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PNCB CPNP-PC > Neuromusculoskeletal > Flashcards

Neuromusculoskeletal Flashcards

1
Q

Inflammatory MS Disorders
> -1- disease
> Toxic -2-

A
  1. Osgood-Schlatter

2. synovitis

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2
Q

Osgood-Schlatter
Def: Inflammation of the -1- as a result of repetitive stressors (e.g. avulasoin injury) in patents with immature skeletal development
> Peak ages: -2-
> associated with -3-

A
  1. tibial tubercle
  2. 10-14 years
  3. rapid growth spurt
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3
Q

Osgood-Schlatter - S/S
> -1- at tibial tubercle
> -2- at the patella
> -3- compared to unaffected side r/t -4-

A
  1. Pain and tenderness
  2. Point tenderness
  3. Enlargement
  4. irritation/inflammation
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4
Q

Osgood-Schlatter - Lab/Dx
> None: typically, this ais a diagnosis that is made -1-
> -2- to rule out more serious causes of pain, esp. in the presence of -3-

A
  1. clinically
  2. Radiographs
  3. extreme swelling and fever
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5
Q 
Osgood-Schlatter - Mgmt
> -1- disease
> -2- to control pain 
> complete activity restriction is -3- (-4-)
> -5- may provide some relief
A
  1. self-limiting (6 mo.)
  2. limit activity
  3. not recommended
  4. no pain meds before activity, only after
  5. knee immobilizers
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6
Q

Toxic Synovitis

Def: -1- of the -2- that is most likely due to a -3- or immune cause

A
  1. self-limiting inflammatory disorder
  2. hip
  3. viral
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7
Q

Toxic Synovitis
> Occurs most often in children b/t -1-, but can occur at any age
> affects -2- more often than -3-

A
  1. 3-8 years
  2. males
  3. females
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8
Q 
Toxic Synovitis - S/S
> Painful -1-
> -2- involvement
> -3- onset
> Internal -4- causes spasm/pain
> No obvious signs of -5- on inspection/palpation
A
  1. limp
  2. Unilateral
  3. insidious
  4. hip rotation
  5. infection
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9
Q

Toxic Synovitis - Lab/Dx
> -1- Dx
> -2- radiographs
> -3- joint fluid aspiration

A
  1. Clinical
  2. physiologic
  3. physiologic
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10
Q 
Toxic Synovitis - Mgmt
> -1-
> -2- as needed
> typically benign and -3-
> -4- should be considered if the patient has a -5- is suspected
A
  1. analgesics (ace, ibu)
  2. bed rest
  3. self-limiting (5-7 days)
  4. Hospitalization
  5. high fever, or septic arthritis
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11
Q

Non-Inflammatory MS Disorders
> -1- disease
> -2- epiphysis (-3-)
> -4- pain syndrome

A
  1. Legg-Calve-Perthes
  2. Slipped capital femoral
  3. SCFE, “skiffy”
  4. Patellofemoral
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12
Q

Legg-Calve-Perthes Disease

Def: -1- of the -2-; in children it may result from -3-, long-term high-dose -4- treatments, and -5-, among others

A
  1. aseptic or avascular necrosis
  2. femoral head
  3. trauma
  4. steroid and cancer
  5. blood disorders
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13
Q

Legg-Calve-Perthes Disease - Etiology/Incidence
> -1-, possibly due to -2-
> Most common in -3-, ages -4-

A
  1. Unknown etiology
  2. vascular disruption
  3. boys
  4. 4-10 years
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14
Q

Legg-Calve-Perthes Disease - S/S
> -1- onset of -2-; pain may also -3-
> pain less -4- than -5-
> -6-

A
  1. Insidious
  2. limp w/ knee pain
  3. migrate to groin/lateral hip
  4. acute/severe
  5. toxic synovitis/septic arthritis
  6. afebrile
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15
Q

Legg-Calve-Perthes Disease - PE Method

-1- and -2- fo the -3- joint

A
  1. Limited passive interal rotation (PIR)
  2. abduction
  3. hip
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16
Q

Legg-Calve-Perthes Disease - PE
> May be resisted by mild spasm or -1-
> -2- and leg muscle -3- occur in -4- cases

A
  1. guarding
  2. hip flexion contracture
  3. atrophy
  4. long-standing
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17
Q

Legg-Calve-Perthes Disease - Lab/Dx
> -1- studies (shows -2-)
> -3- necessary

A
  1. Radiograph
  2. femoral head necrosis
  3. no labs
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18
Q

Legg-Calve-Perthes Disease - Mgmt/Tx

Goal: to -1- while maintaining -2- within -3-

A
  1. restore ROM
  2. femoral head
  3. acetabulum
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19
Q

Legg-Calve-Perthes Disease - Mgmt/Tx
-1- only if:
> -2- of age
> Involvement of -3- of the femoral head (per -4-)

A
  1. Observation
  2. < 6 years
  3. < 0.5
  4. x-ray
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20
Q

Legg-Calve-Perthes Disease - Mgmt/Tx
-1- treatment
> indicated when -2- head is involved and in children -3-
> Refer to -4-

A
  1. Aggressive (surgical)
  2. 0.5+ of the femoral
  3. > 6 yo
  4. orthopedics
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21
Q

Slipped Capital Femoral Epiphysis (SCFE)
Def: -1- of femoral head (capital epiphysis) both -2- and -3- relative to the femoral neck and secondary to disruption of the epiphyseal plate

A
  1. Spontaneous dislocation
  2. downward
  3. backward
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22
Q

SCFE - Etio/Incidence
> Etiology: -2-; perhaps precipitated by -3- changes
> Generally occurs -4- force or trauma

A
  1. Unknown
  2. puberty-related hormone
  3. w/o severe/sudden
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23
Q

SCFE - Etio/Incidence
> Typical -1- and -2- in girls
> More common in -3-, -4- and -5- adolescents

A
  1. during growth spurt
  2. prior to menarche
  3. male
  4. african american
  5. pacific islander
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24
Q

SCFE - Etio/Incidence

Incidence is greater among -1- with -2-

A
  1. obese adolescents

2. sedentary lifestyles

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25
Q

SCFE - S/S

-1- and often -2- and/or -3-

A
  1. pain in the groin
  2. referred to thigh
  3. knee
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26
Q

SCFE - S/S

When acute onset, -1- with the -2- or -3-

A
  1. pain will be severe
  2. inability to ambulate
  3. move hip
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27
Q

SCFE - S/S
Physical findings
> unable to -1- as -2- (-3-)
> May observe -4-, resulting from -5- of metaphysis

A
  1. properly flex hip
  2. femur abducts/rotates externally
  3. only comfortable sitting with leg out
  4. limb shortening
  5. proximal displacement
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28
Q

SCFE - Lab/Dx
> -1- combined with knowledge of etiological factors (such as -2-)
> -3-
> Lab studies: -4-

A
  1. accurate history
  2. BMI
  3. radiographs
  4. typically none
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29
Q

SCFE - Mgmt/Tx
> -1- to -2-
> -3- permitted (-4-)
> -5- for same problem

A
  1. immediate referral
  2. ortho
  3. NO AMBULATION
  4. wheelchair!
  5. Monitor other hip
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30
Q

Patellofemoral Pain Syndrome (Runner’s Knee)

Definition: …

A

Pain around kneecap (patella)

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31
Q

Runner’s Knee - Etiology/Incidence
> associated with -1- (e.g., -2-), surgery, injury, muscle imbalances
> Twice as common in -3-
> Most common in -4-

A
  1. repetitive stress
  2. running (track), jumping
  3. women as in men
  4. adolescents, young adults
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32
Q 
Runner's Knee
> S/S
>> Dull, aching pain around -1-
>> Exacerbated by -2-, sitting with -3- for extended periods
> Lab/Dx
>> Diagnosis is often made -4-
>> X-rays, CT, MRI may be used to -5-
A
  1. front of knee
  2. climbing stairs, squatting
  3. knees bent
  4. clinically
  5. confirm diagnosis
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33
Q

Runner’s Knee - Mgmt/Tx
> -1-
> -2-, supportive -3-
> Consider -4- if condition is -5- to conservative treatment

A
  1. analgesics
  2. PT (quads)
  3. braces
  4. referral for surgery
  5. refractory
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34
Q

Genu Varum

Def: -1- of the -2-, often due to joint laxity; considered a physiologic variant until -3-

A
  1. lateral bowing [like a pirate (rum)]
  2. tibia
  3. age 2 years (toddler most common)
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35
Q 
Genu Varum
> S/S
>> It is acceptible for bowing that -1- after walking begins
>> -2-
> Lab/Dx
>> -3-
A
  1. does not increase
  2. Retains FROM
  3. None indicated
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36
Q 
Genu Varum - Mgmt
> None necessary -1- years if appears as -2-
> -3- if
>> Continues -4- years
>> -5-
A
  1. under age 2
  2. physiologic variant
  3. Refer to ortho
  4. after age 2
  5. unilateral
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37
Q

Genu Valgum

Def: Knees are -1- and ankle space is increased; typically evolves to physiologic alignment by -2- age (-3- common)

A
  1. markedly close (“stuck together like gum” valgum)
  2. 7 years of
  3. preschool most
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38
Q 
Genu Valgum - S/S
> Knees -1-
> Distance between medial malleoli (ankles) is -2-
> No -3-
> -4-
> Walk or run may be -5-
A
  1. close together
  2. more than 3 inches
  3. pain
  4. FROM
  5. awkward
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39
Q

Genu Valgum - Lab/Dx
> -1-
> Radiographs if -2- or if -3-

A
  1. None necessary
  2. > 7 yo
  3. it’s unilateral
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40
Q

Genu Valgum - Mgmt
> -1-
> Older children (-2-) need a -3-

A
  1. none necessary
  2. (7+ yo)
  3. referral to ortho
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41
Q

Scoliosis
> lateral -1- that is idiopathic and most -2-
> Other types are -3- or -4- (associated with conditions)
> Occurs more often in -5-

A
  1. curvature of the spine
  2. common in adolescence
  3. congenital (e.g. infancy)
  4. neuromuscular
  5. females
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42
Q

Scoliosis - S/S
> May -1-
> Rarely -2-
> -3-, ribs, -4-, and -5-

A
  1. occur at any age (usually around growth spurt)
  2. painful
  3. Asymmetry of shoulder
  4. hips
  5. waistline (Adam’s FB Test)
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43
Q 
Scoliosis
> Lab/Dx
>> -1- for further evaluation
> Mgmt
>> -2- if no pain exists and if -3- curvature
>> -4- or -5- curvature
A
  1. Radiographs
  2. Observe
  3. < 20 deg
  4. Refer if painful
  5. > 20 deg
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44
Q

Duchenne Muscular Dystrophy (DMD)

Def: -1- disorder beginning in the -2- and -3- to the -4- extremities and torso

A
  1. Progressive genetic
  2. Lower extremities
  3. progressing
  4. upper
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45
Q

DMD
> among the -1- neuromuscular diseases in children
> affects -2- children
> average age of diagnosis is -3-

A
  1. most common inherited
  2. 1/3500
  3. 2-6 years
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46
Q

DMD - S/S
> Abnormalities of -1-
> Developmental -2-
> -3- w/ developing peers

A
  1. gait and posture
  2. clumsiness
  3. Trouble keeping up
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47
Q

DMD - S/S
-1- sign
> child -2- to legs to attain standing position when getting up
> suggests -3-

A
  1. Gower’s sign
  2. “walks” hands up
  3. pelvic girdle weakness
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48
Q

DMD - S/S
> -1- large (-2- replaced by -3-)
> Decreased -4-

A
  1. Calf muscles disporportionately
  2. healthy muscle
  3. degenerative tissue
  4. proximal muscle strength
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49
Q

DMD - S/S
> -1- dependent beginning at -2-
> Eventual -3- from -4-

A
  1. wheelchair
  2. age 10-12
  3. death
  4. cardiopulmonary failure
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50
Q 
DMD - Lab/Dx
> -1- patients (5 - 150 kIU/L)
> -2-: myopathy
> -3-: pathologic
> -4-: necrotic degenerating fibers
> -5-
A
  1. CK: markedly elevated in affected
  2. EMG
  3. EKG
  4. Muscle biopsy
  5. genetic testing
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51
Q

DMD - Mgmt
> Symptomatic care to -1- and maintain -2-
> -3- (-4-)

A
  1. delay progression
  2. strength and mobility
  3. Multi-specialty mgmt
  4. incl. psych/family support
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52
Q

DMD - Mgmt
> -1- (-2- prednisone or -3-)
> -4-

A
  1. Corticosteroids
  2. high dose
  3. Emflaza (deflazacort)
  4. palliative care
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53
Q

Ankle Sprain

Usually a forced inversion (-1- is the -2-) or eversion (medial ankle)

A
  1. lateral ankle sprain

2. most common

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54
Q

Ankle Sprain - S/S
Grade I: -1- but -2- of a ligament; no joint instability
> -3-
> minimal -4-

A
  1. STretching
  2. no tearing
  3. local tenderness
  4. edema
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55
Q

Ankle Sprain - S/S - Grade I
> -1- typically insignificant or absent
> -2- remains although may be uncomfortable
> Patient retains -3-

A
  1. ecchymoses
  2. FROM
  3. weight bearing ability
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56
Q 
Ankle Sprain - S/S
Grade II: -1- of ligament; some joint instability but definite endpoint to laxity
> -2- immediately upon injury
> Localized -3-
> Significant -4- bearing
> -5-
A
  1. Partial (incomplete) tearing
  2. pain
  3. edema & ecchymoses
  4. pain with weight
  5. ROM is limited
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57
Q

Ankle Sprain - S/S

Grade III: -1-; joint -2- with -3- to ligamentous stressing

A
  1. Complete ligamentous tearing
  2. unstable
  3. no definite endpoint
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58
Q 
Ankle Sprain - S/S - Grade III
> Severe -1- immediately upon injury
> Significant -2- along foot and ankle
> Profound -3- due to hemorrhage; worsens over several days
> Patient -4-
> No -5-
A
  1. pain
  2. edema
  3. ecchymoses
  4. cannot bear weight
  5. ROM to ankle
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59
Q

Ankle Sprain - Lab/Dx
-1- is indcated according to -2- if:
> There is -3- /and/
> -4- is present at the posterior edge of the distal -5- or the tip of either malleolus /or/
> the patient is unable to bear weight for at least 4 steps at the time of the injury and evaluation
> otherwise, diagnostic studies are not indicated

A
  1. Radiograph
  2. Ottowa Ankle Rules
  3. pain near the malleoli
  4. bone tenderness
  5. 6 cm
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60
Q

Ankle Sprain - Lab/Dx
Radiograph is indcated according to Ottowa Ankle Rules if:
> There is pain near the malleoli /and/
> bone tenderness is present at the posterior edge of the distal 6 cm or the tip of either malleolus /or/
> the patient is -1- weight for -2- at the time of the injury and evaluation
> otherwise, diagnostic studies are -3-

A
  1. unable to bear
  2. at least 4 steps
  3. not indicated
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61
Q

Ankle Sprain - Mgmt
-1-: All grades including non-severe III respond well
> -2-: weight bearing should be avoided for the first several days
> -3-: should be applied on top of the -4- dressing as quickly as possible following the injury, 30 mintues on and off alternately
> -4-: Immediate secure -4- will minimize edema and support -5- ankle
> Elevation: for several days following injury (reduces pain and swelling and promotes recovery)

A
  1. RICE
  2. Rest
  3. Ice
  4. Compression
  5. stability of the
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62
Q

Ankle Sprain - Mgmt
RICE: All grades including non-severe III respond well
> Rest: weight bearing should be avoided for the first several days
> Ice: should be applied on top of the compression dressing as quickly as possible following the injury, 30 mintues on and off alternately
> Compression: Immediate secure compression will minimize edema and support stability of the ankle
> -1-: for -2- follwoing injury (reduces pain and -3- and promotes recovery)

A
  1. Elevation
  2. several days
  3. swelling
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63
Q

Ankle Sprain - Mgmt
> -1- for pharmacologic relief (e.g. -2-, topical ketoprofen or diclofenac)
> Can also -3- such as -4-

A
  1. NSAIDs
  2. ibuprofen
  3. consider other analgesics
  4. acetaminophen
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64
Q

Salter-Harris Fracture
Def: Unique -1- of varying ages, Salter-Harris fractures occur in the -2- of -3- (-4-) during development. Boys are -5- as girls to sustain a Salter-Harris fracture.

A
  1. to pediatric patients
  2. growth plate
  3. long bones
  4. arms & legs
  5. twice as likely
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65
Q 
Salter-Harris Fracture - S/S
> -1-
> Localized -2- with warmth, -3-
> Limited -4- capability
> -5-
A
  1. Traumatic injury
  2. joint pain
  3. swelling, and tenderness
  4. ROM & weight bearing
  5. Bone displacement
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66
Q

Salter-Harris Fracture - Lab/Dx
> -1-
> -2-
> -3- (in infant)

A
  1. X-ray
  2. CT
  3. US
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67
Q

Salter-Harris Fracture - Classification (-5-)
> Salter I (-1-): Fracture line extends -2-
> Salter II (-3-): Most common Salter-Harris fracture; extends through both the -4-

A
  1. Slipped
  2. through physis
  3. Above
  4. physis and the metaphysis
  5. SALTR mnemonic
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68
Q

Salter-Harris Fracture - Classification (-1-)
> Salter III (-2-): intra-articular fracture extending from the -3-
> Salter IV (-4-): intra-articular -5-

A
  1. SALTR Mnemonic
  2. Lower
  3. physis into the epiphysis
  4. Through/Transverse
  5. passing through the epiphysis, physis, and metaphysis (all three layers)
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69
Q

Salter-Harris Fracture - Classification (-1-)

> Salter V (-2-): -3-, with -4- injury that extends through epiphysis and physis

A
  1. SALTR Mnemonic
  2. Rammed/Ruined
  3. Rare
  4. severe crushing or compression
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70
Q 
Salter-Harris Fracture - Tx/Mgmt
> -1-
> Rx strength -2- only if necessary
> -3- for -4-
> -5-
A
  1. Rest, ice, elevation
  2. pain medicine (ibu 10 mg/kg); but opioids
  3. Closed reduction w/ cast/splint
  4. Salter I and II
  5. ORIF for Salter III and IV
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71
Q

Elbow Fracture

Def: often assoc w/ -1- resulting from -2- arm falls

A
  1. injuries

2. straight, outstretched

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72
Q

Elbow Fracture - S/S
Sudden -1- in the -2-
> swelling, bruising, -3-
> -4- are signs of -5-

A
  1. intense pain
  2. elbow & forearm
  3. visible deformity (lump)
  4. numbness and tingling
  5. nerve injury
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73
Q

Elbow Fracture - S/S
-1- sign
> No -2- on -3-
> the lateral view demonstrates -4- -1-

A
  1. Fat pad(s)
  2. fracture is visible
  3. X-ray
  4. elevation of the anterior & posterior
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74
Q 
Elbow Fracture
> Lab/Dx
>> follow up radiographs with an -1-
> Mgmt
>> -2- to be treated as a fracture
A
  1. oblique view

2. Refer to ortho

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75
Q 
Nursemaid Elbow
Def: common injury in young children and -1- resulting from -2- child's arm; -3-.
> S/S
>> Holds arm -4-
>> Significant -5- justify x-ray
A
  1. toddlers
  2. swinging/pulling
  3. radial head subluxation
  4. across body with thumb up
  5. edema & ecchymosis
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76
Q

Nursemaid Elbow - Lab/Dx

-1- as -2- and is usually -3-

A
  1. X-ray
  2. physiologic
  3. forgone
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77
Q

Nursemaid Elbow - Mgmt
> -1- by a -2- or refer (-3-)
> Supportive care at home with -4-

A
  1. Reduction
  2. trained NP
  3. Quick recovery: 15-30 minutes
  4. NSAIDs
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78
Q 
Cranial Nerves
> Types
>> CN II: -1-
>> CN VI: -2-
> Names
>> CN III: -3-
> Major Functions
>> CN X: -4- from the carotid body, carotid reflex
>> CN XI: Movement of the -5-
A
  1. Sensory
  2. Motor
  3. Oculomotor
  4. Talking, swallowing, general sensation
  5. trapezius and sternomastoid muscles (shrugging)
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79
Q 
Cranial Nerves
> Types
>> CN IV: -1-
>> CN V: -2-
> Names
>> CN X: -3-
>> CN XII: -4-
> Major Functions
>> CN XII: -5-
A
  1. Motor
  2. Both
  3. Vagus
  4. Hypoglossal
  5. moves the tongue
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80
Q 
Cranial Nerves
> Major Functions
>> CN II: -1-
>> CN VII: Moves face, -2- and eyes; taste (ant 2/3); Saliva & -3-
> Types
>> CN III: -4-
>> CN XI: -4-
> Names
>> CN VI: -5-
A
  1. vision
  2. closes mouth
  3. tear secretion
  4. Motor
  5. Abducens
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81
Q 
Cranial Nerves
> Names
>> CN I: -1-
>> CN II: -2-
> Major Functions
>> CN III: -3-
>> CN V: -4-, cornea, mucus membranes, and nose
> Types
>> CN X: -5-
A
  1. Olfactory
  2. Optic
  3. Most EOMs, opening eyelids, pupillary constriction
  4. Mastication; sensation of face, scalp
  5. Both
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82
Q 
Cranial Nerves
> Major Functions
>> CN VI: -1-
>> CN VIII: -2-
> Types
>> CN VII: -3-
>> CN IX: -3-
> Names
>> CN IX: -4-
A
  1. Lateral eye movement
  2. Hearing & equilibrium
  3. Both
  4. glossopharyngeal
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83
Q 
Cranial Nerves
> Major Functions
>> CN I: -1-
>> CN IX: -2- swallowing -3-
> Types
>> CN I: -4-
>> CN VIII: -4-
> Names
>> CN VIII: -5-
A
  1. Smell
  2. phonation, gag, carotid
  3. reflex; taste (Posterior 1/3)
  4. Sensory
  5. Vestibulocochlear/Acoustic
84
Q 
Cranial Nerves
> Names
>> CN IV: -1-
>> CN V: -2-
> Types
>> CN XII: -3-
A
  1. Trochlear
  2. Trigeminal
  3. Motor
85
Q 
Cranial Nerves
> Major Functions
>> CN III: -1-, -2-, -3-
> Names
>> CN VII: -4-
>> CN XI: -5-
A
  1. Most EOMs
  2. opening eyelids
  3. pupillary constriction
  4. Facial
  5. Spinal accessory
86
Q

Cranial Nerves - Examples
> -2- mnemonic: -3-
> Facial (-4-): -5-
> Tongue: -1-

A
  1. XII
  2. Eye innervation
  3. LR6SO4 - lateral-rectus IV, superior-oblique VI; all the rest are 3
  4. Bell’s Palsy (Lyme Disease)
  5. VII
87
Q

Common Headaches
4 Primary Mechanisms of HA pain
> Vascular dilation; Cranial -1- (e.g., -2-, fever, -3-, -4-, systemic infection)

A
  1. artery distension
  2. migraine
  3. vasodilator drugs
  4. metabolic distrubance
88
Q

Common Headaches
4 Primary Mechanisms of HA pain
> Muscular contraction: -2- muscle conraction (e.g., -3- or psychogenic HA)
> Traction: -4- (e.g., brain -5-, mass lesions, abscess, -1-, increased ICP)

A
  1. Hematoma
  2. head and neck
  3. tension
  4. space-occupying lesion
  5. tumors
89
Q

Common Headaches
4 Primary Mechanisms of HA pain
> Inflammation: -1- [e.g., -2-, -3-, -4- (-5-)]

A
  1. infection
  2. meninges
  3. sinuses
  4. teeth
  5. sinus and tooth infections rarely cause headaches unless they’re severe
90
Q 
Components of HA Eval
For symptom assessment, use the OLDCART -2- (informs journal): 
> Onset
> Location
> Duration
> Characteristics
> Aggravating factors
> Remedial/alleviating factors
> -10- (what was -11-, and did it -12-?)
A
  1. mnemonic
  2. Treatment
  3. done
  4. work
91
Q 
Components of HA Eval
For symptom assessment, use the -1- mnemonic (informs journal): 
> Onset
> -5-
> Duration
> -7-
> -8- factors
> Remedial/alleviating factors
> Treatment (what was done, and did it work?)
A
  1. OLDCART
  2. Location
  3. Characteristics
  4. Aggravating
92
Q 
Components of HA Eval
For symptom assessment, use the OLDCART mnemonic (-3-): 
> -4-
> Location
> -6-
> Characteristics
> Aggravating factors
> -9- factors
> Treatment (what was done, and did it work?)
A
  1. informs journal
  2. Onset
  3. Duration
  4. Remedial/alleviating
93
Q 
Migraine HAs
Background & Incidence
> Migraine -1- aura (most common -2-)
> Migraine -3- aura (typical onset -4- of age)
> Often, there is a(n) -5-
A
  1. without
  2. in children 10-
  3. with
  4. > 10 years
  5. family history
94
Q

Migraine HAs - Background & Incidence
> -1- more often affected than -2-
> Increased risk in children w/ -3-, intermittent -4-, and -5-

A
  1. Females
  2. males
  3. motion sickness
  4. abdominal pain (abd migraine)
  5. cyclic vomiting syndrome
95
Q

Migraine HAs - Background & Incidence
> A variety of -1- are associated iwth migraine (e.g., dehydration, emotional or phyiscal stress -2-, -3-, escessive screen time, -4-, use of oral -5-.

A
  1. “triggers”
  2. incl. barometric pressure; lack/excess sleep
  3. missed meals
  4. menstruation
  5. contraceptives
96
Q

Migraine HAs
Symptoms
> Location: -1- in -2- children, -3- in -4-
> Character: -5-

A
  1. bifrontal
  2. younger
  3. unilateral
  4. adolescents
  5. throbbing, pounding
97
Q

Migraine HAs - Symptoms
> Severity: -1-
> Related: 2+ of (-2-, -3-,phonophobia, dizziness, or -4-, including -5-)

A
  1. Moderate to severe
  2. nausea/vomiting
  3. photophobia
  4. vision changes
  5. blurred vision and blindness
98
Q

Migraine HAs - Variant migraine syndromes

-1- migraine: more common in -2-; period of -3- followed by -4- and -5-; HA may not be described

A
  1. confusional
  2. younger children
  3. confusion and disorientation
  4. vomiting
  5. deep sleep, waking feeling well
99
Q

Migraine HAs - Variant migraine syndromes

-1-: episodic -2- with nausesa, -3- followed or accompanied by -4-

A
  1. Abdominal migraine
  2. abdominal pain
  3. vomiting
  4. HA
100
Q

Migraine HAs - Variant migraine syndromes

-1- -2-: -1- in the presence of a -2-, appears like a -3- (which needs to be -4-). Strong -5-

A
  1. Hemiplegic/-a
  2. migraine (HA)
  3. stroke
  4. ruled out in the ER
  5. familial correlation
101
Q

Migraine HAs - Lab/Dx
> -1-
> Labs typically aren’t indicated for children with migraine. If appropriate given history and physical, consider -2-, -3-, thyroid studies, and -4-

A
  1. Baseline studies/vitals
  2. CMP
  3. CBC
  4. Vit D level
102
Q 
Migraine HAs - Lab/Dx
> -1- criteria for HAs: MRI of the brain (preferable over CT scan in most cases)
>> -2-
>> -3- (-4-)
> Other studies as indicated by the -5-
A
  1. Imaging
  2. altered mental status
  3. pathologic presentation
  4. sudden changes in symptoms
  5. H&P
103
Q

Migraine HAs - Mgmt
> -1- factors is very important; have the patient keep a(n) -2-
> -3-: balanced diet, avoid skipping meals, -4-, aerobic exercise, -5-, limited screen time

A
  1. Avoidance of trigger
  2. headache diary (informed by OLDCART)
  3. HA hygiene
  4. proper hydration
  5. regular sleep
104
Q

Migraine HAs - Mgmt
> Relaxation/-1- (e.g., cousneling, biofeedback)
> -2-, & -3-
> Prophylactic therapy if atatcks occur -4-, or if migraines interfere with daily functioning or school

A
  1. stress mgmt techniques
  2. Limit/avoid caffeine intake
  3. trigger foods
  4. > 4/month
105
Q 
Migraine HAs - Mgmt
Common prophylactic medications:
> -1-
> -2-
> -3-
> -4-
> -5-
A
  1. Cyproheptadine (Periactin)
  2. Amitriptyline (Elavil)
  3. Topiramate (Topamax)
  4. Propranolol (Inderal)
  5. Valproic Acid (Depakote)
106
Q

Migraine HAs - Mgmt

Common prophylactic medications: -1- tend to be -2-, and/or -3- to -4-

A
  1. side effects, such as hunger in periactin
  2. mild
  3. self-limiting
  4. ~1 month of treatment
107
Q

Migraine HAs - Mgmt - Abortive therapy
> Rest in a -1-
> -2- taken at onset of headache is preferred -3- or -4-, due to the latter’s -5-

A
  1. quiet, dark room
  2. NSAIDs (Naproxen sodium is preferable)
  3. over aceta
  4. even ibu (but ibu will do if naproxen unavailable)
  5. rebound effect
108
Q

Migraine HAs - Mgmt - Abortive therapy
> -1- such as -2- if -3-
> When NSAIDs are -4-, consider -5-

A
  1. Antiemetics
  2. zofran
  3. vomiting
  4. not enough
  5. triptans
109
Q

Migraine HAs - Mgmt - Abortive therapy - Refractory to NSAIDs
> -1- 6.25mg (approved for children -2-)
> -3- 5mg (approved for use in -4-)

A
  1. almotriptan (Axert)
  2. 12+ yo
  3. Rizatriptan (Maxalt)
  4. children and adolescents
110
Q

Migraine HAs - Mgmt - Abortive therapy - Refractory to NSAIDs
> -1-:
» -2- 5mg initially; may go to 10. Pateints may complain of bad taste
» -4-: less expensive; may not work as well due to -3-
> -5-: 5mg nasal spray as initial dose

A
  1. Sumatriptan (Imitrex)
  2. nasal
  3. slower absorption
  4. oral tablets
  5. Zolmitriptan (Zomig)
111
Q

Migraine HAs - Mgmt - Abortive therapy - Refractory to NSAIDs
Most evidence for -1- years: -2- 5mg or -3- 5mg

A
  1. children aged 6-11
  2. rizatriptan (maxalt)
  3. sumatriptan (Imitrex) nasal
112
Q

Migraine HAs - Mgmt - Abortive therapy - Refractory to NSAIDs
> May take -3- at -1-, then repeat -2- needed
> -4- in children at risk for -5-

A
  1. first sign of symptoms
  2. in 2 hours
  3. prescribed triptan
  4. Avoid triptans
  5. heart disease (consult w/ following cardiologist)
113
Q

Tension-type HAs - Background and Incidence
> Often, there is a(n) -1-
> A variety of -2- for tension-type HAs (e.g., -3-, missed meals, emotional or -4-, lack/excess sleep, excessive screen time, mensturation, use of oral contraceptives).
> more common in -5-

A
  1. family Hx
  2. “triggers”
  3. dehydration
  4. physical stress (back to school)
  5. school-age children and adolescents
114
Q

Tension-type HAs - Symptoms
> Location: -1- (may -2-)
> Character: -3-, -4- pain, aching
> Severity: -5-

A
  1. occiput
  2. radiate
  3. pressure
  4. band-like
  5. mild-severe
115
Q

Tension-type HAs - Symptoms
> -1-: at least one in most cases (-2-, photophobia, phonophobia, dizziness, -3-)
> -4-
> Tenderness on exam with light palpation of neck and -5-

A
  1. associated symptoms
  2. N/V
  3. vision changes/blurred vision
  4. aching neck pain
  5. trapezius muscles
116
Q

Tension-type HAs - Lab/Dx
> -1-
> -2- children w/ tension HA. If appropriate given H&P, consider CMP, CBC, thyroid, vit D.
> imaging criteria for HAs: MRI of brain (preferable over CT in most cases)
» Headache -3- sleep
» Altered -4-
» pathologic -5-

A
  1. Baseline studies/vitals
  2. labs typically aren’t indicated for
  3. wakes child from
  4. mental status
  5. presentation
117
Q

Tension-type HAs - mgmt
> -1- is very improtant; have the patient keep a -2-
> HA hygiene: -3-, avoid skipping meals, -4-, regular -5-, limited screen time

A
  1. avoidance of trigger factors
  2. HA diary
  3. balanced diet
  4. proper hydration, aerobic exercise
  5. sleep
118
Q

Tension-type HAs - mgmt
> -1- (e.g., counseling, biofeedback, -2-)
> Consdier -3- (-4-)
> Limit/avoid -5-

A
  1. relaxation/stress reduction techniques
  2. yoga
  3. massage therapy
  4. tension HAs are muscular in nature
  5. caffeine intake
119
Q 
Tension-type HAs - mgmt
-1- if attacks occur -2-, or if HAs interfere w/ daily functioning or school:
> -3-
> -4-
> -5-
A
  1. Prophylactic therapy (pharm)
  2. > 4/month
  3. cyproheptadine (periactin)
  4. Amitriptyline (elavil)
  5. topiramate (topamax)
120
Q

Tension-type HAs - mgmt - Abortive Therapy
> -1-
> -2- is preferred over -3-; taken at onset of HA symptoms

A
  1. rest
  2. naproxen
  3. Aceta, ibu (rebound effect)
121
Q

Potentially Urgent HA Evaluation - Febrile Patient
> -1-: -2-, viral, TB, -3-
> -4- or other intracranial -5-

A
  1. Meningitis
  2. bacterial
  3. aseptic
  4. brain abscess
  5. infection
122
Q

Potentially Urgent HA Evaluation - Febrile Patient
> -1- (-2-)
> -3-
> associated infectoin: -4-, -5-, rubeola

A
  1. Encephalitis
  2. Lyme
  3. Sinusitis
  4. Strep, flu
  5. mono
123
Q

Potentially Urgent HA Evaluation - Febrile Patient - Meningitis
> Viral meningtis is more common -1-
> -2- meningitis occurs only in up to 2%
» Temps higher than -3-
» Causative agents include -4-, salmonella, -5-, protozoa, & E coli

A
  1. in infants, but can occur at any age
  2. Bacterial
  3. 101.8/38.8
  4. GBS, S. pneumoniae, H. influenzae
  5. N. Meningitis
124
Q

Potentially Urgent HA Evaluation - Febrile Patient - Bacterial Meningitis
> Infants between -1- are at -2-
> -3- cases occur in children aged -4-
> -5- reduce risk: hx should always include -5- status

A
  1. 6 & 12 months
  2. greatest risk
  3. 90% of
  4. 1 month to 5 years
  5. immunization(s)
125
Q

Potentially Urgent HA Evaluation - Febrile Patient - S/S - Newborns & young infants
> mimics -1-
> -2-, lethargy
> -3-

A
  1. septiciemia
  2. irritability
  3. poor feeding
126
Q

Potentially Urgent HA Evaluation - Febrile Patient - S/S - Newborns & young infants
> -1-
> -2- (caused by -3-)
> No -4-

A
  1. vomiting
  2. bulging fontanel
  3. inflammation
  4. stiff neck
127
Q

Potentially Urgent HA Evaluation - Febrile Patient - S/S - Older infants and children
> -1-
> -2-, back pain, -3-
> Hyperesthesia, cranial nerve palsy, -4-
> -5-

A
  1. N/V
  2. HA
  3. nuchal rigidity
  4. ataxia
  5. photophobia
128
Q 
Potentially Urgent HA Evaluation - Febrile Patient - S/S - Older infants and children
> Positive -1- sign
>> Flexion of the hip at 90
>> Pain on -2-
> Positive -3- sign
>> Involuntary -4- when -5-
A
  1. Kernig’s
  2. extension of leg at knee
  3. Brudzinksi’s
  4. flexion of legs
  5. neck is flexed
129
Q 
Potentially Urgent HA Evaluation - Febrile Patient - Dx
> -1- analysis via -2-
>> -3-
>> -4- present
> Imaging (-5-)
A
  1. CSF
  2. LP
  3. cloudy
  4. WBCs
  5. MRI > CT for masses
130
Q

Afebrile Pt w/ Acute Onset HA
> Rule out: -1-, -2-, & -3-
> -4-
> -5- HA

A
  1. migraine
  2. tension type
  3. post-traumatic (concussion)
  4. hemorrhage (subarachnoid or intraparenchymal)
  5. Postictal (Sz related)
131
Q

Afebrile Pt w/ Acute Onset HA
> Severe -1-
> -2- (brain -3-, -4-)

A
  1. HTN
  2. space-occuypying condition
  3. tumor
  4. hydrocephalis
132
Q 
Brain Tumors
> Etiology -1-
> -2- tumors predominate, most common ages 4-11 years
>> -3-
>> -4-
A
  1. is unkown
  2. Infratentorial, brainstem
  3. Cerebellum - balance/coordination
  4. brainstem - life functions
133
Q 
Brain Tumors
> Occiput: -1-
> parietal: -2-
> Frontal: -3-
> temporal: -4-
A
  1. vision, color
  2. perception, spelling, math
  3. executive function
  4. hearing, language, memory
134
Q 
Brain Tumors - S/S
Infants
> Incrased head circumference, -1-
> -2-
> -3-
> loss of -4-
A
  1. tense, bulging fontanels
  2. irritability
  3. head tilt
  4. developmental milestones
135
Q

Brain Tumors - S/S - Older Children
> -1-
» -2- (-3-) followed by vomiting

A
  1. HA
  2. Awakens with worst HA in the morning
  3. Also awakened overnight with severe HA
136
Q

Brain Tumors - S/S - Older Children
-1- or -2-
> -3-, FTT, DI

A
  1. Pathologic neurologic
  2. ocular findings
  3. Head tilt
137
Q 
Brain Tumors - S/S - Older Children - Pathologic neurologic or ocular findings
> -1-
> Loss of -2-
> Possible -3-
> -4- changes
A
  1. papilledema (swelling around the optic nerve)
  2. fine motor control
  3. return of Babinski’s reflex (splayed toes)
  4. behavioral
138
Q

Brain Tumors - Diagnostic Tests
> -1- when available
> -2-: only -3- to show -4-

A
  1. MRI preferred over CT
  2. LP
  3. after imaging’s been done
  4. that it’s safe to perform
139
Q

Seizures
Def: A transient disturbance of cerebral function due to an abnormal -1- in the brain.
Children with epilepsy are at risk for increased mortality -2-.

A
  1. paroxysmal neuronal discharge

2. based upon age

140
Q

Seizures - Causes/Incidence
> -1- abnormalities and -2- may result in seizures presenting in infacny and early childhood
> -3- abnormalities: many types of epilepsy havae a -3-basis, but -3- testing is not routinely done for all children with seizures

A
  1. congenital
  2. perinatal injuries
  3. genetic
141
Q

Seizures - Causes/Incidence

Metabolic disorders: -1- (-2-), hypoglycemia, pyridoxine (B6) deficiency, -3-, -4-, and others

A
  1. Hypocalcemia
  2. as in DiGeorge Syndrome
  3. renal failure
  4. acidosis
142
Q

Seizures - Causes/Incidence
> -1- and other -2-
> -3-: Bacterial meningitis. -4-, -5-

A
  1. Tumors
  2. space occupying lesion
  3. Infectious diseases
  4. herpes encephalitis
  5. neurosyphilis
143
Q

Seizures - Causes/Incidence
> Seizure -1- is -3- with -2- (i.e. easier for them to have a seizure if -2-)
> -4-: the majority of cases of seizures in children -5-

A
  1. threshold
  2. fever/febrile
  3. lowered
  4. Idiopathic
  5. do not have an identified cause
144
Q 
Seizures - Categories - -1-
-1- origin: -2- regions of the brain
> -1- seizures -3-
>> No -4-
>> May be -5- symptoms
A
  1. Focal
  2. One+ specific
  3. without impaired awareness
  4. loss of conciousness
  5. characterized by motor and/or non-motor
145
Q

Seizures - Categories - Focal
Focal seizures w/ impaired awareness
> Impaired consicousness: -1-, during or after -2- symptoms

A
  1. staring > 20 seconds before,

2. motor and/or non-motor

146
Q 
Seizures - Categories - Generalized
Involves the -1-
> -2-
>> Brief -3- w/ -4-
>>> Mistaken for -5-
A
  1. entrie cortex of the brain
  2. absence
  3. “staring” episodes (10-20s)
  4. unresponsiveness
  5. “daydreaming,” inattention, ask about responsiveness, memory
147
Q 
Seizures - Categories - Generalized
-1-
> Sudden -2- tone producing a number of characteristic postures
> -3- during event
> -4- varies; may -5-
A
  1. Tonic
  2. increase in muscle
  3. unresponsive
  4. postictal consciousness alteration
  5. last several minutes
148
Q

Seizures - Categories - Generalized
-1-
> Sudden -2- with -3-

A
  1. Tonic-clonic
  2. LOC
  3. arrested respirations
149
Q

Seizures - Categories - Generalized - Tonic-Clonic

> The -1- involves -2- followed by -3- lasting -4- followed by -5-

A
  1. clonic stage
  2. increased muscle tone
  3. bilateral rhythmic jerks
  4. 2-3 min
  5. flaccid coma
150
Q

Seizures - Categories - Generalized - Tonic-Clonic

> -1- and/or -2- may occur

A
  1. urinary

2. fecal incontinence

151
Q

Seizures - Categories - Generalized - Tonic-Clonic
> The -1- may be characterized by -2- for -3-, followed by -4-, muscle discomfort and/or -5-, which can last minutes to hours

A
  1. postictal state
  2. deep sleep
  3. up to an hour
  4. HA, disorientation
  5. Nausea
152
Q 
Seizures - Categories - Generalized
Atonic (-1-)
> Sudden, -2-
> May result in -3- to -4- without presence of protective reflexes
> A(n) -5- is extremely helpful
A
  1. “drop seizure”
  2. brief loss of muscle tone
  3. head drop or falling
  4. the ground
  5. eyewitness account or video
153
Q

Seizures - Lab & Dx
-1-, glucose, -2-, and -3- should be performed with other pertinent labs based on history in the emergency setting (e.g., serology test for -4-)

A
  1. CBC
  2. RFTs
  3. LFTs
  4. Syphilis
154
Q

Seizures - Lab & Dx
> Other tests to rule out suspected etiology as indicated by the Hx and age of the patient (e.g., -1-, neuroimaging for focal seizures: -2-)
> -3-: -4- require an -3-; helps to determine seizure classification (-5-)

A
  1. LP
  2. MRI preferred
  3. EEG
  4. All patients with unprovoked seizure
  5. febrile seizures exception
155
Q

Seizures - Mgmt: Acute Attack
> Initial mgmt is supportive as most Sz are self-limiting
» -1-
» protect patient from injuries; esnure patient is in a safe place (in the -2-)
» -3- if patient is cyanotic
> Do not force -4- or -5-

A
  1. Maintain open airway
  2. side-lying position
  3. May administer O2
  4. artificial airways
  5. objects b/t teeth
156
Q

Seizures - Mgmt: Acute Attack
Parenteral -1- (if IV access available) is/are used to stop convulsive seizures
> First line: -2-
> -3-, -4- or -5- are most common

A
  1. anticonvulsants
  2. Benzos
  3. Lorazepam (Ativan)
  4. midazolam (Versed)
  5. diazepam (Valium)
157
Q

Seizures - Mgmt: Acute Attack

-1- may be -2- if -3- in stopping the seizure (e.g., -4-, levetiracetam, -5-, lacosamide).

A
  1. other anticonvulscants
  2. considered
  3. benzos are unsuccessful
  4. fosphenytoin
  5. valproic acid
158
Q 
Seizures - Mgmt: Acute Attack
-1- for all unprovoked seizures or if the following occur
> Regression of -2-
> Regression of -3-
> -4- is unacceptable
A
  1. Consider referral
  2. dev skills occurs
  3. cog function occurs
  4. Side-effect profile
159
Q

Seizures - Mgmt: Acute Attack
> -1- follow-up
> -2- consult

A
  1. Primary care

2. Neuro

160
Q

Febrile Seizures
Def: seizures occurring -1- a fever
> -2- of all febrile seizures are -3-

A
  1. during or immediately before
  2. Over 90%
  3. simple
161
Q

Febrile Seizures

Occur in 2-5% of children b/t -1- of age; -2- between -3- of age (-4-)

A
  1. 6 m & 5 years
  2. peak incidence
  3. 12 & 18 months
  4. High incidence of URI and AOM in this age group
162
Q

Febrile Seizures
> Risk factors include a -1- of febrile seizures or epilepsy, frequent infections/illness (viral greater risk than bacterial), recent immunization, tobacco use by mother during pregnancy, prematurity, and/or neonatal hospitalization > 28 days

> If a seizure occurs -2- onset, it is likely -3-

A
  1. family history
  2. > 24 hours after fever
  3. Due to infection
163
Q

Febrile Seizures - S/S
-1- vs -2-
> -1-: generalized, -3-, lasts -4- (most common)

A
  1. Simple
  2. Complex
  3. typically tonic-clonic
  4. for <15 minutes
164
Q

Febrile Seizures - S/S
> Simple vs. -1-
» -1-: -2-, last -3-, or -4-
> Most episodes -5-

A
  1. Complex
  2. focal
  3. > 15 minutes
  4. clustering
  5. last < 5 min
165
Q

Febrile Seizures - S/S
> PE to -1- (e.g., -2-) cause of seizure
> -3- of seizure -4-

A
  1. r/o infectious
  2. meningitis
  3. no recurrence
  4. w/in 24 hours
166
Q

Febrile Seizures - Lab/Dx
> Dx is -1-
> -2-
> -3- if meningitis is suspected

A
  1. clinical
  2. CBG
  3. LP
167
Q

Febrile Seizures - Lab/Dx
> -1- only indicated for -2-
> -3- correlate w/ -4-

A
  1. EEG and imaging (preferably MRI)
  2. complex febrile seizure
  3. WBC of 20k+
  4. bacteremia
168
Q

Febrile Seizures - Mgmt

Febrile seizures are -1-; goal is to ensure -2- and -3-

A
  1. short term and limited
  2. child safety
  3. decrease associated fever
169
Q

Febrile Seizures - Mgmt
> -1-; place in -2- in a safe place
> -3- (e.g., -4-, remove blankets or warm -5-)

A
  1. protect airway
  2. side-lying position
  3. cooling measures
  4. tepid bath
  5. clothing
170
Q

Febrile Seizures - Mgmt

-1-: -2- (15 mg/kg/dose) -3- -4- (5-10 mg/kg/dose)

A
  1. antipyretics
  2. acetaminophen
  3. OR
  4. ibuprofen (not both, do not alternate, EVER for ANY REASON)
171
Q

Neurofibromatosis (NF)

Def: a -1- characterized by numerous -2- on the body, and -3- on the -4- and in the body

A
  1. neurocutaneous syndrome
  2. cafe-au-lait spots (CLS)
  3. nerve tumors
  4. skin
172
Q

Neurofibromatosis (NF)
> -1-, does not affect -2-
> Severity -3-
» -4- = -5-

A
  1. Progressive disorder
  2. intelligence
  3. is highly variable
  4. NF 1
  5. von Recklinghausen disease (most common)
173
Q

Neurofibromatosis (NF)
> Severity is higly variable
» -1-
» -2-

A
  1. NF 2

2. Schwannomatosis (rare)

174
Q

Neurofibromatosis (NF) - S/S
> Although -1-, at least 40% of all the children with NF 1 have a -2-
> Multiple -3-
> -4- (-5-)

A
  1. NF does not affect intelligence
  2. learning disability (ADHD, vision/hearing, etc)
  3. Cafe au lait spots
  4. Seizures
  5. w/ brain tumor
175
Q

Neurofibromatosis (NF) - S/S
Diagnostic Criteria: must have at least two of the following:
> six or more CLS spots > 5 mm in -5- or -6- postpubertal
> 2+ cutaneous NFs or 1+ plexiform neurofibroma
> axillary or inguinal freckling
> -11-
> -12-; present in a first degree relative

A
  1. prepubertal child
  2. > 15 mm
  3. optic glioma
  4. autosomal dominant
176
Q

Neurofibromatosis (NF) - S/S
Diagnostic Criteria: must have -2- of the following:
> -3- CLS spots > 5 mm in prepubertal child or > 15 mm postpubertal
> -8- -9- or 1+ plexiform neurofibroma
> axillary or inguinal freckling
> optic glioma
> autosomal dominant; present in a first degree relative

A
  1. at least two
  2. six or more
  3. 2+
  4. cutaneous NFs
177
Q

Neurofibromatosis (NF) - S/S
-1-: must have at least two of the following:
> six or more CLS spots -4- in prepubertal child or > 15 mm -7-
> 2+ cutaneous NFs or 1+ plexiform neurofibroma
> -10- freckling
> optic glioma
> autosomal dominant; present in a first degree relative

A
  1. Diagnostic Criteria
  2. > 5 mm
  3. postpubertal
  4. axillary or inguinal
178
Q

Neurofibromatosis (NF) - Mgmt
> -1-
> Routine -2- as directed by -3-
> -4-

A
  1. refer to neuro
  2. screenings (BP, HC, etc.)
  3. neuro
  4. Genetic counseling
179
Q

Tic Disorders
Def: -1-, repetitive, and irregular -2-
> Tics may be -3- or -4-

A
  1. Brief, abrupt, non-purposeful
  2. movements or utterances (motor or vocal tics)
  3. acute (<1 year)
  4. chronic (> 1 year)
180
Q

Tic Disorders
> The most common is -1-, a combination of chronic motor and vocal tics
> -2- usually involve the -3-, or -4- and sometimes, muscles of the limbs or other parts of the body

A
  1. Tourette’s syndrome
  2. Movements
  3. Face, neck
  4. shoulders
181
Q

Tic Disorders

Comorbidities w/ other -1- (e.g., -2-, anxiety, -3-) are common

A
  1. psychobehavioral problems
  2. ADHD
  3. OCB/D
182
Q

Tic Disorders - Etiology and Incidence

Up to … experience tics at some point in childhood

A

20% of children

183
Q

Tic Disorders - Etiology and Incidence
Most common onset typically b/t -1-; increases in -2- until peak b/t -3- of age; -4- during -5-, and most disappear spontaneously

A
  1. 4 & 6 years of age
  2. severity
  3. 10 & 12 years of age
  4. decreases
  5. adolescence
184
Q

Tic Disorders - Etiology and Incidence
Most common onset typically b/t -1-; increases in -2- until peak b/t -3- of age; decreases during -5-, and most -6-spontaneously

A
  1. 4 & 6 years of age
  2. severity
  3. 10 & 12 years of age
  4. adolescence
  5. disappear
185
Q

Tic Disorders - Etiology and Incidence
> -1- in many cases
> -2-
> Can be associated with or worsened by -3- such as dopaminergic agonists (e.g., -4-, pemoline, -5-)

A
  1. cause in unknown
  2. family predisposition
  3. medications
  4. methylphenidate
  5. amphetamines
186
Q 
Tic Disorders - Clinical Manifestations
> -1- when body is -2- and lesser when child is engaged in tasks
> Types
>> -3- tics
>> -4- tics (includes -5- tics)
A
  1. More prominent
  2. relaxed
  3. simple motor
  4. complex motor
  5. vocal
187
Q

Tic Disorders - Clinical Manifestations - Complex Motor Tics
> -1- and -2-
> -3- (-4-, -5-)

A
  1. Copropraxia (obscene gestures)
  2. Coprographia (obscene writing)
  3. complex movements
  4. head turning
  5. hand scratching
188
Q 
Tic Disorders - Clinical Manifestations
-1- tics
> -2-, nasopharyngeal, or -3- sounds
> -4-
> -5-
A
  1. Vocal
  2. Oropharyngeal
  3. laryngeal
  4. consonants or syllables
  5. Coprolalia (obscene speech) (Tourette’s)
189
Q

Tic Disorders - Clinical Manifestations - Vocal Tics

-1- (repeating -2-) and -3- (repeating -4-)

A
  1. Palilalia
  2. one’s own words
  3. Echolalia
  4. another’s words
190
Q

Metatarsus adductus
> Causes -1- with a -2- of -3-
> Metatarsus adductus with a -4- is typically -5-; however, a non–4- warrants referral to orthopedics.

A
  1. in-toeing
  2. foot progression angle
  3. > 15 degrees
  4. flexible foot
  5. responsive to physical therapy
191
Q

Tibial stress fractures
> Common in -1-
» Complaints of pain in anterior shin which -2-
» Urgent -3- required for positive outcome

Lab/Dx
> Most sensitive diagnostic tool: -4-

A
  1. runners
  2. intensifies with running (15 minutes in)
  3. orthopedic referral
  4. MRI (X-ray too slow, bone scan not sensitive enough)
192
Q 
Tibial stress fractures
Mgmt
> Initial treatment: -1-, PT
> Meds: -2-
> -3-, pneumatic -4- may be necessary
A
  1. ice, acetaminophen, rest
  2. NSAIDs not recommended
  3. Casting, crutches, surgery
  4. compression walking boots (quicker return to full activity, better pain reduction)
193
Q

Migraine is the -1- in childhood and may have an aura associated -2- of the headache. Auras are typically -3-, occurring -4- minutes before the start of the headache.

A
  1. most common headache
  2. at the onset
  3. visual/sensory symptoms
  4. less than 60
194
Q

There is a -1- for migraines. Migraine headaches are typically throbbing and have -2-, and light and/or sound sensitivity. -3- are disordered or insufficient sleep, -4-, and skipping meals.

A
  1. familial predilection
  2. associated nausea/vomiting
  3. Common triggers
  4. dehydration
195
Q

Ibuprofen is -1- in the treatment of migraines, but analgesic use should be limited to no -2- uses per week.

-3- are caused by using analgesics too frequently. Use of analgesics -2- times per week for headaches can -4-.

A
  1. an effective analgesic
  2. more than 3
  3. Medication-overuse headaches
  4. actually cause headaches
196
Q

Treatment of medication-overuse headaches requires -1-.

If there are -2- on examination or a history of headaches that -3-, an MRI is the -4- strategy.

A
  1. discontinuation of analgesics
  2. neurological abnormalities
  3. awaken the individual
  4. most appropriate imaging
197
Q

Triptan medications can be an -1- for migraines and feedback therapy can be effective in acute and preventative management to provide the individual -2-.

Focus should be on -3- including regular and sufficient sleep, avoidance of -4- and ensuring adequate protein intake, -5-, and increasing hydration.

A
  1. effective abortive therapy
  2. with some self-control
  3. good life-style activities
  4. skipping meals
  5. minimizing caffeine intake
198
Q

Migraine Management
After a month of -1- and focusing only on life-style activities, re-evaluation of -2- is warranted, at which time an -3- can be created that includes limiting the frequency of -4-.

A
  1. no analgesic use
  2. the headache frequency
  3. appropriate treatment plan
  4. analgesic use
199
Q

Juvenile idiopathic arthritis (JIA), previously referred to as JRA, is the -1- of arthritis in children. The etiology of JIA is likely due to an -2- in genetically pre-disposed individuals. There are -3- subtypes. Systemic JIA is considered an -4-, whereas the other types are considered -5-.

A
  1. most common type
  2. environmental influence
  3. six JIA
  4. autoinflammatory disease
  5. autoimmune diseases
200
Q

Systemic JIA causes inflammation in one or more joints for -1- in a child -2- years of age and is often accompanied by fatigue, -3-, and -4- that lasts at least -5-.

A
  1. 6 weeks’ duration
  2. younger than 16
  3. skin rash
  4. a high fever (103° F [39.4° C] or higher)
  5. 2 weeks
201
Q

-1-, pleuritis, anemia, or enlargement of lymph nodes, liver or the -2- may also occur with JIA. Researchers believe there is a genetic component to JIA and a -3- the disease process.

A
  1. Pericarditis
  2. spleen
  3. virus may trigger
202
Q

JIA DDx
SLE is a -1- disease. Symptoms include fatigue, skin rashes, fever, and joint involvement with non-deforming arthritis but with -2-. SLE can involve many organ systems (kidney, skin, blood cells, and -3-). A malar rash across the -4- in the shape of a -5- is seen in ninety-five percent of SLE cases.

A
  1. chronic systemic rheumatic
  2. effusion and tenderness
  3. nervous system
  4. cheeks and nose
  5. butterfly
203
Q

JIA DDx
The most common manifestation of acute rheumatic fever is -1-. The latency period from infection with -2- until the onset of -1- is -3-. Acute rheumatic fever is most common in -4- of age.

A
  1. large-joint polyarthritis
  2. group A streptococcus
  3. about 2-6 weeks
  4. children 5-15 years
204
Q

JIA DDx
Dermatomyositis is an -1- affecting the pediatric population. Progressive -2- in addition to -3-, are characteristic of dermatomyositis. Laboratory results are -4- at the time of diagnosis. A definitive diagnosis is made with -5-; ongoing management is coordinated with rheumatology specialists.

Early recognition of -3- is key to the diagnosis of dermatomyositis.

A
  1. autoimmune myopathic illness
  2. proximal muscle weakness
  3. Gottron papules (thick scaling on extensor surfaces)
  4. often normal
  5. muscle biopsy
205
Q

SCFE - Mgmt
-1- from urgent care to primary care would be inappropriate, as this may -2-. -3- referral is appropriate intervention, as is -4- and treating the patient’s pain with -5- apparently.

A
  1. Delaying referral
  2. delay special interventions
  3. Immediate
  4. disallowing for ambulation
  5. opioids
206
Q

-1- is due to the presence of blood, which may be caused by subarachnoid hemorrhage, intracerebral hemorrhage, or cerebral infarct, but would -2- in a patient with bacterial meningitis. Although a traumatic tap may also cause -1-, this is an uncommon event.

Bacterial meningitis causes an -3-, mild to marked -4-, and physiologic to marked decrease in -5-.

A
  1. Pink CSF
  2. not be expected
  3. increase in WBC
  4. elevation in protein
  5. CSF-to-serum glucose ratio

PNCB CPNP-PC (19 decks)

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