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PANP802 > Exam 1 Neuro > Flashcards

Exam 1 Neuro Flashcards

1
Q

Red flag: 2 months

A

Lack of fixation

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2
Q

Red flag: 4 months

A

Lack of visual tracking

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3
Q

Red flag: 6 months

A

Failure to turn to sound/voice

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4
Q

Red flag: 9 months

A

Lack of babbling consonant sounds

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5
Q

Red flag: 24 months

A

Failure to use single words

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6
Q

Red flag: 36 months

A

Failure to speak in 3 word sentences

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7
Q

Primitive reflexes diminish by what age?

A

3-4 months

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8
Q

Primitive reflex: Assymmetrical tonic neck

A 
#With infant on flat surface, turn head 90 degrees
#Arm & leg should extend on same side face is turned toward, opposite arm & leg flex
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9
Q

Primitive reflex: Moro

A 
#Support infant at 30º angle above flat surface, allow head & trunk to drop back to surface supported by examiner's hand, or pull infant up by hands to 30º angle from exam table & drop back quickly, releasing arms
#Arms should extend, abduct, hands open, fingers fan, thumb & index form C, then arms flex & adduct, knees clench, hips flex, eyes, open, & infant may cry
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10
Q

Primitive reflex: palmar grasp

A 
#With infant's head midline, touch palm of hand on ulnar surface with examiner's thumb
#Fingers clasp examiner's thumb
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11
Q

Primitive reflex: Placing

A 
#Hold infant upright under arms over edge of table & touch dorsal foot to table edge
#Flexion of knees/hips, foot lifts as if stepping up on table
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12
Q

Primitive reflex: plantar grasp

A 
#Touch infant on plantar surface of foot at base of toes
#Toes curl downward
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13
Q

Primitive reflex: rooting

A 
#Touch or stroke cheek
#Infant's head turns toward stimulus with open mouth
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14
Q

Primitive reflex: stepping

A 
#Hold infant upright under arms above exam table, plantar surface of feet just touching surface
#Stepping like motion with alternate flexion/extension of legs
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15
Q

Primitive reflex: sucking

A 
#Gently stroke lips
#Infant mouth opens, sucking begins; gloved finger inserted into mouth to evaluate strength of sucking
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16
Q

Primitive reflex: truncal incurvation (Galant reflex)

A 
#Hold infant firmly suspended in prone with hand supporting chest. With opposite hand, stroke along spine with fingernail just adjacent to vertebrae from shoulder to coccyx
#Hips & buttocks curve toward stimulus side
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17
Q

Postural reflexes appear at what age?

A

5-6 months

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18
Q

If postural reflexes don’t appear by _____ it’s considered abnormal finding.

A

8-9 months

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19
Q

Postural reflex: neck righting

A 
#Infant's head turned to R or L from midline, 90º to exam table
#Rotation of trunk in the direction which the head is turned
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20
Q

Postural reflex: Landau

A 
#Hold infant firmly suspended in prone with hand supporting abdomen & head; legs should extend over hand
#Infant should lift head, extend spine/lower extremities
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21
Q

Postural reflex: lateral parachute

A 
#Assessed at 5-7 months. Hold infant prone & firmly supported, slowly lower toward flat surface
#Observe symmetry of hand opening; should extend arms/legs
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22
Q

Postural reflex: forward parachute

A 
#Assessed at 7-9 months. Suspend infant in prone with arms/legs extended, supported with both hands over flat surface.
#Observe symmetry of hand opening; infant will lift head & extend spine along horizontal plane
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23
Q

Postural reflex: positive support

A 
#Hold infant upright & firmly support under arms over exam table; touch feet to table surface
#Infant should extend legs, bear some weight
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24
Q

Infant cranial nerve testing: CN 1, olfactory

A

Pass strong smell under nose, observe for startle reflex

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25
Q

Infant cranial nerve testing: CN2, optic

A

Light source: pupils constrict. Able to fix on object, follow for 60-90º, blink to light

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26
Q

Infant cranial nerve testing: CN3, 4, 6

A 
#Pupillary response by shining pen light toward pupil, should track & follow
#Doll's eyes maneuver: rotate head & body from side to side, eyes should move away from rotation
#Evaluate shape, size, symmetry of extra ocular movements. 
#Eyes should deviate left when turning right. If eyes are fixed or don't track, suspect brain stem issue
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27
Q

Infant cranial nerve testing: CN5, trigeminal

A

Touch cheek, gloved finger in mouth. Should turn toward touch on cheek, suck on finger

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28
Q

Infant cranial nerve testing: CN7, facial

A

Observe for symmetrical facial movements. Asymmetrical movements/folds may indicate nerve palsy

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29
Q

Infant cranial nerve testing: CN8, acoustic

A

Ring bell sharply within a few inches of ears. Startle or blink reflex.

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30
Q

Infant cranial nerve testing: CN9, glossopharyngeal

A

Tongue blade to apply pressure on mid-tongue area, then elicit gag reflex

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31
Q

Infant cranial nerve testing: CN10, vagus

A

Observe while crying. Evaluate pitch, hoarseness, stridor. Normal: loud & angry. Shrill, penetrating: intracranial hemorrhage. Whiny, high-pitched: CNS dysfunction

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32
Q

Infant cranial nerve testing: CN11, accessory

A

Turn infant’s head to one side while lying supine. Infant should work to bring head back to midline.

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33
Q

Infant cranial nerve testing: CN 12, hypoglossal

A

Observe while feeding. Sucking & swallowing should be efficient & coordinated.

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34
Q

Indications for head CT re: blunt head trauma (Duderstadt)

A 
#Suspicion of abuse
#Focal neuro finding
#Acute skull fracture, including depressed or basilar
#Altered mental status (lethargy, irritability)
#Bulging fontanel
#Persistent vomiting
#Seizure after injury
#Definite LOC for > few seconds and especially with focal neuro findings
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35
Q

General CT indications (Bolick)

A 
#AMS
#Acute intracranial bleed
#Initial trauma evaluation
#Ischemic vs hemorrhagic CVA
#Eval of cerebral/cerebellar infarct in 24 hours
#Tumors
#Hydrocephalus
#Brain abscess
#Acute hemorrhage
#Abnormal calcification
#Bone structures
36
Q

General MRI indications (Bolick)

A 
#Cranial nerve dysfunction
#Ischemic areas, CVA
#Ligamentous injuries
#Ischemic infarct after 12-24 hours
#Smaller tumors, esp in posterior fossa
#Spinal cord tumor/trauma
#Disc disease
#Demyelinating, white matter, neurodegenerative disease
#Epilepsy
#Primary & secondary neoplasm
37
Q

Definition of cerebral palsy

A

Group of permanent disorders of development of movement and posture causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. Motor disorders of CP are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior by epilepsy and by secondary musculoskeletal problems. (Rosenbaum et al., 2007)

38
Q

10 risk factors predicting CP

A 
#Low birth weight
#Meconium aspiration
#Placental abnormality
#Birth defects
#Instrumental/emergency c-section
#Neonatal seizures
#Neonatal infection
#Birth asphyxia
#Hypoglycemia
#Respiratory distress syndrome
39
Q

Why are physical findings so important to the diagnosis of CP?

A

It’s a clinical diagnosis of movement or posture.

40
Q

CP: progressive or not?

41
Q

Hydrocephalus: definition & types

A 
#Excessive accumulation of CSF in the brain
#Congenital, acquired, or iatrogenic
42
Q

Shunt complications

A 
#Malfunction (obstruction, migration, disconnection)
#Infection
#Intracranial hemorrhage
#Disproportionate drainage
#Over-shunting
43
Q

Mortality rate of untreated bacterial meningitis

44
Q

Most common pathogens in bacterial meningitis

A

3 months to 9 years: Streptococcus pneumoniae, Neisseria meningitidis
10-18 years: N. meningitidis mostly

45
Q

Signs & symptoms of meningeal inflammation

A 
#HA
#Irritability
#Nuchal rigidity
#Confusion
#Photophobia
#Back pain
46
Q

Kernig sign

A

Flexion of the hip 90º with pain on extension of leg

47
Q

Brudzinski sign

A

Involuntary flexion of knees & hips after passive flexion of the neck while supine

48
Q

Muscular dystrophies

A

Genetic disorders characterized by PROGRESSIVE muscle weakness (usually involving structural proteins in or near cell membrane)

49
Q

Dystrophies usually present with what sign?

A

Gait disturbance d/t hip girdle weakness

50
Q

Muscular dystrophy & cardiac evaluation

A

Should have an echo & cardiac workup by 6-7 years, because cardiac muscle is always involved in DMD

51
Q

Muscular dystrophy & malignant hyperthermia

A

Much higher incidence of MH in those with DMD & other muscle disorders

52
Q

Neurofibromatosis

A

Loss of function of neurofibromin which regulates cell growth, particularly of neurocutaneous tissue

53
Q

Clinical features of neurofibromatosis

A 
#Cafe-au-lait macules
#Freckling in skin folds
#Lisch nodules
#Neurofibromas
#Optic pathway gliomas
#Distinctive bony lesions
#1st degree relative with the disease
54
Q

NIH Diagnostic Criteria for Neurofibromatosis Type 1

A 
2 or more of the following:
#6 or more cafe-au-lait macules > 5mm  in prepubertal or > 15mm in post pubertal
#2 or more neurofibromas of any type or 1 or more plexiform neurofibroma
#Freckling in the axial or inguinal region
#Optic glioma
#2 or more Lisch nodules
#Distinctive bony lesion
#1st degree relative with the disease
55
Q

Neurofibromatosis Type 1 & 2 difference

A

Type 2 does not present until late adolescence or young adulthood

56
Q

NIH Diagnostic Criteria for Neurofibromatosis Type 2

A 
Any of the following:
#Bilateral vestibular schwannomas before age 70, unilateral before age 70 AND a 1st degree relative with disease
#Any 2: meningioma, nonvestibular schwannoma, neurofibroma, glioma, cerebral calfication, cataract, AND 1st degree relative or unilateral vestibular schwannoma & negative LZTR1 test
#Multiple meningiomas AND unilateral vestibular schwannoma OR any 2: nonvestibular schwannoma, neurofibroma, glioma, cerebral calcification, cataract
57
Q

Major clinical features of tuberous sclerosis

A 
#Hypomelanotic macules (>3, at least 5mm)
#Angiofibromas or fibrous cephalic plague
#Ungual fibromas
#Shagreen patch
#Retinal hamartomas
#Cortical dysplasias
#Subependymal nodules
#Subependymal giant cell astrocytoma
#Cardiac rhabdomyoma
#Lymphangioleiomyomatosis
#Angiomyolipomas
58
Q

Minor clinical features of tuberous sclerosis

A 
#Confetti skin lesions
#Dental enamel pits
#Intraoral fibromas
#Retinal achromic patch
#Multiple renal cysts
#Non-renal hamartomas
59
Q

Hypotonia

A

Low muscle tone, or decreased resistance to passive movement

60
Q

Seizure (Bolick)

A

Abnormal electrographic and/or clinical manifestations of high-frequency bursts of action potentials and abnormal, excessive, and hypersynchronous discharges within a cortical neuronal network

61
Q

Seizure (Fleisher)

A

Transient, involuntary alteration of consciousness, behavior, motor activity, sensation, and/or autonomic function caused by excessive rate & hypersynchrony of discharges from group of cerebral neuron.

62
Q

Generalized seizure

A 
#Involvement of both cerebral hemispheres
#Convulsive or non-convulsive
#Impaired consciousness likely
#Bilateral motor involvement
#Absence, myoclonic, tonic, clonic, atonic, and tonic-clonic
63
Q

Partial seizure

A 
#Focal, local
#One cerebral hemisphere
#Further classified whether impaired consciousness or not
64
Q

Simple partial seizure

A 
#No impairment of consciousness
#Motor, somatosensory, autonomic, or psychic symptoms
65
Q

Complex partial seizure

A

Consciousness impaired

66
Q

Status epilepticus

A 
#Prolonged seizure more than 5 minutes
#Persistent, repetitive seizure activity without recovery of consciousness in between
67
Q

Psychogenic non-epileptic seizures

A 
#Pseudoseizures
#Movement disorder that looks seizure like but no corresponding abnormal electrical brain activity
#Bizarre & thrashing, vocalizations
#No post-ictal
#Suspect when episodes always witnessed, never during sleep, and eyes are closed during episodes
#Mostly occur in people with underlying seizure disorder
68
Q

Febrile seizures

A 
#Caused by a fever
#Diagnosis of exclusion
#Some things can directly cause fever AND seizures, like meningitis
69
Q

Common electrolyte abnormalities causing seizures

A 
#Hyponatremia
#Hypocalcemia
#Hypomagnesemia
#Refractory to anticonvulsants until underlying electrolyte abnormality is corrected
70
Q

Infantile water intoxication

A

Formula is too dilute, causing hyponatremia, possibly seizures

71
Q

Super last resort for status epilepticus

A

General anesthesia (with intubation of course)

72
Q

Pediatric vs adult migraines

A 
#Classic findings only in a minority of children
#Duration, lateralization differ in children from adults
73
Q

The best studied traditional HA meds for pediatric migraine?

A

NSAIDS & prochlorperazine

74
Q

Types of migraine in pediatric

A 
#Classic when it's localized and with aura
#Common when it's not
75
Q

Predominant migraine type in children

A

Common (common things are common!)

76
Q

Abdominal migraine

A

Cyclic vomiting with discreet, recurring bouts of abdominal pain, nausea, vomiting, pallor

77
Q

Pediatric migraine management in ED

A 
#APAP & ibuprofen
#Toradol if they're puking
#SHORT narcotic course if non-narcotics have failed, especially if trouble sleeping
#Commonly used dopamine receptor antagonists (Reglan, Compazine, Phenergan) probably should get diphenhydramine with them to prevent dystonia
78
Q

Pseudotumor cerebri syndrome

A

Idiopathic intracranial hypertension

79
Q

IIH clinical presentation

A 
#Headache with variable severity, duration
#Worse in AM
#N/V, dizzy, double/blurred vision
#Lethargy, irritability in infants
#Papilledema in almost all cases
#Cranial nerve palsy
80
Q

The REAL name for Guillain-Barre syndrome

A

Acute polyneuritis

81
Q

Acute polyneuritis presentation

A 
#Symmetric ascending paralysis
#Primary demyelination of motor & sensory nerves
#Probably autoimmune
#Respiratory/GI infection or immunization precedes by 1-2 weeks
82
Q

Number one concern with acute polyneuritis

A

Might progress to respiratory compromise

83
Q

Myasthenia gravis

A

Antibodies directed against acetylcholine receptor proteins at the postsynaptic neuromuscular junction resulting in intermittent failure of neuromuscular transmission

84
Q

Myasthenia gravis clinical presentation

A 
#Fluctuating weakness of cranial, skeletal muscles exacerbated by exertion
#Acute or insidious
#Most cases involve cranial nerves
85
Q

Myasthenia gravis pediatric types

A 
#Transient neonatal
#Infantile (congenital)
#Juvenile (most common)

PANP802 (4 decks)

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