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1. Disciplines 2 > Peds Neuro > Flashcards

Peds Neuro Flashcards

1
Q

What midline defects can indicate spina bifida?

A

Tufts of hair, lipomas, dimpling

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2
Q

What are head circumference patterns?

A

Accelerating = possible hydrocephalus

Decelerating = possible degenerative neuro d/o

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3
Q

What is the fxn of CN I?

A

Smell

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4
Q

What is the fxn of CN 2?

A

Pupillary light reflex

Visual acuity

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5
Q

What is the fxn of CN III, IV, VI?

A

Follow objects
Fixate
EOMs

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6
Q

What is the fxn of CN V?

A

Sucking, swallowing

Light touch

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7
Q

What is the fxn of CN VII?

A

Observe face at rest

Crying/blinking

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8
Q

What is the fxn of CN VIII?

A

Hearing

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9
Q

What is the fxn of CN IX, X?

A

Gag reflex

Sucking, Salivation

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10
Q

What is the fxn of CN XI?

A

Posture

Spontaneous movement

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11
Q

What is the fxn of CN XII?

A

Tongue movement

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12
Q

When do each of the 4 fontanelles close?

A

Posterior: 2 mos
Anterior lateral: 3 mos
Posterior lateral: 1 yr
Anterior: 2 yrs

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13
Q

Primitive reflexes: asymmetry indicates…

A

Focal brain or PNS lesions

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14
Q

When do primitive reflexes normally disappear?

A

4-6mos

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15
Q

What are characteristics of upper motor neurons vs lower motor neurons?

A

Upper: fasciculations absent*, increased DTRs, spastic paralysis

Lower: fasciculations present*, absent DTRs, flaccid paralysis

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16
Q

Strength: UMN vs LMN

A

UMN = stiffness

LMN = weakness

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17
Q

Tone: UMN vs LMN

A

UMN = increased passive tone

LMN = decreased passive tone

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18
Q

What sensory tests can you perform on an infant?

A

Light touch vs pinprick

Stimulation = withdrawal of limb

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19
Q

What sensory tests can you perform on older children?

A

Proprioception/vibration
Graphesthesia
Stereognosis
2 point discrimination

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20
Q

What are red flags for children w/ HAs?

A 
< 5yo 
New &amp; worsening 
Worst HA of life
Unexplained fever 
Night time or early AM HA
HA w/ vomiting 
HA worse w/ straining 
Postural HA
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21
Q

What is the most concerning HA pattern?

A

Chronic progressive (usually increased ICP)

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22
Q

What are DDx of chronic progressive HA?

A 
Pseudotumor cerebri
Brain tumor
Hydrocephalus
Chronic meningitis
Abscess
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23
Q

Describe chronic nonprogressive/ daily HAs

A

> 4mos or >15x/month

Possible psych factors

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24
Q

What are sx of pediatric migraines?

A

Throbbing

Unilateral after puberty

Possible visual aura

N/V, abd pain, phono/photophobia

25
How do you tx migraines?
Eliminate triggers! NSAIDs, APAP, triptans, antiemetics
26
When is prophylaxis indicated for migraines?
Frequent, prolonged, or disabling HAs
27
What population most often suffers from pseudotumor cerebri?
MC in childbearing females But also occurs in adolescents (11+)
28
What are sx of pseudotumor cerebri?
``` HA Transient visual obscurations Intracranial noises Photopsia Back pain Retrobulbar pain Diplopia ```
29
What is the required dx criteria for pseudotumor cerebri?
Presence of each of the following: - Papilledema or 6th nerve palsy - Otherwise normal neuro exam - Normal brain parenchyma w/out evidence of hydrocephalus, mass, lesion - Normal CSF composition - Elevated LP pressure
30
Why should you perform imaging before lumbar puncture?
Increased ICP may cause cerebral herniation when LP is performed if obstructive hydrocephalus or mass present
31
What is the main complication of pseudotumor cerebri?
Vision loss
32
What meds are used to treat pseudotumor cerebri?
Acetazolamide | Topiramate
33
What are surgical tx options for pseudotumor cerebri?
Optic nerve sheath fenestration CSF shunt
34
What causes cerebral palsy?
Brain injury or malformation (before, during, or after delivery)
35
Describe the MC delayed motor milestones in children w/ CP
Not sitting by 8mo Not walking by 18mo Early asymmetry of hand fxn before 1 yr
36
What are tx goals for CP?
- Social, emotional development - Education - Communication - Nutrition - Mobility - Max independence
37
Describe: meningomyelocele
Meninges & spinal cord exposed Total paralysis Chiari II malformation & hydrocephalus
38
Describe: meningocele
Spinal canal & meninges exposed Spinal cord intact
39
Describe: spina bifida occulta
Skin intact but underlying defects in bone & spinal canal Sinus tract, dimple, or tuft of hair
40
How do you dx spina bifida?
AFP in maternal serum U/S
41
How do you tx spina bifida?
surgical closure | VP shunt
42
Which type of chiari malformation is NOT compatible w/ life?
Chiari 4 hypoplasia/aplasia of the cerebellum w/ spina bifida
43
Describe "communicating" hydrocephalus vs "noncommunicating" hydrocephalus
Communicating: CSF circulates through ventricular system into subarachnoid space Noncommunicating: obstruction blocks CSF in the ventricular system
44
What are sx of hydrocephalus?
HA, vomiting, altered status | Ocular nerve palsies**
45
What is spinal muscular atrophy (SMA)?
Autosomal recessive Degeneration of anterior horn & motor nuclei in the lower brainstem
46
How many subtypes of SMA are there?
5 subtypes 0-4 0 = prenatal onset (weakness, hypotonia, areflexia)
47
What is guillain barre syndrome?
Acute immune-mediated polyneuropathy Paralyzing illness provoked by preceding infection (MC = campylobacter jejuni)
48
How does guillain barre present?
Hallmark = ascending weakness Refusal to walk & leg pain
49
How do you dx guillain barre?
LP: elevated CSF protein w/out increased WBC EMG
50
How do you tx guillain barre?
IVIG | Plasmapheresis
51
What is duchenne muscular dystrophy?
X-linked recessive absence of dystrophin
52
How does DMD present?
Proximal muscles affected before distal, lower before upper Gower's sign
53
How do you dx DMD?
Muscle bx Myopathic EMG Serum CK
54
How do you tx DMD?
Glucocorticoids New tx = gene therapy, creatine, aminoglycosides
55
What are the MC presenting sx of neurofibromatosis type 1?
cognitive or psychomotor
56
How does neurofibromatosis type 1 present on PE?
Cafe-au-lait spots Neurofibromas (late adolescence) Greater incidence of CNS tumors
57
How do you treat neurofibromatosis type 1?
Excision of tumors
58
What are complications of neurofibromatosis type 1?
``` seizures deafness short stature early puberty HTN optic glioma ```
59
Neurofibromatosis type 2 manifests as...
bilateral vestibular schwannomas

1. Disciplines 2 (11 decks)

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