Pedia Hx and PE

Question 1

age when adult neuro exam can be used in children

Answer 1

4 yo

Question 2

most useful and objective information

Answer 2

observation at play

Question 3

traits making children more predisposed to injury

Answer 3

top heavy
cranial bones are thin and not well developed
brain is highly vascular
excessive spinal mobility
wedge shaped cartilaginous vertebral bodies

Question 4

characteristics of sturge weber syndrome

Answer 4

port wine stain

vascular malformations in the brain –> calcification and sequelae of epilepsy and developmental delay

Question 5

characteristics of neurofibromatosis

Answer 5

cafe au lait sport
axillary freckling
neurofibromas
neruologicaldeficits

Question 6

characteristics of ataxia telangiectasia

Answer 6

telangiectatic lesions in conjunctiva, skin, mucosa
progressive cerebella ataxia
can be misdiagnosed as ataxic cerebral palsy

Question 7

characteristics of neurocutaneous melanosis

Answer 7

seizures most common presentation

partches of hyperpigmentation and tufts of hair

Question 8

when to measure head size

Answer 8

babies to 3 yo

>3 yo with small head size

Question 9

early closure of cranial sutures

Answer 9

primary craniosynostosis
>/= 1 sutures fuse prematurely = restricted perpendicular skull growth
multiple sutures = inc icp

Question 10

early fusion of sagittal suture

Answer 10

scaphocephaly

long and narrow head

Question 11

early fusion of one coronal suture

Answer 11

anterior plagiocephaly
asymmetrical head
“harlequin” deformity

Question 12

early bilateral coronal suture fusion

Answer 12

brachycephaly

short head but wide, cone shape

Question 13

early closure of one lambdoid suture

Answer 13

posterior plagiocephaly

Question 14

early fusion of the metopic suture

Answer 14

trigonocephaly

triangle shaped forehead

Question 15

features of trisomy 21

Answer 15

protruding tongue
flat nasal bridge
epicanthal folds
single palmar crease
congenital cardiac defect

Question 16

features of gargoylism

Answer 16

gapped teeth
thickened tongue
frontal bossing
associated with hunter’s syndrome

Question 17

features of tunrner syndrome

Answer 17

mental retardation
webbed neck
heart shaped face
low hairline at back

Question 18

features of prader willi syndrome

Answer 18

almond eyes
downturned mouth
hypogonadism

Question 19

features of treacher-collins syndrome

Answer 19

underdevelopment of jaw and zygomatic bones
precursors of ear fail to develop
cc: deafness

Question 20

how to measure occipitofrontal circumference

Answer 20

most prominent part of glabella around most prominent part of the occiput
during first 2 months and then 2x a year after

Question 21

normal head circumference and growth

Answer 21

table 4

Question 22

normal hc vs cc

Answer 22

hc > cc at birth
hc = cc at 6 mos
hc < cc at end of 1st year

Question 23

what are craniotabes

Answer 23

softening of parietal or occipital bones

indicates prematurity or rickets

Question 24

closure of anterior fontanelle

Answer 24

earliest: 8 mos
latest: 17-19 mos

Question 25

closure of posterior fontanelle

Answer 25

6-8 weeks

Question 26

t/f in younger children whose sutures have not yet mineralized increased icp may result with a child with a bigger head

Answer 26

true

12 yo: vomiting and increased sensorium

Question 27

normal transillumination of the skull

Answer 27

2 cm halo of light in frontoparietal

1 cm halo of light in occipital

Question 28

abnormal transillumination of the skull

Answer 28

uniform transillumination = thinned or absent cortex
(+) setting sun sign = hydrocephaly
decreased area of transillumination = subdural hematoma

Question 29

what to look out for in palpation of the spine

Answer 29

sacrum and coccyx present (sacral agenesis)
spina bifida occulta (hairy or pigmented patch over lower spine)
sacrococcygeal pit

Question 30

when is babies eyesight 20/20

Answer 30

6 mos

Question 31

when can visual acuity be tested

Answer 31

> 4 yo

Question 32

how to test visual field

Answer 32

toys to get attention

Question 33

how to test oculomotor system

Answer 33

doll’s eye maneuver

toys

Question 34

how to test cn 7

Answer 34

smiling and crying

Question 35

when can infants localize sound

Answer 35

6 mos

Question 36

t/f muscle fasciculations & atrophy are best demonstrated in tongue

Answer 36

true

Question 37

tremors at rest signal __

Answer 37

cns disease

Question 38

signs of hypotonic infant

Answer 38

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)

Question 39

when does hypertonia decrease

Answer 39

after 3 mos

Question 40

what is gowers sign

Answer 40

pushing up unto one’s legs otherwise being unable to rise

Question 41

characteristics of tetanus

Answer 41

acute onset hypertonia, painful muscular contractions

generalized muscle spasms

Question 42

spasticity vs rigidity

Answer 42

spasticity: umn, clasp-knife phenomenon
rigidity: extrapyramidal, cogwheel rigitiy

Question 43

most reliable reflexes

Answer 43

biceps, knee, and ankle jerk

Question 44

normal clonus in childdren

Answer 44

< 3 mo: 5-10 beats

older children: 1-2 beats

Question 45

primitive reflexes

Answer 45

moro reflex (falling head)
grasp reflex
asymmetric tonic neck reflex (fencing)
parachute reflex (falling trunk)