Neuro/Behavioral Flashcards
Wessels rule of three?
Colic definition
Crying >3h/d
Crying >3d/w
Crying >3w
Crying by age
1st 2wk - cries little
6w - 3hr/day
12w - 1/d
M-Chat is used to screen what? When?
Autism 18-24mo
Cerebral palsy is?
Non-progressive motor impairment due to brain anomalies/lesions before/after birth
Hemiparesis is?
Unilateral Arm/Leg (AKA - hemiplegia)
Diplegia is?
Motor impairment of legs (+- limited arms)
6 types of Cerebral palsy?
Spastic Dyskinetic Dystonic Choreathetotic Ataxic Mixed Cerebral Palsy
MC cerebral palsy?
Spastic Cerebral palsy
Spastic Cerebral palsy affects? what area of the brain?
Pyramidal
Extrapyramidal defects of the brain cause what types of cerebral palsy?
Dyskinetic (Dystonic or Choreathetotic)
Ataxic
Spastic Cerebral palsy is due to?
Injury to UMN of pyramidal tract
Spastic Cerebral palsy criteria?
At least 2/3
- ABNL movement
- Increased tone
- Pathologic reflexes
Neonates w/ spastic Cerebral palsy often present as?
Hypotonic w/ brisk reflexes
Toddlers w/ spastic Cerebral palsy often present as?
Muscular hypertonicity (contractures)
Hyperactive DTRs
Scissor gait/toe walking
Clinical features of Cerebral palsy?
Basal ganglia involvement
ABNL - involuntary, uncontrolled, recurring movements
-(Athetoid/choreiform, INC w/ stress - gone w/ sleep)
Facial grimacing - dysarthria
Dyskinetic Cerebral palsy - Athetosis general hand position?
A-town down/gang
Dyskinetic Cerebral palsy - Chorea general hand position?
Extended up (stop hand)
Mixed Cerebral palsy indicates?
More than one type of motor pattern present
Ass/w sensory deficits, seizures, cog impairments
Ataxic Cerebral palsy is?
Cerebellar injury - ABNL posture/movement - loss coordination of muscles
Dystonic Cerebral palsy is?
Reduced activity and stiff movement
hypokinesia - hypotonia
Choreoathetotic Cerebral palsy is?
Due to hyperbilirubinemia - increased stormy movements (Hyperkinesia) and Hypotonia
Dx of Cerebral palsy?
Developmental delay w/ UMN signs Persistent infantile reflexes Asymmetric motor activity (Hand dominance <12mo) Labs - UA - organic acids Rad - Brain CT/MRI and EEG
Signs of UMN issues?
Brisk DTRs
Spasticity
Cerebral palsy is ass/w what other d/o?
MR and seizures mostly
- sensory defects
- ADHD
- GERD
Cerebral palsy TXT?
PT
Medical therapy (Decrease spasticity/co-morbids)
Surgical
Rx to TXT Cerebral palsy spasticity?
Botox
PO muscle relaxants
Intrathecal Baclofen
Surgical therapy of Cerebral palsy?
Dorsal Rhizotomy (cut L5-S1 nerve roots) (incontinence) Selective osteotomies (reduce hip-dislocation) Superior-medial cortex implant (decrease brain activity)
Best factor of good prognosis of Cerebral palsy?
Nl mental fx
Dx of ADHD?
Several S/S present <12yo
<16yo - >6 S/S
>17yo - >5 S/S
At least 6mo in 2 or more environments
NEPI-Reup inhibitor used for ADHD?
Atomoxetine (Strattera)
Oppositional vs Conduct d/o?
Oppositional - Irritable, argumentative, vindictive
Conduct - Basic rights of others/norms violated
Sleep length of PEDs?
Infants - 16-18h
1yo - 10-11h/d AND nap 2-3h/d
12yo - 9-10yo
Behavioral insomnia types?
Sleep-onset - (Infants/young) change in conditions than when child fell asleep causes insomnia
Limit-setting - (preschool/older) Bedtime resisance
Parasomnias occurs in what stage of sleep?
NREM
MC pop of parasomnias?
Preschool children
Types of parasomnias?
Sleep walking
Sleep/night terrors
Confusional arousals
Difference between nightmare, night terror, confusion arousal?
Nightmares - Later in the night (REM) - remembers
Night terror - Abrupt loud scream, Doesn’t remember
Confusion arousal - Like night terror, but less dramatic but longer
Can someone have parasomnia w/ nightmares that child remembers?
No - nightmares occur in REM, Night terrors occur in NREM
What is circadian rhythm d/o?
Inability to arouse in AM, cognition/emotional issues
MC of adolescence
Anorexia Nervosa presents as?
Wgt loss Lanugo/alopecia Brady-C Osteopenia Amenorrhea
Standout clues of Anorexia Nervosa
Restriction of calories unnecessarily
Self perception disturbance
Fear of wgt gain + behavior cause of it (diet, purge, PT)
Dx criteria of Anorexia Nervosa?
<85% body weight due to wgt loss
Intenst fear
Denial of seriousness
Amenorrhea
TXT of Anorexia Nervosa?
1st step - feeding program
Admit PRN
Bulimia Nervosa is?
Binge eating episodes of - LRG quantites - Rapid consumption - Followed by vomiting Metabolic d/o due to excess vomiting/laxative/diuretics
Differences between Bulimia Nervosa and Anorexia Nervosa?
Bulimia Nervosa
- Slightly over wgt
- Enamel erosion / hand scrapes
- Abuse laxatives/diuretics
Anorexia Nervosa
- Under-wgt!
- Calorie/exercise programs
TXT of Bulimia Nervosa?
Nutrition, education, monitoring
Antidepressants
Electrolytes affected by Eating d/o’s?
Hypokalemia
Hypochloremia
(Alkalosis)
Female athlete triad is?
Eating D/O
Menstrual dysfx
Osteoporosis
Pathophys of female athlete triad?
Too much exercise vs calories > Malnutrition > Body fat % is low > Shuts down HPA > Menstrual dysfx / osteoporosis
Eval of Female athlete triad?
HCG,
Labs (CBC, TSH, ESR, CMP, FSH/LH, PRL)
XR - femur, hip, spine
DEXA scan
TXT of Female athlete triad?
PO OCP - restore menstruation Nutrition Lifestyle - decrease exercise WGT # is NOT a goal Supplement - Ca2, K+, Vit D
What is the only approved Rx to TXT child depression?
Fluoxetine
