Peds.

Question 1

An infant’s brain is ___ the weight of an adult’s brain.

Answer 1

2/3.

Question 2

Posterior fontanel closes around ___ months. Anterior fontanel closes around ___ months.

Answer 2

3, 18-24.

Question 3

Measure head circumference until ___ months; at 12 months head circumference will equal ___.

Answer 3

36, chest.

Question 4

An infant is better able to accommodate rising ICP because…

Answer 4

the skull is more elastic; fontanels not yet closed.

Question 5

S/S of rising ICP in an infant:

Answer 5

high pitched cry, bulging fontanel, dilated scalp veins, wide sutures (with palpation), and irritability.
newborns are hypertonistic and draw up in a fetal position.

Question 6

Factors that predispose infants and children to head injury:

Answer 6

poor judgment, unsteady gait, immature immune system, fragile neurons, nerve cells not completely myelinated, top heavy, weak neck muscles, thinner cranium, small subarachnoid space, uncoordinated.

Question 7

Cushing’s triad:

Answer 7

hypertension - increased systolic; widened pulse pressure - difference of > 30-40; bradycardia; combined with dilated pupils.

Question 8

Assess CN II and III:

Answer 8

shine light source in eye; rapid, concentrically constricting pupils should result.

Question 9

Assess CN II, IV, and VI:

Answer 9

perform with eyes held open (doll’s eyes) and head moved horizontally or vertically.

Question 10

Assess CN III and VIII:

Answer 10

place head midline and slightly elevated, inject ice water into ear canal; eyes deviate to the toward irrigated ear.

Question 11

Assess CN V and VII:

Answer 11

touch cornea with sterile cotton swab; should blink.

Question 12

Assess CN IX and X:

Answer 12

irritate pharynx with cotton swab; should gag.

Question 13

Doll’s eye:

Answer 13

sign of impending brain death.

Question 14

Hydocephalus:

Answer 14

increased production, impaired absorption or block of CSF that results in excessive amounts of SCF within the cerebral ventricles; highly associated with spinal bifida.

Question 15

2 types of hydrocephalus:

Answer 15

communicating: faulty absorption of CSF; flows freely between normal channels and pathways, but the absorption is altered in the subarachnoid space.
non-communicating: obstruction of cerebral blood flow; tumor, infection, blood clot from a brain bleed, more common.

Question 16

Hydrocephalus is often ___ and commonly associated with ___. It can occur as a result from ___.

Answer 16

congenital, myelomeningocele, the complication of an illness (meningitis or brain tumor or hemorrhage).

Question 17

S/S of hydrocephalus:

Answer 17

neonate: sunsetting sign - visible sclera above the iris, macewen’s sign - hollowed sign when skull percussed; rapidly increasing head circumference, tense bulging fontanel, protrusion of frontal area, translucent skin covering forehead, prominent scalp veins, head will be disproportionally large as compared to face; will be fussy, restless, poor feeding and cat-like cry.
older child: no head increase, Increased ICP, headache, nausea, vomiting, irritability, decreased judgment, confusion, change in motor ability; will lose interest in activities and will not eat; may also have papilledema (swelling of the optic disc), strabismus, and decreased visual acuity.
Arnold-Chiari malformation
Dandy-Walker Syndrome.

Question 18

Arnold-Chiari malformation:

Answer 18

congenital herniation of the brainstem and lower cerebellum through the foramen magnum into the cervical vertebral canal
type 1: adult; more common, s/s won’t be noticed until adulthood.
type 2: pediatric; more severe; will be noticed immediately.
s/s: headache, poor hand coordination, dizziness, difficulty swallowing, surred speech.

Question 19

Dandy-Walker syndrome:

Answer 19

congenital brain malformatoin involving the cerebellum and the fluid filled spaces around it; genetically sporadic disorder, mostly in females; enlargement of 4th ventricle.

Question 20

Tx of hydrocephalus:

Answer 20

shunts placed as soon as dx; after shunt - lay <30 on unoperative side; VS frequently; infection most likely 1-2 months after surgery (staph); measure head; note every change.

Question 21

S/S of shunt infection:

Answer 21

low grade fever, malaise, nausea, headache, increase in leukocytes; CSF will have increased WBC, elevated protein, decreased glucose and positive for pathogen.

Question 22

S/S of shunt malfunction:

Answer 22

signs of increased ICP.

Question 23

S/S of over drainage:

Answer 23

low BP, postural HS while sitting decreased HR, seizure, NV, lethargy, and irritability.

Question 24

Meningitis S/S:

Answer 24

poor feeding, irritability, fever, seizures, photosensitivity, SIADH or DI, bulging fontanel, lethargy, refusal o feed, vomiting.
triad: fever, stiff neck (nuchal rigidity), and change in LOC.
with bacterial will have rash.

Question 25

Bacterial meningitis:

Answer 25

pneumococcal (strep), meningococcal (neisseria), staph, haemophilus influenzae, listeria monocytogenes.

Question 26

Viral meningitis:

Answer 26

enteroviruses (polioviruses, coxsackieviruses, echoviruses), adenoviruses, paramyxoviruses, herpes virus, epstein-barr, cytomegalovirus.
85% viral.

Question 27

Encephalitis:

Answer 27

inflammation of the brain, LOC impaired, tick bite - lyme disease; viral - common w herpes; lethargic.

Question 28

Spinal bifida occulta:

Answer 28

failure of the posterior vertebral arches to fuse; 5th lumbar or 1st sacral vertebrae; no herniation; not visible externally.
will see dimple or small depression; may not be detected until toddler.

Question 29

Encephalocele:

Answer 29

brain and meninges herniate through defect in skull and into a sac; sx repair in stages.

Question 30

Meningocele:

Answer 30

sac contains meninges and CSF, but not spinal cord.

Question 31

Meningomyelocele:

Answer 31

sac contains meninges, CSF, and portion of spinal cord or nerve roots; the higher the lesion, the higher the neuro deficit.

Question 32

Cerebral palsy:

Answer 32

abnormal muscle tone and movement, lack of coordination with spasticity; chronic, non-progressive; caused by damage to the motor areas of the brain; congenital malformation or injury to the brain.
most dx by age 3.

Question 33

S/S of spastic CP:

Answer 33

70% of cases, walk on toes, scissor gate.

Question 34

Cause of CP:

Answer 34

premature birth or very low birth weight; will see if shaken baby or head trauma.

Question 35

Management of CP:

Answer 35

muscle contractures, skin breakdown, nutritional concerns, feeding, use of botulinum toxin to mange spascity; baclofen pump, mainstreaming.

Question 36

Neurofibromatosis:

Answer 36

von Recklinghausen - tumors grow along nerves; autosomal recessive; mild to debilitating.
skin, eye, bones, cv, cns, endocrine.

Question 37

Reye syndrome:

Answer 37

sudden brain damange (encephalopathy) and liver function problems of unknown cause.
has occurred with use of aspirin.

Question 38

S/S of Reye:

Answer 38

vomiting, irritable and aggressive behavior, confusion, lethargy, loss of consciousness or coma, mental changes, NV, seizures, decerebrate posture.

Question 39

Abusive head trauma:

Answer 39

most common cause of death from child physical abuse.

Question 40

Common fractures with child abuse:

Answer 40

skull, rib, classic metaphyseal lesion.