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Neuro II: Test 2 > Peds > Flashcards

Peds Flashcards

1
Q

most common cause of seizure in first 3 days of life?

A

perinatal hypoxia/anoxia

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2
Q

simple partial seizure

A

(focal seizure w/out impairment of consciousness)

  1. with motor signs 2. with somatosensory or special sensory symptoms
  2. with autonomic symptoms or signs with psychic symptoms (higher cerebral functions)
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3
Q

complex partial seizure

A

(focal seizure consciousness impaired)

  1. Starting as simple partial seizures (a) without automatisms (b) with automatisms (such as lip smacking and drooling, dazed look)
  2. With impairment of consciousness at onset (a) without automatisms (b) with automatisms
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4
Q

absence seizures**

A

brief lapse in awareness without postictal impairment (atypical absence seizures may have the following: mild clonic, atonic, tonic, automatism, or autonomic components)

  • Start around 5-6 yrs
  • Short (5-20 sec) lapses in consciousness, speech, or motor activity
  • No aura
  • No postictal drowsiness
  • May have automatisms
  • ** EEG: 3 cycles per second generalized spike and wave activity
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5
Q

myoclonic seizures

A

brief, repetitive, symmetrical muscle contractions

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6
Q

clonic seizures

A

: rhythmic jerking; flexor spasm of extremities

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7
Q

tonic seizures

A

sustained mm. contraction

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8
Q

** Differences in pediatrics?

A

Generalized seizures are more common in children than adults.

** Generalized tonic–clonic seizures are rare before 2 yrs of age.

Children older than 6 years old will have seizures similar to that of adults.

** Younger children have less complex behaviors, especially with complex partial seizures.

** Can be difficult to determine altered LOC in infants/young children

Newborns’ seizures can present in a variety of different ways:

  • Apnea, subtle eye deviations, or abnormal chewing movements
  • Differentiating between a newborn who has a seizure and a ‘‘jittery baby’’:
  • seizures cannot be suppressed by passive restraint,
  • seizures are not elicited by motion or startling
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9
Q

febrile seizures

A

most common type of seizure in childhood

  • febrile illness in children between 6 months and 5 years of age.
  • Simple febrile seizure is single, brief (15 minutes), and generalized
  • 3-6% of kids will develop afebrile seizures or epilepsy later in life
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10
Q

** infantile spasms **

A
  • Any disorder that can produce brain damage can be associated with infantile spasms.
  • 2% of childhood epilepsies but 25% of epilepsy with onset in the first year of life.
  • ** EEG shows hypsarrhythmia.
  • ** Long-term overall prognosis for patients with infantile spasms is poor. Associated with cognitive impairment.
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11
Q

seizures vs. syncope

A

seizures: occur in any position, eyes often open
syncope: usually when sitting or sanding, eyes closed

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12
Q

*** why are kids more at risk of head injury??

A

** Developing brain is more sensitive to concussion injury in an adult athlete.

Developing brain is not able to recover as quickly as adult brain.

Axons in pediatric brain are not as well myelinated – more vulnerable to injury.

** Younger have less well-developed cervical and shoulder muscles, less stability to absorb impact.

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13
Q

glasgow coma scale

A

MVE-654

motor response = 6
verbal response = 5
eye opening = 4

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14
Q

*** predictors of clinically important TB? (ciTBI)

A
  • altered mental status including GCS 5 seconds
  • severe mechanism
  • signs of basilar skull fx
  • severe HA

factors NOT predictive of ciTBI?

  • post-traumatic amnesia
  • post-traumatic seizure
  • dizziness/ataxia
  • bulging fontanelle
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15
Q

*** what is emergent head CT recommended?

A
    • GCS <1 yr old
  • bulging fontanel
  • irritability, persistent vomiting, LOC
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16
Q

*** when to image for children of difft ages for falls??

A

for age 2 years:

- fall greater than 5 feet, MVA, biking accident

17
Q

** management of concussion kids?

A

day of injury:

    • no same-day return to play!
    • no driving!!
  • don’t leave injured athlete unattended for first 24 hours
  • emphasize physical and cognitive rest
    • Premature return to play may confer increased risk to the athlete
  • ** Physical and Cognitive Rest: 1st few days
  • ** Step-wise Return To Play protocol
    • no cacooning!
18
Q

** graduated return to play protocol**

A
  1. no activity –> light aerobic exercise –> sport-specific exercise –> noncontact training –> full contact practice –> return to play

** athlete who has sustained concussion should proceed to next level if w/out sx at the current level. Each step usually takes 24 hours - if sx recur then pt. drops back to previous level

19
Q

arthrogyrposis

A

congenital joint contractures in two ore more areas of body – the joints look funny, but brain is often times normal

20
Q

TORCH infections

A

TORCH: toxoplasma gondii, other, rubella, cytomegalovirus, herpes

common manifestations:

  • SGA
  • CNS changes: hydrocephalus, microcephaly, periventricular calcification (CMV)
  • pneumonitis
  • petechiae
  • hepatomegaly/splenomegaly
  • jaundice
  • chorioretinitis (toxoplasmosis and CMV)
  • each disease may be teratogenic, each crosses placenta and affects the developing fetus

** hydrops reported in most TORCH and oligohydramnios

21
Q

syndromic vs. nonsyndromic congenital mm. dystrophy

A
  • syndromic CMD has CNS lesions

- nonsyndromic CMD “classic” - absence of CNS findings by MRI

22
Q

high CK?

A

think mm. disease w/in the child

also see elevated aldolase: high in cases of damage to mm.

23
Q

three presentations of HSV infection in neonate?

A
  1. SEM disease (localized to skin, eyes, mucosa) - see vesicular lesions
  2. CNS disease: Seizure, lethargy, irritability, tremor, poor feeding, temperature
    instability, full anterior fontanelle
  3. Disseminated disease:
    - Multiple organ involvement (CNS, skin, eye, mouth, lung, liver,
    adrenal glands)
    - May appear septic – fever/hypothermia, apnea, irritability, lethargy,
    respiratory distress
    - Hepatitis, ascites, direct hyperbilirubinemia, neutropenia,
    disseminated intravascularcoagulation, pneumonia, hemorrhagic
    pneumonitis, necrotizing enterocolitis, meningoencephalitis, skin
    vesicles

which Abs to start?
- acyclovir and an Ab to cover gram -/+

24
Q

congenital rubella syndrome

A

“german measels” (part of MMR) - rubella virus

  • microcephaly
  • PDA
  • cataracts
25
Q

blueberry muffin baby?

A

CMV or rubella

26
Q

CMV

A

most common congenital infection

- ventriculomegaly, FGR, intracranial calcifications and oligohydramnios are most commonly seen!

27
Q

laminin-alpha2

A

indicates congenital muscular dystrophy when absent

Congenital muscular dystrophy = Genetic AR

  • Genetically determined set of conditions presenting as muscular dystrophy at birth
  • Multiple genetic mutations involving various genes have been associated with CMD
  • **CK levels are usually elevated
  • Muscle biopsy characteristically abnormal with extensive fibrosis, degeneration and regeneration of muscle fibers with proliferation of fatty and connective tissue
  • Absence of CNS findings by MRI is found in “Classical” CMD
  • Classic form typically displays laminin α-2 chain mutations and further characterized as merosin positive or negative forms

“Syndromic CMD” = characterized by CNS lesions

28
Q

when to do full sepsis work up on baby?

A

4-6 weeks old

  • irritable child, bulging fontanel and fever always needs full work up of CBC, blood culture, u/a, urine culture and LP
  • don’t need to worry about increased ICP with babies d/t fontanelle expansion unless there are focal signs
29
Q

meningitis in children over 2 mos?

A

pneumococcus and meningococcus

tx: cephalosporin + vancomycin

30
Q

meningitis in children under 2 mos?

A

Group B Strep, E. Coli, Listeria

tx: cephalosporin + ampicillin (unless in nursery use ampicillin + gentamicin)
- add acyclovir for herpes coverage

31
Q

complications of meningitis?

A
  1. Cerebral Edema
  2. Cushing’s triad (Bradycardia, hypertension and respiratory abnormalities), tonsillar herniation
  3. SIADH: manage w/ fluid restriction
  4. seizures: imply vascular insult or abscess if present after 72 hours of tx

long term complications:
- hearing loss, seizure, hydrocephalus, spasticity, blindness, learning disability

Neuro II: Test 2 (11 decks)

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