Neuro Flashcards
Preventative measures, nutrition, fostering optimal development: birth/3-5 days
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
Preventative measures, nutrition, fostering optimal development: 2wks-1mo
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
Preventative measures, nutrition, fostering optimal development: 2 months
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
Preventative measures, nutrition, fostering optimal development: 4 months
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
Preventative measures, nutrition, fostering optimal development: 6 months
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
Preventative measures, nutrition, fostering optimal development: 9 months
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
Preventative measures, nutrition, fostering optimal development: 12 months
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
Preventative measures, nutrition, fostering optimal development: 15 months
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
Preventative measures, nutrition, fostering optimal development: 18 months
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
Preventative measures, nutrition, fostering optimal development: 2 years
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
Preventative measures, nutrition, fostering optimal development: 3 years
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
Preventative measures, nutrition, fostering optimal development: 4 years
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
Preventative measures, nutrition, fostering optimal development: 5 years
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
Preventative measures, nutrition, fostering optimal development: 6 years
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
Preventative measures, nutrition, fostering optimal development: 7-10 years
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
Preventative measures, nutrition, fostering optimal development: 11-13 years
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
Preventative measures, nutrition, fostering optimal development: 14-16 years
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
Preventative measures, nutrition, fostering optimal development: 17-21 years
Preventative Measures
Review/assess
Nutrition
Healthy diet for life
Fostering Optimal Development
College/employment
growth and development:
abstract reasoning, opposite sex friends, personality formation
Down Syndrome definition and causes
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)
Down Syndrome sx
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
Down Syndrome dx
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
Down Syndrome tx
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
When to give Hep B
3 total
at birth, 2 months, and between 6-18 months
When to give DTaP
5 total
2 months, 4 months, 6 months, 15-18, 4-6 yrs
When to give rotavirus vaccine
3 total
2 months, 4 months, 6 months
When to give Haemophilus B vaccine
4 total
2 mo, 4 mo, 6 mo, 12-15 mo
When to give PVC13
4 total
2 mo, 4 mo, 6 mo, 12-15 mo
When to give polio vaccine
4 total
2 mo, 4 mo, 6-18 mo, 4-6 yr
When to give MMR
2 total
12-15 mo, 4-6 yrs
When to give Varicella
2 total
12-15 mo, 4-6 yrs
When to give Hep A
2 dose series, 6 mo apart
between 12-23 mo
When to give TDaP
11-12 yrs
When to give HPV vaccine
11-12 yrs
When to give meningococcal vaccine
2 total
1-12 yrs and 16 yrs
Meningitis definition
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
Viral Meningitis definition, sx, dx, tx
*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
Bacterial Meningitis definition, sx, dx, tx
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)
Seizure Disorders types
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
Seizure Disorders focal vs generalized
Type I: Focal Seizures
- w/ Retained Awareness (Simple)
*no alteration in consciousness
*abnormal movements or sensations - w/ Loss of Awareness (Complex)
*altered consciousness, automatisms (lip-smacking)
*postictal state: confusion & loss of memory
Type II: Generalized Seizures
- Absence (Petit Mal)
*brief lapse of consciousness, staring episodes w/ pauses
*eyelid twitching, lip smacking; NO POSTICTAL - Atonic (Drop Attacks)
*sudden loss of muscle tone - Tonic
*extreme rigidity 🡪 LOC - Clonic
*repetitive rhythmic jerking; often associated w/ postictal state - Myoclonic
*sudden, brief, sporadic involuntary twitching - Tonic Clonic (Grand Mal): sudden LOC
*Tonic Phase: stiff & rigid 10-60sec
*Clonic Phase: generalized convulsions & limb jerking
*Postictal Phase: a confused state
Status Epilepticus defintion and tx
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)
Seizure Disorders dx and tx
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)
Teething definition, tx, routine dental care
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
Turner’s Syndrome definition, sx, dx, tx
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
Moro reflex
Hold infant supine and then drops head slightly but suddenly. infant should extend and abduct arms with palms open
Asymmetric tonic neck reflex
infant lying supine, examiner rotates head to one side and infant extends leg to arm on side towards which head has been turned
Palmar grasp
examiner places finger on infants palm and infant flexes fingers downward to grasp finger
rooting
examiner strokes infants cheek and infant turns head towards side stroked and makes suckling motions
parachute
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
