Pediatrics Flashcards
What do you always include in pediatric history taking? (4)
- immunizations
- birth history
- po intake
- excretions: BM/urine
neonatal period
0-28 days`
postnatal period
29 days to 1 yr
primary HA’s - what types
tension migraine cluster sinus hormonal
secondary HA’s - what types
minor illness
serious condition - CNS tumor
common symptom of brain abscess
nighttime awakening HA
Tension HA presentation
bilateral
forehead
neck
squeezing
Tension HA tx
NSAIDs
MSK relaxers
Migraines commonly affects who
teens
females
POUND criteria for migraines
P: pulsatile O: hours of onset U: unilateral N: nauseating D: disabling
Migraine classic
aura
migraine common
no aura (80% of migraines)
Cluster HA presentation
severe unilateral periorbital lacrimation nasal congestion Horner's syndrome (affects trigeminal nerve): ptosis, anhidrosis, miosis
Cluster Tx
100% oxygen
What do you always document with a HA?
- maximal at onset
- worse HA of life
- sudden onset
Otherwise SAH!!
CNS tumors have a ____ onset
gradual
CNS tumors are accompanied by ____
focal neuro deficit
MC CNS tumor
glioma
Worst CNS tumor
glioblastoma multiforme
seizure definition
sudden, uncontrolled electrical disturbance in the brain
focal seizures occur…
in one area of the brain
focal seizures are defined as…
simple: no loss of consciousness (LOC)
Complex: LOC or altered level of consciousness
generalized seizures involve…
both hemispheres of the brain
have a LOC
What is status epilepticus
seizure duration >5mins.
Tx of status epilepticus
lorazepam
diazepam
IV, IM, or rectal –> usually rectal
When you work up a seizure, you are working up….
the potential causes: electrolyte abnormalities, seizure medications, anemia, infections, get an ECG/CXR/CT of head
Febrile seizure definition
convulsion associated with fever > 103.0 not associated with CNS/infection/inflammation
febrile seizure recurrence rsik
30-50%
MC neuro disorder in infants/young children (6m-6yrs)
febrile seizures
Tx of febrile seizures
lower temp rectal diazepam (>5min duration)
Why do febrile seizures occur in young?
lower seizure threshold in infants places them at greater risk
who gets breath holding spells
infants - 6y/o
breath holding spells are associated with…
genetics
IDA
thought to be secondary to autonomic dysfunction
Autosomal dominant
who gets vasovagal syncope
young and healthy
AKA “common faint”
how long does vasovagal syncope last
1-2 minutes
when does vasovagal syncope occur
sitting or standing
cause of vasovagal syncope
neural reflex: hypotension due to bradycardia or peripheral vasodilation
type of reflex syncope
vasovagal syncope classically due to…
emotion orthostatic pain fear heat physical activity
atypical vasovagal syncope occurs when
in elderly
or recurrent in patients
three characteristics to diagnose GBS
- progressive weakness
- worsening respiratory status
- significant bulbar weakness –> cranial nerves, dysphagia, slurred speech, difficulty handling secretions, dysphonia
ascending paralysis
what is juvenile transient myasthenia gravis
rare form of MG, an autoimmune disorder of the neuromuscular junction resulting in ocular manifestations or weakness in the ocular, bulbar, limb or respiratory muscles
antibody mediated & target ACH receptors/proteins
T cell dependent
symptoms of juvenile transient myasthenia gravis
progressive weakness
treatment of juvenile transient myasthenia gravis
cholinesterase inhibitors for several weeks
how do you diagnose juvenile transient myasthenia gravis
Ice pack test
serology: AChR-Ab
what must you do when dealing with juvenile transient myasthenia gravis
rule out thymoma with a CT or MRI of chest
strong link of 30-40% have a thymoma and 30-40% will develop a thymoma
Concussions can result in chronic traumatic encephalopathy. What is that?
permanent mood and behavior changes; often seen in repetitive injuries, boxers, football players, military
imaging done with concussion
non-contrast CT
ESPECIALLY GET A non-contrast CT if…
- altered mental status
- signs of skull fracture
- severe injury mechanism (pedestrian/motorist and no helmet; fall >5ft; head struck by high-impact object)
What causes tourettes
result from complex social + emotional factors multiple genetic affecting the meso-limbic circuit or cortico-striatal-thalamic-cortical circuit
In order to have tourettes….
both parents must have had it
Tourette disorder commonly affects…
males>females
Tx tourettes wtih…
medication that treats both tics and ADHA: alpha adrenergic agonists: guanfacine or clondine
What is cerebral palsy
a heterogenous group of conditions causing permanent, non-progressive motor dysfunction
Affects muscle tone, posture, movement, can cause intellectual disability, alterations in sensation and perception, seizures
what causes cerebral palsy
some sort of abnormality or injury to the developing fetal or infantile brain
PE characteristic of cerebral palsy
microcephaly
Number 1 lab test for cerebral palsy
Tests for muscular abnormalities: elevated serum creatinine
Huge defining characteristic of cerebral palsy
NON-progressive
MC motor dysfunction in children
cerebral palsy
what causes infantile botulism
by eating food contaminated with Clostridium Botulinum:
a Gram +, rod-shaped, spore forming anaerobe
infantile botulism presentation
descending paralysis
dilated pupils
dry mouth
infantile botulism pathogenesis
- neurotoxin enters blood
- releases out of blood into NMJ
- binds motor nerve terminal and blocks synaptic fusion
- blocks release of ACh or inhibits muscle contraction
- causes muscle weakness/flaccid paralysis from upper to lower extremities
what are Duchenne and becker muscular dystrophies
an inherited group of progressive myopathic disorders resulting from defects in a number of genes required for normal muscle function
what is the primary symptom of Duchenne and becker muscular dystrophies
muscle weakness onset of 2-3y/o, sometimes later
Progressive weakness is the principal symptom as muscle fiber degeneration is the primary pathologic process
what causes Duchenne and becker muscular dystrophies
mutations of dystrophin gene on the X chromosome
common PE of DMD/BMD
gower sign: have to tripod to stand up
Kernig sign
meningitis
knee flexion causes pain in neck
meningitis agents in babies
E.coli (GNR)
GBS
Tx of meningitis
dexamethasone and empric ABX (cephalosporins/vanco/penicillins)
why give dexamethasone in meningitis
prevent hearing loss due to H. influenzae
MC of encephalitis
HSV
CMV if immunocompromised
