Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Peds > Neurology > Flashcards

Neurology Flashcards

1
Q

Neuro assessment

A

Starts with observation as soon as the pt enters the office

  • Appearance, gait, behaviors
  • Brain and skin have the same embryonic origin: ectoderm
  • -Cafe au lait spots, adenoma sebaceum, shagreen patches (genetic d/o on lower back, looks like orange peel)
  • Head circumference
  • -Premature closure of the suture lines (craniosynostosis) may indicate genetic etiology
  • Ocular exam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Neonatal exam

A

Healthy neonates will have periods of quiet and sustained wakefulness
Primative reflexes should be symmetrical when conduction and most resolve in about 4-6 mos
-If they reappear, mass or lesion in neuro system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Posture in neonates

A

Position that a calm infant naturally assumes when supine
28 wks: extended, not a lot of tone
32 wks: trending towards increased tone and flexion
34 wks: upper extended and lower flexed
Full term: flexed upper and lower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Movement in neonates

A

Speeds up with age of infant (premature- slow/full term- faster)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Child mental status exam

A

Alertness
Response to stimuli
Observation of play
Language
-Receptive (understanding speech)
-Expressive (spoken phrases)
Aphasias
-Broca (anterior/expressive): sparse, nonfluent language
-Wernicke (posterior/receptive): inability to understand speech: speech is fluent but non-sensical
-Global: impaired expressive and receptive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cranial nerve child exam: CNs I-VI

A

I: smell can be assessed like adults starting at age 2+
II: visual acuity is estimated to be 20/200 in newborn and 20/20 by 6 mos
-Swinging flashlight test
–Marcus Gunn pupil
III, IV, and VI: eye movement assessed with something to catch attention
-Infants: dolls eye movement (move head to the right, the eyes move to the left, nl in infants up to 6 mos of age)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Child cranial nerve exam: CNs V, VII, VIII

A

V: mastication muscles observed with swallowing or bottle use
-Corneal reflex tests V and VII
-Facial sensation: light touch, cotton gause, rooting reflex
VII: facial muscle observation or just like adults (puff out cheeks, blink etc)
VIII: neonate- blink with sound, 4 mo-turn to sound, older: whisper a word with other ear covered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Child cranial nerve exam: CNs IX-XII

A

IX and X: gag reflex is brisk at all ages except very immature neonate
-Check gag reflex with tongue depressor
XI: observation of movement
-Drooping of the shoulder and sternocleidomastoid suggests lesions of this nerve
XII: atrophy or fasciculations of the tongue
-Tongue deviates towards the week side in unilateral lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Motor exam: power

A

Sponetaneous movements and movements against gravity

Scored 0-5, where 5 is nl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Motor exam: tone

A

Lower motor lesions: decreased tone (hypotonia)
Upper motor lesions: increased tone: spasticity
Extrapyramidal dz: rigidity of a joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Motor exam: what are the other parts of it?

A

Muscle bulk
Coordination
-Ataxia is defined as the lack of coordination- think cerebellar pathway
Gait
-Typical as a toddler it starts as wide based and unsteady it narrows with age
-By 6 yo should be able to walk on toes, heels, and heel toe walk
Reflexes
-0-4 (2 is nl)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the most common recurrent pattern of primary HAs in children and adolescents?

A

Tension HAs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Tension HAs: characteristics

A

Mild
Global
Squeezing
Last for hours or days
No associated nausea, vomiting, photophobia or phonophobia
May be related to environmental stress, anxiety or depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Migraine HAs

A

Another common type of recurrent HA that often begins in childhood
Frontal, bitemporal, unilateral
Severe pounding or throbbing
Last 1-72 hrs
N/V/photo/phonophobia associated
Toddlers typically appear tired, irritable, pallor color, with vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Dx of HAs

A

In most cases, a good hx and PE provides an accurate dx and nor further testing would be needed
HOWEVER, imaging is warranted when abnl neuro exam is accompanied with the complaints
Focal neurological deficits, alteration of consciousness, or chronic progressive HA pattern
-MRI with and without contrast is study of choice
-Sudden and severe onset, CT should be done quickly
–If CT neg, LP should be done

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

1st line tx for HAs

A

Symptomatic therapy APAP or NSAID such as ibuprofen or naproxen
Hydration
Anti-emetics for adjunctive therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

2nd line tx for HAs

A 
Triptan class of meds
-CIed in pts with focal deficits or basilar migraines bc of stroke risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Preventative tx for HAs

A 
Must change lifestyle first!!
-Regulate sleep, diet/exercise, counseling, stress management, etc
Antihistamine
TCAs
BBs
CCBs
Anticonvulsants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Seizures

A

Defined as a transient occurrence of s/sx resulting from abnl excessive synchronous neuronal activity of the brain
Approximately 4-10% of children will experience at least one seizure
-Epilepsy is about 1-4%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Focal seizures

A

Simple focal (partial)
-Arise from a specific anatomic focus and location determines sx
-Consciousness is preserved!
Generalized
-Tonic, clonic, biphasic tonic-clonic
–Your typical thought of seizure activity (tonic state then clonic activity leading to a post-ictal phase)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Absence seizure

A

Clinical hallmark is a brief (seconds) loss of environmental awareness accompanied by simple automatisms
Typically start around 4-6 yrs of age
EEG will note a generalized 3-Hz spike and wave activity
Tx: ethosuximide or valproic acid
-Oxcarbamazepine and carbamazepine are relatively contraindicated for children with absence activity as these meds will potentially worsen the activity of the seizure.

22
Q

Febrile seizure

A

The MCC of seizures among children between 6 mos and 6 yrs of age
Occurs in about 4% of all children
Recur in 30-50% of children, however, prognosis is excellent
Tx is usually related to the infection at hand
Rectal diazepam for prolonged event
Antipyretics will not prevent febrile seizures

23
Q

Juvenile myoclonic epilepsy (of Janz)

A

MC generalized epilepsy among adolescents and young adults
Onset is typically in early adolescence with myoclonic jerks (typically worse in the morning)
Valproic acid classically used however, many more are effective
Must be on meds for life

24
Q

Infantile spasms

A

Brief contractions of the neck, trunk, arms followed by a phase of sustained muscle contraction lasting < 2 secs
Most frequently when going to sleep or awakening
Peak age of onset is 3-8 mos
May often be mistaken for colic or acid reflux
ACTH, oral corticosteroid, vigabatrin used for tx

25
Q

Benign neonatal convulsions

A

Autosomal dominant genetic disorder linked to abnormal K+ channels
“Fifth day fits”: otherwise healthy baby leading to focal seizures by the end of week 1
Long-term outcome favorable after tx

26
Q

Acquired epileptic aphasia

A

AKA Landau-Kleffner Syndrome
Abrupt loss of previously gained language in young children
Language disability is an acquired cortical auditory deficit
Should be considered for young pts with clear autistic regression, as potentially treatable entity!

27
Q

Status epilepticus

A

Emergency
Continuous seizure activity for >30 mins when there is no return of consciousness
14% chance of new neuro deficits
-Includes scarring, peripheral neuro loss
-The longer they go without regaining consciousness, the higher the chance of deficits

28
Q

Status epilepticus tx

A

First line of tx is establish ABCs
Oxygen either administered or through pos pressure
IV access and if this is first seizure activity in pt, conduct lab studies
Initial management is usually with a Benzo (lorazepam, diazepam, and midazolam all effective)
If after 2 doses, move to second line
-IV phenytoin, but evaluate for cardiac arrhythmias
-3rd line:
–Phenobarbital or valproic acid
—4th line: continues medication- general anesthesia

29
Q

Botulism

A

Results from intestinal infection by Clostridium botulinum
This produces a neurotoxin blocking cholinergic transmission
This is the most poisonous biological substance known to man

30
Q

Predisposing factor to botulinism

A

Infants do not have competitive bowel flora

Seen in honey, poorly canned foods, dust or soil with spores

31
Q

S/sx of botulism

A

Progressive neuromuscular blocks lead to constipation, poor feeding, hypotonia, and weakness, cranial nerve dysfunction (decreasing gag reflex, diminished eye movement, decreased pupillary contraction, and ptosis)
Respiratory failure may ensue leading to rapid death

32
Q

Tx of botulism

A

Therapy with IVIG should be administered as soon as the dx is suspected
C. botulinum can be found in stool samples
Prognosis is good with tx, respiratory and supportive care

33
Q

Disorders of consciousness

A

Consciousness is the awareness of self and environment
-Mediated by the cerebral cortex
Arousal is the system that maintains consciousness
-Mediated by the reticular activating system extending from the mid pons through the mid brain and hypothalamus to the thalamus
Lethargic means they have difficulty maintaining arousal
Obtunded are decreased arousal but can respond to stimuli
Stupor means they only respond to pain
Coma is not responsive at all
Defect in the cerebral hemispheres, brainstem or both

34
Q

What is the MCC of abrupt, episodic loss of consciousness

A

Syncope
2/3 of children with syncope have irregular, myoclonic movements as they lose consciousness (anoxic seizure)
If you can’t explain the loss of consciousness, cardiac exam must be completed

35
Q

Metabolic derangements

A

Hypoglycemia; gives rise to lethargy, confusion, seizures, coma

36
Q

Concussion

A

Process in which the traumatic forces on the brain result in the rapid onset of short lived neurologic impairment
Somatic sx- HA
Cognitive sx- poor attention or fogginess
Emotional sx- labile or irritable
Sleep sx- drowsiness
Physical sx- LOC
Majority of sx resolve in about 10 days
1 week at least before return to sporting activity
Recurrent leads to higher risks of permanent damage

37
Q

Head trauma

A

Drowsiness, HA, and vomiting are common after head trauma
They are not a concern if consciousness is preserved and neuro exam is nl
Should sx worsen in 1-2 days imaging is warranted to r/o subdural hematoma or cerebral edema

38
Q

Posttraumatic seizures after head trauma

A

Impact
-Seconds after impact, stimulation of the cortex- prognosis is excellent
Early
-Within 1 wk of injury, localized area of cerebral contusion or edema- prognosis is favorable
Late
-More than a wk afterwards, cortical scarring- may be a source of long-term epilepsy

39
Q

Rett syndrome

A

Classically affects girls
Nl development for the first 6-18 mos
Followed by a regression, loss of purposeful hand movements, loss of verbal communication skills, gait apraxia, hand motions that typically resemble repetitive washing
or clapping
Boys will not typically survive to delivery
Etiology is linked to the mutation on the X chromosome for MECP2 gene

40
Q

PE of Rett syndrome

A

Acquired microcephaly is noted

Apnea, peripheral vasomotor disturbances, growth retardation, abnl muscle tone and prolonged QTc interval often occur

41
Q

Spina bifida

A

Defective closure of the caudal neural tube
Range in severity from insignificant to myelomeningocele
-Later resulting in flaccid paralysis, loss of sensation in legs and bowel/bladder incontinence
A dimple of tuft hair may be present on PE
Surgical correction and ventriculoperitoneal shunting for hydrocephalus may be needed
Prevention with folate in pregnancy

42
Q

Meningocele

A

The underlying spinal cord is exposed but functionally and anatomically intact

43
Q

Spina bifida occulta

A

The skin on back is apparently intact but defects of the underlying bone or spinal cord are present

44
Q

Microcephaly

A

Less than the 3rd percentile
Can be secondary to infections, metabolic, toxic, vascular etiology
Sx often present secondary to cause

45
Q

Macrocephaly

A

Greater than the 97th percentile
May be the results of macrocrania- thick skull
-Or hydrocephalus- enlargement of the ventricles
-Or megaloencephaly- enlargement of the brain
Most often, macrocephaly is of no clincial significance and has a familial trait
Ensure with each visit that the child is developing normally
The brain grows in size until 14 yoa

46
Q

Aseptic meningitis

A

Viral meningitis with neg CSF

Lyme dz, syphilis, TB, abscess in the brain, NSAID, autoimmune disorders

47
Q

Meningitis

A

Inflammation of the leptomeninges

Viral, bacterial, fungi (rare)

48
Q

Incidence of meningitis

A

Very high in children <1 yoa
Genetic predisposition may play a role
CSF leaks (fistula) increase the risk, esp of S. pneumo
Bactrim can be a cause

49
Q

S/sx of meningitis

A 
Apnea
Stiff or painful neck
HA
Hearing loss
Fever of unknown origin
Irritable infant
50
Q

Tx of meningitis

A 
Empirical cefotaxime (or ceftriaxone) + Vanc should be administered until abx susceptibility testing is available
For infants < 2 mos of age: ampicillin is added to cover the possibility of listeria
Dexamethasone for 2 days as adjunctive therapy with the first dose of abx diminishes the chance of hearing loss and neuro deficits

Peds (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions