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Neurology Flashcards

0
Q

Craniosynostosis - dx?

A

1) head measurement

2) CT/xray

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1
Q

What is craniosynostosis?

A

premature fusion of the suture

restricts the brain from growing

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2
Q

Craniosynostosis - tx?

A

neurosurgery

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3
Q

Craniosynostosis - most common?

A

scaphocephaly (egg shape)

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4
Q

What can cause microcephaly?

A

mom:

  • TORCH
  • FAS
  • drugs
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5
Q

What type of macrocephaly?

A

hydrocephalus (too much CSF)

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6
Q

Macrocephaly- cx?

A

TORCH (toxo)

aquaductal stenosis

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7
Q

Congenital hydrocephalus - sx adults?

A

cushing’s triad - increased ICP

  • bradycardia
  • hypertension
  • irregular breathing pattern
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8
Q

Congenital hydrocephalus - sx infants?

A

triad:

  • increased head circumference
  • widening of sutures
  • bulging fontanels
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9
Q

ICP in infants?

A

vomiting
jerky movements
sun-setting eyes (eyes cannot move up)

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10
Q

Hydrocephalus - tx?

A

VP shunt

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11
Q

Neural tube defects conditions?

A

anencephaly
encephalocele
spina bifida

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12
Q

Neural tube defect - anencephaly?

A

failure of tube closure

bad news bears

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13
Q

Neural tube defects - encephalocele?

A

protusion of meninges

surgical repair but longterm consequences

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14
Q

Neural tube defects - spina bifida type?

A

spina bifida cystic

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15
Q

Meningocele?

A

protusion of the dural sac

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16
Q

Types of spina cystica?

A

meningocele

mylelomeningocele

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17
Q

Spina bifida occulta?

A

NO obvious physical features

ONLY problematic if chord attaches to the defect

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18
Q

Mylelomeningocele?

A

protrusion of NEURAL elements
lack of sensation and motor
signs of kyphosis/scoliosis
impairment of bladder of bowel fxn

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19
Q

Spinal dysraphism - sx newborns?

A

hairy patch

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20
Q

Spinal dysraphism?

A

complication of spina bifida occulta - has tethered chord

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21
Q

Spinal dysraphism - infants and older childern sx?

A

sciolosis

bladder changes

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22
Q

Dysraphism- dx?

A

gold standard: MRI scan

US: <2-3 mo

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23
Q

Spinal dysraphism-tx?

A

neuro surgery

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24
Q

What are the different categories of cerebral palsy?

A

spastic
non spastic
limbs: one, two, three, four

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25
Q

Cerebral palsy?

A

insult of the CNS system

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26
Q

Cerebral palsy - sx?

A

spasticity
seizures
EXAGGERATED PRIMITIVE REFLEXES for more than 1yr

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27
Q

Cerebral palsy - dx?

A

CT

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28
Q

Cerebral palsy - tx?

A

symptomatic care

  • benzo: spasticity
  • bracing/ortho
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29
Q

Cerebral palsy - complication?

A

scoliosis

contractures

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30
Q

What are the 3 phases of seizures?

A

pre-seizure
seizure
post ictal

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31
Q

Seizure - tx and ADRS?

A

carbamazepine: SJS, neutropenia, aplastic anemia
phenytoin: gingival hyperplasia, neuropathy
lamotrigine: SJS, hepatoxicity

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32
Q

What is sandifer syndrome?

A

DDx for seizures

tiny human GERD

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33
Q

Sandifer syndrome-sx?

A

spit up
arching of back
cyanosis

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34
Q

Sandifer syndrome-dx?

A

pH probe testing

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35
Q

Spells -age?

A

common in 15mo-36 mo

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36
Q

Spells?

A

seizure DDx
child holds breathe when not getting their way
able to “reproduce” when this happened - unlike seizures

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37
Q

Spells -types?

A

cyanotic

pallid

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38
Q

Tics?

A

DDx for seizures

isolated muscle group (face, neck)

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39
Q

Nonepileptic myoclonus?

A

hiccups
hypnic jerks
nocturnal myoclonus
DDx for seizures

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40
Q

Absence seizure -sx?

A

staring off into space

no more than 30 sec –> no post ictal phase

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41
Q

Absence seizure - dx?

A

EEG: 2.5-3

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42
Q

Absence seizures - tx and ADR?

A

Ethosuximide: JS, leukopenia, panctypenia

valporic acid

43
Q

Can febrile seizures turn into epilepsy?

44
Q

Febrile seizures - criteria?

A 
fever 100.4F
less than 15 min
6mo-6yrs (peak at 2yrs)
no hx of seizures 
no family hx of seizures 
no signs of CNS infxn 
does not reoccur in 24 hrs
45
Q

When do you LP febrile seizure?

A

<12 mo with NO immunization
12-18mo
signs and sx of meningeal
hx of 2wks of abx

46
Q

Febrile seizure- tx?

A

supportive and reassurance

+/- tylenol (no proven studies)

47
Q

Meningitis - sx adults?

A

triad:

  • fevers
  • rigidity
  • changes in mentation
48
Q

Meningitis - infants-sx?

A

bulging fontanelle
decreased activities
not eating
pallor

49
Q

<3mo baby has fever for 48hrs?

50
Q

<30days old + fever - labs?

A 
UA
CXR
BC
LP
CBC
51
Q

Meningitis - bug?

A

viral> bacterial

52
Q

Meningitis - bacterial bug?

A

s. pneumoniae
h influenza
n. meningitis

53
Q

What is important to know about the bacterial meningitis?

A

vaccines are available

bugs are from mom’s vaginal during delivery

54
Q

Meningitis - bug <1mo?

A

Group B strep

55
Q

Meningitis - bug 1-23mo?

A

strep pneumoniae

56
Q

Meningitis - bug 2-18yo?

A

N meningitis d/t being in school, dorms

57
Q

Meningitis - bug 19-60yo?

A

strep pneumoniae

58
Q

Meningitis - labs?

A 
CBC w/ diff
BC
PT/INR d/t petechiae
glucose
lytes
UA + cultures
LP w/ gram stain and cell counts
59
Q

What is in LP fluid analysis?

A 
glucose
protein
CBC 
opening pressure 
CSF to serum glucose ratio
60
Q

Meningitis tx?

A

1) cover all gram pos –> VANCOMYCIN/AMPICILLIN (babies)
2) adjust management after results
3) manage complications: sepsis, DIC, seizures
longterm: hearing impairment, speech, cognitive delays

61
Q

Muscular dystrophy -types?

A

Duchenne muscular dystrophy

Becker muscular dystrophy

62
Q

What is muscular dystrophy?

A

hereditary
non inflammation
progressive weakness
degeneration of muscles

63
Q

What is Duchenne muscular dystrophy?

A

X linked

males

64
Q

What causes death in Duchenne muscular dystrophy?

A

diaphragm dies out b/c no longer able to breath
wheel chair bound at 6-10yrs
bad news bears

65
Q

Duchenne muscular dystrophy - PE?

A

inability to walk/regression
Gower sign
big calves d/t unstable hips

66
Q

Duchenne muscular dystrophy-labs?

A

CK

muscle bx - GOLD STANDARD

67
Q

Duchenne muscular dystrophy - tx?

A

prednisone

supportive

68
Q

Becker muscular dystrophy?

A

not as bad- can live up to adult hood

69
Q

Boy that is not able to walk by 18mo - labs?

70
Q

Neurocutaneous syndrome - types?

A

Neurofibromatosis I and II
Sturge weber syndrome
Tuberous sclerosis

71
Q

What is neurocutaneous syndrome?

A

congenital

inherited

72
Q

NF1-sx?

A

short
MACROCEPHALY
bowing of long legs
learning difficulties

73
Q

NF1 - imaging?

74
Q

Child has cafe au lait spots?

A

look for:

1) axillary freckling
2) MRI
3) opthalamologist - lisch nodules
4) surgery for myelin sheath

75
Q

NF 1 - tx?

A
  • opthalamologic eval if vision is affected

- genetic counseling

76
Q

NF 1- prognosis?

A

until late 50s

77
Q

NF 2 -tx?

A

surgery
chemo
auditory brainstem implant

78
Q

NF 2 criteria?

A

bilateral vestibular schwannomas/acoustic neuroma
OR
family hx of NF 2 + unilateral acoustic neuroma + 2 of meningioma, glioma, schwannaoma

79
Q

Baby has birth mark?

A

look for more

80
Q

Baby has lisch nodules?

A

NF 1 until proven otherwise

81
Q

Acoustic neuroma?

82
Q

NF 1 and NF 2-cx?

A

autosomal dominant

83
Q

What is sturge weber syndrome?

A

port-wine stain w/ ophthalmic division of trigeminal nerve

84
Q

Sturge weber sx-sx?

A

intracranial calfication

glaucoma

85
Q

Sturge weber syndrome - imaging?

86
Q

Sturge weber sx - tx?

A

seizures - antiepileptic, surgery
glacoma - beta blocker drops, ophthalomologic surgery
HA - ASA

87
Q

Tuberous sclerosis-sx?

A

seizures
mental retardation
tumors: brain, heart, liver, kidneys

88
Q

Tuberous scerosis - PE?

A

ash-leaf spots
shagreen patch
periungal fibromas

89
Q

What is shagreen patch?

A

thickening of skin w/ orange peel texture

90
Q

What is ash leaf spots?

A

hyperpigmented maules w/ irregular borders

91
Q

Tuberous scleorsis - imaging?

A

CT/MRI - astrocytomas (predisposes seizures)

92
Q

Tuberous sclerosis -tx?

A

antiepliptic meds

supportive

93
Q

Questions to ask for TBI?

A

battle signs?
visual changes?
unexplained vomiting?
bleeding/discharge from nose? (leaking of cribiform)

94
Q

When do you scan TBI?

A 
GCS1 min
open skull fx
battle sign
visual changes 
amnesia 
high impact
95
Q

When do you scan <2yo?

A 
fall is from 3+ft
scalp hematoma
unwitnessed fall
vomiting
LOC > 30sec
behavioral changes
96
Q

Concussion-cx?

A

usually d/t coup/countercoup

97
Q

Concussion - sx?

A

13

normal CT

98
Q

Concussion dx criteria-somatic?

A
  • HA
  • N&V
  • dizziness
  • visual probs
99
Q

Concussion dx criteria- affective?

A

irritability

sadness

100
Q

Concussion diagnostic criteria-cognitive?

A

foggy
cannot concentrate
cannot remember
confused

101
Q

Concussion diagnostic criteria-sleep?

A

drowsiness

sleeping more/less

102
Q

When to scan concussion?

A

ANY 1 FOR CONCUSSION Dx CRITERIA - SOMATIC, AFFECTIVE, SLEEP, COGNITIVE

103
Q

Short and dirty of when to scan concussion?

A 
seizures
cannot awake
vomiting
confusion
unusual behavioral change
irritability
LOC > 30sec
104
Q

Concussion tx?

A 
REST: BOTH PHYSICAL AND COGNITIVE 
-no hmwk
-no texting/comp
-no bright lights
no same day play
observe 24-48hrs
105
Q

When to refer concussion?

A

sx after 14 days
many RF
severe injury

106
Q

What are the steps for concussion tx?

A 
step 0 - NOTHING but rest
step 1- light aerobic
step 2- mod exercise
step 3- non contact exercise
step 4 - prac
step 5 - play
DO NOT CONTINUE IF NOT SX FREE FOR 24HRS

Pediatrics (12 decks)

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