Week 7 Flashcards
pediatric neuro exam- provider needs to consider what three factors when considering the findings?
- age
- developmental level
- temperament (shy, happy etc.)
6 cafe-au-lait spots can indicate what syndrome?
neurofibromatosis
port wine stain over the eye can be a sign of what neuro syndrome?
sturge-weber symdrome
do port wine stains go away?
no but they can now be lasered
neuro exam order: from the highest level of neuro functioning and conducting to the lowest
- cerebral functioning (behavior and mental status)
- cranial nerves
- motor function
- sensory function
- reflexes
think about carly- she was disabled in points 2-5 but lost them in the opposite order
when do we start to evaluate abstract reasoning (age)?
11 years
cranial nerve abnormalities found on assessment and what nerve they are associated with:
Ptosis
facial symmetry
horse voice
expressive language difficulties
abnormal eye position
abnormal puppillary reactions
shrugging shoulders
Ptosis 3
facial symmetry 7
horse voice 10
expressive language difficulties 9, 10 and 12
abnormal eye position 3,4, 6
abnormal pupillary reactions 2, 3
shrugging shoulders 11
accronyms to rember names of cranial nerves and functions of cranial nerves
NAMES: Oo Oo Oo To Touch And Feel, Very Good Virgins Always Heal
FUNCTIONS: Some Say Marry Money But My Brother Says Big Brains Matter Most
components of the cerebellar function examination
1, gait and balance
2. romberg
3. hopping in place
4. heel to toe walking
5. heel to shin walking
6. rapid alternating movements
7 finger to nose
romburg test
stand behind child, they can midly sway but should not lose balence
hop on 1 foot by what age?
4 years
heel to toe walking- what is it and what age
walking on a tight rope by age 6
heel to shin what is it and when to test for it
age 8-9 and adults
sit supine, have patient put heel on shin under the knee and run it down to the top of the foot- as quickly as possible and repeated. abnormalities indicate ipsilateral lesion on cerabellar
what does ipsilateral mean and contralateral mean?
same side, opposite side
rapid alternating movement- what to do and what age
8-9 years
place hands on thighs and then rapidly turn hands over with palms up quickly alternating and repeating the movements. ask to do for 10 seconds as fast as possible. movements should be quick and rhythmic
light touch exam
stretch cotton ball, pt should be able to identify area of the body that is being touched
proprioception sensation
move fingers or toes up and down while child closes eyes and they tell you what direction its being moved
pain assessment
sharp/dull sensation
use end of reflex hammer
temperature test
this should only be assessed when perception of pain is abnormal
vibration
low pitched tuning fork placed on bony prominences, repeated on both sides- patient states when the vibration stops
stereognosis
placing a familure object in childs hand (paperclip, pencil, coin) and asking them to name it with their eyes closed
graphestesia
writing a number on the palm of the hand of a child and having them identify which number you drew
when does the tricep reflex appear?
6 months
when does the patellar relex appear?
birth
what are the superficial reflexes
abdominal, plantar, cremasteric and anal wink. evaluated as present or absent (not graded)
abdominal reflex
reflex hammer is stroked over the abdomen toward umbilicus and the muscles contract
Babinski reflex
plantar reflex
foot stroke with hammer, normal is flexion of the toes
kids who are not walking yt- positive babinski is normal becuase of the immaturity of the nervous sytem
cremasteric reflex
male only
cotton applicator is stoked upper, inner thigh of the patient and in response the scrotum on the same side elevates
primitive reflexes- what are they and when do they go away?
present at birth, go away by age 4-6 mo
should be tested in kids 1 year or younger
postural reflexes replace primitive
- moro
-rooting
-sucking
-stepping (placing)
- palmar grasp
- ankle clonus
- galant (truncal incurvation)
- asymmetric tonic neck reflex
two postural reflexes that replace primitive
- landau reflex (superman)
appears at 3 months, disappears at 12-24 mo - parachute reflex
appears at 6-9 mo, doesn’t disappear
major depression mnemonic
what are ACE’s
universal screening for depression
Borderline personality disorder mnumonic
mnumonic to test for depression
changes in states of consciousness causes:
Person, place, time
person: amnesia, seizures, cerebral trauma
Place: delirium, psychiatric disorder, cognitive impairment
time: anxiety, delirium, depression, cognitive impairment
screening tests to assess cognition
- mini mental state examination (most studied)
- Mini Cog
brocha, wernicke and global aphasia
word comprehension, spontaneous speech, reading comprehension and writing for each.
glasco coma scale used to measure what and how do you score?
quantify consciousness in a person with head trauma or hypoxic event.
measures eye-opening responses, verbal, motor
scores range from 3 to 15, 15 being the optimal level of consciousness
delirium vs dementia
Delirium is acute onset
dementia is a slow progressive
tug test
breast bud happen when
ages 8-13
menarche happens when
appx 2 years after breast buds
axillary hair happens when
axillary hair happens 2 years after pubic hair
thelarche is what
start of breast development
tanner stages breasts
tanner stage pubic hair (F)
nmunonic for tanner stages
age of puberty onset for males what happens first?
9.3 and 13.5- testes enlarge, then pubic hair, then penis size increase
tanner staging in males
kleinfelters syndrome
boys are born with an extra X
undescended testes can cause what
increased risk of testicular cancer
peak age of testicular cancer
15-25
when should you start asking about menstruation
8/9
