CLIPP 20

Question 1

nature of tension headaches

Answer 1

episodic, worse throughout day, band like with accompanying tenderness of posterior neck

Question 2

most common cause of recurrent headache in kids

Answer 2

migraine

Question 3

classic vs common migraine

Answer 3

classic = w/ aura
common = w/o aura - is most common type seen in kids

Question 4

signs of increased ICP in terms of HA sx

Answer 4

HA + projectile vomiting, HA worsening w recumbency, HA awaken from sleep, HA worse w/ valsalva/cough,

Question 5

headache in child w/ photo and phono phobia

Answer 5

could be migraine but also could be meningitis/encephalities

Question 6

dennie’s lines

Answer 6

nfraorbital transverse creases and are associated with mild chronic inflammation of the conjunctivae, as in allergic conjunctivitis

Question 7

cobblestoning

Answer 7

Refers to the fine granular appearance of the palpebral conjunctivae resulting from edema and hyperplasia of the papillae.
Cobblestoning of the pharynx occurs with chronic nasopharyngeal drainage of allergic rhinitis and represents areas of lymphocytic hyperplasia

Question 8

romberg test

Answer 8

The Romberg test is performed by asking the patient to stand with feet together and arms extended anteriorly, palms upward.

Question 9

Romberg test is abnormal (+) with eyes opened and eyes closed.

Answer 9

cerebellar pathology

Question 10

the Romberg test will be + only with eyes closed; vision helps the patient compensate for the loss of sensation

Answer 10

dz resulting in abnormal position sense

Question 11

things causing pseudo tumor cerebri

Answer 11

Tetracycliens, vit A, galactosemia, hypothy, obesity,

Question 12

dx criteria pseudotumor cerebri

Answer 12

Increased intracranial pressure (with associated symptoms such as headache and vomiting)
Normal brain anatomy
Normal cerebrospinal fluid.
The diagnostic test is an elevated CSF opening pressure during a lumbar puncture.

Question 13

major sequelae of PTC

Answer 13

blindness resulting from transmission of elevated CSF pressure to the optic nerve sheath.

Question 14

when would you not need brian mri in context of bad headache

Answer 14

normal physical and neurologic examinations and lack of symptoms associated with increased intracranial pressure

Question 15

ataxia

Answer 15

lack of coordination of muscle movements and is a non-specific neurologic sign which can result from dysfunction in various parts of the nervous system that coordinate movement, such as the cerebellum, the inner ear, and the dorsal columns.

Ataxia can be congenital or acquired.

Question 16

most common cause of acute cerebellar ataxia in kids

Answer 16

post infectious cerebelitis aka acute cerebellar ataxia, happens in 1-3yo, dx of exclusion, follows a viral infxn like vaicella or cocksackie and leads to AI demyelination of cerebellum.

• will see vom, nystag, ataxia suddnely but few if any systemic sx
• csf can show pleocytosis, w maybe high prot
• most kids recover on own within a few months

Question 17

infectious cerebellitis

Answer 17

fever often , as well as AMS

-can be bacterial or viral

Question 18

types of meds that can lead to ataxia and how it presents

Answer 18

xposure to a medication such as an anticonvulsant, or to a toxin such as alcohol (or even to sedating anthistamines) can lead to acute ataxia.
The ataxia may be accompanied by nystagmus and dysmetria and is usually bilateral, owing to diffuse involvement of the cerebellum including the vermis and the cerebellar hemispheres.

Question 19

opsoclonus myoclonus syndrome

Answer 19

araneoplastic syndrome that occurs most often with neuroblastoma, generally occurs in the younger child (6 months-3 years).
Ataxia is accompanied by intermittent jerking movements (myoclonus) and erratic, jerky conjugate movements of the eyes (opsoclonus).

Question 20

what kind of headaches are due to ataxia and how do they present

Answer 20

Basilar artery migraines or hemiplegic migraines can cause recurrent intermittent episodes of acute ataxia.
Accompanying symptoms may include intermittent loss of vision, change in speech, headache and vomiting.

Question 21

hydrocephalus ataxia

Answer 21

insidious onset, vomiting, headache

Question 22

taxia may be intermittent or chronic with intermittent exacerbations when it is due to–

Answer 22

metabolic dz

Question 23

his gait is wildly erratic and involves lurching of the body which requires extraordinary balance.
The child is generally able to sit without difficulty, but when put in a standing position, immediately begins to sway at the waist.

Answer 23

consider conversion disorder

Question 24

can stress rxn or tension HA cause ataxia

Answer 24

no but conversion disorder can

Question 25

vermis/ midline cerebellar lesiosn

Answer 25

dysarthria, truncal ataxia, and gait abnormalities.

Question 26

cerebellar hemispheric lesions

Answer 26

ipsilateral limb abnormalities, nystagmus, tremor/dysmetria and tend to spare speech.

Question 27

what lesions spare spech

Answer 27

cerebellar hemispheric lesiosn

Question 28

Patients fall _ the side of the lesion and have worse nystagmus when they look _ the side of the lesion.

Answer 28

toward, tworad

Question 29

Lesions of the - cause resting tremor, myoclonus, and opsoclonus such as that seen in children with a -.

Answer 29

deep cerebellar nuclei, NB

Question 30

where do germ cell brain tumors typically present and they make what?

Answer 30

pineal or suprasellar region
make b hcg or AFP
cause visual or CN deficits

Question 31

focal motor and sensory abnormalities, on the side opposite to the lesion

Answer 31

supratentorial

Question 32

cerebellar signs and raised ICP

Answer 32

infratentoiral

Question 33

CN and gaze palsies

Answer 33

brainstem tumors

Question 34

change in muscle tone/DTR and hyporeflex and hypoton

Answer 34

cerebellar hemispheriec lesions

Question 35

Brain tumors are the _solid tumor in children and are the _ form of childhood cancer behind leukemia.

Answer 35

most common, second most common

Question 36

Deaths caused by childhood brain tumors are the _ among all childhood cancer deaths.

Answer 36

highest

Question 37

incidence of brian tumors peaks in

Answer 37

1st decade

Question 38

gender brain tumor

Answer 38

typically males esp for ependymoma and medullo

Question 39

location of tumor and age

Answer 39

Supratentorial tumors are more common in the first 2 years of age; for the rest of the first decade, infratentorial tumors predominate.
In adolescence and adulthood, supratentorial tumors once again become more common.

Question 40

RF brain tumros

Answer 40

ionizing radio

genetics like li fraumeni, TS, NF

Question 41

most common brain tumors

Answer 41

Medulloblastoma (20%),
Juvenile pilocytic astrocytoma (20%)
Low-grade astrocytoma (15%)
High-grade astrocytoma (7%)

Question 42

ependymoma

Answer 42

arises from the 4th ventricle , lead to hydroceph

Question 43

best prognosis of all infratent

Answer 43

astrocytoma

Question 44

which tumor has cystic component

Answer 44

astrocytoam

Question 45

most common peds brian tumor infratent

Answer 45

medulo PNET

Question 46

which tumor can specifically be noted to metast to extracran sites

Answer 46

medullo

Question 47

which tumor is noted to specifically use chemo along w/ rads/surg

Answer 47

med

Question 48

5 most common complications of brain tumor

Answer 48

Neurocognitive defects
Attention deficit disorder
Learning disabilities
Endocrine abnormalities, and
Stroke

Question 49

most common location of peds brian tumros

Answer 49

posterior fofssa