Neuro/Development Flashcards
Lift head
2 months
same time as social smile
Roll over
4 months
Sit up
6 months (same time as stranger danger)
Walk
1 years
same time as separation anxiety
Root reflex
corner of mouth is touched –> baby turns head
Sucking reflex
roof of babies mouth is touched –> baby begin to suck
Moro reflex
aka “startle reflex” –> baby throws head back, extends out arms/legs –> cries –> then pulls arms/legs back in
lasts until 5/6 months of age
Tonic Neck Reflex
babys head is turned to one side arm on that side extends opposite arm bends at the elbow "fencing position" lasts until 6/7 months of age
Grasp reflex
stroke palmar side of hand –> baby closes fingers in a grasp
lasts until 5/6 months of age
Babinski
stroke sole of foot (plantar) –> big toe bends backwards while rest of toes fan out
Meningitis is most commonly caused by?
encapsulated organisms - invade through upper airways and get into subarachnoid space
Neonates: E. Coli, Group B strep
Children/Adults: S. Pneumoniae
What is the treatment for meningitis in neonates?
Cefotaxime + Ampicillin
What is the treatment for meningitis in Children?
ceftriaxone + Vancomycin
Kernig sign
pt is supine, flexion of neck causes flexion of the hips
POSITIVE: flexion of the hips and the knees
K for Kick
Brudzinski’s sign
pt is supine, knee and hip are flexed to 90 degrees and then an attempt to extend the knee is made
POSITIVE: pain in neck or back
How can you tell if an infant has meningitis?
bulging fontanelles
toxic appearing
LP for bacterial meningitis?
HIGH proteins
LOW glucose
be sure to do a CT before LP to prevent herniation
What is the tx for meningitis?
ceftriaxone or cefotaxime x 10 days
for neonates: must give ampilicillin to cover listeria and group B strep x 2-3 weeks
What defines a simple febrile seizure?
tonic clonic attack associated with fever than doesnt last for more than 15 minutes and doesnt recur within 24 hours
What defines a complex febrile seizure?
> 15 minutes, focal, or recurs within 24 hours (basically an atypical simple febrile seizure)
When are febrile seizures most common?
6-60months (less than 5 yo, RARE to have febrile seizures greater than 5 yo)
temps higher than 38C
What is the workup for febrile seizures?
for complex febrile seizures: CT scan, LP, +/-EEG
What is the first line treatment for absence seizures?
Ethosuximide
What is the cause of cerebral palsy?
perinatal injury to the nervous system that results in motor spasticity
What is the first line treatment for tics?
clonidine or BZs
What is the rule on concussions for kids playing sports?
after the 3rd concussion, they should terminate the season and return next season
immediate tx:
physical rest between 24-28 hours - then graduate return to play
What is the MC sx of concussion?
HA
Turner syndrome
XO - absence of all or part of 2nd chromosome
nondisjunction (not inherited)
How do pts with Turner syndrome present?
webbed neck low set ears and lower hairline wide spaced nipples hip dysplacia horseshoe kidney short stature primary amenorrhea
What is the tx for Turner syndrome?
GH for short stature
Estrogen and progesterone for secondary sex characteristics
What is the most common syndromic for of obesity?
Prader-Willi Syndrome
caused by absence of expression of long arm of chromosome 15
How do pts with Prader-Willi Syndrome present?
prenatal: breech positioning, polyhramnios, reduced fetal activity
neonate: poor suck, failure to thrive, cryptorchidism
learning difficulties
food-seeking behaviors (hence obesity association)
When do pts get tested for Prader-Willi Syndrome?
if they are between 2-6yo and have a hx of poor suck with global developmental delay
How do pts with fetal alcohol syndrome present?
growth deficiency (length, weight, and head circumference) facial abnormalities --> short palpebral fissure, epicanthal folds, maxillary hypoplasia, micrognathia, a thin smooth upper lip mental and developmental delays
Trisomy 21
Down’s syndrome
MC d/t nondisjunction (failure of one or more pairs of homologous chromosomes or sister chromatids to separate normally during nuclear division)
What is the MC chromosomal abnormality affecting children?
Down’s Syndrome
Brushfield spots
speckling on the iris
seen in down’s syndrome
What are some complications/associations to down’s syndrome?
cardiac anomaly (tetraology of fallot) primary congenital hypothyroidism SNHL opthalmologic disorders late hip dislocations
What is neurofibromatosis?
mutation on NF1 on chromosome 17
neurocutaneous disorder
MC in adolescence
these pts are at increase risk for optic nerve glioma (schwannomas), and soft tissue sarcomas
What is Guillain Barre Syndrome?
post-infectious polyneuropathy
MC associated with campylobacter jejuni, EBV, and CMV
How does Guillian Barre Syndrome present?
weakness in the LEs that ascends to the trunk
loss of tendon reflexes
What would an LP show on a pt with Guillain Barre Syndrome?
elevated protein level, typically 2x the upper limit of normal
normal WBC
What is the treatment for Guillain Barre Syndrome?
plasmapheresis or IVIG
What is the path behind myasthenia gravis?
auto antibodies to acetylcholine receptors
What are the first clinical signs of MG?
ptosis or extraocular muscle weakness
sxs usually increase throughout the day
What is the dx for MG?
Tensilon test - admin of edrophonium chloride causes immediate improvement of eye sxs
in infants: neostigmine is used instead of edrophonium chloride d/t risk of cardiac dysrhythmias
How is MG tx?
cholinesterase inhibitors - pyridostigmine (first line)
others: IVIG, plasmapheresis
Thymectomy can be used in refractory cases
