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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
SCFE - S/S | -1- and often -2- and/or -3-
1. pain in the groin 2. referred to thigh 3. knee
26
SCFE - S/S | When acute onset, -1- with the -2- or -3-
1. pain will be severe 2. inability to ambulate 3. move hip
27
SCFE - S/S Physical findings > unable to -1- as -2- (-3-) > May observe -4-, resulting from -5- of metaphysis
1. properly flex hip 2. femur abducts/rotates externally 3. only comfortable sitting with leg out 4. limb shortening 5. proximal displacement
28
SCFE - Lab/Dx > -1- combined with knowledge of etiological factors (such as -2-) > -3- > Lab studies: -4-
1. accurate history 2. BMI 3. radiographs 4. typically none
29
SCFE - Mgmt/Tx > -1- to -2- > -3- permitted (-4-) > -5- for same problem
1. immediate referral 2. ortho 3. **NO AMBULATION** 4. wheelchair! 5. Monitor other hip
30
Patellofemoral Pain Syndrome (Runner's Knee) | Definition: ...
Pain around kneecap (patella)
31
Runner's Knee - Etiology/Incidence > associated with -1- (e.g., -2-), surgery, injury, muscle imbalances > Twice as common in -3- > Most common in -4-
1. repetitive stress 2. running (track), jumping 3. women as in men 4. adolescents, young adults
32
``` 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- ```
1. front of knee 2. climbing stairs, squatting 3. knees bent 4. clinically 5. confirm diagnosis
33
Runner's Knee - Mgmt/Tx > -1- > -2-, supportive -3- > Consider -4- if condition is -5- to conservative treatment
1. analgesics 2. PT (quads) 3. braces 4. referral for surgery 5. refractory
34
Genu Varum | Def: -1- of the -2-, often due to joint laxity; considered a physiologic variant until -3-
1. lateral bowing [like a pirate (rum)] 2. tibia 3. age 2 years (toddler most common)
35
``` Genu Varum > S/S >> It is acceptible for bowing that -1- after walking begins >> -2- > Lab/Dx >> -3- ```
1. does not increase 2. Retains FROM 3. None indicated
36
``` Genu Varum - Mgmt > None necessary -1- years if appears as -2- > -3- if >> Continues -4- years >> -5- ```
1. under age 2 2. physiologic variant 3. Refer to ortho 4. after age 2 5. unilateral
37
Genu Valgum | Def: Knees are -1- and ankle space is increased; typically evolves to physiologic alignment by -2- age (-3- common)
1. markedly close ("stuck together like gum" val*gum*) 2. 7 years of 3. preschool most
38
``` Genu Valgum - S/S > Knees -1- > Distance between medial malleoli (ankles) is -2- > No -3- > -4- > Walk or run may be -5- ```
1. close together 2. more than 3 inches 3. pain 4. FROM 5. awkward
39
Genu Valgum - Lab/Dx > -1- > Radiographs if -2- or if -3-
1. None necessary 2. > 7 yo 3. it's unilateral
40
Genu Valgum - Mgmt > -1- > Older children (-2-) need a -3-
1. none necessary 2. (7+ yo) 3. referral to ortho
41
Scoliosis > lateral -1- that is idiopathic and most -2- > Other types are -3- or -4- (associated with conditions) > Occurs more often in -5-
1. curvature of the spine 2. common in adolescence 3. congenital (e.g. infancy) 4. neuromuscular 5. females
42
Scoliosis - S/S > May -1- > Rarely -2- > -3-, ribs, -4-, and -5-
1. occur at any age (usually around growth spurt) 2. painful 3. Asymmetry of shoulder 4. hips 5. waistline (Adam's FB Test)
43
``` Scoliosis > Lab/Dx >> -1- for further evaluation > Mgmt >> -2- if no pain exists and if -3- curvature >> -4- or -5- curvature ```
1. Radiographs 2. Observe 3. < 20 deg 4. Refer if painful 5. > 20 deg
44
Duchenne Muscular Dystrophy (DMD) | Def: -1- disorder beginning in the -2- and -3- to the -4- extremities and torso
1. Progressive genetic 2. **Lower extremities** 3. progressing 4. upper
45
DMD > among the -1- neuromuscular diseases in children > affects -2- children > average age of diagnosis is -3-
1. most common inherited 2. 1/3500 3. 2-6 years
46
DMD - S/S > Abnormalities of -1- > Developmental -2- > -3- w/ developing peers
1. gait and posture 2. clumsiness 3. Trouble keeping up
47
DMD - S/S -1- sign > child -2- to legs to attain standing position when getting up > suggests -3-
1. Gower's sign 2. "walks" hands up 3. pelvic girdle weakness
48
DMD - S/S > -1- large (-2- replaced by -3-) > Decreased -4-
1. Calf muscles disporportionately 2. healthy muscle 3. degenerative tissue 4. proximal muscle strength
49
DMD - S/S > -1- dependent beginning at -2- > Eventual -3- from -4-
1. wheelchair 2. age 10-12 3. death 4. cardiopulmonary failure
50
``` DMD - Lab/Dx > -1- patients (5 - 150 kIU/L) > -2-: myopathy > -3-: pathologic > -4-: necrotic degenerating fibers > -5- ```
1. CK: markedly elevated in affected 2. EMG 3. EKG 4. Muscle biopsy 5. genetic testing
51
DMD - Mgmt > Symptomatic care to -1- and maintain -2- > -3- (-4-)
1. delay progression 2. strength and mobility 3. Multi-specialty mgmt 4. incl. psych/family support
52
DMD - Mgmt > -1- (-2- prednisone or -3-) > -4-
1. Corticosteroids 2. high dose 3. Emflaza (deflazacort) 4. palliative care
53
Ankle Sprain | Usually a forced inversion (-1- is the -2-) or eversion (medial ankle)
1. lateral ankle sprain | 2. most common
54
Ankle Sprain - S/S Grade I: -1- but -2- of a ligament; no joint instability > -3- > minimal -4-
1. STretching 2. no tearing 3. local tenderness 4. edema
55
Ankle Sprain - S/S - Grade I > -1- typically insignificant or absent > -2- remains although may be uncomfortable > Patient retains -3-
1. ecchymoses 2. FROM 3. **weight bearing ability**
56
``` 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- ```
1. Partial (incomplete) tearing 2. pain 3. edema & ecchymoses 4. pain with weight 5. ROM is limited
57
Ankle Sprain - S/S | Grade III: -1-; joint -2- with -3- to ligamentous stressing
1. Complete ligamentous tearing 2. unstable 3. no definite endpoint
58
``` 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- ```
1. pain 2. edema 3. ecchymoses 4. cannot bear weight 5. ROM to ankle
59
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
1. Radiograph 2. Ottowa Ankle Rules 3. pain near the malleoli 4. bone tenderness 5. 6 cm
60
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-
1. unable to bear 2. at least 4 steps 3. not indicated
61
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)
1. RICE 2. Rest 3. Ice 4. Compression 5. stability of the
62
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)
1. Elevation 2. several days 3. swelling
63
Ankle Sprain - Mgmt > -1- for pharmacologic relief (e.g. -2-, topical ketoprofen or diclofenac) > Can also -3- such as -4-
1. NSAIDs 2. ibuprofen 3. consider other analgesics 4. acetaminophen
64
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.
1. to pediatric patients 2. growth plate 3. long bones 4. arms & legs 5. twice as likely
65
``` Salter-Harris Fracture - S/S > -1- > Localized -2- with warmth, -3- > Limited -4- capability > -5- ```
1. Traumatic injury 2. joint pain 3. swelling, and tenderness 4. ROM & weight bearing 5. Bone displacement
66
Salter-Harris Fracture - Lab/Dx > -1- > -2- > -3- (in infant)
1. X-ray 2. CT 3. US
67
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-
1. Slipped 2. through physis 3. Above 4. physis and the metaphysis 5. SALTR mnemonic
68
Salter-Harris Fracture - Classification (-1-) > Salter III (-2-): intra-articular fracture extending from the -3- > Salter IV (-4-): intra-articular -5-
1. SALTR Mnemonic 2. Lower 3. physis into the epiphysis 4. Through/Transverse 5. passing through the epiphysis, physis, and metaphysis (all three layers)
69
Salter-Harris Fracture - Classification (-1-) | > Salter V (-2-): -3-, with -4- injury that extends through epiphysis and physis
1. SALTR Mnemonic 2. Rammed/Ruined 3. Rare 4. severe crushing or compression
70
``` Salter-Harris Fracture - Tx/Mgmt > -1- > Rx strength -2- only if necessary > -3- for -4- > -5- ```
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
71
Elbow Fracture | Def: often assoc w/ -1- resulting from -2- arm falls
1. injuries | 2. straight, outstretched
72
Elbow Fracture - S/S Sudden -1- in the -2- > swelling, bruising, -3- > -4- are signs of -5-
1. intense pain 2. elbow & forearm 3. visible deformity (lump) 4. numbness and tingling 5. nerve injury
73
Elbow Fracture - S/S -1- sign > No -2- on -3- > the lateral view demonstrates -4- -1-
1. Fat pad(s) 2. fracture is visible 3. X-ray 4. elevation of the anterior & posterior
74
``` Elbow Fracture > Lab/Dx >> follow up radiographs with an -1- > Mgmt >> -2- to be treated as a fracture ```
1. oblique view | 2. Refer to ortho
75
``` 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 ```
1. toddlers 2. swinging/pulling 3. radial head subluxation 4. across body with thumb up 5. edema & ecchymosis
76
Nursemaid Elbow - Lab/Dx | -1- as -2- and is usually -3-
1. X-ray 2. physiologic 3. forgone
77
Nursemaid Elbow - Mgmt > -1- by a -2- or refer (-3-) > Supportive care at home with -4-
1. Reduction 2. trained NP 3. Quick recovery: 15-30 minutes 4. NSAIDs
78
``` 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- ```
1. Sensory 2. Motor 3. Oculomotor 4. Talking, swallowing, general sensation 5. trapezius and sternomastoid muscles (shrugging)
79
``` Cranial Nerves > Types >> CN IV: -1- >> CN V: -2- > Names >> CN X: -3- >> CN XII: -4- > Major Functions >> CN XII: -5- ```
1. Motor 2. Both 3. Vagus 4. Hypoglossal 5. moves the tongue
80
``` 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- ```
1. vision 2. closes mouth 3. tear secretion 4. Motor 5. Abducens
81
``` 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- ```
1. Olfactory 2. Optic 3. Most EOMs, opening eyelids, pupillary constriction 4. Mastication; sensation of face, scalp 5. Both
82
``` Cranial Nerves > Major Functions >> CN VI: -1- >> CN VIII: -2- > Types >> CN VII: -3- >> CN IX: -3- > Names >> CN IX: -4- ```
1. Lateral eye movement 2. Hearing & equilibrium 3. Both 4. glossopharyngeal
83
``` Cranial Nerves > Major Functions >> CN I: -1- >> CN IX: -2- swallowing -3- > Types >> CN I: -4- >> CN VIII: -4- > Names >> CN VIII: -5- ```
1. Smell 2. phonation, gag, carotid 3. reflex; taste (Posterior 1/3) 4. Sensory 5. Vestibulocochlear/Acoustic
84
``` Cranial Nerves > Names >> CN IV: -1- >> CN V: -2- > Types >> CN XII: -3- ```
1. Trochlear 2. Trigeminal 3. Motor
85
``` Cranial Nerves > Major Functions >> CN III: -1-, -2-, -3- > Names >> CN VII: -4- >> CN XI: -5- ```
1. Most EOMs 2. opening eyelids 3. pupillary constriction 4. Facial 5. Spinal accessory
86
Cranial Nerves - Examples > -2- mnemonic: -3- > Facial (-4-): -5- > Tongue: -1-
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
Common Headaches 4 Primary Mechanisms of HA pain > Vascular dilation; Cranial -1- (e.g., -2-, fever, -3-, -4-, systemic infection)
1. artery distension 2. migraine 3. vasodilator drugs 4. metabolic distrubance
88
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)
1. Hematoma 2. head and neck 3. tension 4. space-occupying lesion 5. tumors
89
Common Headaches 4 Primary Mechanisms of HA pain > Inflammation: -1- [e.g., -2-, -3-, -4- (-5-)]
1. infection 2. meninges 3. sinuses 4. teeth 5. sinus and tooth infections rarely cause headaches unless they're severe
90
``` 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-?) ```
2. mnemonic 10. Treatment 11. done 12. work
91
``` 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?) ```
1. OLDCART 5. Location 7. Characteristics 8. Aggravating
92
``` 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?) ```
3. informs journal 4. Onset 6. Duration 9. Remedial/alleviating
93
``` Migraine HAs Background & Incidence > Migraine -1- aura (most common -2-) > Migraine -3- aura (typical onset -4- of age) > Often, there is a(n) -5- ```
1. without 2. in children 10- 3. with 4. > 10 years 5. family history
94
Migraine HAs - Background & Incidence > -1- more often affected than -2- > Increased risk in children w/ -3-, intermittent -4-, and -5-
1. Females 2. males 3. motion sickness 4. abdominal pain (abd migraine) 5. cyclic vomiting syndrome
95
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-.
1. "triggers" 2. incl. barometric pressure; lack/excess sleep 3. missed meals 4. menstruation 5. contraceptives
96
Migraine HAs Symptoms > Location: **-1- in -2- children, -3- in -4-** > Character: -5-
1. bifrontal 2. younger 3. unilateral 4. adolescents 5. throbbing, pounding
97
Migraine HAs - Symptoms > Severity: -1- > Related: 2+ of (-2-, -3-,phonophobia, dizziness, or -4-, including -5-)
1. Moderate to severe 2. nausea/vomiting 3. photophobia 4. vision changes 5. blurred vision and blindness
98
Migraine HAs - Variant migraine syndromes | -1- migraine: more common in -2-; period of -3- followed by -4- and -5-; HA may not be described
1. confusional 2. younger children 3. confusion and disorientation 4. vomiting 5. deep sleep, waking feeling well
99
Migraine HAs - Variant migraine syndromes | -1-: episodic -2- with nausesa, -3- followed or accompanied by -4-
1. Abdominal migraine 2. abdominal pain 3. vomiting 4. HA
100
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-
1. Hemiplegic/-a 2. migraine (HA) 3. stroke 4. ruled out in the ER 5. familial correlation
101
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-
1. Baseline studies/vitals 2. CMP 3. CBC 4. Vit D level
102
``` 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- ```
1. Imaging 2. altered mental status 3. pathologic presentation 4. sudden changes in symptoms 5. H&P
103
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
1. Avoidance of trigger 2. headache diary (informed by OLDCART) 3. HA hygiene 4. proper hydration 5. regular sleep
104
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
1. stress mgmt techniques 2. Limit/avoid caffeine intake 3. trigger foods 4. >4/month
105
``` Migraine HAs - Mgmt Common prophylactic medications: > -1- > -2- > -3- > -4- > -5- ```
1. Cyproheptadine (Periactin) 2. Amitriptyline (Elavil) 3. Topiramate (Topamax) 4. Propranolol (Inderal) 5. Valproic Acid (Depakote)
106
Migraine HAs - Mgmt | Common prophylactic medications: -1- tend to be -2-, and/or -3- to -4-
1. side effects, such as hunger in periactin 2. mild 3. self-limiting 4. ~1 month of treatment
107
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-
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
Migraine HAs - Mgmt - Abortive therapy > -1- such as -2- if -3- > When NSAIDs are -4-, consider -5-
1. Antiemetics 2. zofran 3. vomiting 4. not enough 5. triptans
109
Migraine HAs - Mgmt - Abortive therapy - Refractory to NSAIDs > -1- 6.25mg (approved for children -2-) > -3- 5mg (approved for use in -4-)
1. almotriptan (Axert) 2. 12+ yo 3. Rizatriptan (Maxalt) 4. children and adolescents
110
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
1. Sumatriptan (Imitrex) 2. nasal 3. slower absorption 4. oral tablets 5. Zolmitriptan (Zomig)
111
Migraine HAs - Mgmt - Abortive therapy - Refractory to NSAIDs Most evidence for -1- years: -2- 5mg or -3- 5mg
1. children aged 6-11 2. rizatriptan (maxalt) 3. sumatriptan (Imitrex) nasal
112
Migraine HAs - Mgmt - Abortive therapy - Refractory to NSAIDs > May take -3- at -1-, then repeat -2- needed > -4- in children at risk for -5-
1. first sign of symptoms 2. in 2 hours 3. prescribed triptan 4. Avoid triptans 5. heart disease (consult w/ following cardiologist)
113
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-
1. family Hx 2. "triggers" 3. dehydration 4. physical stress (back to school) 5. school-age children and adolescents
114
Tension-type HAs - Symptoms > Location: -1- (may -2-) > Character: -3-, -4- pain, aching > Severity: -5-
1. occiput 2. radiate 3. pressure 4. band-like 5. mild-severe
115
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-
1. associated symptoms 2. N/V 3. vision changes/blurred vision 4. aching neck pain 5. trapezius muscles
116
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-
1. Baseline studies/vitals 2. labs typically aren't indicated for 3. wakes child from 4. mental status 5. presentation
117
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
1. avoidance of trigger factors 2. HA diary 3. balanced diet 4. proper hydration, aerobic exercise 5. sleep
118
Tension-type HAs - mgmt > -1- (e.g., counseling, biofeedback, -2-) > Consdier -3- (-4-) > Limit/avoid -5-
1. relaxation/stress reduction techniques 2. yoga 3. massage therapy 4. tension HAs are muscular in nature 5. caffeine intake
119
``` Tension-type HAs - mgmt -1- if attacks occur -2-, or if HAs interfere w/ daily functioning or school: > -3- > -4- > -5- ```
1. Prophylactic therapy (pharm) 2. >4/month 3. cyproheptadine (periactin) 4. Amitriptyline (elavil) 5. topiramate (topamax)
120
Tension-type HAs - mgmt - Abortive Therapy > -1- > -2- is preferred over -3-; taken at onset of HA symptoms
1. rest 2. naproxen 3. Aceta, ibu (rebound effect)
121
Potentially Urgent HA Evaluation - Febrile Patient > -1-: -2-, viral, TB, -3- > -4- or other intracranial -5-
1. Meningitis 2. bacterial 3. aseptic 4. brain abscess 5. infection
122
Potentially Urgent HA Evaluation - Febrile Patient > -1- (-2-) > -3- > associated infectoin: -4-, -5-, rubeola
1. Encephalitis 2. Lyme 3. Sinusitis 4. Strep, flu 5. mono
123
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
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
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
1. 6 & 12 months 2. greatest risk 3. 90% of 4. 1 month to 5 years 5. immunization(s)
125
Potentially Urgent HA Evaluation - Febrile Patient - S/S - Newborns & young infants > mimics -1- > -2-, lethargy > -3-
1. septiciemia 2. irritability 3. poor feeding
126
Potentially Urgent HA Evaluation - Febrile Patient - S/S - Newborns & young infants > -1- > -2- (caused by -3-) > No -4-
1. vomiting 2. bulging fontanel 3. inflammation 4. stiff neck
127
Potentially Urgent HA Evaluation - Febrile Patient - S/S - Older infants and children > -1- > -2-, back pain, -3- > Hyperesthesia, cranial nerve palsy, -4- > -5-
1. N/V 2. HA 3. nuchal rigidity 4. ataxia 5. photophobia
128
``` 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- ```
1. **Kernig's** 2. extension of leg at knee 3. **Brudzinksi's** 4. flexion of legs 5. neck is flexed
129
``` Potentially Urgent HA Evaluation - Febrile Patient - Dx > -1- analysis via -2- >> -3- >> -4- present > Imaging (-5-) ```
1. CSF 2. LP 3. cloudy 4. WBCs 5. MRI > CT for masses
130
Afebrile Pt w/ Acute Onset HA > Rule out: -1-, -2-, & -3- > -4- > -5- HA
1. migraine 2. tension type 3. post-traumatic (concussion) 4. hemorrhage (subarachnoid or intraparenchymal) 5. Postictal (Sz related)
131
Afebrile Pt w/ Acute Onset HA > Severe -1- > -2- (brain -3-, -4-)
1. HTN 2. space-occuypying condition 3. tumor 4. hydrocephalis
132
``` Brain Tumors > Etiology -1- > -2- tumors predominate, most common ages 4-11 years >> -3- >> -4- ```
1. is unkown 2. Infratentorial, brainstem 3. Cerebellum - balance/coordination 4. brainstem - life functions
133
``` Brain Tumors > Occiput: -1- > parietal: -2- > Frontal: -3- > temporal: -4- ```
1. vision, color 2. perception, spelling, math 3. executive function 4. hearing, language, memory
134
``` Brain Tumors - S/S Infants > Incrased head circumference, -1- > -2- > -3- > loss of -4- ```
1. tense, bulging fontanels 2. irritability 3. head tilt 4. developmental milestones
135
Brain Tumors - S/S - Older Children > -1- >> -2- (-3-) followed by vomiting
1. HA 2. Awakens with *worst HA in the morning* 3. Also awakened overnight with severe HA
136
Brain Tumors - S/S - Older Children -1- or -2- > -3-, FTT, DI
1. Pathologic neurologic 2. ocular findings 3. Head tilt
137
``` Brain Tumors - S/S - Older Children - Pathologic neurologic or ocular findings > -1- > Loss of -2- > Possible -3- > -4- changes ```
1. papilledema (swelling around the optic nerve) 2. fine motor control 3. return of Babinski's reflex (splayed toes) 4. behavioral
138
Brain Tumors - Diagnostic Tests > -1- when available > -2-: only -3- to show -4-
1. MRI preferred over CT 2. LP 3. after imaging's been done 4. that it's safe to perform
139
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-.
1. paroxysmal neuronal discharge | 2. based upon age
140
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
1. congenital 2. perinatal injuries 3. genetic
141
Seizures - Causes/Incidence | Metabolic disorders: -1- (-2-), hypoglycemia, pyridoxine (B6) deficiency, -3-, -4-, and others
1. Hypocalcemia 2. as in DiGeorge Syndrome 3. renal failure 4. acidosis
142
Seizures - Causes/Incidence > -1- and other -2- > -3-: Bacterial meningitis. -4-, -5-
1. Tumors 2. space occupying lesion 3. Infectious diseases 4. herpes encephalitis 5. neurosyphilis
143
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-
1. threshold 2. fever/febrile 3. lowered 4. Idiopathic 5. do not have an identified cause
144
``` Seizures - Categories - -1- -1- origin: -2- regions of the brain > -1- seizures -3- >> No -4- >> May be -5- symptoms ```
1. Focal 2. One+ specific 3. without impaired awareness 4. loss of conciousness 5. characterized by motor and/or non-motor
145
Seizures - Categories - Focal Focal seizures w/ impaired awareness > Impaired consicousness: -1-, during or after -2- symptoms
1. staring > 20 seconds before, | 2. motor and/or non-motor
146
``` Seizures - Categories - Generalized Involves the -1- > -2- >> Brief -3- w/ -4- >>> Mistaken for -5- ```
1. entrie cortex of the brain 2. absence 3. "staring" episodes (10-20s) 4. unresponsiveness 5. "daydreaming," inattention, ask about responsiveness, memory
147
``` Seizures - Categories - Generalized -1- > Sudden -2- tone producing a number of characteristic postures > -3- during event > -4- varies; may -5- ```
1. Tonic 2. increase in muscle 3. unresponsive 4. postictal consciousness alteration 5. last several minutes
148
Seizures - Categories - Generalized -1- > Sudden -2- with -3-
1. Tonic-clonic 2. LOC 3. arrested respirations
149
Seizures - Categories - Generalized - Tonic-Clonic | > The -1- involves -2- followed by -3- lasting -4- followed by -5-
1. clonic stage 2. increased muscle tone 3. **bilateral** rhythmic jerks 4. 2-3 min 5. flaccid coma
150
Seizures - Categories - Generalized - Tonic-Clonic | > -1- and/or -2- may occur
1. urinary | 2. fecal incontinence
151
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
1. postictal state 2. deep sleep 3. up to an hour 4. HA, disorientation 5. Nausea
152
``` Seizures - Categories - Generalized Atonic (-1-) > Sudden, -2- > May result in -3- to -4- without presence of protective reflexes > A(n) -5- is extremely helpful ```
1. "drop seizure" 2. brief loss of muscle tone 3. head drop or falling 4. the ground 5. eyewitness account or **video**
153
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-)
1. CBC 2. RFTs 3. LFTs 4. Syphilis
154
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-)
1. LP 2. MRI preferred 3. EEG 4. All patients with unprovoked seizure 5. **febrile seizures exception**
155
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-
1. Maintain open airway 2. side-lying position 3. May administer O2 4. artificial airways 5. objects b/t teeth
156
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
1. anticonvulsants 2. Benzos 3. Lorazepam (Ativan) 4. midazolam (Versed) 5. diazepam (Valium)
157
Seizures - Mgmt: Acute Attack | -1- may be -2- if -3- in stopping the seizure (e.g., -4-, levetiracetam, -5-, lacosamide).
1. other anticonvulscants 2. considered 3. benzos are unsuccessful 4. fosphenytoin 5. valproic acid
158
``` Seizures - Mgmt: Acute Attack -1- for all unprovoked seizures or if the following occur > Regression of -2- > Regression of -3- > -4- is unacceptable ```
1. Consider referral 2. dev skills occurs 3. cog function occurs 4. Side-effect profile
159
Seizures - Mgmt: Acute Attack > -1- follow-up > -2- consult
1. Primary care | 2. Neuro
160
Febrile Seizures Def: seizures occurring -1- a fever > -2- of all febrile seizures are -3-
1. during or immediately before 2. Over 90% 3. simple
161
Febrile Seizures | Occur in 2-5% of children b/t -1- of age; -2- between -3- of age (-4-)
1. 6 m & 5 years 2. peak incidence 3. 12 & 18 months 4. High incidence of URI and AOM in this age group
162
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-
1. family history 2. > 24 hours after fever 3. **Due to infection**
163
Febrile Seizures - S/S -1- vs -2- > -1-: generalized, -3-, lasts -4- (most common)
1. Simple 2. Complex 3. typically tonic-clonic 4. for **<15 minutes**
164
Febrile Seizures - S/S > Simple vs. -1- >> -1-: -2-, last -3-, or -4- > Most episodes -5-
1. Complex 2. focal 3. > 15 minutes 4. clustering 5. last < 5 min
165
Febrile Seizures - S/S > PE to -1- (e.g., -2-) cause of seizure > -3- of seizure -4-
1. r/o infectious 2. meningitis 3. no recurrence 4. w/in 24 hours
166
Febrile Seizures - Lab/Dx > Dx is -1- > -2- > -3- if meningitis is suspected
1. clinical 2. CBG 3. LP
167
Febrile Seizures - Lab/Dx > -1- only indicated for -2- > -3- correlate w/ -4-
1. EEG and imaging (preferably MRI) 2. complex febrile seizure 3. WBC of 20k+ 4. bacteremia
168
Febrile Seizures - Mgmt | Febrile seizures are -1-; goal is to ensure -2- and -3-
1. short term and limited 2. child safety 3. decrease associated fever
169
Febrile Seizures - Mgmt > -1-; place in -2- in a safe place > -3- (e.g., -4-, remove blankets or warm -5-)
1. protect airway 2. side-lying position 3. cooling measures 4. tepid bath 5. clothing
170
Febrile Seizures - Mgmt | -1-: -2- (15 mg/kg/dose) -3- -4- (5-10 mg/kg/dose)
1. antipyretics 2. acetaminophen 3. **OR** 4. ibuprofen (not both, do not alternate, EVER for ANY REASON)
171
Neurofibromatosis (NF) | Def: a -1- characterized by numerous -2- on the body, and -3- on the -4- and in the body
1. neurocutaneous syndrome 2. **cafe-au-lait spots (CLS)** 3. nerve tumors 4. skin
172
Neurofibromatosis (NF) > -1-, does not affect -2- > Severity -3- >> -4- = -5-
1. Progressive disorder 2. intelligence 3. is highly variable 4. NF 1 5. von Recklinghausen disease (most common)
173
Neurofibromatosis (NF) > Severity is higly variable >> -1- >> -2-
1. NF 2 | 2. Schwannomatosis (rare)
174
Neurofibromatosis (NF) - S/S > Although -1-, at least 40% of all the children with NF 1 have a -2- > Multiple -3- > -4- (-5-)
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
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
5. prepubertal child 6. > 15 mm 11. optic glioma 12. autosomal dominant
176
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
2. at least two 3. six or more 8. 2+ 9. cutaneous NFs
177
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
1. **Diagnostic Criteria** 4. > 5 mm 7. postpubertal 10. axillary or inguinal
178
Neurofibromatosis (NF) - Mgmt > -1- > Routine -2- as directed by -3- > -4-
1. refer to neuro 2. screenings (BP, HC, etc.) 3. neuro 4. Genetic counseling
179
Tic Disorders Def: -1-, repetitive, and irregular -2- > Tics may be -3- or -4-
1. Brief, abrupt, non-purposeful 2. movements or utterances (motor or vocal tics) 3. acute (<1 year) 4. chronic (> 1 year)
180
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
1. Tourette's syndrome 2. Movements 3. Face, neck 4. shoulders
181
Tic Disorders | Comorbidities w/ other -1- (e.g., -2-, anxiety, -3-) are common
1. psychobehavioral problems 2. ADHD 3. OCB/D
182
Tic Disorders - Etiology and Incidence | Up to ... experience tics at some point in childhood
20% of children
183
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
1. 4 & 6 years of age 2. severity 3. 10 & 12 years of age 4. decreases 5. adolescence
184
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
1. 4 & 6 years of age 2. severity 3. 10 & 12 years of age 5. adolescence 6. disappear
185
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-)
1. cause in unknown 2. family predisposition 3. medications 4. methylphenidate 5. amphetamines
186
``` 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) ```
1. More prominent 2. relaxed 3. simple motor 4. complex motor 5. vocal
187
Tic Disorders - Clinical Manifestations - Complex Motor Tics > -1- and -2- > -3- (-4-, -5-)
1. Copropraxia (obscene gestures) 2. Coprographia (obscene writing) 3. complex movements 4. head turning 5. hand scratching
188
``` Tic Disorders - Clinical Manifestations -1- tics > -2-, nasopharyngeal, or -3- sounds > -4- > -5- ```
1. Vocal 2. Oropharyngeal 3. laryngeal 4. consonants or syllables 5. Coprolalia (obscene speech) (Tourette's)
189
Tic Disorders - Clinical Manifestations - Vocal Tics | -1- (repeating -2-) and -3- (repeating -4-)
1. Palilalia 2. one's own words 3. Echolalia 4. another's words
190
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.
1. in-toeing 2. foot progression angle 3. >15 degrees 4. flexible foot 5. responsive to physical therapy
191
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-
1. runners 2. intensifies with running (15 minutes in) 3. orthopedic referral 4. MRI (X-ray too slow, bone scan not sensitive enough)
192
``` Tibial stress fractures Mgmt > Initial treatment: -1-, PT > Meds: -2- > -3-, pneumatic -4- may be necessary ```
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
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.
1. most common headache 2. at the onset 3. visual/sensory symptoms 4. less than 60
194
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.
1. familial predilection 2. associated nausea/vomiting 3. Common triggers 4. dehydration
195
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-.
1. an effective analgesic 2. more than 3 3. Medication-overuse headaches 4. actually cause headaches
196
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.
1. discontinuation of analgesics 2. neurological abnormalities 3. awaken the individual 4. most appropriate imaging
197
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.
1. effective abortive therapy 2. with some self-control 3. good life-style activities 4. skipping meals 5. minimizing caffeine intake
198
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-.
1. no analgesic use 2. the headache frequency 3. appropriate treatment plan 4. analgesic use
199
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-.
1. most common type 2. environmental influence 3. six JIA 4. autoinflammatory disease 5. autoimmune diseases
200
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-.
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
-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.
1. Pericarditis 2. spleen 3. virus may trigger
202
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.
1. chronic systemic rheumatic 2. effusion and tenderness 3. nervous system 4. cheeks and nose 5. butterfly
203
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.
1. large-joint polyarthritis 2. group A streptococcus 3. about 2-6 weeks 4. children 5-15 years
204
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.
1. autoimmune myopathic illness 2. proximal muscle weakness 3. Gottron papules (thick scaling on extensor surfaces) 4. often normal 5. muscle biopsy
205
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.
1. Delaying referral 2. delay special interventions 3. Immediate 4. disallowing for ambulation 5. opioids
206
-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-.
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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