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123 Cards in this Set
- Front
- Back
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VP shunt malfunctions vs infections
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blockages and mechanical problems much more common. Ventricular end has more problems than peritoneal, true for infectin as well.
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chronic AM headache, papilledema, isotretinoin, tetracycline
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pseudotumor cerebri
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most common association with tourette syn
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ADHD, half have ADHD
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lower extremity weakness. absent dtr
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guillain barre
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toddler with developmental arreast, regression, microcephaly, girl, loss of puposefull hand motions
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Rett Syndrome.
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correlation between level of spina bifida and intellect
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higher lesions have more problems
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spina bifida, poor prognostic indicators
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multipel shunt revisions, shunt, hight level.
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required test for guillain barre
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pulmonary function tests, vital capacity.
LP is helpful. protein elevated to make dx |
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10 month old, global hypotonia, good dtr
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Prader-Willi S
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global hypotonia, no dtr
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SMA (central)
central core myopathy, MG, myotonic dystrophy (peripheral) |
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myasthenia neonatal
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transient. transplacental AchR-Ab from mom. weakness, ptosis, respiratory compromise. hypotonia persists for days to months.
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juvenile myasthenia gravis onset
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10yrs old
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severe hypotonia, ptosis, arthrogryposis, poor bbreathign and feeding
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myotonic dystrophy in early infancy.
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principle risk factor for stroke in kid
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congenital heart disease.
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hyperacusis, pairn, paresthesias in ear
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prelude to Bell palsy
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central lesion as opposed to Bell palsy
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lower portion of face weak only.
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causes of Bell palsy
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HPV, EBV, mycoplasma, otitis media, mastoiditis
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episodic headache with emesis, photophobia, sonophobia
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migraine.
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initial rx for migrain in young child
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ibuprofen.
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meningitis, pleocytosis, elevated protein, low glucose, neg gram
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TB or fungus but fungus should only occur in immunocomprimised patient
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juvenile myoclonic epilepsy
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myoclonic jerks on awakening. EEG: high burst spike followed by slow waves.
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14yr old jerks upon awakening recurrently. Rx
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juvenile myoclonic epilepsy. valproate or topiramate
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Difficulty brushing teeth in mornign, irratic control of muscles, improves during the day. Later early AM TC seizures
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Juvenile myoclonic epilepsy. req lifelong valproate.
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myolclonic movements of neck, trunk and extrem of infant. nl exam
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benign myoclonis of infancy. EEG is nl. No meds req. most outgrow by age 2.
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brief symmetric contraction followed by loss of tone, collapse
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myoclonic seizure
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typical myoclonic epilepsy of early childhood
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6mo-4yr. myoclonic seizures. half have gen T-C sz also. language and learning difficulties are common.
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seizure disorder precuations
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no swimming alone. no climbing trees, no bike riding on freeway. teach school and parents how to respond to seizure
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3 month old jerks of trunk when falling asleep. perinatal asphyxia
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infantile spasms. 80% are due to congenital brain or perinatal trauma. The 20% that are not have nl exams and usually improve with age.
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10yr old pins and needles followed by progressive symmetric weakness. loss of reflexes.
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guillain-barre
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most common severe complication of guillain barre
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arrhythmia.
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Rolandic epilepsy
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benign partial epilepsy with centrotemproal spikes. common. excellent prognosis. rolandic foci on EEG, 9-10yr old with nl PMHx. nml neuro exam. Partial sz, often of the face. More common in sleep.
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9yr old girl. arm spasms in sleep. nl hx. nl neuro exam
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rolandic epilepsy. Carbamazepine until teenager when epilepsy tends to resolve
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absence sz age
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3-8yr onset. girls normal between seizures
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typical vs atypical absence
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typical is 5-15s sz. mild decrease in tone or eye fluttering.
atypical: automatisms or autonomic phenomena |
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how to provoke absence
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hyperventilate
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sense of stomach full, fear, lip-smacking and fumbling of hands for minutes
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comlex partial seizures.. Aura always indicatees focal onset.
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carbamazepine (tegretol) is for
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gen T-C sz or partial
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gabapentin
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adjunct, poorly controlled sz
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Lamotrigine
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broad spectrum anticonvulsant, adjunct
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phenobarb
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gen T-C, Parial, status
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dilantin
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gen T-C, partial, status
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age range for febrile seizures
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6mo-4yrs
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trauma to chest with L arm and leg paralysis
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carotid dissedtion and stroke. MCA strike from clot due to chest trauma
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risk factors for stroke in kids
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sickle cell. Fe deficiency anemia in toddlers. AVM,
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birth difficulty with shoulder traction. limp arm, adduction, intern rotation.
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Erb palsy , brachial plexus injury
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miosis, ptosis, anhidrosis of half face
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Horner s S., often found with Erb palsy
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ASD, focal seizure, fever
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brain abscess. septal defect increases likelihood
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brief attacks of vertigo and ataxia in 1-5yr old
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benign paroxysmal vertigo.
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infant vomiting with ataxia lasting for days. Fam Hx migraine
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benign paroxysmal toritcollis of infancy.
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infant inability to look up, vomiting
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increased ICP
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repetitive flexor spasms in infant. hypsarrhythmia on EEG,
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infantile spasms
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5yr old agitation at night, pupils dilated. flailing extremities.
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night terrors. 18mo-5yrs. early stages of sleep 1-2 hrs after falling asleep. differentiate from sz can occur during nap or upon awakening.
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5yr old inability to walk, areflexia, no sensory loss, weakness all extremities, ptosis.
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Tick paralysis, Guillain-Barre. Tick paralysis progresses more quickly than does Guillain Barre.
Myasthenia waxes and wanes, evening fatigue. transverse myelitis has sensory level. |
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mental retardation, seizures, agression, hypopigmented macules
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TS
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Most specific marker of TS
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adenoma sebaceum develops after age 5
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10yr girl, leg weakness, dermatome pain, unilat facial wekaness, areflexia, normal sensation
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guillain-barre. EMG and nerve conduction studies helpful.
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6 week old ELBW, multiple antibiotics in past. brain abscess. what organism
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Citrobacter diversus. causes sporadic and epidemic neonatal sepsis and meningitis. causes brain abscesses, multiloculated.
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premie with perventricular leukomalacia is at risk for what type of CP
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spastic diplegia. (bilat lower extrem spasm)
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HIE term infant with basal ganglia lesion. setup for what type of CP
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athetoid
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status epilepticus in 2yr old with fever and normal exam. cause:
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febrile seizures (meningitis will not have normal exam.)
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drugs for generalized seizures
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carbamazepine, phenytoin, phenobarb
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drugs for absence seizures
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valproic acid
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3 per s generalized spike and wave discharge
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absence seizures
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14yr old girl myclonic sz, some t-c on awakening. 4-5cycle per s spike and wave
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juvenile myoclonic epilepsy. lifelong valproic acid
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When to taper off seizure meds
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2years seizure free.
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prognosis for absence epilepsy
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often resolves by teen years
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prognosis for complex parital seizures
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likely to recur lifelong.
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effect of antiepileptics on school performance
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all are detrimental, phenobarb is the worst. valproate is least likely to change behavior and cognitive performance.
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carbamazepine cross reaction
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macrolides
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Lamotrigine SE
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rash, stevens-johnson, especially if with valproate.
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centrotemporal spikes
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rolandic epilepsy
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nocturnal seizures, healthy child, unilat T-C face
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rolandic epilepsy
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distal hypotonia, infant, progressive, bulbar dysfunction
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spinal muscular atrophy. test for survival motor neuron gene
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13yr old, progressive distal leg weakness, atrohpy of foot, pes cavus.
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charcot-marie-tooth, AD
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painfull, burning paresthesia and motor polyneuropathy
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arsenic poisoning
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comatose toddler, long fast, hypoglycemic, nonketotic
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medium chain fatty acid disorder
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anti-cholinergic toxidrome, what to do
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proglonged QRS can occur, check EKG
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chorea, hypotonia, emotional lability
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syenham chorea: most common chorea in children: Rheumatic fever.
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chorea without mood sweing or hypotonia
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SLE chorea, = antiphospholipid Ab
consider Wilson disease with any movment disorder = 24hr urine colection for Cu. associated with hepatic failure. |
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Hepatic failure, movement disorder
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Wilsons D.
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hypotonia with spinal level in infant
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brainstem or spine disorders
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infant, hyptonia, no reflex, fasciculations, poor such, swallow
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SMA, Pompe (glycogen storage), polio, cosxackievirus infection
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infant with gen hypotonia, weakness, eye movements reduced, poor suck, weak cry, dff dx
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Botulism, neonatal mysasthenia, congenital myasthenia
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normal osmolality
osmolality approx equation |
275-285mOsm/L
2Na + glucose/18 + BUN/2.8 |
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cerebellar tonsils and medula through formen magnum
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Chiari II malformaion associated with myelomeningocele
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infant with flat parieto occiput and ipsi prominence of forehead
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ositional plagiocephaly.
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biggest risk factor for CP in preterm infant
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perinatal infection, not birth asphyxia.
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valproic acid embryopathy
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neural tube defects.
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best birth control for epileptic
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depo shots
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severe neonatal seizures. hx of hiccups in utero. refractory to entiepileptics
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Pyridoxine dependency
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treatment following febrile status epilepticus with nl recovery
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none. febrile seizure even if status gets no meds.
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abrupt headache, sz, obtundation, hemiparesis
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intracranial aneurysm. sccular, large, internal carotid
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irregular respirations, bradycardia, hypertension
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cushings triad
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worrisome signs of headache
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severe, incapacitating pain, incresing freq or severeity, focal pain. vomiting persistent or increaseing in frequency. any associated neuro findings. awaken from sleep or worse on rising from bed or other valsalva maneuvers.
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bandlike headache, normal neuro, no aura
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tension headache
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CNS complication of cyanotic heart disease
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emboli and abscess.
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electrolyte disturbances causing seizure
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hyponatremia, hypomag, hypoCa
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risk factors for febrile sz to turn into epilepsy
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FH of afeb seizures, abnormal development, copmlex first febrile seizure
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syringomyelia
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presence of syrinxes lined with gliogenous tissue.
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diastematomyelia
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sagital division of cord by fibrous or osseous tissue
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encephalocele
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protrusion of brain tissue through midline skull defect. meninglecele is same but with no brain only csf filled.
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Lissencephaly
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no gyri, smooth brain
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schizencephaly
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unilat or bilat clefcts in cerebrum (schezen-split) usually severely affected CP, MR, sz
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porencephaly
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cysts or cavities in brain from acquired lesions like infarct or abscess.
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agenesis of corpus callosum, spectrum
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normal intelligence if no other anomalies. If other brain anomalies, may be very affected.
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Chiari type I
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teen or adult , no hydrocephalus. recurrent headache, neck pain, urinary freq, progressive LE spasticity.
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Chiari type II
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progressive hydrocephalus, myelomeningocele.10% present in infancty, gait abn, spasticit, inccored during childhood.
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Dandy walker malformation
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cystic expansion of fourth ventricle. hydrocephalus, lower ext spasticity, dev delays.
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cafe au lait spots, inguinal freckles
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NF-1
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comlications of NF-1
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neuro complicatiosn. learning disabilities. ADHD, speech problems, seizures, rarely hydrocephalus. rarely a nf can go malignant
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NF-2
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CN VIII mass
NF, meningioma, glioma, schwannoma. |
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infant with colic, seizures, rigidity, blindness
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Krabbe disease. ar. lysosomal storage disease causing demyelintion. death by 2
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girl, 1yr old loss of milestones, microcephaly. hand tremor, sighing respirations with apnea
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Rett, hand wringing
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most common post fossa tumor in kids
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cerebellar astrocytoma. good prognosis
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most common brain tumor <7
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medulloblastoma. post fossa.
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abrupt onset weakness, sensory spinal level, preceding viral infection, no reflex.
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transverse myelitis. GBS has normal sensation.
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weakness in toddler years. progressive wasting of distal muscle. v-shapped upper lip, temporal muscle wasting
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myotonic Muscular dystrophy. myotonia develops late. cardiac involvement. endocrine involvement
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ptosis, EOM weaknessdiplopia
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Myasthenia gravis.
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transient neonatal myasthnia gravis
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similar to neonatal SLE. needs support until ABs gone. different than very rare congenital MG which is severe.
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myasthenia dx
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EMG. edrophnioum test. should suddenly fix the problem
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severe hypotonia in infant, thin muscle mass, no DTR, tongue, face jaw
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SMA type I
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11yr old with foot deformity, gait abn. pes cavus. stork leg
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charcot-marie tooth. AD demyelinating
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flacid upper extremity in infant with no transverse palmar creases
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congenital cervical spinal atrophy
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