Neuro- Practice Q's! Flashcards
Which primitive reflexes are expected to disappear as the infant matures?
A) Babinski and blink reflex
B) Rooting and Moro reflex
C) Pincer and grasp reflex
D) Triceps and biceps reflex
Answer:** B) Rooting and Moro reflex
What is the expected head circumference of an infant at 9 months of age?
A) 40 cm
B) 42 cm
C) 45 cm
D) 50 cm
Answer:** C) 45 cm
What is the typical management approach for primary microcephaly?
A) Surgical intervention
B) Corticosteroid administration
C) Symptomatic care and support
D) Folic acid supplementation
Answer:** C) Symptomatic care and support
Craniosynostosis is correctly defined as:
A) Increased intracranial pressure due to excess fluid
B) Premature closure of the cranial sutures
C) Enlargement of head due to fluid accumulation
D) Undeveloped brain tissue
B) Premature closure of the cranial sutures
An 18-month-old child is expected to achieve which of the following motor milestones?
A) Walks with help
B) Sits independently
C) Runs and kicks a ball
D) Walks independently
Answer:** D) Walks independently
A common trigger for migraines, as per the provided information, is:
A) Bright blue light exposure
B) Sweetened beverages
C) High-stress environments
D) Lack of physical activity
Answer:** C) High-stress environments
Which of the following neurodiagnostic tests is used to measure the electrical activity of the brain?
A) MRI
B) EMG
C) EEG
D) Karyotype
Answer:** C) EEG
Macrocephaly in a child is defined as:
A) Head circumference less than two standard deviations of the mean for age
B) Head circumference more than two standard deviations of the mean for age
C) Head circumference at the mean for age
D) Frenquency of headaches in adolescence
Answer:** B) Head circumference more than two standard deviations of the mean for age
In assessing a child’s eye movements, the presence of nystagmus might indicate:
A) Normal physiological development
B) A possible neurological disorder
C) Enhanced visual acuity
D) Improved coordination in infants
Answer:** B) A possible neurological disorder
Which of the following developmental milestones is typically achieved by a child at 3 years of age?
A) Hops on one foot
B) Stands on one leg and jumps
C) Walks with help
D) Sits and places weight on legs
Answer:** B) Stands on one leg and jumps
What is the significance of performing a karyotype test in neurological assessment?
A) To determine cerebrospinal fluid composition
B) To identify chromosome abnormalities
C) To measure brain electrical activity
D) To assess metabolic enzyme function
Answer:** B) To identify chromosome abnormalities
When an infant displays disconjugate gaze, it suggests:
A) Normal coordination of both eyes
B) Unequal pupil size
C) Misalignment of the eyes, potentially indicating a neurological issue
D) Rapid blinking rate
Answer:** C) Misalignment of the eyes, potentially indicating a neurological issue
A female patient presents with headaches accompanied by nausea and light sensitivity. These symptoms are likely indicative of:
A) Tension-type headache
B) Sinus infection
C) Migraine
D) Cluster headache
*Answer:** C) Migraine
If the head circumference of a newborn is significantly smaller than the normal range for their age, what condition might this indicate?
A) Macrocephaly
B) Plagiocephaly
C) Microcephaly
D) Hydrocephalus
Answer:** C) Microcephaly
Which neurological test evaluates muscle response and function by measuring electrical activity?
A) Polysomnogram
B) Electroencephalogram (EEG)
C) Electromyography (EMG)
D) Magnetic Resonance Imaging (MRI)
*Answer:** C) Electromyography (EMG)
In the evaluation of infantile reflexes, the persistence of primitive reflexes beyond the expected age may indicate:
A) Advanced development
B) A potentially normal variation
C) Neurological dysfunction
D) Improved coordination
Answer: C) Neurological dysfunction
Case Study 1: Infant with Macrocephaly
Case:
A 6-month-old infant presents to the clinic with a head circumference measuring in the 98th percentile, while other developmental milestones seem appropriate for age. Parents note that both mom and dad have “big heads.” No signs of developmental delay or abnormal neurological findings are observed.
Questions:
1. What additional information should you gather from the infant’s history?
2. Which diagnostic test might be appropriate in this scenario, if any?
3. What is the potential diagnosis and plan of care for this infant?
Answers:
1. Gather a detailed family history focusing on head size, as well as any signs of neurological problems, developmental delays, or syndromes.
2. An ultrasound or MRI might be recommended if there were concerns for increased intracranial pressure (ICP) or developmental delays. However, given the familial history and no delay, observation might be appropriate.
3. The infant likely has familial macrocephaly. Monitor head circumference regularly and watch for signs of developmental delay or neurological symptoms.
Case Study 2: Child with Developmental Delay
Case:
Parents bring in their 18-month-old son who has not begun to walk independently. He can pull to stand and cruise along furniture. He also only says two words besides “mama” and “dada.”
Questions:
1. What assessments should you perform during the examination?
2. What could be the potential causes of these delays?
3. What referral or intervention might you consider?
Answers:
1. Assess muscle tone, reflexes (especially primitive reflexes), and overall neurological function. Take comprehensive developmental history and routine growth measurements.
2. Potential causes include neuromuscular disorders, genetic syndromes, or developmental disorders.
3. Referrals could include a developmental pediatrician or early intervention services for developmental evaluation. Physical therapy might be recommended.
Case Study 3: Headache in a Preschool-Aged Child
Case:
A 4-year-old girl is brought in with frequent headaches that her mother describes as focused on one side of her head, often accompanied by nausea and sensitivity to light.
Questions:
1. What are some differential diagnoses for her condition?
2. What history and physical examination aspects are important to address?
3. What initial management strategies and education should be considered?
Answers:
1. Differential diagnoses include migraine headaches, tension-type headaches, and other less common types like cluster headaches.
2. Explore detailed headache history (timing, duration, triggers), neurologic exam, family history of migraines or headaches, and vision assessments.
3. Initial management may include lifestyle adjustments, headache diaries to identify triggers, education on avoiding triggers, and possible referral to a neurologist for further evaluation. Medication might be considered under guidance if lifestyle measures fail.
Case Study 4: Infant with Craniosynostosis
Case:
During a routine checkup of a 4-month-old, your examination reveals an abnormal head shape, with a noticeable ridge running along one of the cranial sutures.
Questions:
1. What is the likely diagnosis based solely on physical exam findings?
2. What is the appropriate course of action for further evaluation and management?
3. How might this condition impact the infant’s neurodevelopment if untreated?
Answers:
1. Likely diagnosis is craniosynostosis, where a cranial suture has prematurely closed.
2. Refer for imaging (probably a CT scan) and surgical consultation for an evaluation. Early detection is crucial for planning potential surgical intervention.
3. If untreated, craniosynostosis can lead to increased ICP, affecting brain development, potentially causing neurodevelopmental delays, and needs to be addressed surgically.
Pediatric Migraines and Headaches
Question 1: What are common triggers for migraines in children?
Answer: Common migraine triggers include fever, stress, certain foods or additives, head injury, environmental factors, and inherited disorders.
When should neuroimaging be considered in a child with headaches?
Neuroimaging should be considered if the child presents with “red flags” such as an abnormal neurological exam, headache with vomiting without nausea, worst headache of their life, or a new type of headache pattern.
Describe the Tier 1 treatment for pediatric migraines?
Tier 1 treatment involves the use of analgesics such as Acetaminophen (15 mg/kg per dose), Ibuprofen (10 mg/kg per dose), or Naproxen (5 mg/kg per dose).
What lifestyle modifications can help manage headaches in children?
Answer:** Lifestyle modifications may include maintaining a regular sleep schedule, staying hydrated, eating balanced meals at regular intervals, reducing screen time, practicing relaxation techniques, and identifying and avoiding known headache triggers.
