Peds Exam 4

Front 1

history of HA and vomiting, esp without nausea is concern for what?

Back 1

ICP or tumor

Front 2

what are reasons you might want to do an MRI work up for HA? (5)

Back 2

1. worsening or severe HA
2. Vomiting (esp, w/o N --> tumor, ICP)
3. HA that occurs only at night or early morning
4. Papilledema (ICP)
5. Any focal neurologic deficits

Front 3

What are indications for LP with HA?

Back 3

1. any sign of infection
2. papilledema after - MRI

Front 4

Hemicranial or generalized
Occurs in less than 30%
Aura is visual (scotoma) or other sensory or focal motor
Aura precedes headache by 20-30 minutes

Back 4

Classic migraine

Front 5

Occurs in 60%
Associated with nausea, vomiting, photophobia, noise sensitivity
Can last from an hour to several days

Back 5

common migraine
Migraine without aura

Front 6

MC in adolescent females
Occipital headache
Associated ataxia, dizziness, diplopia, hearing disturbance, paresthesias, drop attacks
Neurologic symptoms are brief

Back 6

Basilar Migraine

Front 7

Rare, may be precipitated by trauma
Delirium, confusion, restlessness, combativeness
Resolves with sleep
May later develop into classic migraine

Back 7

confusional migraine

Front 8

Occurs mainly in younger children and girls
Vomiting and abdominal pain lasts up to 48 hrs
Headache NOT usually present

Back 8

Cyclic Vomiting syndrome

Front 9

what medication may help at onset of aura HA?

Back 9

Triptans

Front 10

what is the MC generalized seizure?

Back 10

Tonic-Clonic (Grand Mal)

Front 11

Tonic stiffness and upward deviation of eyes followed by clonic jerks

Back 11

tonic clonic seizure

Front 12

do children lose consciousness in tonic clonic seziures?

Back 12

yes

Front 13

Myoclinic jerks, usually bilateral with or without loss of consciousness?

Back 13

without loss

Front 14

Onset between 1-3 y/o
Loss of body tone – wears helmet. Drop seizures
Frequent underlying brain pathology

Back 14

atonic

Front 15

Occur most often age 4-8
More common in girls
Staring spell without loss of consciousness – gets diagnosed mostly at school. Literrally just stare
No prodrome or post-ictal period
Child has no recollection of the event

Back 15

Absence (Petit Mal)

Front 16

Grand mal is what type of seizure?

Back 16

tonic-clonic

Front 17

are febrile seizures associated with how high the fever goes or how sudden the increase?

Back 17

associate with sudden increase

Front 18

how do we treat partial seizures?

Back 18

1. Phenytoin
2. Valproate
3. carbamazpeine

Front 19

what is the criteria for status epilepticus?

Back 19

prolonged seizure of greater than 20-30 minutes

Front 20

Rapid tonic contraction of neck, limb and trunk lasting 2-10 seconds

Occur frequently when falling asleep or waking

Back 20

infantile spasms (West syndrome)

Front 21

When is the peak age for West syndrome?

Back 21

4-6 months of age

Front 22

what is the tx for infantile spasms (west syndrome)?

Back 22

1. ACTH
2. vigabitrin
3. Corticosteroids
4. Valproate
5. Pyridoxine (B6)

Front 23

40-60% of seizures are what kind?

Back 23

partial

Front 24

Lisch nodules (iris hamartomas)
Optic nerve gliomas
Scoliosis, sphenoid wing dysplasia, cortical thinning of long bones
Reno-vascular hypertension
Learning disabilities and ADHD common
Café au lait spots (>6 spots)
Axillary freckling
Cutaneous neurofibromas

Back 24

NF type 1

Front 25

Bilateral vestibular schwannomas
Intracranial and spinal tumors
Average life span <40 yrs

Back 25

NF type 2

Front 26

the most common known cause of infantile spasms is?

Back 26

Tuberous Sclerosis

Front 27

Ash leaft spot (Fitzpatrick patch) is seen in what? dz, what is another name for it?

Back 27

Shagreen patch
seen in Tuberous sclerosis

Front 28

Angiomas of the leptomeninges (pia and arachnoid mater)
Ipsilateral facial port wine stain

Back 28

sturge webeter syndrome

Front 29

have to walk arms up their legs after being on all fours

Back 29

gowe'rs sign

Front 30

CPK markedly elevated due to release of enzyme with muscle deterioration

Back 30

duchenne muscular dystrophy

Front 31

do you hear a clunk in a subluxating hip or dislocated hip?

Back 31

dislocated

Front 32

Abnormal pathology of proximal medial metaphysics. Femur translating off proximal tibia

Back 32

Bounts disease

Front 33

lack of vit D bone disease

Back 33

Ricketts

Front 34

if a child has knee and thigh pain think what kind of pathology?

Back 34

hip

Front 35

Infection of bone involving periosteum, cortical bone, and medullary cavity

Back 35

osteomyelitis

Front 36

pain, restless, malaise, limb held very still. can be from a hematogenous or traumatic source

Back 36

neonatal osteomyelitis

Front 37

involucrum

Back 37

new bone formation

Front 38

if you aspirate pus from a bone what levels will indicate septic arthritis?

Back 38

> 80k

Front 39

What are the Kocher criteria used for a child with painful hip?

Back 39

1. non-weight bearing on affected side
2. sed rate elevation >40 mm/hr
3. fever
4. WBC >12k

the more you have the higher the likelihood

Front 40

noted a birth, medial deviation of forefoot, convex lateral border

Back 40

metatarsus adductus

Front 41

internal foot thigh axis seen with inverted feet

Back 41

tibial torsion

Front 42

duck walk is known as

Back 42

femoral anteroversion

Front 43

Bitsy disease

Back 43

combined deformity makes gait appear exceptionall poor. have tibial torsion and femoral anteroversion

Front 44

as babies we start off as varus or vagus? then what?

Back 44

start of as varus and then normal at 2-3 then vagus and then back to normal at 5-7 yo

Front 45

clinical findings of what pathology?
1. asymmetric abduction
2. galeazzi
3. asymmetric thigh folds
4. trendelenburg
5. short legged gait
6. telescoping

Back 45

Dislocated hip

Front 46

Top of Trochanter to ASIS passes at or superior to umbilicus

Back 46

Klisic's LIne

Front 47

idiotpathic avascular necrosis is known as?

Back 47

perthes dz

Front 48

what is the tx for perthes dz?

Back 48

maintain ROM, bracing may be needed, push head deeper into socket

Front 49

distal thigh or knee pain in adolescents, loss of IR, endocrine, renal failure. Bilateral 25-50% of the time. Chronic is >3 weeks

Back 49

Slipped capital femoral epiphysis

Front 50

referreed pain, adolescent, 
examining child for limb pain and they have a limp
 --get xray of both hips
likely to find

Back 50

SCFE or perches

Front 51

MC in active males during growth spurts, jumpers knee

Back 51

Sliding Larsen Johansson Syndrome