Peds 28 Flashcards
At what ages does the AAP recommend that developmental screening be performed?
9, 18, 24, 30 months
Anton is a nondysmorphic 18-month-old male ex-29-week preemie who exhibits delays in gross motor and language developmental milestones with hypertonicity, spasticity, and hyperreflexia in the lower extremities and a positive Babinski sign.
What’s the leading dx?
Cerebral palsy
Which risk factor for cerebral palsy has the highest incidence?
Prematurity
What further studies would you order for a child you suspected had cerebral palsy?
- MRI
- Hearing evaluation
- Vision evaluation
- Formal developmental testing
A 20-month-old girl is brought to the primary care clinic for follow-up of cerebral palsy. She was born via home birth at 38 weeks gestation to a primigravida mother. She developed severe jaundice requiring admission at 5 days of life and required phototherapy and exchange transfusion. She has subsequently developed slow and uncontrolled movements throughout her body. Her brain MRI shows atrophy of the basal ganglia. Which type of cerebral palsy is most consistent with this patient’s presentation?
A. Ataxic cerebral palsy B. Dyskinetic cerebral palsy C. Spastic diplegia D. Spastic hemiplegia E. Spastic quadriplegia
B. Dyskinetic cerebral palsy
Dyskinetic CP is associated with kernicterus, due to hyperbilirubinemia, with findings of basal ganglia pathology on imaging. Patients typically have motor abnormalities throughout the body. Dyskinetic CP is also associated with perinatal asphyxia and can involve the thalamus and cerebellum on imaging.
An 18-month-old boy is brought to the primary care office for a well child visit. His family recently moved into town, and this is the first visit to the clinic. He was born at 32 weeks gestation and spent four weeks in the nursery due to breathing problems. Developmental screening shows normal social language and social development, but delayed gross motor development. He is able to stand, but not walk. Physical exam reveals increased tone, exaggerated deep tendon reflexes, and clonus in both of his lower extremities. Which of the following is the most likely diagnosis in this patient?
A. Autistic spectrum disorder B. Cerebral palsy C. Chromosomal disorder D. Metabolic disorder E. Myopathy
B. Cerebral palsy
A 15-month-old is able to stand on his own, walk backward, and throw objects underhand. He is unable to draw/scribble or grasp markers. He can say the one-syllable words “ma” and “da” but his words are unintelligible. He holds a sippy cup with help. He does come when called, plays with a ball and waves bye-bye by imitating his parents. Which of the following is the most likely diagnosis in this patient?
A. Fine motor and language delay B. Gross motor and fine motor delay C. Normal development D. Language delay and gross motor E. Social and language delay
A. Fine motor and language delay
An 18-month-old boy comes to the clinic for a well-child check. His mother says he is a happy boy and endorses no complaints. She notes that he was born a few weeks early via emergency C-section and spent two months in the NICU. She says he is feeding well and gaining weight. When you ask about developmental milestones, you find out that that he pulls himself up to stand, but is not walking yet. He has several words and is interactive. There is no family history of disease during infancy. He is up to date on his immunizations. He is one of five children and his parents are currently experiencing difficult financial times. Exam reveals increased tone and hyperreflexia in his lower extremities. What is the most likely diagnosis of his developmental delay (if any)?
A. Cerebral palsy B. Genetic abnormality C. Normal variant D. Metabolic disorder E. Psychosocial stress reaction
A. Cerebral palsy
What would you order for diagnostic evaluations if you suspect a child has cerebral palsy?
MRI, vision eval, hearing eval, formal developmental testing
What findings on an MRI support a cerebral palsy diagnosis?
- Irregularly shaped ventricles and increased FLAIR signal indicating periventricular leukomalacia
- Thinned corpus callosum
