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EOR- PEDS > Neuro > Flashcards

Neuro Flashcards

1
Q

When is water + baby food recommended

A

6 months

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2
Q

When can infants have honey

A

1yr

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3
Q

When can whole cows milk be introduced?

A

15 months

Introduction of whole cow’s milk (and constipation with change discussed) Assess anemia, discuss iron-rich foods →3x birth weight

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4
Q

When can the car seat be forward facing & what else happens at this age?

A

2 years + Toilet training begins

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5
Q

When can children transition from booster to normal car seat with lap seatbelt?

A

7-12

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6
Q

When can children start sitting in the front seat?

A

13

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7
Q

flat facial profile, flat nasal bridges, open mouth, protruding tongue, upslanting palpebral

fissures, folded/dysplastic ears, brachycephalic, prominent epicanthal folds, excessive skin @ the nape of the neck, short neck

A

Down syndrome

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8
Q

What are physical exam findings in neonates suggestive of down syndrome?

A

Poor Moro reflex, hypotonia, dysplasia of the pelvis, hypotonia, may develop transient neonatal leukemia

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9
Q

What prenatal screenings are performed to r/o down syndrome?

A

Biochemical screening: free beta-hCG: abnl high/low ~indicative of chromosomal abnormalities, PAPP-A: low with fetal DS

Nuchal Translucency Ultrasound @ 10-13 weeks – increased thickness can be seen with trisomy 13, 18, & 21

→ If increased thickness, chorionic villous sampling or amniocentesis is offered

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10
Q

Convulsion associated w/ an elevated temperature greater than 38C with absence of CNS infection or inflammation

A

Febrile seizures

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11
Q

MC seizure disorder during childhood, occur in 2-5% of children 6 months – 6 years

A

Febrile seizures

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12
Q

Tx of febrile seizures

A

If more the 5 minutes, treat with an IV benzodiazepine – Diazepam or Lorazepam

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13
Q

Febrile seizure patients have an increased risk of

A

Increased risk of epilepsy (2% as opposed to 1% in general population)

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14
Q

In pts with Neomycin & Streptomycin allergy what vaccine is avoided?

A

avoid MMR & inactivated Polio vaccine

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15
Q

What vaccines are given 1-1.5yrs

A

(MAD HPV)

MMR, Hepatitis A, DTap, H. influenza, Pneumococcal, Varicella

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16
Q

What vaccines are given at 4-6 years

A

4 VERY DIM

Varicella, DTap, IPV (Polio), MMR

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17
Q

What vaccines are given at 11-12

A
  • *TADA HUMAN MEN**
  • *T**daP, Human Papillomavirus, Meningococcal
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18
Q

What vaccines are given at 16-18

A

Meningococcal Booster

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19
Q

Which vaccines are live attenuated?

A

MMR, Varicella Zoster, Rotavirus

Smallpox, yellow fever, oral typhoid, oral polio

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20
Q

4 bugs associated with bacterial meningitis

A

Streptococcus pneumoniae: MCC in adults all ages & children aged 3m-10y

Neisseria menigitidis: MCC in older children (10-19 y/o), 2nd MCC in adults, may be assoc. w/ petechial rash

Group B Streptococcus (S. agalactiae): MCC in neonates under 1m (part of vaginal flora) & infants under 3m

Listeria monocytogenes: Increased incidence in neonates, 50+ y/o, immunocompromised states (hx of glucocorticoid use, alcoholism, pregnancy, AIDS/HIV, chemotherapy)

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21
Q

Sx of meningitis

A

Meningeal signs: nuchal rigidity, (+) Brudzinski (neck flexion produces knee &/ hip flexion, (+) Kernig sign (inability to extend the knee/leg with hip flexion); look for bulging fontanelle in babies

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22
Q

Dx of Bacterial meningitis

A

Lumbar puncture + CSF examination = best initial test & definitive diagnosis: decreased glucose (under 45), increased neutrophils, increased protein & increased pressure

Head CT scan = best initial test PRIOR TO LP ONLY if needed to rule out mass effect if any of these are present: papilledema, seizures, confusion, focal neuro findings, 60y/o+, immunocompromised, or history of CNS disease

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23
Q

In bacterial meningitis is protein increased or normal?

A

Bacterial = Protein increased (protein eats glucose aka bacteria)

Viral = Protein and glucose are normal

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24
Q

Tx of bacterial meningitis

A

Antibiotics, along with Dexamethasone when indicated – should be started ASAP after LP is to head CT if needed before LP (basically ASAP after blood cultures are obtained or LP done)
• Dexamethasone has been shown to reduce mortality & sequelae of S. pneumo, H. influenza, & N. menigitidis

• Give if suspect H. influenza type B in children – reduces incidence of CN8-related hearing loss

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25
Q

MCC of aseptic or viral meningitis

A

Enteroviruses = MCC (Coxsackivirus & Echovirus)

Other viruses, mycobacteria, fungi, spirochetes, medications, and malignancies

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26
Q

By what age does the MORO reflex dissapear?

A

3 mo

27
Q

ocal sensory, motor or autonomic symptoms depending on the lobe affected – may be followed by a neurologic deficit

(Todd’s paralysis) lasting up to 24 hours

A

Focal partial seizures

28
Q

2 types of focal (partial) seizures seen on EEG

A

Simple partial: focal discharge at the onset of the seizure

Complex partial: interictal spikes or with slow waves in the temporal or frontotemporal area

29
Q

Pause/stare: sudden, marked impairment of consciousness without loss of body tone (patient remains upright), staring episodes with pauses (behavioral arrest)

Episodes typically last 5-10 seconds,

A

Absence (petit mal)

30
Q

MC seizure seen in childhood – age @ onset is 4-10 years (often ceases by early puberty or 20 y/o in most patients)

A

Absence or petit mal

31
Q

Dx of absence seizure

A

EEG: bilateral symmetric 3 Hertz spike & wave activity (2.5-5Hz)

32
Q

Tx of absence seizure

A

Ethosuximide first-line medical management, Valproic acid 2nd line, Lamotrigine

Carbamazepine or Gabapentin can exacerbate absence seizures

33
Q

Sudden loss of consciousness with tonic activity (contraction & rigidity) that may be associated with respiratory arrest followed by 1-2 minutes of clonic activity (repetitive, rhythmic, symmetric jerking usually lasting under 3 min) followed by postictal confusion phase – cyanosis & urinary incontinence may occur

A

Grand mal or generalized seizure

34
Q

Dx of grand mal seizure

A

Initial workup is to r/o reversible causes (CBC, electrolytes, liver & renal function, RPR)

Increased prolactin & lactic acid immediately after seizures helpful to r/o pseudoseizures – MRI to r/o focal mass

EEG: bilateral symmetric 3 Hertz spike & wave activity (2.5-5Hz)

35
Q

single, continuous epileptic seizure lasting 5 minutes or greater, or more than 1 seizure within a 5 minute period w/out recovery in between episodes – a neurologic emergency

A

Status epilepticus = Emergency

36
Q

Tx of status epilepticus seizures

A

Benzodiazepines are preferred initial agents (Lorazepam usually preferred) – associated with rapid control of seizure &

additional doses can be given
• Midazolam can be used as initial IM therapy if IV access cannot be established

Second line: Phenytoin or Fosphenytoin if no response to benzos – can also be used to prevent recurrence • Alternatives: Valproate and Levetiracetam

3rd line: Phenobarbital if no response to Phenytoin (refractory)

37
Q

At what age should children should have all primary teeth including second molars

A

By age 2.5 years

38
Q

Group of X chromosome abnormalities characterized by females with an absent or nonfunctional X sex chromosome & is phenotypically female

A

Turner syndrome

39
Q

Sx of Turner syndrome

A

Hypogonadism: 45, XO leads to gonadal dysgenesis (rudimentary fibrosed streaked ovaries) that can cause early ovarian

failure (primary amenorrhea in 80% or early secondary amenorrhea), delayed secondary sex characteristics (absence of breasts), & infertility

Physical examination: short stature, webbed neck (pterygium colli), prominent ears, low posterior headline, broad chest w/ widely spaced nipples, short 4th metacarpals, high-arched palate, nail dysplasia, congenital lymphedema in neonates, small mandible, narrow maxilla, epicanthal folds, pedal edema, cubitus valgus (forearm angled slightly away from body), impaired sensorineural hearing

40
Q

Turner syndrome cardiovascular abnormalities

A

Coarctation of the aorta (30%), mitral valve prolapse, bicuspid aortic valves, aortic dissection, HTN

41
Q

Dx turner syndrome

A

Karyotyping – definitive diagnosis, 45,XO mosaicism or X chromosomal abnormalities

Low estrogen + high FSH & LH

42
Q

Persistent (@ least 6m) intense fear or anxiety of a specific situation (heights, flying), object (animals), or place (hospital)

Exposure to the situation causes an immediate response, & the fear is out of proportion to any real danger

A

Specific phobia

43
Q

MC primary childhood CNS tumor

A

Grade 1 Astrocytoma

MC type in children: pilocytic astrocytoma (grade I) aka Juvenile Astrocytoma – typically localized, considered “most benign,” MC in children & young adults, cerebellar astrocytoma & desmoplastic infantile other grade I astrocytomas

44
Q

MC malignant posterior fossa tumor & most prevalent brain tumor in children under 7

A

Medulloblastoma

45
Q

Peak age for medulloblastoma

A

Bimodal peak @ age 3-4 years & at age 8-10 years

Tends to invade the fourth ventricle & spread along CSF pathways

46
Q

One of the MC supratentorial brain tumors of childhood associated with short stature or other endocrine associated problems

A

Craniopharyngioma

47
Q

Dx of craniopharyngioma

A

90% of craniopharyngiomas show calcification on CT scan;

Tx = Surgical resection

48
Q

Ependymal cells line the ventricles & parts of the spinal column

A

Neurofibromatosis: Ependyoma

49
Q

Dx of Neurofibromatosis: Ependyoma

A

CT scan/MRI with contrast: hypointense T1, hyperintense T2, enhances with gadolinium

Brain biopsy: perivascular pseudo rosettes (tumor cells surrounding a blood vessel)

50
Q

Myeloproliferative disorder of uncontrolled production of mature &Germinal/pregerminal B-cell malignancy originating in the lymphatic system

A

CML

Chronic myeloid leukemia

QUICK RECALL: CML = WBC >100K + hyperuricemia + adults 50+, 70% asyx until a blastic crisis (presents as acute leukemia) Diagnosis: (+) splenomegaly, Philadelphia chromosome (translocation on chromosome 9 & 22)
Treatment: Philadelphia chromosome (+) – tyrosine kinase inhibitors (Imatinib)

51
Q

Bimodal distribution: peaks @ 20 and then again at 50

maturing granulocytes with fairly normal differentiation (predominantly neutrophils but also basophils & eosinophils)

A

Hodgkin Lymphoma

52
Q

Asymptomatic PAINLESS lymphadenopathy: MC presentation, usually painless but ETOH ingestion may induce lymph node pain within minutes

A

Hodgkin lymphoma

53
Q

When is Hep A given?

A

First dose at 12-24 mo

2nd dose given at least 6 months after

54
Q

What age does Moro reflex dissapear

A

3 mo

55
Q

What age does infants have stranger anxiety?

A

6 mo

56
Q

Tx of meningitis

A

Dexamethasone + Empiric IV antibiotics (Cephalosporin, Vancomycin, Penicillins)

  • Household contacts: treat with rifampin, Cipro, Levaquin, azithromycin, ceftriaxone
57
Q

Tx of focal seizures

A

phenytoin, and carbamazepine are drugs of choice

58
Q

single epileptic seizure lasting more than five minutes or two or more seizures within a five-minute period without the person returning to normal between them

A

Status epilepticus

59
Q

When does teething start to occur?

A

6 to 24 months of age

60
Q

When does the American Dental Association and the American Academy of Pediatric Dentistry recommend scheduling a child’s first dental visit

A

At or near 1st birthday

61
Q

Turner syndrome is a genetic disorder caused by a missing what chromosome?

A

X chromosome in females (45XO)

62
Q

The most common cause of primary amenorrhea

A

Turner syndrome

63
Q

Low anti-Mullerian hormone signify which syndrome?

A

Turner Syndrome 45XO

64
Q

Tx of Turner syndrome

A

TX: growth hormone therapy and sex hormone replacement therapy

EOR- PEDS (9 decks)

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