Peds Neuro

Question 1

Static symptom

Answer 1

-seen early and don’t change over time

Ex. cerebral palsy

Question 2

Progressive symptom

Answer 2

degenerative disease or neoplasm

Question 3

Intermittent symptom

Answer 3

epileptic or migraine syndromes

Question 4

Saltatory symptom

Answer 4

bursts of symptoms followed by partial recovery

Question 5

What should you be concerned for if the fontanelles remain bulging?

Answer 5

infection or increased ICP

Question 6

Head circumference

Answer 6

Accelerating: possible hydrocephalus

Decelerating: possible degenerative neurologic disorder

Question 7

What is the name for abnormal shape of the head due to premature suture closure?

Answer 7

craniosynostosis

Question 8

Fontanelle closure

Answer 8

Posterior - 2 months
Anterior lateral - 3 months
Posterior lateral - 1 year
Anterior - 2 years

Question 9

What can asymmetry indicate in the peds neuro exam?

Answer 9

focal brain or PNS lesion

Question 10

When do most primitive reflexes disappear

Answer 10

4-6 months

Question 11

Upper motor neuron lesion

Answer 11

• Increased tone
• Increased DTR
• No fasciculations

Question 12

Lower Motor neuron lesion

Answer 12

• Decreased tone
• Absent DTR
• Muscle atrophy
• Fasciculations

Question 13

Motor neuron lesions

Answer 13

Lower - weakness

Upper - stiffness

Question 14

Which headache pattern is the most concerning for kids?

Answer 14

Chronic progressive

-usually due to increased ICP

Question 15

If a kid has chronic, non progressive headaches for more than 4 months what can be suspected?

Answer 15

psych factors

Question 16

When do migraines become unilateral in childhood

Answer 16

unilateral after puberty

Question 17

Migraine headache : Acute tx

Answer 17

headache diary to help eliminate triggers (diet, menses, stress. Increase sleep exercise)

NSAIDS***
-nasal sumitriptan approved over 12 years

Question 18

Migraine headache: Prophylaxis Tx

Answer 18

<6: cyproheptadine

>6 propranolol

Question 19

Pseudotumor cerebri

Answer 19

• 11 years and older
• obesity is main risk factor**
• Morbidity: vision loss** (call opthalmology)

Question 20

Cerebral Palsy

Answer 20

before, during or after birth - permanent but non-progressive brain damage

Question 21

Cerebral palsy delayed motor milestones

Answer 21

• not sitting by 8 mo
• Not walking by 18 month
• early asymmetry of hand function (hand preference) before age 1

Question 22

What are the 4 major classifications of cerebral palsy

Answer 22

1. Spastic
   -MC type**
   -features of UMN syndrome
   2 Athetoid/Dyskinetic
2. Ataxic
3. Atonic

Question 23

Neural tube disorder

Answer 23

Spina bifida is MC**

-Defective closure of neural tube in early gestation (about week 4)

Question 24

How do you screen for spina bifida before the baby is born?

Answer 24

1. Alpha fetoprotein level in Mom’s serum

2. Ultrasound

Question 25

Chiari Malformation

Answer 25

parts of the brain herniate into the flow of the CSF blocking flow (esp. the cerebellum)

Question 26

Chiari 2 (Arnold-Chiari Malformation)

Answer 26

- herniation of the cerebellar tonsils - hydrocephalus - Myelomeningocele

Question 27

Chiari 4

Answer 27

Not compatible with life

Question 28

Almost all patients with myelomeningocele have what malformation?

Answer 28

Chiari II and Hydrocephalus

Question 29

You suspect the patient may have increased ICP, what sign would increase your suspicion further?

Answer 29

ocular nerve palsies | sunsetting eyes, can't look upward

Question 30

What cells are affected in spinal muscular atrophy (LMN)?

Answer 30

- anterior horn cells in spinal cord | - motor nuclei in the lower brainstem

Question 31

Spinal muscular atrophy

Answer 31

- autosomal recessive (SMN1 gene) - Chromosome 5 - 5 subtypes Subtype 0 is prenatal SMA: severe weakness, hypotonia, and areflexia

Question 32

Spinal muscular atrophy: Dx

Answer 32

- EMG - muscle biopsy - DNA testing (homozygous deletion of exon 7 of SMN1 to confirm diagnosis****)

Question 33

The majority of Guillain Barre Syndrome are caused by which bacteria

Answer 33

Campylobacter jejuni | GI or respiratory infections

Question 34

Guillain Barre

Answer 34

Ascending symmetric paralysis** LP: Increased protein in CSF, no increased WBC Tx: IVIG and plasmaphoresis

Question 35

Duchenne Muscular Dystrophy

Answer 35

-X-linked recessive so, boys exhibit around age 3 - proximal muscles affected before distal - Lower extremities before upper - Calf hypertrophy - Gower's Sign**

Question 36

Duchenne Muscular Dystrophy

Answer 36

Dx: - Muscle biopsy - Myopathic EMG - Serum CK levels elevated

Question 37

Neurofibramatosis Type 1

Answer 37

- cafe au lait spots - lisch nodules - optic tumor (glioma) - Neurofibromas - Freckles in Axilla

Question 38

Neurofibramatosis Type 2

Answer 38

- Autosomal dominant - Bilateral vestibular schwannomas (CN VIII), uniquie to type 2 -No cafe au lait spots