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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
Q

How do you tx migraines?

A

Eliminate triggers!

NSAIDs, APAP, triptans, antiemetics

26
Q

When is prophylaxis indicated for migraines?

A

Frequent, prolonged, or disabling HAs

27
Q

What population most often suffers from pseudotumor cerebri?

A

MC in childbearing females

But also occurs in adolescents (11+)

28
Q

What are sx of pseudotumor cerebri?

A 
HA
Transient visual obscurations
Intracranial noises
Photopsia
Back pain
Retrobulbar pain
Diplopia
29
Q

What is the required dx criteria for pseudotumor cerebri?

A

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
Q

Why should you perform imaging before lumbar puncture?

A

Increased ICP may cause cerebral herniation when LP is performed if obstructive hydrocephalus or mass present

31
Q

What is the main complication of pseudotumor cerebri?

A

Vision loss

32
Q

What meds are used to treat pseudotumor cerebri?

A

Acetazolamide

Topiramate

33
Q

What are surgical tx options for pseudotumor cerebri?

A

Optic nerve sheath fenestration

CSF shunt

34
Q

What causes cerebral palsy?

A

Brain injury or malformation (before, during, or after delivery)

35
Q

Describe the MC delayed motor milestones in children w/ CP

A

Not sitting by 8mo

Not walking by 18mo

Early asymmetry of hand fxn before 1 yr

36
Q

What are tx goals for CP?

A
  • Social, emotional development
  • Education
  • Communication
  • Nutrition
  • Mobility
  • Max independence
37
Q

Describe: meningomyelocele

A

Meninges & spinal cord exposed

Total paralysis

Chiari II malformation & hydrocephalus

38
Q

Describe: meningocele

A

Spinal canal & meninges exposed

Spinal cord intact

39
Q

Describe: spina bifida occulta

A

Skin intact but underlying defects in bone & spinal canal

Sinus tract, dimple, or tuft of hair

40
Q

How do you dx spina bifida?

A

AFP in maternal serum

U/S

41
Q

How do you tx spina bifida?

A

surgical closure

VP shunt

42
Q

Which type of chiari malformation is NOT compatible w/ life?

A

Chiari 4

hypoplasia/aplasia of the cerebellum w/ spina bifida

43
Q

Describe “communicating” hydrocephalus vs “noncommunicating” hydrocephalus

A

Communicating: CSF circulates through ventricular system into subarachnoid space

Noncommunicating: obstruction blocks CSF in the ventricular system

44
Q

What are sx of hydrocephalus?

A

HA, vomiting, altered status

Ocular nerve palsies**

45
Q

What is spinal muscular atrophy (SMA)?

A

Autosomal recessive

Degeneration of anterior horn & motor nuclei in the lower brainstem

46
Q

How many subtypes of SMA are there?

A

5 subtypes 0-4

0 = prenatal onset (weakness, hypotonia, areflexia)

47
Q

What is guillain barre syndrome?

A

Acute immune-mediated polyneuropathy

Paralyzing illness provoked by preceding infection (MC = campylobacter jejuni)

48
Q

How does guillain barre present?

A

Hallmark = ascending weakness

Refusal to walk & leg pain

49
Q

How do you dx guillain barre?

A

LP: elevated CSF protein w/out increased WBC

EMG

50
Q

How do you tx guillain barre?

A

IVIG

Plasmapheresis

51
Q

What is duchenne muscular dystrophy?

A

X-linked recessive absence of dystrophin

52
Q

How does DMD present?

A

Proximal muscles affected before distal, lower before upper

Gower’s sign

53
Q

How do you dx DMD?

A

Muscle bx

Myopathic EMG

Serum CK

54
Q

How do you tx DMD?

A

Glucocorticoids

New tx = gene therapy, creatine, aminoglycosides

55
Q

What are the MC presenting sx of neurofibromatosis type 1?

A

cognitive or psychomotor

56
Q

How does neurofibromatosis type 1 present on PE?

A

Cafe-au-lait spots

Neurofibromas (late adolescence)

Greater incidence of CNS tumors

57
Q

How do you treat neurofibromatosis type 1?

A

Excision of tumors

58
Q

What are complications of neurofibromatosis type 1?

A 
seizures 
deafness
short stature
early puberty 
HTN 
optic glioma
59
Q

Neurofibromatosis type 2 manifests as…

A

bilateral vestibular schwannomas

1. Disciplines 2 (11 decks)

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