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Peds Rotation PA-S2 > Neuro > Flashcards

Neuro Flashcards

1
Q

Preventative measures, nutrition, fostering optimal development: birth/3-5 days

A

Preventative Measures
Rear-facing car seat in back seat from birth until 2-4yo
Crib safety – slats <3in, no soft bedding
Water heater <120F, smoke detectors
Back to sleep

Nutrition
Exclusive breastfeeding q2-3h encouraged – need vitamin D supp.
Formula second-best; q3-4h
Neonates: require 100kcal/kg/d
Should be back to birth weight by 2wks; gain ~30g/d

Fostering optimal development
Parenting skills; bonding/attachment
Parenting education
Accept help; give siblings attention

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2
Q

Preventative measures, nutrition, fostering optimal development: 2wks-1mo

A

Preventative Measures
Falls; back to sleep; gun safety in home
Tummy time: 5-10min 2-3x/d

Nutrition
Should be back to birth weight by 2wks

Fostering Optimal Development
Recognize/manage postpartum blues
Childcare options

Normal growth and development
should be back to birth weight by 2 wks
moro and grasp reflex, cries

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3
Q

Preventative measures, nutrition, fostering optimal development: 2 months

A

Preventative Measures
Burns/hot liquids; back to sleep

Nutrition
Delay solids until 4-6mo
Do not need to eat during night after 3mo

Fostering Optimal Development
Establish bedtime routine, age-appropriate toys
Parents getting enough rest, returning to work

Normal growth and development
lifts head, smiles responsively, coos

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4
Q

Preventative measures, nutrition, fostering optimal development: 4 months

A

Preventative Measures
Don’t leave baby alone in tub/high places
Childproof home – safety locks
Avoid baby walkers

Nutrition
Introduce solids – cereals, fruits, veggies, protein (wait several days between introduction of new foods)
Should be double birth weight
Teething

Fostering Optimal Development
Introduce comfort item
Talk, read, sing to baby

Growth and development
Should be double birth weight
holds head steady, rolls to back from tummy
brings hand to mouth, laughs

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5
Q

Preventative measures, nutrition, fostering optimal development: 6 months

A

Preventative Measures
Burns/hot surfaces
Place on back to sleep – ok once they learn to roll over themselves
Brush teeth w/ soft toothbrush

Nutrition
Start water cup, limit juice
Avoid choke foods

Fostering Optimal Development
Separation anxiety

Growth and development
beings to sit w/o support, babbles
knows familiar people/stranger anxiety begins

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6
Q

Preventative measures, nutrition, fostering optimal development: 9 months

A

Preventative Measures
Safety locks/stair gates
Poison control number, learn first aid

Nutrition
Avoid juice, no honey until 1yo
Increase soft, moist foods; encourage self-feeding/cup use

Fostering Optimal Development
Assist w/ sleeping through night, set simple limits/rules
Praise good behavior

Growth and development
Responds to name, crawls, pulls to stand
sits w/o support, waves

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7
Q

Preventative measures, nutrition, fostering optimal development: 12 months

A

Preventative Measures
May turn car seat to forward-facing if >20lbs
Childproof home – dangling cords, poisons/medicines, guns
Supervise near water, pets, mowers, streets, driveways
Use sunscreen
Anemia screening, assess TB risk

Nutrition
Should be triple birth weight; 3 meals +2-3 snacks/d
Introduction of whole cow’s milk (constipation caution)
Schedule first dental exam

Fostering Optimal Development:
Don’t put child to bed w/ bottle
Praise good behavior; talk, sing, read to baby
Show affection; avoid TV
Genitalia curiosity
Don’t allow hitting/biting/aggressive behavior

Growth and development
should triple birth weight, calls mama and dada
understands “no”
precise pincer grasp, uses cup
walks with assistance

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8
Q

Preventative measures, nutrition, fostering optimal development: 15 months

A

Preventative Measures
Assess hearing/vision loss risk – screening as indicated
Water temperature
Pot handles to back of stove; window guards, safety locks, stair gates

Nutrition
Eat meals as family; let child decide how much to eat
Don’t use food as comfort/reward
Brush teeth
Decline in eating w/ slower growth

Fostering Optimal Development
Time-outs; limit-setting
Praise good behavior
Fostering independence, ignore annoying but not unsafe behaviors

growth and development
Walks well w/o assistance, stoops, stacks 2 blocks
temper tantrums, understands simple commands
points to wants, several words

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9
Q

Preventative measures, nutrition, fostering optimal development: 18 months

A

Preventative Measures
Limit punishment to high yield

Nutrition
Food choices, portions, “finicky” eaters

Fostering Optimal Development
Prepare for toilet training
Nightmare strategies; encourage self-expression/choices
Specific/consistent limits

growth and development
walks quickly/runs stiffly, walks up stairs
names objects, scribbles, toilet training

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10
Q

Preventative measures, nutrition, fostering optimal development: 2 years

A

Preventative Measures
Forward-facing car seat in back seat
Begin hyperlipidemia screening
Bike helmet; washing hands/wiping nose

Nutrition
Variety of healthy foods, let child pick, avoid struggles
Child-size utensils

Fostering Optimal Development
Begin toilet training when child is ready
Use proper terms for genitalia

growth and development
runs, 2-word sentences, several 100 vocab words
follows 2 step commands, self feeding, stacks 5-6 blocks

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11
Q

Preventative measures, nutrition, fostering optimal development: 3 years

A

Preventative Measures
Blood pressure; should be potty trained (maybe not at night)
Smoke alarms, stranger safety

Nutrition
Low-fat dairy products; dental appointment

Fostering Optimal Development
Limit TV; teach that certain body parts are private
Read to child

growth and development
rides tricycle, 3 word sentences, knows first/last name
climbs stair, asks “why”
draws circle

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12
Q

Preventative measures, nutrition, fostering optimal development: 4 years

A

Preventative Measures
Vision/hearing screening; swimming lessons
May transition to booster seat if >40lbs
Cigarettes, matches, poisons, alcohol safety

Nutrition
Limit candy, chips, soft drinks

Fostering Optimal Development
Assign chores; read to child
Pre-K

growth and development
Hops on 1 foot, draws X and square, draws person w/ 3 body parts
full sentences, dresses self, tells stories, sings songs

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13
Q

Preventative measures, nutrition, fostering optimal development: 5 years

A

Preventative Measures
Water safety, teach child emergency phone numbers
Physical activity

Nutrition
Eat meals as family
Supervise tooth brushing

Fostering Optimal Development
Family rules, respect for authority, right vs wrong
Sex-ed w/ age-appropriate books

growth and development
Draws triangle, counts to 10, knows some letters/can write some
skips, holds pencil correctly, brushes teeth, easy convo

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14
Q

Preventative measures, nutrition, fostering optimal development: 6 years

A

Preventative Measures
Fire safety; booster seat until 4’9

Nutrition
Eat as family; avoid high fat/low nutrition meals

Fostering Optimal Development
Limit TV/computer time; ensure adequate sleep
Reinforce consistent discipline

growth and development
development of conscience, same sex friends
Lears to read, learns to write and do math

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15
Q

Preventative measures, nutrition, fostering optimal development: 7-10 years

A

Preventative Measures
Sports safety
Lap/shoulder seat belt in back seat for 8-12yo

Nutrition
Avoiding alcohol, tobacco, drugs; healthy food choices

Fostering Optimal Development
Encourage reading/hobbies
Limits, established consequences; conflict resolution

growth and development
development of conscience, same sex friends
Lears to read, learns to write and do math

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16
Q

Preventative measures, nutrition, fostering optimal development: 11-13 years

A

Preventative Measures
Can sit in front seat at 13y

Nutrition
Junk food vs healthy eating

Fostering Optimal Development
Homework; substance abuse prevention
Encourage abstinence

growth and development:
abstract reasoning, opposite sex friends, personality formation

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17
Q

Preventative measures, nutrition, fostering optimal development: 14-16 years

A

Preventative Measures
Motor vehicle safety – drunk driving

Nutrition
Junk food vs healthy eating

Fostering Optimal Development
Curfews, chores, career discussion/college prep
STDs, protection

growth and development:
abstract reasoning, opposite sex friends, personality formation

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18
Q

Preventative measures, nutrition, fostering optimal development: 17-21 years

A

Preventative Measures
Review/assess

Nutrition
Healthy diet for life

Fostering Optimal Development
College/employment

growth and development:
abstract reasoning, opposite sex friends, personality formation

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19
Q

Down Syndrome definition and causes

A

Genetic disorder due to 3 copies of chromosome 21 (Trisomy 21) or 3 copies of a region of the long arm of chromosome 21

MC chromosomal disorder & cause of mental developmental disability

RF: advanced maternal age

Associated Comorbidities:
*Acute Lymphocytic Leukemia (ALL)
*Early-onset Alzheimer’s Disease
*Atlantoaxial instability (C1-C2)

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20
Q

Down Syndrome sx

A

Head & neck:
*low-set small ears, flat facial profile, flat nasal bridges
*open mouth, protruding tongue, upslanting palpebral fissures
*folded or dysplastic ears, brachycephalic, microcephaly
*prominent epicanthal folds, excessive skin at the nape
*short neck, almond-shaped eyes
*Brushfield spots – white, grey, or brown spots on the iris

Extremities:
*transverse, singular palmar crease (Simian crease)
*hyperflexibility of the joints, short broad hands
*increased space between first & second toes (sandal gap deformity)

Neonates:
*poor Moro reflex, hypotonia, dysplasia of the pelvis
*may develop transient neonatal leukemia

Congenital heart disease:
*atrioventricular septal defects, tetralogy of Fallot
*patent ductus arteriosus

GI: duodenal or esophageal atresia, Hirschsprung disease

Males: sterility

21
Q

Down Syndrome dx

A

Based on hx, physical exam

Confirmation 🡪 genetic testing

U/S 🡪 prenatal diagnosis
*nuchal translucency (11-14wks) – increased nuchal translucency & hypoplastic nasal bone

Prenatal dx w/ labs 🡪 chorionic villus sampling/amniocentesis

Amniocentesis (@ 15wks)
*indicated in mothers >35y
*less risk than chorionic villus sampling

Chorionic Villus Sampling (@ 10-12wks)
*placental tissue sample retrieved via vagina & cervix
*indicated in mothers >35y

QUAD Screen (15-22wks): AFP, hCG, estriol, inhibin-A
*↑: beta-hCG, inhibin-A
*↓: estriol, AFP

Postnatal dx 🡪 FISH, karyotyping; clinical based on dysmorphic features

22
Q

Down Syndrome tx

A

PRENATAL SCREENING:

Biochemical screening
*free beta-hCG: abnormally high or low
*PAPP-A: low w/ fetal Down Syndrome

Nuchal translucency U/S: @ 10-13wks
*increased thickness can be seen w/ trisomies 13, 18, & 21
*if increased thickness 🡪 chorionic villous sampling or amniocentesis is offered

TX: prenatal genetic counseling; supportive for affected body systems

23
Q

When to give Hep B

A

3 total
at birth, 2 months, and between 6-18 months

24
Q

When to give DTaP

A

5 total
2 months, 4 months, 6 months, 15-18, 4-6 yrs

25
Q

When to give rotavirus vaccine

A

3 total
2 months, 4 months, 6 months

26
Q

When to give Haemophilus B vaccine

A

4 total
2 mo, 4 mo, 6 mo, 12-15 mo

27
Q

When to give PVC13

A

4 total
2 mo, 4 mo, 6 mo, 12-15 mo

28
Q

When to give polio vaccine

A

4 total
2 mo, 4 mo, 6-18 mo, 4-6 yr

29
Q

When to give MMR

A

2 total
12-15 mo, 4-6 yrs

30
Q

When to give Varicella

A

2 total
12-15 mo, 4-6 yrs

31
Q

When to give Hep A

A

2 dose series, 6 mo apart
between 12-23 mo

32
Q

When to give TDaP

A

11-12 yrs

33
Q

When to give HPV vaccine

A

11-12 yrs

34
Q

When to give meningococcal vaccine

A

2 total
1-12 yrs and 16 yrs

35
Q

Meningitis definition

A

Meningitis is an inflammation of the leptomeninges, the two innermost membranes that surround & protect both the brain & spinal cord (arachnoid & pia mater)
*Starts when a foreign substance makes its way inside the leptomeninges, either by direct contact or hematogenous spread through the BBB
*Immune system responds to antigen by flood subarachnoid space w/ WBCs which release chemokines & creates inflammation

36
Q

Viral Meningitis definition, sx, dx, tx

A

*Systemic viral infection within the CNS restricted to the meninges, ependyma, & subarachnoid space

MC Etiologies: enteroviruses (esp. Coxsackievirus B & Echovirus), HSV-2, HIV
Less Common: mumps, VZV, lymphocytic choriomeningitis virus

*Acute onset
*Less severe than bacterial, usually w/o alterations in consciousness

sx
Cardinal SXS: fever, HA, nuchal rigidity
*general malaise, myalgia, N/V, photophobia, diarrhea, rash
PE: absence of abnormal neurologic findings +/- transiently increased DTRs
Clinical Considerations by Viral Cause:
Enteroviruses: summer, fall (MCC overall)
1) Echovirus: maculopapular rash
2) Coxsackie B: myocarditis, pericarditis, pleurodynia
HIV: year-round, mono-like syndrome
HSV-2: year-round, +/- polyradiculitis

dx
CSF pattern: lymphocytic pleocytosis, mildly elevated protein, normal glucose
Other: viral PCR, culture to r/o bacterial

tx
Self-limited, only supportive tx
*analgesics, antiemetics, IVF

HIV: antiretroviral therapy
HSV: acyclovir

37
Q

Bacterial Meningitis definition, sx, dx, tx

A

MCC: S. pneumoniae (gram+ diplococci), Neisseria meningitides (gram- diplococci), Haemophilus influenzae B (Hib)
*Acute onset

Etiology by Age:
Neonates: GBS, E. coli, L. monocytogenes
Babies, Children: S. pneumo, N. meningitides, Hib
Teens, Adults: N. meningitides (teens), S. pneumo
>50y: S. pneumo, N. meningitides, L. monocytogenes

L. monocytogenes: immunocompromised, >50yo, pregnancy, alcoholism, cirrhosis

Classic SXS: severe HA, fever, stiff neck (nuchal rigidity), AMS
*Almost all pts will have 2/4 classic sxs
Other sxs: N/V, photophobia
Infants: fever, irritability, poor feeding, bulging fontanelles
*generally do not have stiff neck

+Kernig: inability/reluctance to allow full knee extension when hip flexed 90o
+Brudzinski: spontaneous hip flexion during passive neck flexion

N. meningitides: petechial rash on trunk, legs, & mucous membranes**

dx
CT before LP if: immunocompromised, hx of CNS disease, new-onset seizure, papilledema, abnormal level of consciousness, focal neurological deficit
CSF pattern: neutrophilic pleocytosis, elevated protein, low glucose
Other: CSF gram stain & culture, PCR

tx
Empiric ABX:
<1mo: ampicillin + gentamicin

> 50y: vancomycin + ampicillin + 3rd gen cephalosporin (ceftriaxone or cefotaxime)

Everyone else:
*vancomycin + (ceftriaxone or cefotaxime)

38
Q

Seizure Disorders types

A

Focal (Partial): abnormal neuronal discharge from one discrete section of one hemisphere

Generalized: simultaneous neuronal discharge of both hemispheres (diffuse brain involvement)

Status Epilepticus: seizure lasting ≥5min or >1 seizure within a 5min period w/o recovery between episodes

Febrile Seizure: associated w/ fever >100.4F

FEBRILE SZ: MC seizure in infants/young children
*between 6mo-5y; MC in males
*fever >100.4F w/o evidence of CNS infection or metabolic disturbance

RF: fever >100.4, age, viral infection (HHV-6, influenza), family hx, recent immunizations

DX: clinical – consider LP if suspicious of meningitis
*i.e., lack of Hib/S. pneumoniae vaccination or PE suggesting meningitis

39
Q

Seizure Disorders focal vs generalized

A

Type I: Focal Seizures

  1. w/ Retained Awareness (Simple)
    *no alteration in consciousness
    *abnormal movements or sensations
  2. w/ Loss of Awareness (Complex)
    *altered consciousness, automatisms (lip-smacking)
    *postictal state: confusion & loss of memory

Type II: Generalized Seizures

  1. Absence (Petit Mal)
    *brief lapse of consciousness, staring episodes w/ pauses
    *eyelid twitching, lip smacking; NO POSTICTAL
  2. Atonic (Drop Attacks)
    *sudden loss of muscle tone
  3. Tonic
    *extreme rigidity 🡪 LOC
  4. Clonic
    *repetitive rhythmic jerking; often associated w/ postictal state
  5. Myoclonic
    *sudden, brief, sporadic involuntary twitching
  6. Tonic Clonic (Grand Mal): sudden LOC
    *Tonic Phase: stiff & rigid 10-60sec
    *Clonic Phase: generalized convulsions & limb jerking
    *Postictal Phase: a confused state
40
Q

Status Epilepticus defintion and tx

A

NEUROLOGIC EMERGENCY

Etiologies:
*structural abnormalities
*infections (meningitis, encephalitis)
*metabolic abnormalities
*medications
*toxins

Diagnostics: neuroimaging once stabilized

Management:
*place pt in left lateral decubitus position
*BDZs first line (lorazepam)
*second line: phenytoin or fosphenytoin
*third line: phenobarbital (refractory)

41
Q

Seizure Disorders dx and tx

A

Labs: CBC, electrolytes, glucose, renal & liver function, RPR
*↑ prolactin & lactic acid immediately after seizures

CT 🡪 first seizure

EEG 🡪 BEST TEST

Management:
*Focal Seizures: phenytoin & carbamazepine
*Absence: ethosuximide first line
*levetiracetam, phenytoin, valproic acid, carbamazepine, lamotrigine, phenobarbital, topiramate

Febrile Seizures: counseling, reassurance, parental education, antipyretics for fever
*BDZ if seizure lasts >5min
*status epilepticus: BDZ or phenytoin
*rarely develops into epilepsy – monitor if complex febrile seizure (more likely to recur)

42
Q

Teething definition, tx, routine dental care

A

Generally occurs between 6-24mo of age

The two bottom front teeth (lower central incisors) are usually the first to appear, followed by the two top front teeth (upper central incisors)

Classic s/sxs:
*excessive drooling
*chewing on objects
*irritability or crankiness
*sore or tender gums
*a slight increase in temperature (but not fever)

tx
Palliative – chewing on a chilled (NOT FROZEN) teething ring, systemic analgesia
*should be ONE PIECE!
*do not dip in sugary substances
*necklaces/bracelets made of beads = avoid!
*avoid OTC topical analgesics
*OTC pain meds (acetaminophen, ibuprofen) if esp. fussy

dental care
*run a soft, clean cloth over baby’s gums 2x/d – after the morning feeding & before bed

*when baby’s teeth first appear: use small, soft-bristled toothbrush to clean 2x/d – use a smear (grain of rice) of fluoride toothpaste until age 3 when children learn to spit

*first dental visit = near child’s first birthday

43
Q

Turner’s Syndrome definition, sx, dx, tx

A

Group of X chromosome abnormalities characterized by females w/ an absent or nonfunctional X sex chromosome

PATHO:
*45,XO
*46,XX
*45,X/abnormal X
*46,XY

sx
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

PE:
*short stature, webbed neck, prominent ears
*low posterior headline, broad chest w/ widely spaces nipples
*short fourth metacarpals, high-arched palate, nail dysplasia
*congenital lymphedema in neonates

Cardiovascular: coarctation of the aorta, MVP, bicuspid aortic valves, aortic dissection, HTN

Renal: congenital abnormalities (horseshoe kidney), hydronephrosis

Endocrine: osteoporosis, hypothyroidism, DM, dyslipidemias

GI: telangiectasias (may present w/ GI bleeding), IBD, colon cancer

dx
Karyotyping – definitive
↓ estrogen
↑ FSH & LH

tx
*recombinant human growth hormone replacement (may increase final height)
*estrogen/progesterone replacement to cause pubertal development

44
Q

Moro reflex

A

Hold infant supine and then drops head slightly but suddenly. infant should extend and abduct arms with palms open

45
Q

Asymmetric tonic neck reflex

A

infant lying supine, examiner rotates head to one side and infant extends leg to arm on side towards which head has been turned

46
Q

Palmar grasp

A

examiner places finger on infants palm and infant flexes fingers downward to grasp finger

47
Q

rooting

A

examiner strokes infants cheek and infant turns head towards side stroked and makes suckling motions

48
Q

parachute

A

infant held upright with back to examiner. body rotated quickly forward. infant reflexively extends the upper extremities towards the ground as if to break a fall

Peds Rotation PA-S2 (12 decks)

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