Pedia Hx and PE Flashcards
age when adult neuro exam can be used in children
4 yo
most useful and objective information
observation at play
traits making children more predisposed to injury
top heavy
cranial bones are thin and not well developed
brain is highly vascular
excessive spinal mobility
wedge shaped cartilaginous vertebral bodies
characteristics of sturge weber syndrome
port wine stain
vascular malformations in the brain –> calcification and sequelae of epilepsy and developmental delay
characteristics of neurofibromatosis
cafe au lait sport
axillary freckling
neurofibromas
neruologicaldeficits
characteristics of ataxia telangiectasia
telangiectatic lesions in conjunctiva, skin, mucosa
progressive cerebella ataxia
can be misdiagnosed as ataxic cerebral palsy
characteristics of neurocutaneous melanosis
seizures most common presentation
partches of hyperpigmentation and tufts of hair
when to measure head size
babies to 3 yo
>3 yo with small head size
early closure of cranial sutures
primary craniosynostosis
>/= 1 sutures fuse prematurely = restricted perpendicular skull growth
multiple sutures = inc icp
early fusion of sagittal suture
scaphocephaly
long and narrow head
early fusion of one coronal suture
anterior plagiocephaly
asymmetrical head
“harlequin” deformity
early bilateral coronal suture fusion
brachycephaly
short head but wide, cone shape
early closure of one lambdoid suture
posterior plagiocephaly
early fusion of the metopic suture
trigonocephaly
triangle shaped forehead
features of trisomy 21
protruding tongue flat nasal bridge epicanthal folds single palmar crease congenital cardiac defect
features of gargoylism
gapped teeth
thickened tongue
frontal bossing
associated with hunter’s syndrome
features of tunrner syndrome
mental retardation
webbed neck
heart shaped face
low hairline at back
features of prader willi syndrome
almond eyes
downturned mouth
hypogonadism
features of treacher-collins syndrome
underdevelopment of jaw and zygomatic bones
precursors of ear fail to develop
cc: deafness
how to measure occipitofrontal circumference
most prominent part of glabella around most prominent part of the occiput
during first 2 months and then 2x a year after
normal head circumference and growth
table 4
normal hc vs cc
hc > cc at birth
hc = cc at 6 mos
hc < cc at end of 1st year
what are craniotabes
softening of parietal or occipital bones
indicates prematurity or rickets
closure of anterior fontanelle
earliest: 8 mos
latest: 17-19 mos
closure of posterior fontanelle
6-8 weeks
t/f in younger children whose sutures have not yet mineralized increased icp may result with a child with a bigger head
true
12 yo: vomiting and increased sensorium
normal transillumination of the skull
2 cm halo of light in frontoparietal
1 cm halo of light in occipital
abnormal transillumination of the skull
uniform transillumination = thinned or absent cortex
(+) setting sun sign = hydrocephaly
decreased area of transillumination = subdural hematoma
what to look out for in palpation of the spine
sacrum and coccyx present (sacral agenesis)
spina bifida occulta (hairy or pigmented patch over lower spine)
sacrococcygeal pit
when is babies eyesight 20/20
6 mos
when can visual acuity be tested
> 4 yo
how to test visual field
toys to get attention
how to test oculomotor system
doll’s eye maneuver
toys
how to test cn 7
smiling and crying
when can infants localize sound
6 mos
t/f muscle fasciculations & atrophy are best demonstrated in tongue
true
tremors at rest signal __
cns disease
signs of hypotonic infant
supine: frog leg posture
suspended in prone: limbs and head hang limply like rag doll
resting posture: extended elbows, hips, and knees (should be flexed)
when does hypertonia decrease
after 3 mos
what is gowers sign
pushing up unto one’s legs otherwise being unable to rise
characteristics of tetanus
acute onset hypertonia, painful muscular contractions
generalized muscle spasms
spasticity vs rigidity
spasticity: umn, clasp-knife phenomenon
rigidity: extrapyramidal, cogwheel rigitiy
most reliable reflexes
biceps, knee, and ankle jerk
normal clonus in childdren
< 3 mo: 5-10 beats
older children: 1-2 beats
primitive reflexes
moro reflex (falling head)
grasp reflex
asymmetric tonic neck reflex (fencing)
parachute reflex (falling trunk)
