Ch 10 - Peds: TBI and CP Flashcards

1
Q

What does not indicate severity of TBI?

A

Presence or absence of skull fractures

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2
Q

What can result in greater shearing injury in children?

A

Incomplete myelination

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3
Q

What are causes of neonatal brachial plexus injuries?

A

– Trauma

– Obstetrical complications

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4
Q

What is Erb–Duchenne Palsy?

A

Due to sudden traction to the neck, causing injury to the upper trunk of the brachial plexus (C5–C6 roots)

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5
Q

What is Klumpke’s Palsy?

A

Due to violent upward pull of the shoulder, causing damage to the lower trunk (C8–T1 roots)

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6
Q

What can be associated with Klumpke’s Palsy?

A

Horner’s syndrome can be associated with injury of the C8 and T1 roots, which affects the superior cervical sympathetic ganglion

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7
Q

What are verbal scores for GCS in <2 yo?

A

1: no response
2: Inconsolable crying, irritable
3: Cries but is inconsistently consolable, moaning
4: Cries but consolable, interacts inappropriately
5: Smiles, oriented to sound, follows objects, interacts

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8
Q

Which children are more likely to sustain TBI?

A

Hyperactive children

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9
Q

How does hypopituitarism present after TBI in children?

A

Growth failure and delayed or arrested puberty

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10
Q

When is HO MC in TBI in children?

A

> 11 yo
More severe injury
2 extremity fractures

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11
Q

When are children considered to have posttraumatic epilepsy?

A

2 or more late seizures

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12
Q

Which has a better prognosis, TBI or anoxic brain injury?

A

TBI

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13
Q

What is cerebral palsy?

A

Primarily of movement control and posture but associated with cognitive and sensory problems resulting from a nonprogressive lesion to an immature brain

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14
Q

What is the leading cause of childhood disability?

A

Cerebral palsy

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15
Q

When do the majority of cerebral palsy cases occur?

A

70-80% in prenatal period

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16
Q

What are risk factors of CP during the prenatal period?

A
  • Prenatal intracranial hemorrhage
  • Placental complications • Gestational toxins
  • Gestational teratogenic agents
  • Congenital malformations of the brain and cerebral vascular occlusions during fetal life
  • TORCH infections
  • Socioeconomic factors
  • Reproductive inefficiency
  • Prenatal hypoxicischemic injury
  • Maternal causes (seizures, MR, hyperthyroidism)
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17
Q

What is the MC antecedent of CP?

A

Prematurity

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18
Q

What are the types of CP?

A

– Spastic (pyramidal) (75%)
– Dyskinetic (extrapyramidal)
– Mixed type

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19
Q

What is the MC type of CP?

A

Spastic diplegia

LE»UE

20
Q

What is a typical cause of spastic diplegia CP?

A

IVH at 28-32 weeks gestation

21
Q

What is seen on MRI with IVH in spastic diplegia CP?

A

Periventricular leukomalacia or post-hemorrhagic porencephaly

22
Q

What is Athetosis?

A

Slow writhing involuntary movements, particularly in the distal extremities

23
Q

What is chorea?

A

Abrupt, irregular jerky movements, usually occurring in the head, neck, and extremities

24
Q

What is Choreoathetoid CP?

A

Combo of athetosis and choreiform movements
Gen large amp involuntary movements
Dominating pattern is the athetoid movement

25
What is Dystonia
A slow rhythmic movement with tone changes generally found in the trunk and extremities; associated with abnormal posturing
26
What is Ataxia?
Uncoordinated movements often associated with nystagmus, dysmetria, and a widebased gait
27
What is associated with Ataxia CP?
Sensorineural hearing loss which has been associated with hyperbilirubinemia and neonatal jaundice
28
What is the MC mixed type of CP?
Spastic athetoid (predominant dyskinetic movement pattern with an underlying component of spasticity)
29
Where does ischemia occur in spastic diplegic CP?
Hypoperfusion of the germinal matrix of the periventricular region of the premature fetus
30
Which CP group has the highest disability?
Quadriplegic
31
What is a GMFCS Level 1?
Walks without restrictions Limitations in more advanced gross motor skills Does not need handrails
32
What is a GMFCS Level 2?
Walks without assistive devices Limitations walking outdoors and in the community Uses handrails
33
What is a GMFCS Level 3?
Walks with assistive mobility devices | Limitations walking outdoors and in the community
34
What is a GMFCS Level 4?
Self-mobility with limitations | Transported or use power mobility outdoors and in the community
35
What is a GMFCS Level 5?
Self-mobility severely limited even with use of assistive devices
36
What are good prognosis for ambulation in CP?
Independent sitting by 2 years | Ability to crawl on hands and knees by 1.5 to 2.5 years
37
What is a poor prognostic sign for ambulation in CP?
Persistence of 3 or more primitive reflexes at 18 to 24 months
38
What is the MC visual deficit in CP?
Stabismus
39
What is a good indication of intellectual | potential in CP?
Speaking in two to three word sentences by age 3
40
Which CP type MC has MR?
Spastic quadriplegia
41
Which CP type MC has seizures?
Spastic quadriplegia | Hemiplegia
42
Which CP type MC has oromotor issues?
Spastic quadriplegia | Dyskinetic
43
What is the most widely used therapuetic exercise method in CP?
Bobath | Also known as neurodevelopmental treatment (NDT)
44
Describe the Asymmetric tonic neck reflex.
Head turning to side causes Extremities extend on face side, flex on occiput side (“fencer position”)
45
Describe the palmar grasp reflex.
Touch or pressure on palm or stretching finger flexors causes flexion of all fingers