Pediatrics, Ch. 19

Front 1

_ is also known as hypotonia.

Back 1

floppiness

Front 2

_ is defined as diminished resistance to passive movement around a joint.

Back 2

hypotonia/floppiness

Front 3

What must be determined in a newborn with floppiness?

Back 3

if there is a concurrent disease such as asphyxia, sepsis, meningitis, hyperbilirubinemia

Front 4

It is important to determine the timing of the floppiness, such as???

Back 4

was the flopiness present at birth or acquired later.

Front 5

If there is any family history of neuromuscular disorders hints at a ___ genetic disorder.

-autosomal dominant
-autosomal recessive
-x-linked dominant
-x-linked recessive

Back 5

autosomal recessive

Front 6

what are 4 important historical items in the evaluation of the floppy infant?

Back 6

intercurrent illness
are all limbs floppy
details of infant development
family hx of neuromuscular disorder

Front 7

Infants with _ heads frequently have hypotonicity as an associated finding.

-large
-small
-normal

Back 7

large

Front 8

If a child's deep tendon reflexes are normal or hyperactive..is this a cerebral or motor unit disorder?

Back 8

cerebral/UMN/clonus

Front 9

If a pt. has reduced or absent reflexes....you should suspect?

-UMN lesion
-LMN lesion
-cerebral lesion

Back 9

LMN lesion

Front 10

Cafe au lait spots, port wine stains is called ????

Back 10

neurocutaneous stigmata

Front 11

how are seizures classified?

Back 11

generalized

focal/partial

Front 12

what are the most important features of the PE in the child with convulsions associated with fever?

Back 12

anterior fontanelle
assessment for meningismus

Front 13

EEG evidence of focality in teh presence of _ neurologic examination.

-normal
-abnormal

Back 13

abnormal

Front 14

If a patient has a seizure which affects only their arm and they do not affect consciousness, is termed?

-grand mal
-simple complex
-complex

Back 14

simple complex

Front 15

t/f

a family history of epilepsy in a patient with febrile seizures does not mean increased risk of later epilepsy

Back 15

false; it does increase the risk

Front 16

_ in infancy or childhood are associated with fever of extracranial origin and without acute neurologic illness is called?

Back 16

benign febrile seizures

Front 17

benign febrile seizures are limited to less than _ minutes.

-5
-10
-15
-30

Back 17

less than 15 minutes

Front 18

a child is in status epilepitcus if the seizure has lasted longer than _ minutes.

-15
-30
-45
-60

Back 18

longer than 30 min. with no regaining of consciousness

Front 19

in the preliminary exam of an infant-after a seizure-the most important features of the basic general and neurologic exam include _ and _.

Back 19

anterior fontanelle and assessment for meningismus (stiff neck)

Front 20

stiffness of the neck in an otherwise cooperative patient or flexion of the knees is called _ sign.

Back 20

brudzinski sign

Front 21

t/f

if there is no papilledema under fundoscopic exam of the infant-then increased ICP is ruled out.

Back 21

false; increased ICP is most certainly possible without papilledema

Front 22

in an infant with a benign febrile seizure-you should check the skin for???

Back 22

neurocutaneous disorders

Front 23

what is the recommended evaluation of a child with a brief febrile seizure that is alert with no signs of neurologic abnormalities?

Back 23

observation and a very simple workup directed at the cause of the fever are all that is necessary.

Front 24

what 3 key characteristics about a seizure should be documented?

Back 24

-duration
-generalized or focal
-post-ictal phase or not

Front 25

t/f

a pt with an engorged anterior fontalle has a seizure you must perform a lumbar puncture to determine the ICP.

Back 25

false; if there are signs of ICP a lumbar puncture should is not safe

Front 26

t/f

it is not necessary to perform an EEG after the first febrile seizure

Back 26

true

Front 27

what is the most important practical consideration in te diff. dx of febrile seizures is _.

Back 27

bacterial meningitis (or any form of meningitis)

Front 28

if a child is having a prolonged seizure that does not seem to be stopping spontaneously, what drug should you consider?

-IV dilantin
-IV valium
-PO dilantin
-IV lorazepam

Back 28

IV lorazepam, 0.1mg/kg-max 4 mg

Front 29

in _ seizures, the abnormal discharge is generated in deep midline structures of the brain.

-focal
-generalized
-tonic/clonic

Back 29

generalized

Front 30

which of the following about generalized seizures is not true?

-begin in deep brain structures
-have an aura
-no focal features during the seizure
-most begin focal and progress generalized

Back 30

auro; there is NO aura (warning)

Front 31

_ seizures discharge that generates the seizure arises from a localized area of the brain and is manifested by involvement of the limited portion of the body (hand/arm).

-generalized
-focal

Back 31

focal

Front 32

If consciousness is impaired during a focal seizure this is called a ?

-simple partial seizure
-complex partial seizure

Back 32

complex partial seizure

Front 33

_ paralysis (Todd paralysis) can last for several hours or more.

Back 33

post-ictal

Front 34

_ is a recording of brain electrical activity, is extremely useful in the assessment of children with seizures.

Back 34

EEG

Front 35

epileptic seizures can sometimes be mistaken for _ seizures.

-tonic-clonic seizures
-psychogenic
-grand mal

Back 35

psychogenic

Front 36

staring spells without aura, with minimal body movements sound like what type of seizure?

Back 36

absence

Front 37

t/f

a single seizure generally does not constitute epilepsy.

Back 37

true

Front 38

after a child has been seizure free for _ years, the anticonvulsant therapy can be tapered and stopped.

-1
-2
-3
-4

Back 38

2 years

Front 39

t/f

when doing an EEG for the diagnosis of complex partial seizures, hyperventilation will induce an attack.

Back 39

false; it will not provoke

Front 40

_ seizures are localized motor or sensory symptoms with no impairment in the level of consciousness are characteristic.

Back 40

simple partial seizures

Front 41

what is the MC encountered vascular HA in children?

-tension headache
-temporal arteritis
-migraine HA without aura
-migraine HA with aura

Back 41

migraine HA without aura

Front 42

what is considered a "classic" migraine?

migraine without aura
migraine with aura

Back 42

migraine with aura is "classic" but not the MC

Front 43

t/f

some kids can present with abdominal migraines

Back 43

true

Front 44

What is the common description of a migraine without aura? (4)

Back 44

bifrontal
generalized
bitemporal
difficult to define

Front 45

which medication is an option for infrequent attacks of common migraines?

-caffeine
-nsaid's
-acetomeniphen
-narcotics

Back 45

nsaid's

Front 46

which classes of medications are useful in the prophylaxis of migraine headaches? (4)

Back 46

beta blockers
anti-depressants
ccb
divalproex sodium

Front 47

which class of drugs are 1st line in the prevention of migraines?

-beta blockers
-ccb's
-anti depressants
-divalproex sodium

Back 47

beta blockers

Front 48

in most kids/adolescents with migraines-what should be avoided if possible?

-beta blockers
-ccb's
-anti depressants
-divalproex sodium

Back 48

anti depressants

Front 49

what symptoms are generally associated with increased intracranial pressure? (3)

Back 49

vomiting
headache
visual dysfunction

Front 50

diplopia is a common visual disturbance that occurs with ??

Back 50

increased intracranial pressure

Front 51

compression of what cranial nerve causes diplopia (lateral gaze)?

-3
-4
-6

Back 51

6th cranial nerve

Front 52

t/f

brain parenchyma is insensitive to pain.

Back 52

true; but large arteries, venous sinuses, and the dura at the base of the skull are sensitive to pain

Front 53

what other things may a child with a migraine complain of?

Back 53

photophobia
phonophobia
nausea

Front 54

if a child has focal neurological findings, you should perform _ _ before a LP to check for possible cerebral herniation.

Back 54

neuroimaging

Front 55

personality changes, drowsiness, irritability, or changes in LOC may be present with ___?

-meningitis
-increased intracranial pressure
-migraine with aura
-all of the above

Back 55

increased intracranial pressure

Front 56

_ is double vision that is commonly seen in pt's with increased ICP due to many factors.

Back 56

diplopia

Front 57

_ constitute a group of diverse disorders in which skeletal muscle is the organ system primarily involved.

Back 57

myopathies

Front 58

what are the 3 types of myopathies?

mneumonic- DIM

Back 58

dystrophic
inflammatory
myotonic

Front 59

muscular dystrophies are what type of myopathy?

-dystrophic
-inflammatory
-myotonic

Back 59

dystrophic

Front 60

polymiositis and dermatomyositis are what type of myopathy?

-dystrophic
-inflammatory
-myotonic

Back 60

inflammatory

Front 61

which 2 of the following myopathies are genetically determined?

-dystrophic
-inflammatory
-myotonic

Back 61

dystrophic and myotonic

Front 62

what symptoms are associated with the myopathies? (4)

Back 62

difficulty with stairs
awkwardness with running
difficulty toe walking
difficulty rising from a sitting position

Front 63

What 3 items of history are important in the child with possible myopathy?

Back 63

-has the child lost function (were they well before)
-is weakness accompanied by signs of systemic involvement (rash, fever, GI symptoms)
-are there problems swallowing or chewing.

Front 64

what lab values may be abnormal in myopathies? All except 1.

-CK
-CK-MB
-LDH
-AST
-ALT

Back 64

not CK-MB

Front 65

what manifestations are associated with Duchenne muscular dystrophy?

Back 65

-toe walking
-waddling gait
-pseudohypertrophy of the calves
-pelvic girdle weakness

Front 66

which chromosomal disorders are associated with hypotonia? (2)

-down's syndrome
-prader-willi syndrome
-turner's syndrome
-paget's syndrome

Back 66

downs and prader-willi are associated

Front 67

vomiting, headache and gait unsteadiness are signs of all except?

-astrocytoma
-medulloblastoma
-increasing ICP
-ependymoma

Back 67

not increasing ICP

Front 68

t/f

duchenne muscular dystrophy affects only girls

Back 68

false; it affects only boys except in very rare instances

Front 69

what is the major complaint with myopathies?

-fatigue
-difficulty with ambulation
-weakness

Back 69

weakness

Front 70

most brain tumors arise from the ?

-medulla
-brainstem
-pons

Back 70

pons

Front 71

brain tumors that arise from the pons commonly result in?

-headaches
-visual disturbances
-cranial nerve palsies
-dysphagia

Back 71

cranial nerve palsies

Front 72

vomiting, headache and visual dysfunction are all s/s of???

Back 72

increased intercranial hemorrhage

Front 73

what medication can used to slow the progression of DMD?

-nsaid's
-steroids
-dmard's
-immunosuppresants

Back 73

steroids prenisone 0.75mg/kg/day can slow the relentless progression

Front 74

t/f

with inflammatory muscle myopathies weakness of the legs is usually worse than weakness of the arms

Back 74

true

Front 75

which is more common dermatomyositis or polymyositis?

Back 75

dermatomyositis