Peds Emergency: Neuro

Front 1

what is the most common form of facial palsy?

Back 1

7th nerve (bell's palsy)

Front 2

central facial palsy effects only the __ __ of the face and spares the __ __

Back 2

lower 1/2; fontralis muscle

Front 3

central facial palsy is secondary to lesion in the __ __ __

Back 3

contralateral cerebral hemisphere

Front 4

what is the most common cause of central facial palsy?

Back 4

stroke or demyelinating disease or tumor

Front 5

ToF: in bell's palsy, both the upper and lower 1/2 of the face is involved

Back 5

TRUE

Front 6

what are the causes of bells palsy?

Back 6

trauma, infection, para infectious (guillian-barre) or neoplasm

Front 7

what are the infectious causes of bell's palsy

Back 7

otitis, mastoiditis, parotitis, mono, varicella, Lyme

Front 8

what neoplasm often causes bell's palsy?

Back 8

neurofibromatosis

Front 9

what is the workup for bell's palsy?

Back 9

good exam; lyme titer; mono spot or EBV; varicella titers; CT or MRI if weakness is central;

Front 10

what is the tx for eye symptoms of bells palsy?

Back 10

artificial tears

Front 11

what is given w/in 48 hours of presentation of bell's palsy?

Back 11

prednisone 2mg/kg/day 5-7 days; may last for up to 1 month

Front 12

what is given for lyme + bell's palsy?

Back 12

amox < 8 years of age: 40mg/kg/day TID x 28 days; Doxy > 8yrs: 100mg bid for 28 days

Front 13

tof: the worst headache of your life is not concerning

Back 13

FALSE

Front 14

__% of the general population suffer from HAs

Back 14

80

Front 15

75% of childern will have experienced a severe HA by age _-

Back 15

15

Front 16

ToF: migraines exist in childhood

Back 16

TRUE

Front 17

headaches commonly accompany infections such as __ __ and ___

Back 17

otitis media; sinusitis

Front 18

what are the major mechanisms of pain causing headaches?

Back 18

vascular dilatation; msucular contraction; traction; inflammation of pain-sensitive areas

Front 19

what are the examples of vascular dilation causing HA?

Back 19

pain sensitive arteries cause HA, migraine HA are most common

Front 20

what are the characteristics of muscular contraction causing HA?

Back 20

tension HA; psychogenic; migraines can have component of this

Front 21

what are the things that cuase traction resulting in HA?

Back 21

brain tumor, abscess; subdural hematoma, increased ICP

Front 22

what are the examples of inflammation of pain-sensitive areas causing HA?

Back 22

meningitis, sinusitis, dental disease

Front 23

what are the causes of acute generalized HA's?

Back 23

cns infection; systemic infection; hypoglycemia; trauma

Front 24

what are the causes of acute localized headaches?

Back 24

sinusitis; otitis media; dental disease

Front 25

what are the causes of acute recurrent HA's?

Back 25

migraine; cluster; post seizure

Front 26

what are the symptoms associated with potential intracranial pathology?

Back 26

AM headache; recurrent localized HA; HA r/t sneezing, coughing, straining; persistent vomiting; diplopia, papilledema; macroceph; grwoth abnormalities; nurocutaneous syndrome; lack of repsonse to medications

Front 27

what are the differentials for chronic HA (continuous or increasing)?

Back 27

IC mass lesion; hydrocephalou; post LP HA; psuedotumor cerebri; transformed migraine; depression; post traumatic HA; chronic sinusitis

Front 28

___ __ is most often associated with obesity and females

Back 28

pseudotumor cerebri

Front 29

ToF: pseudotumor cerebri has focal neuro exam

Back 29

false: non focal

Front 30

what are the signs of psuedotumor cerebri?

Back 30

impaired reabsorption of csf w/ or w/ of increased ICP, papiledema; 6th nerve palsy; occasional mild ataxia;

Front 31

what does the MRI show with psuedotumor cerebri?

Back 31

normal brain

Front 32

what is the tx for psuedotumor cerebri?

Back 32

supportive; usually the initial tap will ease the HA but sometimes multiple taps are needed

Front 33

what are migraines?

Back 33

episodic, periodic, paroxysmal attacks of headache separated by pain-free intervals

Front 34

___% of children under 7 get migraines

Back 34

2.5

Front 35

what age does the incidence of migraines increase?

Back 35

15

Front 36

Boys (> or <) girls for migraines up until adolescence

Back 36

>

Front 37

what is the genetic makeup of migraines?

Back 37

autosomal dominant with greater penetration in females

Front 38

ToF: classic migraines do not have an aura?

Back 38

FALSE

Front 39

what are the symptoms of classic migraines?

Back 39

abd pain, NV, hemicrania, throbbing pulsatile pain, complete relief after rest; aura; phono and photophobia; relieved by sleep; exacerbation or onset with puberty; college or stress; may be related to food; hx of migraine in one or more immediate family members

Front 40

what are the foods that often cause migrain?

Back 40

chocolate; red wine; nitrates; msg

Front 41

what are the types of auras?

Back 41

visual; sensory; motor

Front 42

what is different about a common migraine?

Back 42

no aura; has autonomic changes (mood or pallor); bifrontal or bitemporal; can be bilateral or variable in distribution

Front 43

what are the symptoms of basilar arterial migraines?

Back 43

dizziness, weakness, ataxia, severe occipital pain, vomiting

Front 44

what is the symptom of hemiplegic migraine?

Back 44

hemiparesis followed by HA

Front 45

what are the symps of ophthalmoplegic migraine?

Back 45

diplopia following the cessation of HA

Front 46

what are the symptoms of confusional migraine?

Back 46

more common in younger; period of confusion/disorientation followed by, vomiting, deep sleep, waking feeling better; HA may not be reported or may be minor!!!!

Front 47

what is an abdominal migraine?

Back 47

episodic abd pain w/ NV followed or accompanied by HA (minor); aura may be present; relief: sleep, antimigraine meds

Front 48

which sex gets cluster headaches more often?

Back 48

male

Front 49

how are cluster HA's described?

Back 49

steady burning or pain usually behind one eye, that is severe but brief

Front 50

what are some associated symptoms with cluster HA's?

Back 50

rhinorrhea; tearing and conjuinctival injection on same side as pain

Front 51

when do cluster HA's happen?

Back 51

multiple times a day, but usually in early AM and may awaken pt from sleep

Front 52

what is the common duration of seizures; migraines; clusters; psychogenic?

Back 52

sz: minutes; migraine: hours to days; cluster: 1/2 to 1 day; psychogenic: "always there"

Front 53

how many attacks (HA's) must occur w/o aura to be classified as a migraine?

Back 53

5

Front 54

if migraines happen with aura, how many are needed for official dx of migraines?

Back 54

2

Front 55

tof: recurrent HA w/ periods of relief often need lab or xray work up

Back 55

FALSE

Front 56

when should imaging be done on headaches?

Back 56

complex hx or any question regarding dx

Front 57

what is the tx of migraine in the ED?

Back 57

IV hydration; benadryl or anti nausea; pain meds (tardol)

Front 58

head trauma is __ as common in boys than girls

Back 58

twice

Front 59

what are the 3 hx questions to ask for head trauma?

Back 59

LOC? Texture of the ground where they fell? Symptoms following fall?

Front 60

what are the 3 PE's to do following head trauma?

Back 60

EOMs; feel the skull, level of alertness

Front 61

what region is the highest for skull fracture?

Back 61

parietal region

Front 62

TOF: bleeding after 10 minutes of pressure with HA is not reassurring

Back 62

TRUE

Front 63

seizures occuring ___ following head trauma is bad

Back 63

later

Front 64

if a child cries for more than __ minutes following head trauma they need immediate evaluation

Back 64

10

Front 65

a child that vomits more than __ times following head trauma needs immediate eval

Back 65

5

Front 66

if a child has swelling around the __ following head trauma they need immediate eval

Back 66

ear

Front 67

neck pain following head injury needs immediate eval?

Back 67

yes

Front 68

what if a child has unequal or unreactive pupils following a head injury?

Back 68

immediate eval

Front 69

TOF: LOC and vomiting have been shown predictors of IC injury following head trauma

Back 69

FALSE

Front 70

asymptomatic or occult IC injury is sig more prevalent in young aged children (< __ to ___ old)

Back 70

3 to 6 months old

Front 71

what is a good predictor for ICI in children with minor head trauma

Back 71

skull fracture

Front 72

what are the indication for skull films follow head trauma?

Back 72

younger age; scalp hematoma; specificity temporal and parietal; presence of scalp hematoma is 80-100% sensitive for associated skull fracture

Front 73

in most studies a + skull fracture was associated with ICI __ to __% of the time?

Back 73

15-30

Front 74

ToF: children with normal CT following head injury have been found to often have late detiororation

Back 74

false! 0%

Front 75

what are the characteristics of the high risk following head injury?

Back 75

depressed mental stat; focal neuro s/s; signs of depressed or basilar fracture; acute fracture on exam; irritability; bulging fontanel; child with seizure; progressive vomiting; LOC > 1 minute

Front 76

what are the 2 subgroups of intermediate risk following head injury?

Back 76

1. children with clinical indicators of possible brain injury 2. chidren w/ concenring or unknown mech of who have findings on exam

Front 77

what are the characteristics of the low risk group following Head injury?

Back 77

trivial injuries; low energy mechanisms (Fall < 3 ft); no s/x at least 2 hours after injury; > 3-6 months of age; child has reliable caretaker

Front 78

what are the at home treatments following head injury?

Back 78

wound care; clear liquids; avoidance of aspirin and motrin; check pupils; awaken at night; call provider if HA worsens, vomits > 2; pupils become unequal or non reactive

Front 79

what are the parital seizures?

Back 79

focal, localized; simple partial (unimpaired consciousness); complex partial (impaired consciousness); partial that then generalize

Front 80

what are the general seizures?

Back 80

absence; tonic-clonic; atonic; infantile spasms

Front 81

what are the unclassified epileptic seizures?

Back 81

those that don’t fit into parital or generalized

Front 82

ToF: seizures are a disease

Back 82

false they are a symptoms

Front 83

what are the common pathologic causes of seizures?

Back 83

infection, truama, metabolic endocrinologic, toxic, congenital or structural, vascular, neoplastic, degenerative, idiopathic

Front 84

what is the common age for febrile seizures?

Back 84

3 months to 5 years

Front 85

when is the onset most common for febrile seizures?

Back 85

before 2 years

Front 86

when is the peak incidence for febrile seizures?

Back 86

10-20 months

Front 87

febrile seizures are more common in __ __

Back 87

white boys

Front 88

when are the seasonal peaks for febrile seizures

Back 88

nov-jan (resp); june-aug (GI illness)

Front 89

tof: it is normal to have multiple febrile seizures in one day

Back 89

false!!

Front 90

up to __% of children w/ febrile sz will have recurrence

Back 90

30

Front 91

children with febrile seizures at __ temps have higher rate of recurrence

Back 91

low

Front 92

the __ the child the higher rate for febrile sz recurrence

Back 92

younger

Front 93

when do febrile sz usually stop?

Back 93

by age 5

Front 94

children with febrile seizures have __% of chance above rest of population for afebrile seizures

Back 94

1

Front 95

what are the characterstics of a simple febrile sz?

Back 95

between 6 months and 5 yrs; generalized; lasts < 15 mins; no s/s of ICI; no other neuro problems; no hx of afebrile sz; only once w/in 24 hours

Front 96

what are the characterstics of complex febrile seizures?

Back 96

sz lasting > 15 mins; sz occuring late in an illness ie day 4; multiple sz in 24 hour period

Front 97

ToF: sepsis workup is the tx for ill looking complex feb sz

Back 97

TRUE

Front 98

what is the peak age for meningitis?

Back 98

6-12 months

Front 99

ToF: children with feb sz are irritable and sleepy, while children w/ meningitis are alert and active

Back 99

false; other way around

Front 100

tof: meningitis may not have associated fever

Back 100

TRUE

Front 101

the associated symptoms of meningitis are ___, of febrile sz are ___

Back 101

photophobia; vomiting; chills; feb sz: associated to source of infection

Front 102

what type of rash is often associated with feb sz?

Back 102

macular or papular rash

Front 103

what is the rash associated with meningitis?

Back 103

purpuric

Front 104

ToF: unlike meningitis, febrile seizures have a long term sequelae

Back 104

false: meningitis has a long term sequelae

Front 105

what is the workup and tx for feb seizures?

Back 105

simple workup; sz management; fever management; counseling/prevention; phone f/u

Front 106

describe absence seizures,

Back 106

few physical manifestations, typically respresented by abrupt cessation of activity for 5-10 seconds during which child is unresponsive. Sz rapidly resolves w/o postictal state and activity resumes as if no pause occurred

Front 107

what is a seizure?

Back 107

abnormal electrical activity of the brain resulting in altered mental status or involuntary neuromuscular activity

Front 108

__ sz originate in localized area of the brain

Back 108

partial

Front 109

how do general sz begin?

Back 109

w/ abnormal electrical discharges occuring in both hemispheres simultaneously

Front 110

what are the manifestations of generalized seizures?

Back 110

can range in LOC; rhythmic jerking ofa ll extremities accompanied by loss of posture and consciousness

Front 111

what are tonic-clonic sz?

Back 111

rhythmic jerking of all extremities accompanied by loss of posture and consciousness

Front 112

what is an example of secondary generalized sz?

Back 112

temporal lobe sz that starts with motor automatisms: picking at clothes or affective changes (fear, déjà vu) and then changes to generalized tonic clonic

Front 113

what is the age range for absence sz?

Back 113

usually after 3-5 years and most occuring before age 10

Front 114

tof: absence seizures have an aura

Back 114

FALSE

Front 115

tof: absence sz have postictal state

Back 115

FALSE

Front 116

what is status epilepticus?

Back 116

single sz lasting > 30 mins or recurrent sz lasting 30 mins w/o the pt returning to baseline between sz

Front 117

what is the dlose for lorazepam to treat status epilep?

Back 117

0.05-0.1mg/kg IV slowly over 2 mins

Front 118

what is the dose for diazepam for status epilep?

Back 118

0.2mg/kg @ 5 mg/min IV or oral solution PR 0.5mg/kg (20mg max)

Front 119

what is the dose for dilatin to tx status epilep?

Back 119

15-20mg/kg @ 1 mg/kg/min IV max 30mg/kg; must do EKG, BP and saline

Front 120

what is the dose for phenobarb to tx status epilep?

Back 120

20mg/kg @ 100mg/kg/ min IV and intubate

Front 121

what are the characteristics of nonepileptic paroxysmal episodes?

Back 121

breath-holding spells; vertigo; syncope; ataxia

Front 122

what are the ages for breath holding spells?

Back 122

1-6 yrs

Front 123

when does the onset of breath holding spells often occur?

Back 123

before age 2?

Front 124

what age do breath holding spells peak?

Back 124

1

Front 125

tof: breath holding spells runs in families

Back 125

TRUE

Front 126

breath holding spells are always initiated by ___

Back 126

crying

Front 127

you may see __ and __ with breath holding spells?

Back 127

cyanosis and twiching

Front 128

the recovery of breath holding spells occurs within __ to __ mins

Back 128

2/3/2013

Front 129

how long do breath holding spells tend to last?

Back 129

5-10 seconds and up to 1 minute