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Pediatrics > Pediatric Neuro > Flashcards

Pediatric Neuro Flashcards

1
Q

What is epilepsy?

A

repeated afebrile seizures without cause, often in ages 4-16 yrs

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2
Q

what is neonatal epilepsy?

A 
< 4 weeks old
May or may not have motor symptoms
face twitching
Responsiveness in and out
Prognosis depends on cause (abusive head trauma, maternal substance use, inborn error of metabolism, infection, hypoxic, ischemic, encephalopathy, etc) 
can develop cerebral palsy
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3
Q

what are infantile spasms (AKA West Syndrome)?

A 
2-12 months
seemingly fine before spasms
Brief muscle movements, eye rolling
Common upon waking up
Note lost of milestones - goes backwards 
Intellectual disability can develop
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4
Q

what is absence “petit-mal”?

A

Non-obvious intermittent seizures, may not be aware seizure is occurring
No motor symptoms, but have “staring spells”, lose awareness (may be dx w/ ADD)
Young school age children onset and can struggle in school
tx: anti-epileptic

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5
Q

what is Simple partial/focal?

A 
Abnormal smells, hallucinations
sudden mood changes (deja vu) 
one area of body that twitches
perceptions of skin tingling/burning 
conscious
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6
Q

child has decreased level of mentation (impaired consciousness, staring, less responsive). Afterwards, child is tired, disoriented, has a headache and loss of bowel control. what do you suspect?

A

complex partial epilepsy

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7
Q

child has uncontrollable muscular contraction resulting in a dislocated shoulder which alternates with loss of muscle tone. what type of seizure do you suspect?

A

generalized tonic-clonic “grand-mal”

seizure >5 minutes send to ER

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8
Q

child has facial twitching and eye movement every few days-weeks, but no loss of consciousness. what do you suspect?

A

Benign epilepsy of childhood (Rolandic seizures)

no Rx’s needed, will resolve in adolescence

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9
Q

what should you use to evaluate for epilepsy?

A

electroencephalogram (EEG), MRI

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10
Q

what is the most common type of seizure in childhood?

A

febrile seizure (between 6 mo-5 years)

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11
Q

febrile 18 mo old has uncontrollable muscle contraction alternating with loss of muscle tone for <15 minutes. what do you suspect?

A

simple febrile seizure (generalized (tonic-clonic))

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12
Q

what classifies as a complex febrile seizure?

A

focal OR
duration >15 minutes OR
recurrent w/in 24 hrs.

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13
Q

what should be evaluated in a complex febrile seizure?

A

lumbar puncture and EEG

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14
Q

what is the tx for simple febrile seizures?

A

antipyretics

educate and have parents check back if recurrent episode (anticonvulsants not warranted)

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15
Q

what is the tx for complex febrile seizures?

A

diazepam at onset of febrile illness

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16
Q

what is hydrocephalus?

A

dilation of ventricles in brain due to increased CSF volume

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17
Q

what causes hydrocephalus?

A

hemorrhage, infection, tumors, congenital malformation

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18
Q

infant has accelerated rate of head growth, irritability, vomiting, loss of appetite, impaired upward gaze. what do you suspect?

A

hydrocephalus

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19
Q

what imaging should be used in hydrocephalus?

A

cranial ultrasound if anterior fontanelle is open

otherwise, CT/MRI

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20
Q

what is the tx for hydrocephalus?

A

ventriculoperitoneal shunt

21
Q

a child with a shunt presents w/ fever, lethargy, irritability, and redness of the shunt path. what should you do?

A

shunt evaluation (head CT, shunt series, CSF evaluation)

22
Q

what is cerebral palsy?

A

chronic static impairment of muscle tone, strength, coordination, or movements

23
Q

what causes cerebral palsy?

A

Intrauterine or birth hypoxia
Intrauterine bleeding
Congenital malformations (e.g. blood vessels)
Intrauterine or neonatal infections
Neonatal hypoglycemia or acidosis
Kernicterus (uncontrolled increased bilirubin levels)

24
Q

what type of cerebral palsy is characterized by uncontrolled, painful muscle contractions?

A

spastic cerebral palsy

25
Q

what type of cerebral palsy is characterized by inability to muster coordinated muscle movement?

A

ataxic cerebral palsy

26
Q

what type of cerebral palsy is characterized by writhing-like movements?

A

choreoathetoid cerebral palsy

27
Q

what are associated conditions of cerebral palsy?

A

microcephaly, seizures, intellectual disability, disorders of vision, hearing, speech/language

28
Q

how should cerebral palsy be managed?

A

physical, occupational and speech therapy
educational support
orthopedic monitoring and intervention (dislocations, scoliosis)
tx for spasticity (botox, surgery)

29
Q

child complains of HA, dizziness, blurred/double vision, slurred speech, N/V, ataxia and fatigue. What do you suspect?

A

concussion

30
Q

Child complains of HA, fatigue, sleep disturbance, difficulty concentrating, impaired memory, mental fogginess, dizziness, irritability, depression and social withdrawal over the past weeks. What do you suspect?

A

post-concussion syndrome

31
Q

what are young athletes at risk for if they return to activity despite still having concussion symptoms?

A

second impact syndrome

32
Q

how are children affected differently by concussions vs. adults?

A

take longer to recover
increased risk for repeat concussion
second impact syndrome

33
Q

what can second impact syndrome result in?

A

rapidly progressive brain edema, brain stem herniation, high mortality within minutes of 2nd concussion

34
Q

how should you counsel a parent with a child who had a concussion?

A

return to activity no sooner than 14 days after cessation of all symptoms
start w/ less intensive activity, may step up next level only if child remains asymptomatic
note need for cognitive rest

35
Q

child presents w/ new onset of nocturnal enuresis, fatigue and weakness, vision changes, and unexplained weight loss. They had a recent illness/surgery. PE is normal. What do you suspect?

A

T1DM

36
Q

Pt presents to the ED w/ dehydration, unusual breathing, and altered mental state. What do you suspect?

A

DKA

37
Q

how is T1DM diagnosed?

A

random BG >200
fasting BG >126
or A1c if BG normal

38
Q

What is the ADA HA1c recommendation for pediatric age groups?

A

<7.5

39
Q

child was normal size at birth. between ages 2-8 months, you notice deceleration in growth. PE is normal, but child appears to be immature. what do you suspect?

A

constitutional growth delay

40
Q

what is congenital short stature?

A

both parents are short

41
Q

what should be evaluated if growth delay is suspected?

A 
wrist x-ray for bone age (reveals bone age that lags by 2-4 yrs)
thyroid panel
GH production
LH and FSH if puberty
CBC
chemistry panel
ESR
UA
sweat chloride if hx pneumonia/hospitalizations
42
Q

what differential diagnoses can growth delay include?

A

CF, eating disorders, FTT, growth hormone deficiency, pituitary/thyroid disorders, genetic syndromes

43
Q

what are tx options for growth delay?

A 
measure frequently
balanced diet
contact sports w/ caution
androgens can be used in males, or GH in either
pt and parent education
44
Q

what classifies as status epilepticus:

A

clinical/electrical seizure >30 minutes

45
Q

what are post ictal symptoms indicating complex partial epilepsy?

A 
Fatigue.
Headache.
Loss of bladder control.
Loss of bowel control.
Lack of consciousness.
Confusion.
Fear and anxiety.
Trouble walking or writing.
46
Q

Which viruses can cause febrile seizures?

A

roseola (HHV-6), shigella

47
Q

do febrile seizures lead to epilepsy?

A

rarely

48
Q

what is the recurrence risk w/ febrile seizures?

A

30-50%

49
Q

what is the best predictor of concussion severity/prognosis?

A

duration of symptoms

Pediatrics (7 decks)

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