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Phase 2 PEDs > Neuro > Flashcards

Neuro Flashcards

1
Q

Gower sign is?

A

Arises from floor by pulling on legs and body to get up

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2
Q

Pronator drift is?

A

Weaker hand - cups and supinates

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3
Q

Muscle fasciculations are?

A

Denervation from anterior horn cell or peripheral nerve disease.

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4
Q

LMN and Cerebellar lesions will affect tone how?

A

Hypotonia

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5
Q

UMN lesions will affect tone how?

A

Hypertonia - Spasticity

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6
Q

Extrapyramidal disease affects tone how?

A

Rigidity - resistance through ROM

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7
Q

Dysfx of cerebellar pathways will affect coordination how?

A

Ataxia, Intention tremor, Dysmetria (cant judge distance)

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8
Q

Cerebellar dysx affects gait how?

A

Broad-based, unsteady gait, that cant turn

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9
Q

Corticospinal tract dysfx affects gait how?

A

Stiff, scissoring gait and TOE walking

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10
Q

Extrapyramidal dysfx affects gait how?

A

Slow, Stiff, SHUFFLING gait w/ dystonic postures

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11
Q

LMN or neuromuscular d/o affects gait how?

A

Waddling gait w/ hip weakness.

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12
Q

LMN dz affects DTRs how?

A

Decreased DTRs

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13
Q

UMN dz affects DTRs how?

A

Increased DTRs

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14
Q

Corticospinal tract dysfx affects DTRs how?

A

Babinski response OR extensor plantar reflex

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15
Q

REDFLAGS of HAs?

A 
Worst HA of my life - SAH
AM HA - Tumor
Pain wakes child at night
Chronic progressive HA (Most ominous)
ABD/Focal neuro exam 
Changes w/ positioning - Pseudotumor cerebri
Recurrent vomiting
No family Hx
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16
Q

Worst HA of my life may indicate?

A

SAH

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17
Q

AM HA may indicate?

A

Tumor

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18
Q

Most ominous HA pattern?

A

Chronic progression

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19
Q

REDFLAGs of HA that overlap w/ migraines?

A

Changes w/ position

Recurrent vomiting

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20
Q

MC recurrent HA pattern?

A

Tension HA

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21
Q

Tension HA attributes?

A

Mild - lack S/S - Not disruptive
PAIN = global, squeezing/pressing
LASTS - Hrs to days
W/OUT - N/V, phonophobia/photophobia

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22
Q

Migraine HA attributes?

A 
Frontal, Bitemporal, Unilateral
PAIN - Mod/sev = Pounding/throbbing
LASTS - 1-72hr
Aggravated by activity and has AURA (15-30m)
W/ - N/V, Photo/Phono-phobia, pallor
Wants to seek dark quiet room to rest
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23
Q

Auras are experienced as?

A

Visual - Spots, flashes, flickering lines of light

Atypical - Perioral numbness, vertigo, unilateral weak

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24
Q

2ndy reasons for HAs?

A 
Head trauma
Viral illness
Sinusitis
Rx overuse
Serious causes (increased ICP)
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25
Q

Causes of Increased ICP?

A

Masses, intrinsic increase of pressure

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26
Q

Increased ICP HAs attributes?

A 
Worse HA w/ vomiting upon - lying down, 1st AM
Wakens child at night
Goes away standing up
Worse w/ coughing/Valsalva/stooping
Papilledema or Neuro deficits
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27
Q

What study checks for Intracranial bleeding?

A

Head CT

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28
Q

What study checks for posterior fossa lesions or subtle ABNLs concerning HAs?

A

MRI +- gadolinium contrast (SOC)

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29
Q

Basic HA TXT?

A

Lifestyle mods

NSAIDs/APAP

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30
Q

Migraine TXT?

A

1L - NSAIDS/APAP
2L - Triptans (Sumatriptan/Imitrex) Serotonin ag
Antiemetics
- Odansetron, Metoclopramide, Promethazine

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31
Q

CI to triptan therapy for migraines?

A

Focal neuro deficits w/ migraines

Basilar migraine signs > Syncope occurs = Stroke risk

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32
Q

Migraine prophylaxis considered if?

A

> 1 disabling HA/wk

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33
Q

Migraine prophylaxis Rx?

A 
BB - propranolol (CI - asthmatic/DM)
TCA
Anticonvulsants (Valproic acid/topiramate)
CCB
AH - Cyproheptadine
SSRI - Fluoxetine
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34
Q

Types of seizures?

A
  1. Generalized (begins diffusely)
    - (Tonic/clonic - Grand mal OR Absence - Petit mal)
  2. Febrile seizure (type of generalized)
  3. Partial (begins focally)
    - (Simple - no altered consciousness)
    - (Complex -Altered consciousness)
  4. Status epilepticus (neuro emergency)
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35
Q

Simple partial seizure attributes?

A

Consciousness preserved

- Starts at specific anatomic focus +- spread

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36
Q

Simple partial seizure S/S?

A

Motor - Tonic/Clonic/myoclonic

Sensory, psychic, autonomic ABNLs

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37
Q

Complex partial seizure attributes?

A

Consciousness altered
- Starts at specific anatomic focus +- spread
Spread to whole brain = 2ndy generalized
Spread - Face to arm to leg = Jacksonian March
+- staring or automatisms

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38
Q

Types of generalized seizures?

A

Tonic-Clonic - Grand mal

Absence - Petit mal

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39
Q

Generalized - Tonic clonic seizure attributes?

A

Grand Mal seizure

  • Tonic - Brief cry, Fall, LOC
  • Clonic - Spastic, Rhythmic, symmetric shaking
  • Postictal - Gradual return of consciousness
  • EEG - NL when not seizing
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40
Q

Generalized Absence seizure - attributes?

A

Petit Mal

  • Begins 4-6yo
  • Short <15s blank stares and loss of awareness
  • +- lip smacking/eye fluttering
  • NO post-ictal state
  • EEG - 3hz spike and wave activity
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41
Q

TXT Generalized Absence seizure w/?

A

Petit Mal

- Ethosuximide or Valproic Acid

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42
Q

What is a neurological emergency w/ ongoing seizures?

A

Status Epilepticus

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43
Q

Status epilepticus is?

A

Ongoing seizure activity or repetitive seizures w/out return of LOC for >30m

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44
Q

TXT of status epilepticus?

A

ABC, EKG, O2/SO2 monitoring, IV
Labs- CMP, CBC, GLU Anticonvulsant Rx, Toxicology
Rx

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45
Q

Rx TXT of status epilepticus?

A

Diazepam or Lorazepam - Rapid/short

Midazolam - IV/Rectal

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46
Q

Seizure eval req?

A

Febrile - r/o meningitis, encephalitis, brain abscess
Focal neuro S/S or Papilledema - CT before LP
CT - acute/blood in brain
MRI - subacute/brain lesions

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47
Q

Why CT before LP in a pt w/ seizures + focal neuro S/S or papilledema?

A

LP in a pt w/ ICP = herniation through foramen magnum

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48
Q

MRI is a study for what concerning neurology?

A

Brain lesions

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49
Q

What study is best for detecting brain bleeds?

A

CT

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50
Q

MC cause of seizures between 6mo-6yo?

A

Febrile seizures

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51
Q

Simple febrile seizure attributes?

A

Onset is generalized <15m occurring once/24h

  • good prognosis - no relative complications
  • No neuro Hx
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52
Q

Complex/atypical febrile seizure attributes?

A

Onset is focal >15m reoccurring w/in 24h
OR
Child has preexisting neuro Hx

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53
Q

Febrile seizure Mgmt?

A

Typically None - benign

+- rectal diazepam (prolonged or Hx of prolonged)

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54
Q

Sites where pathology for weakness/hypotonia occurs?

A

Anterior Horn cells
Peripheral nerves
NMJ
Muscle tissue

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55
Q

Conditions causing weakness/hypotonia at the Anterior Horn cells?

A

Spinal Muscular atrophy

Polio

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56
Q

Conditions causing weakness/hypotonia at the Peripheral Nerves?

A

Guillain-Barre syndrome
Charcot-Marie-tooth disease
Tick paralysis

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57
Q

Conditions causing weakness/hypotonia at the NMJ?

A

Myasthenia Gravis

Botulism

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58
Q

Conditions causing weakness/hypotonia at the muscular tissue?

A

Muscular dystophies

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59
Q

UMN destruction causes?

A

Loss of voluntary control - BUT not loss of movement

  • Mild dysfx (slow/stiff motions)
  • Severe dysfx (Stiff/ABNL postures/spastic)
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60
Q

Severe UMN destruction pt posture will be in what position?

A

Forearm flexed at elbow,
Wrist adduction to chest,
Leg extension and adduction

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61
Q

LMN destruction causes?

A

Absence of movement/Complete paralysis + hypotonia

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62
Q

LMN is common pathway for?

A

Muscle activity - Destruction = paralysis

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63
Q

Does LMN have abnormal posturing?

A

NO - paralyzed - progressive weakness/hypotonia

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64
Q

UMN is ass/w what pathway?

A

Corticospinal tract

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65
Q

LMN is ass/w what pathway?

A

Neuromuscular junctions

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66
Q

UMN lesions tone/DTR/Babinski?

A

Tone - Increased
DTR - Increased
Babinski - Present

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67
Q

LMN lesions tone/DTR/Babinski?

A

Tone - Decreased
DTR - Decreased
Babinski - Absent

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68
Q

Spinal muscular atrophy (SMA) pathology is at what site?

A

Anterior horn cells (degeneration)

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69
Q

Types of Spinal muscular atrophy?

A

Types
I - Wernig-Hoffman Dz
II - Kugelberg-Welander syndrome
III - Juvenile form

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70
Q

MC Spinal muscular atrophy type?

A

Type II - Kugelberg-Welander syndrome

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71
Q

Spinal muscular atrophy - Type I attributes?

A

Wernig-Hoffman Dz

  • Severe infantile form
  • die w/in 2y
72
Q

Spinal muscular atrophy - Type II attributes?

A

Kugelberg-Welander syndrome

  • Late infantile
  • Slower than type I
  • Survive to adulthood
73
Q

Spinal muscular atrophy - Type III attributes?

A

Juvenile

  • Chronic
  • NL life
74
Q

Spinal muscular atrophy is?

A

Progressive anterior horn cell degeneration

75
Q

Clinical features of Spinal muscular atrophy?

A

Tongue fasciculations - Esp. sleeping
Proximal atrophy/weakness = progressive
Floppiness - decreased movement
Absent DTR

76
Q

TXT of Spinal muscular atrophy?

A

None - PVT respiratory infection/support

77
Q

Poliomyelitis pathology occurs at what site?

A

Anterior horn cells - destroyed in spinal cord

78
Q

Poliomyelitis is due to?

A

A2M transmission of the poliovirus

79
Q

Clinical features of Poliomyelitis?

A

Fever, Malaise, HA, URI s/s, N/V/D, myalgias
Meningeal signs
Prodrome > flaccid paralysis 3-8d after S/S

80
Q

What is VAPP?

A

OPV - Vaccine associated paralytic poliomyelitis (No longer used)
USA - IPV used only

81
Q

Guillain-Barre Syndrome pathology affects what site?

A

Peripheral nerves

82
Q

Guillain-Barre Syndrome is?

A

Acute inflammatory demyelinating polyradiculoneuropathy.

83
Q

MC cause of acute flaccid paralysis is PEDs?

A

Guillain-Barre Syndrome

84
Q

Guillain-Barre Syndrome is due to?

A

Post infectious autoimmune peripheral neuropathy

respiratory/GI infection - Mycoplasma pneumonia or Campylobacter Jejuni

85
Q

Guillain-Barre Syndrome clinical features?

A

Absent Reflexes
Symmetrical ASCENDING weakness (hrs-wks)
Hand/feet paresthesia
Bulbar/respiratory weakness - progressed

86
Q

Mgmt of Guillain-Barre Syndrome?

A

Admit for observation +- respiratory support
IVIG, Plasma exchange, Immunosuppressive Rx
Resolution - 1yr

87
Q

Charcot-Marie-Tooth Dz pathology is at what site?

A

Group of Peripheral nerve diseases

88
Q

What pathway is affected 1st w/ Charcot-Marie-Tooth Dz?

A

Motor > sensation or autonomic

89
Q

MC type of Charcot-Marie-Tooth Dz?

A

Type 1A

90
Q

Clinical features of Charcot-Marie-Tooth Dz?

A

Ankle weakness/frequent tripping
PES CAVUS deformity (high arched feet)
Slow progression

91
Q

Earliest nerves affected by Charcot-Marie-Tooth Dz?

A

Peroneal and tibial nerves

92
Q

TXT of Charcot-Marie-Tooth Dz?

A

Support - foot bracing

PT

93
Q

Tick paralysis is clinically similar to what neuro disease?

A

GBS

94
Q

What does tick saliva do?

A

Blocks NM transmission causing acute motor neuron weakness

95
Q

Clinical features of Tick paralysis?

A

Severe generalized flaccid weakness

- including ocular, papillary, bulbar paralysis

96
Q

TXT of Tick paralysis?

A

Find/remove tick > motor fx returns

97
Q

Myasthenia gravis is ass/w what pathologic site?

A

NMJ

98
Q

Myasthenia gravis is?

A

Autoimmune - ABs block ACh Receptors at NMJ causing rapid muscle fatigue

99
Q

Childhood types of Myasthenia gravis?

A

Juvenile Myasthenia gravis
Transient neonatal Myasthenia gravis
Congenital Myasthenia gravis

100
Q

Transient neonatal Myasthenia gravis is due to?

A

Neonates born to mothers w/ Myasthenia gravis and have maternal anti-AChR

101
Q

Congenital Myasthenia gravis is?

A

genetic mutations of NMJ (NO autoimmunity)

102
Q

Myasthenia gravis presents as?

A

Ptosis, Diplopia, ophthalmoplegia

Extremity, Neck, face, jaw - weakness

103
Q

Myasthenia gravis is dx how?

A 
Tensilon test (Edrophonium) = ACh inhibitor
- POS= temporary improvement in strength
104
Q

TXT of Myasthenia gravis?

A

ACh inhibitors - Pyridostigmine
Thymectomy - Reduce AB burden
PO CCS or Immunosuppressive
Severe - plasma exchange/respiratory support

105
Q

Botulism is due to?

A

Clostridium botulinum - neurotoxin

106
Q

PVT of infantile botulism?

A

No honey/canned food <1yo

107
Q

Botulism presents as?

A 
1st signs - Constipation/poor suck/feed
Hypotonia/weak
Decreased Gag reflex, Eye movements, Pupil contract
Ptosis
Respiratory difficulty
108
Q

Botulism pathology site?

A

NMJ

109
Q

Types of muscular dystrophies?

A

Duchenne Muscular dystrophy

Becker Muscular dystrophy (milder than Duchenne)

110
Q

What is Muscular dystrophy?

A

Lack of dystophin production - Genetic muscle diseases causing progressive myofiber degeneration and fibrotic tissue formation.

111
Q

Duchenne Muscular dystrophy attributes?

A

X-linked
Dystrophin gene mutation
Asymptomatic in infancy
Delayed motor milestones

112
Q

Duchenne Muscular dystrophy presents as?

A 
2-3yo w/ awkward gait or cant run
Gait is hyperlordotic/waddling
Proximal leg weakness
Clumsy, easily fatigued, weak muscles
Pseudohypertrophy of calves
Arm weakness by 6yo
Wheelchair bound 12yo
Ass/w Gower sign
113
Q

Gower sign is ass/w what neuro condition?

A

Duchenne Muscular dystrophy

114
Q

Why is Duchenne Muscular dystrophy ass/w Pseudohypertrohic calves?

A

Atrophy of thighs

115
Q

Prader-willi syndrome is?

A

Severe neonatal hypotonia due to deletion of paternal Chromo 15q11q13

116
Q

Prader-willi syndrome presents as?

A

Feeding problems > FTT
Small hands/feet
Boys - Small penis/testicles or cryptorchidism
Early childhood - obesity/hyperphagia

117
Q

Weakness eval req?

A

Muscle enzymes
CSF
Muscle Bx
DNA blood test

118
Q

What test is Dx for muscular dystrophy?

A

Muscle Bx

119
Q

ABNL CSF results will point to what weakness d/o?

A

Polio or GBS

120
Q

What muscle enzyme is elvated for muscular dystrophy?

A

CK elevated

121
Q

MC symptom of concussion?

A

HA

122
Q

Concussion is?

A

TBI resulting in rapid onset of short lived neuro impairment

123
Q

Retrograde amnesia is?

A

Inability to recall events leading up to trauma

124
Q

Anterograde amnesia is?

A

Cant form new memories after trauma

125
Q

Second impact syndrome is?

A

Acute - sometimes fatal brain edema (increased ICP) when 2nd concussion occurs before 1st concussion heals fully.

126
Q

RFs for concussion?

A 
Artificial turf
Football/Rugby
Females playing - soccer/basketball
BMI >27
Training <3hr/wk
127
Q

RFs for recurrent concussion?

A

Hx of Concussion
Longer playing time
QB for football
1st 10d after a Concussion occured

128
Q

Concussion SOC?

A

CT - Normal if a Concussion only (used to r/o)

129
Q

Seizures ass/w Concussions are Benign or Pathologic?

A

If seizure occurs

  • at time of injury - Good prognosis
  • W/in 7d - Good prognosis
  • After 7d - glial scarring > lead to epilepsy
130
Q

When can a Concussion lead to epilepsy?

A

After 7d s/p Concussion pt has seizures = glial scarring

131
Q

A Concussion symptoms usually last how long?

A

<72h

132
Q

Most Concussion resolve how long?

A

7-10d

133
Q

Protocol for returning back to sports?

A

Stepwise Q/24h
Day 1 - No activity - rest
Day 2 - Light aerobic exercise - no resistance pt
Day 3 - Sport specific exercise
Day 4 - Noncontact drills - resistance training
Day 5 - Full contact practice after medically cleared
Day 6 - Gameplay

134
Q

Epidural Hemorrhage attributes

A

ONSET - mins-hrs
CT - Lens-shaped/football bleed compressing brain
TXT - Surgical evac/monitor

135
Q

Epidural Hemorrhage S/S?

A

Lucid interval w/ progressive neurologic deficits

136
Q

Subdural Hemorrhage attributes?

A

ONSET - Hrs
CT - Crescent shape bleed compressing brain
TXT - surgical evac

137
Q

Subdual Hemorrhage S/S?

A

Focal neuro deficits

138
Q

Intraparenchymal Hemorrhage attributes?

A

Bleeding inside the brain tissue

139
Q

Intraparenchymal Hemorrhage S/S?

A

Depressed consciousness
Focal neurologic deficits
+- multiple other contusions

140
Q

TXT of Intraparenchymal hemorrhage?

A

Supportive only

141
Q

Subarachnoid Hemorrhage S/S?

A

Stiff neck
Worst HA of life
Late hydrocephalus

142
Q

TXT of Subarachnoid Hemorrhage?

A

Supportive

143
Q

What brain Hemorrhages have best prognosis?

A

Epidural

Subdural

144
Q

4 types of neurocutaneous d/o’s?

A

Neurofibromatosis
Tuberous sclerosis
Sturge-Weber syndrome
Arnold-Chiari Malformation

145
Q

Types of Neurofibromatosis?

A

Type 1 - (Von Recklinghausen disease)

Type 2 - (Rarer)

146
Q

What is the genetic etiology of Neurofibromatosis Type 1?

A

Autosomal dominate mutation on chromo 17 on NF1 gene (neurofibromin) - BUT can occur w/ spontaneous mutation

147
Q

NF1 gene codes for?

A

Neurofibromin

148
Q

Neurofibromas are?

A

Schwann cells that develop into dome shaped papules

149
Q

Cardinal features of Neurofibromatosis Type 1?

A

Café au lait spots
Axillary/inguinal freckles
Cutaneous neurofibromas
Lisch nodules (iris hamartomas)

150
Q

Dx of Neurofibromatosis type 1 requires?

A

> 1 of

  • Café au lait spots (>5 or >5mm size)
  • Axillary/inguinal freckles
  • 2+ Cutaneous neurofibromas
  • 2+ Lisch nodules (iris hamartomas)
  • Optic gliomas
  • Family Hx of Neurofibromatosis
  • Osseous lesions
151
Q

What RAD is required of Neurofibromatosis?

A

Cranial imaging to r/o neoplasms

152
Q

MC cause of death in pts w/ Neurofibromatosis?

A

Malignancy

153
Q

Neurofibromatosis Type 2 genetic etiology?

A

AD mutation on Chromo 22 (NF2 gene- Merlin)

154
Q

NF2 gene codes for what?

A

Merlin

155
Q

Neurofibromatosis Type 2 is?

A

Intracranial/spinal tumors (schwannomas, meningimas, gliomas)

156
Q

Neurofibromatosis type 2 presents as?

A

Posterior capsular or cortical cataracts

Skin lesions - plaque like, Sub-q nodules, cutaneous schwannomas

157
Q

What is not found in Neurofibromatosis type 2?

A

Café au lait spots
Lisch nodules
axillary/inguinal freckling

158
Q

Tuberous sclerosis genetic etiology?

A

AD - mutation of

    • chromo 9 - TSC 1 gene - Hamartin
    • chromo 21 - TSC 2 gene - Tuberin
159
Q

Tuberous sclerosis is?

A

Hamartomas of brain, eyes, skin, kidneys, heart

160
Q

What does TSC 1 gene code for?

A

Hamartin

161
Q

What does TSC 2 gene code for?

A

Tuberin

162
Q

Cardinal features of Tuberous sclerosis?

A

Facial angiofibromas (ADENOMA SEBACEUM)
MR
Epilepsy
- Common cause for infantile spasms

163
Q

Tuberous sclerosis CNS manifestation?

A

Cerebral cortex TUBERS (dysplasia areas) = MR/epilepsy

164
Q

Tuberous sclerosis SKIN manifestation?

A

Adenoma sebaceum (sml red nodules - nose/cheek)
Ash leaf spots - Hypomelanotic macules
Shagreen patch - Raised, rough plaques (low back/ass)

165
Q

Tuberous sclerosis RENAL manifestation?

A

Renal angiomyolipomas - malignant transformation

166
Q

MC cause of death of adults w/ Tuberous sclerosis?

A

Renal angiomyolipomas

167
Q

Dx of Tuberous sclerosis?

A

XR, CT/MRI

Skin lesion Bx

168
Q

TXT of Tuberous sclerosis?

A

Support

Seizure Meds

169
Q

Sturge-Weber syndrome is?

A

ABNL leptomeningeal blood vessels(ANGIOMAS) overlay cerebral cortex

170
Q

Is Sturge-Weber syndrome inherited?

A

NO

171
Q

What is Sturge-Weber syndrome ass/w?

A
  • -Nevus flammeus - ipsilateral port-wine stain on face over ophthalmic division of trigeminal nerve
  • -Glaucoma
172
Q

Sturge-Weber syndrome presents as?

A

Seizures - (MC)

  • hemiparesis
  • Stroke like episodes
  • HA
  • MR
  • Learning disabilities
173
Q

TXT of Sturge-Weber syndrome?

A

Nevus Flammeus = laser surgery

Seizures = anticonvulsants

174
Q

Arnold-Chiari Malformation types?

A

Types
I - Cerenellar tonsils herniate through foramen magnum
II - Type 1 + Lumbar meningomyelocele
III - Type 1 + Occipital encephalocele

175
Q

Arnold-Chiari Malformation may present as?

A

Early life - asymptomatic

Later life - Ataxia and vertigo, Hydrocephalus (obstruct)

Phase 2 PEDs (23 decks)

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