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Neurology Flashcards

1
Q

[Neuro/NTD]

Types of neural tube defects? (3)

A
  1. Spina bifida
  2. Encephalocele
  3. Anencephaly
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2
Q

[Neuro/NTD]

3 forms of spina bifida

A
  1. Spina bifida occulta
  2. Meningocele
  3. Myelomeningocele
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3
Q

[Neuro/NTD]

Diagnosis?

Midline defect of the spinous process
Asymptomatic (m/c)
Leg weakness, Constipation, Neurogenic bladder
Commonly involved in L5-S1

A

Spina bifida occulta

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4
Q

[Neuro/NTD]

Diagnosis?

Defect in the posterior vertebral arches

Delay surgery: completely normal neurologic examinations and complete full-tliickness skin covering of the meningocele
Immediate surgical repair: cerebrospinal fluid (CSF) leaking from the meningocele, with incomplete skin covering need to prevent meningitis

A

Meningocele

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5
Q

[Neuro/NTD]

Diagnosis?

Posterior neuropore fails to close properly
Spinal cord protruding in the sag

A

Myelomeningocele

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6
Q

[Neuro/NTD]

Diagnosis?

Wasting of the small muscles of the hand
Sensory deficits of the arms
Absence of deep tendon reflexes in the upper extremities
Fluid cavity in the spinal cord

A

Cervical syrinx

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7
Q

[Neuro/Hydrocephalus]

Normal CSF volume?

Adult: __
Infant: __

A

Adult: 150 ml
Infant: 50 ml

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8
Q

[Neuro/Hydrocephalus/congenital]

Examples of congenital noncommunicating hydrocephalus? (3)

A
  1. Congenital aqueductal stenosis
  2. Dandy-Walker malformation
  3. Chiari malformations
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9
Q

[Neuro/Hydrocephalus/acquired]

Examples of acquired noncommunicating hydrocephalus? (4)

A
  1. Brain tumors
  2. Intraventricular clots
  3. Abscess
  4. Vein of Galen malformation
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10
Q

[Neuro/Hydrocephalus/acquired]

Name of anomaly?

Prenatal or neonatal period
Sudden increased in head circumference
Prominent visible scalp veins
Bruit from the fontanelle

A

Vein of Galen Malformation (VOGM)

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11
Q

[Neuro/Hydrocephalus]

Three types of hydrocephalus?

A
  1. Non-communicating
  2. Communicating
  3. Excessive CSF production
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12
Q

[Neuro/Hydrocephalus]

Examples of excessive CSF production hydrocephalus?

A

Functional choroid plexus papillomas and carcinomas

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13
Q

[Neuro/Hydrocephalus]

Cranial nerves involved in hydrocephalus? (2)

A

CN 3: Oculomotor
CN 6: Abducens

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14
Q

[Neuro/CN]

Names of cranial nerves? (12)

A
  1. Olfactory nerve
  2. Optic nerve
  3. Oculomotor nerve
  4. Trochlear nerve
  5. Trigeminal nerve
  6. Abducens nerve
  7. Facial nerve
  8. Auditory/vestibular nerve
  9. Glossopharyngeal nerve
  10. Vagus nerve
  11. Accessory nerve
  12. Hypoglossal nerve
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16
Q

[Neuro/CN]

Number of Olfactory nerve?

A

CN 1

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16
Q

[Neuro/CN]

Number of Optic nerve?

A

CN 2

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16
Q

[Neuro/CN]

Number of Oculomotor nerve?

A

CN 3

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16
Q

[Neuro/CN]

Number of Trochlear nerve?

A

CN 4

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16
Q

[Neuro/CN]

Number of Trigeminal nerve

A

CN 5

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17
Q

[Neuro/CN]

Number of Abducens nerve

A

CN 6

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18
Q

[Neuro/CN]

Number of Facial nerve?

A

CN 7

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19
Q

[Neuro/CN]

Number of Auditory/vestibular nerve?

A

CN 8

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20
Q

[Neuro/CN]

Number of Glossopharyngeal nerve?

A

CN 9

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21
Q

[Neuro/CN]

Number of Vagus nerve?

A

CN 10

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22
# [Neuro/CN] Number of Accessory nerve
CN 11
23
# [Neuro/CN] Number of Hypoglossal nerve?
CN 12
24
# [Neuro/CN] Symptoms of CN 3 palsy?
Down and out eye deviation
25
# [Neuro/CN] Symptoms of CN 6 palsy?
Fail to abduct of the eye
26
# [Neuro/Hydrocepalus] Cushing triad for hydrocephalus?
1. Bradycardia 2. Sys­temic hypertension 3. Altered respiratory rates
27
# [Neuro/Hydrocepalus] Name of sign? Cause of this sign?
Sun setting sign Upward gaze is impaired due to pressure on the midbrain (Hydrocephalus)
28
# [Neuro/Hydro/DWM] What consists of Dandy-Walker malformation? (3)
1. Posterior fossa cyst that is continuous with the 4th ventricle 2. Partial or complete absence of the cerebellar vermis 3. Hydrocephalus.
29
# [Neuro/Hydro] Chiari malformation vs Dandy-Walker Developmental delay Hypotonia, later developing spasticity Poor coordination Ataxia
Dandy-Walker malformation
30
# [Neuro/Hydro/Chiari] Types of Chiari malformation? (3)
Type 1: cerebellar tonsils or vermis are pushed down below the level of the foramen magnum Type 2: the 4th ventri­cle and lower medulla are pushed down below the level of the foramen magnum Type 3: Herniation of the cerebellum occurs through a cervical spina bifida defect
31
# [Neuro/Hydro/Chiari] Dandy-Walker vs Chiari malformation type 1 Dysphagia (CN12) Vertigo, ataxia Sleep apnea Headache, neck pain (Symptoms occur due to dysfunction of lower cranial nerves, the brainstem, and/or the spinal cord.)
Chiari malformation type 1
32
# [Neuro/Migrational anomalies] Examples of neuronal Migrational anomalies? (5)
1. Polymicrogyria 2. Lissencephaly 3. Schizencephaly 4. Holoprosencephaly 5. Agenesis of the corpus callo­sum
33
# [Neuro/Migrational/Polymicrogyria] Diagnosis? Causes? (3) Multiple small gyri Symptoms varied, mild to severe Developmental delay, intellectual disability, spasticity, microcephaly, seizure
Polymicrogyria - Cause: Intrauterine ischemic injuries Intrauterine infection Genetic syndromes (Aicardi syndrome, Zellweger spectrum syndrome)
34
# [Neuro/Migrational/Lissencephaly] Diagnosis? Smooth cerebral surface with thickened cortical mantle and a lack of cerebral folds (gyri) and grooves (sulci) Symptoms: Failure to thrive Microcephaly Marked developmental delay Severe epilepsy Blind Associated with Miller-Dieker syndrome
Lissencephaly
35
# [Neuro/Migrational/Schizencephaly] Definition of? Unilateral or bilateral clefts within the cerebral hemispheres
Schizencephaly
35
# [Neuro/Migrational/Holoprosencephaly] Definition of? Defective cleavage of the prosencephalon (i.e., forebrain or cerebral cortex, basal ganglia, thalamus, hypothalamus). Failure of the formation of 2 cerebral hemispheres Symptoms: Diabetes insipidus, Panhypopituitarism, Visual problems, Epilepsy, Facial anomaly Associated with Trisomy 13
Holoprosencephaly
36
# [Neuro/Migrational/Agenesis of corpus callosum] Associated with agenesis of corpus callosum? Associated autosomal trisomies (2) Genetic syndrome (1) Drug (1)
Trisomy 8 Trisomy 18 Aicardi syndrome Cocaine
37
# [Neuro/Cerebral palsy] Causes of cerebral palsy? (5)
(Multifactorial) 1. Neonatal encephalopathy 2. Asphyxia 3. Low birth weight 4. Congenital malformation 5. Infection
38
# [Neuro/Cerebral palsy] Types of cerebral palsy? (5)
1. Spastic (70%) 2. Dyskinetic (15%) 3. Ataxic (5%) 4. Hypotonic (7%) 5. Mixed (3%)
39
# [Neuro/Cerebral palsy] Most common preterm infant cerebral palsy type due to intraventricular hemorrhage?
Diplegic CP (because the hypoxic damage involves the periventricular white matter where the descending motor fibers for the lower extremities are closer to the ventricles)
40
# [Neuro/Cerebral palsy] Medication to prevent cerebral palsy to mother?
Magnesium sulfate
41
# [Neuro/UMN/LMN] Characteristics of upper motor neuron lesions? (3)
Spasticity Hyperreflexia Absent fasiculations
42
# [Neuro/UMN/LMN] Characteristics of lower motor neuron lesions? (3)
Hypotonia Hyporeflexia Fasiculations
43
# [Neuro/Cerebral palsy] Symptoms of spastic cerebral palsy? (3)
(Upper motor neuron signs) 1. Weakness 2. Hypertonicity with contractures 3. Hyperreflexia with clonus
44
# [Neuro/Cerebral palsy] Symptoms of dyskinetic cerebral palsy? Pathologic location of dyskinetic cerebral palsy?
Impaired, uncon­trolled, and purposeless movements that disappear during sleep Basal ganglia
45
# [Neuro/Cerebral palsy] Type of cerebral palsy due to neonatal bilirubin encephalopathy (kernicterus)?
Dystonic cerebral palsy
46
# [Neuro/Cerebral palsy] Medication for spasticity? (4)
1. Diazepam 2. Dantrolene sodium 3. Baclofen 4. Botox injection
47
# [Neuro/Cerebral palsy] Surgery for upper spasticity?
Selective dorsal rhizotomy
48
# [Neuro/Chorea] Causes of chorea? 1. Primary 2. Secondary (3)
1. Primary 2. Secondary Sydenham chorea SLE Drugs/toxins (Oral contraceptive pills, Metoclopromide)
49
# [Neuro/Chorea] Medication to treat chorea?
Dopamine receptor blocker (Tetrabenazine)
50
# [Neuro/Cerebrovascular disease] Diagnosis? Commonly affected artery? Older children, adolescent Secondary to trauma An abrupt cessation of momentum (e.g., car accidents) or when the neck is violently and/or forcefully shaken Headache, neck, or eye pain Honer syndrome (miosis, ptosis, and anhidrosis): Internal carotid artery
Cervicocephalic arterial dissection Internal carotid artery
51
# [Neuro/Cerebrovascular disease] Metabolic causes of ischemic stroke? (3)
1. Fabry disease 2. Homocystinuria 3. MELAS (mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes)
52
# [Neuro/Cerebrovascular disease] Most common artery for ischemic stroke in infant?
Middle cerebral artery
53
# [Neuro/Cerebrovascular disease] Associated syndrome high risk for saccular aneurysms? (4)
1. Coarctation of the aorta 2. Polycystic kidneys 3. Ehlers-Danlos syndrome 4. Marfan syndrome
54
# [Neuro/Cerebrovascular disease] Location of thrombosis? Increased intracranial pressure: headache, papilledema, nausea, vomiting, and cranial nerve (CN) 6 palsy
Superior sagittal sinus thrombosis
55
# [Neuro/Cerebrovascular disease] Sinus thrombosis that is commonly associated with otitis media and mastoiditis, cerebral vein thrombosis?
Right lateral sinus thrombo­sis
56
# [Neuro/Cerebrovascular disease] Location of thrombosis? Proptosis Chemosis Uni- or bilateral ophthalmoplegia (CN 3,4,5,6) Associated with infection of the paranasal sinuses, face, nose, or mouth
Cavern­ous sinuses thrombosis
57
# [Neuro/Head trauma] Characteristics of basilar skull fracture? (5)
1. Bilateral orbital ecchymoses (“raccoon eyes” or black eyes) 2. Posterior auricular ecchymoses (Battle sign) 3. Tympanic membrane discoloration 4. Cerebrospinal fluid (CSF) otorrhea and rhinorrhea 5. Pneumocephalus
58
# [Neuro/Head trauma] Cause? After linear skull fracture Late onset of focal seizures Focal neurologic signs Visible and pal­pable skull deformity
Leptomeningeal cyst
59
# [Neuro/Head trauma/EDH] Pathology of epidural hematoma? (2)
Tear in the bridging veins or dural sinuses (m/c) Tear of the middle meningeal artery: Temporal bone fracture
60
# [Neuro/Head trauma/EDH] Early signs (3) and late signs (3) of brain stem herniation?
Early signs: 1. Ipsilateral dilated pupil 2. Contralat­eral hemiplegia 3. Complete CN 3 palsy Late signs: 1. Fixed and dilated pupils 2. Slow and irregular respiration 3. Hypotension and tachycar­dia
61
# [Neuro/Head trauma/SDH] Treatment? Acute subdural hematoma: __ Chronic subdural hematoma: __ Epidural hematoma: __
Acute subdural: Surgery, most likely arterial Chronic subdural: small -> observation, large -> surgery Epidural: surgery
62
# [Neuro/Head trauma] Most common cause of chronic subdural hematoma?
Shaken baby syndrome
63
# [Neuro/Spinal cord injury] Physical signs for spinal cord injury in newborns?
Galant reflex
64
# [Neuro/Spinal cord injury] Location of injury? Flaccidity Areflexia Autonomic dysfunction: hypotension and shock
Spinal shock
65
# [Neuro/Brachial plexus injury] Which spinal nerves injuries to cause Erb palsy? Possible additional nerve? Absent reflex? Treatment indication?
C5, C6, and/or C7 Phrenic nerve -> Asymmetric diaphragm contraction -> Asymmetric chest expansion Absent biceps tendon reflex Treatment: - No improvement in 3 months
66
# [Neuro/Spinal nerves] How many spinal nerves?
Cervical: 8 Thoracic:12 Lumbar: 5 Sacral: 5
67
# [Neuro/Brachial plexus injury] Presentation of Klumpke palsy? - Motor - Sensory - T1 involvement
Klumpke (C8-T1) Motor: Claw hand: extension of MCP joint, flexion of IPJ Sensory: Ulnar side of hand sensory defect T1 involvement: Horner syndrome (ipsilateral ptosis, miosis, anhidrosis)
68
# [Neuro/Nerve injury] Which nerve injury? After IM injection Foot drop Sensory loss of the leg below the knee Absence of ankle jerk reflex
Sciatic nerve injury
69
# [Neuro/Cranial nerves] CN2 function? (2)
Optic nerve 1. Visual acuity, field, color vision 2. Pupillary reaction
70
# [Neuro/Cranial nerves] CN 3 function?
Oculomotor - Motor for superior rectus, inferior oblique, inferior rectus
71
# [Neuro/Cranial nerves] CN 4 function?
Trochlear - Superior oblique: look down
72
# [Neuro/Cranial nerves] CN 6 function?
Abducens - Lateral rectus
73
# [Neuro/Cranial nerves] CN 5 function? (3)
Trigeminal - Sensation of face: ophthalmic, maxillary, mandibular - Motor: Masseter and temporalis - Reflex: Corneal
74
# [Neuro/Cranial nerves] CN 7 function? (2)
Facial - Sensory: 2/3 anterior tongue taste - Motor: facial muscles -> facial expression
75
# [Neuro/Cranial nerves] CN 8 function?
Vestibulocochlear - hearing - balance
76
[Neuro/Cranial nerves] CN 9 and 10 functions? (3)
9 glossopharyngeal 10 vagus - Sensory: CN9 1/3 taste, CN10 visceral - Motor: uvular/palate - Reflex gag
77
[Neuro/Cranial nerves] CN 11 function?
Accessory - SCM and trapezius
78
[Neuro/Cranial nerves] CN 12 function?
Hypoglossal - Motor: Tongue
79
# [Neuro/Nerve/Facial nerve palsy] Cause of Bell's palsy? (4) Treatment?
1. Postinfectious, viral HSV, herpes zoster 2. Lyme 3. Trauma 4. Neoplasm - Treatment: Oral steroid
80
# [Neuro/Nerve/Facial nerve palsy] Which congenital nerve palsy? Bell's palsy (facial nerve palsy) Ocular abduction impairment
Mobius syndrome (Hypoplasia or agenesis of the facial nucleus and/or nerve and CN 6 (abducens) abnormality)
81
# [Neuro/Nerve palsy/Facial nerve palsy] Name of phenomenon? Simultaneous eyelid blinking with sucking jaw movement Amblyopia Refractive errors Strabismus
Marcus Gunn phenomenon (Abnormal innervation of CN 5 trigeminal (pterygoid muscle) and CN3 oculomotor nerve)
82
# [Neuro/Seizure] Characteristics of generalized seizure? (5) - Onset - LOC - Presentation - Aura - EEG
1. Abrupt onset 2. Loss or alteration of awareness 3. Variable bilateral symmetric motor activity associated with changes in muscle tone 4. No warning of the attack; no aura 5. Epileptiform activity that is bilateral and synchronous (shown on EEG)
83
# [Neuro/Seizure] Types of generalized seizures? (5)
1. Tonic-clonic 2. Myoclonic 3. Juvernile myoclonic 4. Absence 5. Atonic
84
# [Neuro/Seizure] Typical generalized tonic clonic seizure presentation? (3) - Time of tonic - Time of clonic - Postictal
Tonic (sustained contraction) first lasting 10-20 seconds Clonic (rhythmic muscle jerks) second lasting 30-60 seconds Postictal period for a few minutes to several hours
85
# [Neuro/Seizure] Characteristics of myoclonic seizures? (4) - Duration - How many muscle group - Presentation - LOC
1. Short duration (< 1-2 seconds) 2. Rapid muscle contractions, often in 1 limb, but can involve bilateral extremities or trunk 3. Isolated or repetitive jerks 4. Preservation of awareness
86
# [Neuro/Seizure] Characteristics of Progressive myoclonic epilepsy? (3)
1. Progressive neurodegenerative genetic diseases 2. Cognitive and functional decline 3. Worsening seizures, and early death Lafora disease MERRF (Myoclonic epilepsy with ragged red fibers)
87
# [Neuro/Seizure] Which Progressive myoclonic epilepsy? 1. Epilepsy in late childhood or adolescence 2. Difficulty walking, muscle spasms (myoclonus) 3. Cognitive deteriorations and dementia
Lafora disease
88
# [Neuro/Seizure] Characteristics of Juvenile Myoclonic Epilepsy? (5) - Time of the day - Associated seizure - Intelligence - Family history - Typical onset - EEG pattern
1. Morning myoclonic jerks (often with dropping of items in hands) 2. +/- History of absence seizures Generalized tonic-clonic seizures occurring just after awakening or during sleep 3. Normal intelligence 4. Family history of similar seizures 5. Onset 8-20 years of age 6. EEG: Generalized, fast (4 - 6 Hz) polyspike and slow wave pattern
89
# [Neuro/Seizure] Drug of choice for Juvenile Myoclonic Epilepsy?
Valproate
90
# [Neuro/Seizure] Characteristics of Absence seizures? (4) - Aura - Presentation - LOC - Postictal - EEG - Typical remission age
1. No aura 2. Episodes of extremely short lapses in awareness, staring for 10-20 seconds, with possible flickering of the eyelids or eye rolling or mouth automatisms 3. Amnesia during the episodes 4. No postictal period 5. EEG: 3 Hz generalized spike and wave discharge 6. Remission by 12 years old
91
# [Neuro/Seizure] Characteristics of Atonic seizure? (4) - Predrome - Presentation - Duration - LOC, postictal
1. 1 or more myoclonic jerks sometimes occurring immediately before muscle tone is lost 2. Sudden and complete loss of tone in the limbs, neck, and trunk muscles (without warning) 3. Typically brief in duration 4. Loss of awareness, complete awareness returning very quickly after the attack
92
# [Neuro/Seizure] Characteristics of Benign Epilepsy with CentroTemporal Spikes (BECTS, Benign Rolandic Epilepsy)? (4) - Age - Seizure type - Presentation - Time of the day - LOC
1. Elementary school age 2. Focal aware seizure, 50% occur at least 1 secondary generalized tonic-clonic during sleep 3. Facial numbness or twitching, guttural vocalizations, drooling, dysphasia, and difficulty with speech 4. Shortly after going to sleep or just before or after waking up 5. No loss of awareness
93
# [Neuro/Seizure] Characteristics of focal aware seizures (partial simple)? (2) - Seizure type - Post-seizure
1. Focal motor seizures (m/c), or sensory, or adversive (rotation of head or neck), asynchronous tonic or clonic 3. Todd paralysis but no post-ictal
94
# [Neuro/Seizure] Characteristics of focal seizures with impaired awareness (Complex partial)? (3) - Aura - Presentation - Postictal
1. Aura: depersonalization, hallucinations, intense emotions 2. Automatism: repetitive lip smacking, swallowing, chewing 3. Postictal: behavioral
95
# [Neuro/Infantile spasm] Characteristics of infantile spasm? (5) - Age - Presentation - Duration - Aggravating - Development - EEG
1. Peak at 3 to 7 months 2. Jackknife flexor spasm (flexion of neck/trunk, adduction of extremities) 3. Clusters of a brief spasm 4. Aggravated from sleep to awake 5. Developmental regression 6. Hypsarrhythmia: high-voltage, irregular, slow waves that are asynchronous
96
# [Neuro/Infantile spasm] Metabolic/genetic condition associated with infantile spasm? (3)
1. Phenylketonuria 2. Tuberous sclerosis 3. Trisomy 21
97
# [Neuro/Infantile spasm] Percentage of infantile spasm caused by tuberous sclerosis?
30%
98
# [Neuro/Infantile spasm] Triad of West syndrome? (3)
1. Infantile spasm 2. Intellectual disability 3. Hypsarrhythmia
99
# [Neuro/Infantile spasm] Treatment options of infantile spasm? (4)
1. ACTH 2. Oral prednisone 3. Vigabatrin 4. Pyridoxine
100
# [Neuro/Infantile spasm] Drug of choice for infantile spasm from Tuberous sclerosis?
Vigabatrin
101
# [Neuro/Epilepsy] Which epilepsy syndrome? Multiple seizure types (GTC, absence, atonic, tonic) Intellectual disability A characteristic EEG pattern (sharp spike and wave): Slow, repetitive wave complex 1.5-2.5 Hz
Lennox-Gastaut syndrome
102
# [Neuro/Epilepsy] Which epilepsy syndrome? Likely immunologic process involv­ing only 1 hemisphere of the brain Generalized seizures become focal, unremitting, and limited to 1 side of the body Eventually, hemiparesis, diminished intelligence, and hemianopia occur MRI: Unilateral cerebral atrophy
Rasmussen syndrome
103
# [Neuro/Epilepsy] Pathologic laughter Without an appropriate reason for laughing Associated with Hypothalamic hamartomas
Gelastic Seizures
104
# [Neuro/Seizure/AEM] Preferred drug for focal seizures?(2)
Oxcarbazepine Carbamazepine
105
# [Neuro/Seizure/AEM] Possible side effects of Valproate? (5)
1. Teratogen 2. Hyperammonemia 3. Dose-related thrombocytopenia 4. Weight gain 5. Tremor
106
# [Neuro/Seizure/AEM] Possible side effects of carbamazepine? (3)
1. Leukopenia 2. Hepatotoxicity 3. Syndrome of inappropriate antidiuretic hormone secretion (SIADH), resulting in hyponatremia
107
# [Neuro/Seizure/AEM] Possible side effects of phenytoin? (4)
1. Hirsutism 2. Gum hypertrophy 3. Ataxia 4. Stevens-Johnson syndrome
108
# [Neuro/Seizure/AEM] Possible side effects of ethosuximide? (4)
1. Abdominal pain 2. Skin rash 3. Liver dysfunction 4. Leukopenia
109
# [Neuro/Seizure/AEM] Side effects of phenobarbital? (2)
1. Severe behavioral changes 2. Impairment of cognition (Only used in infants)
110
# [Neuro/Seizure/AEM] Possible side effects of oxcarbazepine? (3)
1. Ataxia 2. Nystagmus 3. Hyponatremia
111
# [Neuro/Seizure/AEM] Possible side effects of levetiracetam (1)?
Irritability, aggression
112
# [Neuro/Seizure/AEM] Possible side effect of topiramate? (3)
1. Slowing of cognition 2. Metabolic acidosis 3. Glaucoma
113
# [Neuro/Neonatal seizure] Inborn error of metabolism that can cause seizure? (3)
1. Urea cycle disorder 2. Aminoacidopathies 3. Pyridoxin-dependent epilpesy
114
# [Neuro/Neonatal seizure] Characteristics of benign neonatal seizure? (3) - Patient character - Age - Seizure type - When to stop seizure medication?
1. Term babies with good Apgar scores following a normal pregnancy and delivery 2. Peaks at 4-6 days (“fifth day fits”) 3. Clonic seizures, unifocal or multifocal 4. Stop by 1 month
115
# [Neuro/Seizure/Febrile seizure] For febrile seizures incidence, ___% of children experience at least 1 febrile seizure before 5 years of age ___% of these occur before 18 months of age
2-5% of children expe­rience at least 1 febrile seizure before 5 years of age 50% of these occur before 18 months of age
116
# [Neuro/Seizure/Febrile seizure] Common infections that cause febrile seizures? (2)
1. Roseola (human herpesvirus 6) 2. Shigella infection
117
# [Neuro/Seizure/Febrile seizure] Indications to do Lumbar puncture when febrile seizure? (3)
1. In the presence of meningeal signs and symptoms 2. In children 6-12 months of age whose immunization status is unknown or who are not or incompletely immunized for Haemophilus influenzae or Streptococ­cus pneumoniae 3. In those who are on antibiotics (because antibiotics can mask the clinical manifestations of meningitis)
118
# [Neuro/Seizure/Febrile seizure] Recurrent risk for febrile seizures? (4) - Age - Family history - Fever character
1. 1st seizure before 12 months of age 2. History of a 1st degree relative with febrile seizures 3. History of seizure with only a modest temperature elevation (< 104.0°F [< 40.0°C]) 4. Suffered a seizure after having the fever for only a very short duration
119
# [Neuro/Seizure/Febrile seizure] For febrile seizure prognosis, ___% of children with febrile seizures have only 1 episode ___% of children with simple febrile sei­zures eventually develop epilepsy
65% of children with febrile seizures have only 1 episode 1-2% of children with simple febrile sei­zures eventually develop epilepsy (not too different from general population.)
120
# [Neuro/Migraine] Diagnostic criteria of migraine _without_ aura? (3) At least 5 attacks that: 1. Last between ___ hours 2. Include at least 2 of the following (4): 3. Have at least 1 associated symptom (2):
At least 5 attacks that: 1. Last between 2 and 72 hours 2. Include at least 2 of the following: Bilateral or unilateral location Pulsating Moderate-to-severe pain Pain made worse with activity 3. Have at least 1 associated symptom: Nausea/vomiting Photophobia/phonophobia
121
# [Neuro/Migraine] Diagnostic criteria for migraine _with_ aura? 1. At least 2 attacks with the following features (4): 2. 1 or more fully reversible aura symptoms (visual, sensory, speech, motor, brainstem, or retinal)
1. At least 2 attacks with the following features: Gradual development of autonomic aura Aura that is fully reversible Aura present < 1 hour Headache within 1 hour of aura 2. 1 or more fully reversible aura symptoms (visual, sensory, speech, motor, brainstem, or retinal)
122
# [Neuro/Migraine] Unusual neurologic forms of migraine? (5)
1. Basilar artery migraine 2. Hemiplegic migraine 3. Ophthalmoplegic migraine 4. Confusional migraine 5. Benign paroxysmal vertigo of childhood (BPVC)
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# [Neuro/Migraine] Which migraine? Adolescent girls Vertigo, syncope, dysarthria, visual alterations Loss of consciousness
Basilar artery migraine
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# [Neuro/Migraine] Which migraine? < 18 months of age Hemiplegia with or without aphasia for hours or days Intellectual decline
Hemiplegic migraine
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# [Neuro/Migraine] Which migraine? Between 1 and 4 years of age Sudden episodes of vertigo for a few minutes Nystagmus, worsening vertigo with head movements No postictal state Self-limited condition, a precursor to migraine (family history of migraine)
Benign paroxysmal vertigo of childhood (BPVC)
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# [Neuro/Migraine] Triptan approved for pediatric migraine?
Rizatriptan
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# [Neuro/Migraine] Contraindications for Triptans? (2)
1. History of transient ischemic attack (TIA), or stroke 2. Migraine with brainstem aura, or hemiplegic migraine
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# [Neuro/Migraine] Prophylaxis treatment for migraine? (6)
1. Topiramate 2. Cyproheptadine 3. Valproate 4. Calcium channel blockers 5. Propranolol 6. Amitripty­line
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# [Neuro/Headache] Which headache? Treatment? Prophylaxis? Between 10 and 20 year old Attacks occur at the same hour each day in 50% of patients Unilateral, supraorbital, retroorbital, or tem­poral in location Severe (described as an “ice pick” or “hot poker”)
Cluster headache - Treatment: Oxygen Triptan - Prophylaxis: Verapamil
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# [Neuro/IIH] Risk factors for idiopathic intracranial hypertension (pseudotumor cerebri)? (5) - Weight - Drug - Diseases
1. Obesity 2. Oral contraceptive use 3. Doxycycline or tetracycline (headache in an adolescent being treated for acne) 4. Hypervitaminosis A Vitamin A analogs, such as retinoic acid 5. Primary adrenal insufficiency, (a.k.a. Addison disease), sleep apnea, lupus
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# [Neuro/headache] Cause of headache? Headache, Retiobulbar pain Visual obscurations (brief episodes of blindness) , Photopsia (seeing light flashes), Diplopia Tinnitus
Intracranial hypertension (pseudotumor cerebri)
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# [Neuro/Headache] Red flags (symptoms) requiring CT or MRI for a child with a headache? (9) - Location - Age - Duration - Time of the day - Sleep - Severity - Associated symptoms - Type of headache
1. Occipital headaches 2. Any child < 3 years with chief complaint of headache 3. Persistent focal headaches 4. Early morning headaches with increase in frequency and severity 5. Headache that awakens the child from sleep 6. Increasing or “crescendo” headaches 7. Headache with focal seizure 8. Unexplained academic decline or behavioral changes 9. Cluster headaches
133
# [Neuro/Headache] Red flags (Physical signs) requiring CT or MRI for a child with a headache? (5) - Growth parameters - Eye - Maneuver
1. Abnormal neurologic signs 2. Fall-off in growth 3. Increase in head circumference 4. Papilledema 5. Increase in severity of headache with Valsalva maneuver
134
# [Neuro/NM/MG] Types of myasthenia gravis? (3)
1. Transient neonatal myasthenia gravis 2. Congenital myasthenia gravis 3. Juvenile myasthenia gravis
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# [Neuro/NM/MG] Which neuromuscular disease? Newborns within 3 days Weakness, ptosis Resolves in 2-4 weeks Exposed to transplacental passage of maternal acetylcholine receptor antibodies
Transient neonatal myasthenia gravis
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# [Neuro/NM/MG] Which neuromuscular disease? Treatment? Teenage years Gradual, worsening muscle weakness, fatigability, ptosis and ophthalmoplegia, respiratory compromise Muscle weakness by repetitive muscle use
Juvenile myasthenia gravis (Acquired autoim­mune disorder, Circulating autoantibodies to AChRs) - Treatment: Anticholinesterase medications (pyridostigmine)
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# [Neuro/NM/MG] Antibodies associated with myasthenia gravis? (2)
1. Ace­tylcholine receptor autoantibodies 2. The muscle-specific receptor tyrosine kinase
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# [Neuro/NM] Diagnosis? Treatment? Ascending acute paralysis evolving to respiratory and cranial nerves Loss of vibratory and positional, not sensory (rarely) Hyporeflexia, but Babinski normal Less autonomic instability
Guillain-Barre syndrome - Treatment: IVIG Plasmapheresis
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# [Neuro/NM/GBS] Commonly associated viral/bacterial cause of Guillain-Barre syndrome? (3)
1. Campylobacter (up to 30%) 2. Mycoplasma 3. EBV
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# [Neuro/NM/GBS] Recovery time for Guillain-Barre syndrome?
6 months
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# [Neuro/NM] Diagnosis?
Charcot-Marie-Tooth disease (Hereditary motor sensory neuropathy)
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# [Neuro/NM/Botulism] Common dietary/environmental causes of botulism? (3)
Environmental dust Commercial carrot juice and cheese sauce Wound (for heroin 'black tar' user)
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# [Neuro/NM] Diagnosis? Treatment? Descending paralysis from cranial nerve weakness Hypotonia, ptosis, drooling, Dysphonia, dysphagia, diplopia, feeding difficulties Poor gag reflex, no deep tendon reflex, lack of pupillary reflex
Infant botulism - Treatment: < 1 year, human-derived botulism immunoglobulin > 1 year, equine serum botulism antitoxin
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# [Neuro/NM/Botulism] Antibiotics that can worsen botulism?
Aminoglycoside (gentamicin) that can potentiate the paralytic effects of the toxin
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# [Neuro/NM] Diagnosis? Diagnostic test (2)? Both side of the spinal cord, 3 or 4 segments, mostly thoracic cord Severe back pain radiating around to the front Motor and sensory abnormalities Progressive paraparesis, loss of sphincter tone, sensory loss
Transverse myelitis - Test: Gadolinium-enhanced MRI Lumbar puncture
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# [Neuro/NM] Diagnosis? CSF finding? Adolescent Optic neuritis: Vision abnormalities, oculomotor disturbance Incoordination, sensory deficits
Multiple sclerosis - CSF: IgG or oligoclonal bands
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# [Neuro/Ataxia] Diagnosis? Acute ataxia between 1 and 3 years old Prior URI or viral GI illness Hypotonia, tremor, horizontal nystagmus, dysarthria
Acute cerebellar ataxia
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# [Neuro/NM/MS] Associated anomaly with myasthenia gravis?
Thymic hyperplasia or thymoma
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# [Neuro/NM/DMD] Muscle biopsy finding in Duchenne muscular dystrophy? (2)
Type 2B fiber deficiency Absent dystrophin
150
# [Neuro/Seizure/Febrile] Simple febrile seizure criteria? (5) - Duration - Recurrent - Type of seizure - Age - Comorbidities
Last < 15 minutes Not recurrent in a 24-hour period Generalized in nature Between 6 months trough 5 years of age Developmentally normal child
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# [Neuro/Seizure/Febrile] Complex febrile seizures criteria? (3) - Duration - Recurrent - Seizure type
Last ≥ 15 minutes > 1 episode in a 24-hour period Demonstrate a focal symptomatology
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# [Neuro/NM] Diagnosis? Onset of symptoms varied widely, from 5 to 60 years old Muscular dystrophy symptoms
Becker muscular dystrophy
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# [Neuro/NM] Diagnosis? Treatment? Acute paralysis of 1 or more limbs (bilateral in transverse myelitis) Preserved sensation, Normal mental status Typically within a week of viral symptoms Recovery is variable and often incomplete Suspected cases should be reported to the CDC with samples sent for viral testing
Acute flaccid myelitis - Treatment: supportive

1. Pediatrics (22 decks)

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