Peds NEURO 1 - PE Flashcards
Sx seen in 1st few months & DO NOT CHANGE over time
Congenital abnormalities or brain injury (cerebral palsy)
What type of sx?
STATIC
Sx due to degenerative disease or neoplasm
What type of sx?
Progressive
Epileptic or migraine syndromes
What type of sx?
INTERMITTENT
Bursts of symptoms followed by partial recovery
Vascular, demyelinating d/o
What type of Sx?
SALTATORY
What 6 components of the PE do you perform for pt with neuro sx?
- Hair, skin, teeth, nails
- Head circumference
- Fontanelles
- Ears, eyes
- Hands, feet
- Midline defects
“Has Harry Found Every Happy Moment?”
PE: Hair, skin, teeth, nails
_______&_______ have same embryonic origin
Brain & Skin have same embryonic origin
What do you monitor for during a head circumference check?
microcephaly/macrocephaly
T/F: You plot head circumference on a growth curve
TRUE
What does an accelerating pattern on a growth curve indicate?
possible hydrocephalus
What does a decelerating pattern on a growth curve for head circumference indicate?
possible degenerative neurologic d/o
Define craniosynostosis
abnormal shape of the skull due to premature suture closure
Is this a normal or abnormal fonatanelle?
+/- slightly depressed and pulsatile
may slightly bulge when crying, vomiting
NORMAL
Is this a normal or abnormal fonatanelle? Where would you see this PE finding?
contstant bulging
infection or inc. ICP
Age of anterior and posterior fontanelle closure?
anterior: 2 yrs
posterior: 2 mos
What are the following cranial nerves responsible for?
CN I
CN II
CN I: smell
CN II: pupillary light reflex, visual acuity
_**ALWAYS CHECK RED REFLEX**_
WILL BE ON TEST
What are the following cranial nerves responsible for?
CN III, IV, VI (3, 4, 6)
Following objects, fixating, oculocephalic reflex, EOMs
CN V?
Sucking/swallowing, light touch
CN VII?
Observe face at rest, crying/blinking
CN VIII
HEARING
CN IX, X
gag reflex, sucking, salivation
CN XI
posture, spontaneous movement
CN XII
tongue movement
What 2 things should you look for on the hands during PE?
single crease in down syndrome
polydactyly
What 4 primitive reflexes must be present in normal child development?
Moro: startle reflex
Grasp: put finger in hand, will grasp around finger
Rooting: tactile stimulation around mouth- will search for stimulus
Tonic neck
“My grandchild runs too”
When do primitive reflexes usually disappear?
4-6 mos = normal maturation
Asymmetry of primitive reflexes may indicate What 2 possibilities?
focal brain or PNS lesions
Origination & termination of upper motor neurons?
Origin: motor region of cerebral cortex or brainstem
Termination: brainstem & spinal cord
Origination & termination of lower motor neurons?
Origin: brainstem & spinal cord
Termination: skeletal muscle fibers
Flaccid paralysis
Decreased tone
Absent DTRs
Profound muscle atrophy
Fasciculations present
May have sensory disturbances
Sx of lower or upper motor lesion?
Lower motor neuron lesion
Spastic paralysis
•Increased tone
Increased DTRs/+Babinski (in older children, normal in infants); usually with clonus
Minimal muscle atrophy/strength loss
Fasciculations absent
May have sensory disturbances
Sx of lower or upper motor lesion?
Upper motor neuron lesion
The following midline defects may indicate which condition?
Tufts of hair, lipomas, dimpling
spina bifida
What are the indications of normal strength in infants & toddlers?
What are abnormalities?
Infants: symmetrical movements in supine position
Toddlers: reach high, run, walk, hop, climb stairs
_________________________________________________
Abnormalities:
LMN lesions: weakness
UMN lesions: stiffness
What are the normal passive & active movements seen in tone (in infants)?
What are abnormalities?
Passive: some resistance to stretch normal
Active: posture adopted when placed in particular position
_____________________________________________
Abnormalities:
LMN lesions: decreased passive tone
UMN lesions: increased passive tone
What 3 components are part of the motor evaluation of the PE?
Gait
Cerebellar function/coordination
Reflexes
What are the normal gait findings in infants & toddlers?
infants: crawling
toddler: wide-based & unsteady; gradually closes until 6yrs
What are normal Cerebellar Function/Coordination findings?
Finger to nose, rapid alternating movements, heel to shin
Heel toe walking
Exchange objects
What are normal reflex findings?
Can elicit DTRs at almost any age
Babinski reflex:
Neonates- variable response
Older children- toes down is normal after 18 months
What are the PE findings during the sensory evaluation of infants?
Light touch vs. pinprick
Stimulation = withdrawal of limb
What are the PE findings during the sensory evaluation of older children?
Proprioception/vibration
Graphesthesia
Stereognosis
2-point discrimination
