Neuro Dysfunction of the Child

Question 1

if the pupils are dilated 5+ what does this indicate

Answer 1

brain stem damage

Question 2

if pt has sudden appearance of fixed/dilated pupils what should be done

Answer 2

stay with pt and hit call light immediately

Question 3

pull to the core

dysfunction of cerebral cortex or lesions above brainstem

Answer 3

decorticate (flexion)

Question 4

majority of difference is in arms
dysfunction at midbrain or lesions to brainstem
last sign before brain deterioration

Answer 4

decerebrate (extension)

Question 5

CM of ICP

Answer 5

HA
vomiting
personality changes
irritability
fatigue
Infants: tense, bulginf fontanel
separated sutures
high pitch cry
increased FOC
distended scalp veins
setting sun sign

Question 6

what is late sign of ICP

Answer 6

bradycardia

Question 7

what is normal ICP

Answer 7

<15

Question 8

what medication reduces ICP by promoting rapid excretion of Na by the kidneys and works within 1-5 min

Answer 8

mannitol

Question 9

how should you care for an increased ICP pt

Answer 9

HOB up (at least 30)
pain control
minimal stimulaiton
suctioning contraindicated
generally need cooling blanket
stool softeners

Question 10

what are halmarks of concussion

Answer 10

confusion and amnesia

Question 11

if there is a basilar skull fracture what should you NOT do

Answer 11

do NOT place NGT you can do OGT instead

Question 12

what are s/s of basilar skull fx

Answer 12

sub q bleeding in posterior neck
raccoon eyes
blood around tympanic membrane
clear CSF draining from nose or ear

Question 13

blood accumulates between dura and skull

Answer 13

epidural hemorrhage

Question 14

bleeding between dura and cerebrum

Answer 14

subdural hemorrhage

Question 15

inflammation of the membranes covering the brain and spinal cord (medical emergency)

Answer 15

bacterial meningitis

Question 16

what is a sign specific to bacterial meningitis

Answer 16

nuchal rigidity
kerning sign- flex the knee and try to extend
brudzinski sign- flex head and knee or hips flex

Question 17

where is a lumbar puncture done

Answer 17

L3-L5

Question 18

decreased glucose
positive gram stain
turbid or cloudy urine

Answer 18

bacterial meningitis

Question 19

normal glucose
negative gram stain
clear urine

Answer 19

viral meningitis

Question 20

how can meningitis be prevented

Answer 20

Hib vaccine

Question 21

inflammatory process of the CNS resulting in inflammation of the brain

Answer 21

encephalitis

Question 22

what typically causes encephalitis

Answer 22

virus

Question 23

if encephalitis caused by herpes simplex virus what medication is given

Answer 23

acyclovir

Question 24

what is the cardinal sign a child has rabies

Answer 24

hydrophobia= attempts at swallowing cause spasm of pharynx, neck, and diaphragm

Question 25

if a child has rabies how many immunizations will they receive within 28 days

Answer 25

6

Question 26

when a pt gets bit by rabid animal, why is suturing avoided

Answer 26

because you don’t want to enclose it inside body (clean with soap and water)

Question 27

a NON progressive disorder of muscle control or coordination

Answer 27

cerebral palsy

Question 28

is there a cure for cerebral palsy

Answer 28

no it is permanent

Question 29

acute demyelination with a progressive, usually ascending flaccid paralysis

Answer 29

guillian barre syndrome

Question 30

what is the hallmark symptom of guillan barre

Answer 30

acute peripheral motor weakness (paralysis usually occurs 10 days after nonspecific viral infection)