answer 21

—café au lait spots

Question 22

tuberous sclerosis

Answer 22

hypopigmented patches known as “ash leaf” spots

Question 23

Sturge-Weber

Answer 23

Port wine stain

Question 24

linear nevus syndrome

Answer 24

nevi

Question 25

TORCH infections during gestation include?

Answer 25

toxoplasmosis, “other”, rubella, cytomegalovirus, herpes