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Pediatrics > Pediatric Neurology > Flashcards

Pediatric Neurology Flashcards

1
Q

tissue from which nervous system arises

(and the implication)

A

same tissue as hair, skin, nails

defects in skin, teeth, nails may be sign fo nerologic defects

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2
Q

cafe au lait spots sign of…

A

neurofibromatosis

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3
Q

ash leaf spot sign of…

A

tuberous sclerosis

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4
Q

head circumference:

<3rd %tile or not progressing

or

>97th %tile or rapidly progressing

A

microcephaly / macrocephaly

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5
Q

misshapen head

(2 types)

A

plagiocephaly

(postional or craniosynostosis)

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6
Q

premature closure of sutures

A

craniosynostosis

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7
Q

emergent mishapen head

A

bulging fontonel

(r/o hydrocephalus, meningitis)

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8
Q

closing time of anterior & posterior fontanels

A

posterior - a few weeks

anterior - about 15 months

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9
Q

imaging for head evaluation

(craniosynostosis, hydrocephalus, detail)

A
  • plain film - craniosynostosis
  • US - ventricle size to evaluate hydrocephalus
  • CT/MRI if fontanel size doesn’t permit US or more detail needed
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10
Q

what to check with eye exam

A

red reflex, position/shape, movement

(don’t miss amblyopia or strabismus)

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11
Q

cover / uncover test

A
  • cover test - heterotropia/ablyopia
    • (always deviated)
    • normal, fixating eye covered
    • observe uncovered eye - focuses
  • uncover test - heterophoria/strabismus
    • (sometimes dev.)
    • one eye covered, other fixates on object
    • uncovering causes movement
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12
Q

excessive cerebrospinal fluid in CNS

A

hydrocephalus

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13
Q

malformation of these vertebrae to varying extent

(spina bifida)

A

L5-S1

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14
Q

3 causes of hydrocephalus

A
  • obstruction
    • mass, stenosis, malformation
    • Dandy Walker malformation
    • Arnold Chiari malformation
  • overproduction of CSF
    • Choroid plexus papilloma
  • communicating hydrocephalus
    • defective reabsorption of CSF
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15
Q

sign of hydrocephalus in infant

A

abnormal increase in head circumference

(infant will be protected by head expansion -

CT indicated)

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16
Q

4 symptoms of hydrocephalus

&

which ventrical causes symptom

A
  • ataxia/spasticity of LE
    • d/t expansion of lateral ventricals
  • endocrine dysfunction
    • d/t 2nd and 3rd ventrical distention
  • visual dysfunction
    • d/t anterior 3rd ventrical distention
  • sunsetting eyes
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17
Q

surgical tx for hydrocephalus

A

ventriculoperitoneal shunt

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18
Q

benign cause increased intracranial pressure

s/s, dx, tx

A

pseudotumor cerebri

  • s/s
    • overweight teen
    • papilledema
    • severe HA
    • normal brain imaging
  • dx
    • increased pressure on LP
  • tx
    • serial LPs, diuretic, corticosteroids
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19
Q

spina bifida -

completely covered, dimple/hair tuft

(what s/s)

A

spina bifida occulta

  • bladder incontinence
  • recurrent UTI
  • recurrent meningitis

US to be sure dimple not open to spinal cord

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20
Q

spina bifida -

exposed canal but SC covered by mininges

(what s/s)

A

meningocele

functionally intact

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21
Q

spina bifida -

spinal cord completely exposed, not covered by skin, meninges, or bone

(what s/s)

A

myelomeningocele

  • total paralysis of legs
  • bowel and bladder incontinence
  • assoc. with Arnold Chiari defect of brainstem
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22
Q

what checked with neonate neurological exam

A

primitive reflexes

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23
Q

what checked with infant/child neurological exam

(4 areas)

A
  • mental status
  • cranial nerves
  • motor exam
  • sensory exam
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24
Q

primitive reflex -

head drop: arms abduct and extend

(when disappears)

A

moro reflex

disappears at 3-6 mo

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25
Q

primitive reflex -

infant held vertically will flex/extend legs alternately

(when disappears)

A

stepping reflex

disappears at 1-2 mo

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26
Q

primitive reflex -

palmar and plantar flexion when touched,

open when back stroked

(when disappears)

A

grasp reflex

disappears at 3 mo

27
Q

primitive reflex

turn head & neck, limbs extend to side face turned

(when disappears)

A

tonic neck reflex

disappears at 3-4 mo

28
Q

common cause of HA in children

A

URI, febrile illness

29
Q

uncommon cause of HA in children

A

familial HA (consider role modeling)

30
Q

common cause of chronic HA in children

A

anxiety

31
Q

mild, global, squeezing HA

no NAV, photo/phonophobia

(what age group MC)

A

tension HA

school age and beyond

32
Q

intense pounding/throbbing, localized HA

assoc. w/ NAV, aura, photo/phonophobia

(what age group MC)

A

migraine HA

most often adolescence (teen),

but can present in toddler

33
Q

Tension HA Tx

A
  • often no tx required
  • keep diary it ID triggers
  • acetaminophen or ibuprofen
  • caution rebound HA w/ frequent NSIADs
34
Q

Migraine Tx

A
  • detailed HA diary to ID triggers
  • initial:
    • ibuprofen, rest, dark room
  • acute tx:
    • Triptans (SSR agonists)
  • preventive tx (HA >1/week):
    • Cyproheptadine
    • Propranolol
    • Flunarizine
    • Amitriptyline
    • Topiramate
    • Valproate
  • lifestyle modifications: diet, exercise, sleep
  • CBT
35
Q

description of seizure in children

A

any focal or generalized body movement

that can be set to music

36
Q

MC seizure in toddlers & characteristics

A

febrile seizures

  • mostly in ages 1-2
  • can occur from 6mo to 6y
  • usually in first 24h of febrile illness
  • simple or complex
37
Q

Simple Febrile Seizure

(S/s, Tx)

A
  • S/s
    • single episide of gen. tonic clonic activity
    • < 15 min
    • no focal features
    • brief post ictal period
  • Tx
    • none needed
38
Q

Complex Febrile Seizure

(S/s, Tx)

A
  • S/s
    • any focal features -OR-
    • > 15 min -OR-
    • more than 1 in 24h
  • Tx
    • consider EEG or Tx
39
Q

Absence Seizures

(S/s, Tx)

A
  • S/s
    • typically school age
    • brief “checking out”, ADHD, daydreaming
    • possible mild focal signs
      • lip smacking, eye flutter
    • provoked by hyperventilation
    • EEG: 3 Hz spike and wave
  • Tx
    • anticonvulsants
40
Q

seizure of sleep transition

face/arm movements

A

Rolandic Epilepsy (Benign Focal Epilepsy)

  • ages 5-10
  • induced by lack of sleep
  • Tx: anti-epileptics NOT always indicated
41
Q

jacknife contractions of neck, trunk, arms

(may occur at sleep transitions)

A

infantile spasm

  • peak is 3-8mo
  • assoc. w/ tuberous sclerosis (or idiopathic)
  • difficult to treat
  • assoc. w/ poor intellect, may progress to other seizure types
42
Q

inflammation of the meninges

A

meningitis

43
Q

2 types of minigitis

A
  • aseptic
    • viral, Lyme dz, TB
  • septic
    • bacterial: H. flu, S. pneumonia, N. menin.
44
Q

Top Neonatal Causes of Bacterial Meningitis

A
  • Group B strep
  • E. coli
  • Klebsiella
  • Enterobacter

these inhabit female vaginal tract - no immunization

45
Q

Top 1mo+ Cause of Bacterial Meningitis

A
  • Strep pneumoniae
  • Neisseria miningitides
  • H. flu
  • G-
46
Q

age/demographic w/ highest rates of meningitis

A
  • < 1 year old (d/t immunocompetence)
  • demographics:
    • Native Americans, Alaskan natives, Australian aboriginals (complement fixation)
    • immunodeficiency
    • asplenia
    • CSF leak
    • implanted devices (cochlear, VP shunt)
47
Q

5 signs of meningitis

A
  • fever
  • irritability
  • HA
  • nuchal rigidity
  • Kernig and Brudzinski signs (infant not wanting to be moved)
48
Q

signs to look for w/ newborn meningitis

A
  • maternal fever, +culture for GBS, HSV, others
  • < 48 hours of life
    • temp instability
    • poor feeding
    • irritable, lethargic
    • bracycardia, hypotension
  • > 48 hours of life
    • seizures
    • bulging anterior fontanel
    • extensor posturing
    • focal cerbral signs: gaze deviation, hemiparesis
    • cranial nerve palsies
49
Q

tests for meningitis

A
  • CBC - neutrophilia, left shift
  • CSF - cell counts, neutrophil v. lymphocyte, gram stain, protein and glucose levels
  • blood, urine, CSF cultures
  • PCR of nasopharynx, skin, blood, CSF for virus
50
Q

Tx of pediactric meningitis

A
  • supportive care
  • empiric antibiotics
    • G+, G-, and antivirals in neonate
    • specific Tx when labs return
    • consider Rifampin if TB suspected
51
Q

Tx of meningitis survivors

A
  • follow for vision and hearing deficits
  • assess development at regular intervals
52
Q

inflammation of brain parenchyma

A

encephalitis

53
Q

causes of encephalitis in children

A
  • acute or post infection
  • immune mediated
  • typically viral (HIV common in children)
54
Q

S/s of encephalitis in children

A
  • prodrome of URI symptomes
  • fever, HA, progressive lethargy
  • neurologic deficits and seizures later
55
Q

Dx of encephalitis

A
  • must r/o meningitis
  • CSF analysis:
    • lymphocytosis
    • protein elevation
    • normal glucose
  • PCR or specific antibodies of virus
56
Q

Tx of Encephalitis

A
  • supportive care
  • antiviral if appropriate
    • Acyclovir - HSV, varicella
    • Gancyclovir - CMV
    • antiretroviral therapy - HIV
57
Q

traumatically induced alteration of consciousness

(with or w/out LOC)

A

pediatric concussion

58
Q

Concussion S/s

A
  • staring, confusion
  • blank expression, blunted affect
  • dizziness, vision problems (more significant)
  • retrograd/anterograde amnesia min. to days
59
Q

concussion vs. serious head injury

(signs for CT)

A
  • worsening HA
  • changing level of consciousness
  • focal changes
    • pupillary changes
    • single sided weakness
  • extended LOC
  • bruising behind ears
60
Q

3 factors in concussion return to play

A
  • previous concussions (longer time to recover, sequential evaluations)
  • duration of symptoms (must be totally gone)
  • severity of symptoms (return to baseline)
61
Q

Hx of repeated brain trauma w/

memory loss, confusion, impaired judgement, aggression, explosive anger

A

chronic traumatic encephalopathy

62
Q

3 tools to assess concussion

A
  • Glasgow coma scale (> 14 okay)
  • Sport concussion assessment tool (SCAT)
  • CDC toolkit online
63
Q

assessment of head injury

A
  • ABCs
  • head/neck exam for tenderness and mobility
  • facial bones for pain and deformity
  • neuro exams:
    • eye movement
    • coordination and balance
    • extremity exam for mobility, weakness, sensation
  • CT if GCS < 13, focal findings, signs incr. cranial pressure
  • MRI if prolonged symptoms (delayed bleed)

Pediatrics (13 decks)

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