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48 Cards in this Set
- Front
- Back
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______ is diminished resistance to passive movement around a joint.
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Hypotonia
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Identify important historical items in the evaluation of the floppy infant.
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*intercurrent illness?
*are all limbs floppy? *details of infant development *family hx of neuromuscular disorders? |
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Infants with _____ heads frequently have hypotonicity as an associated finding.
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large
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What will be the finding of DTRs if the floppiness is due to cerebral origin?
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hyperactive or maintained
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What will be the finding of the DTRs if the floppiness is due to motor unit disorders?
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reduced to absent
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What key characteristics about a seizure should be documented?
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*duration
*generalized or focal *presence of a post-ictal phase |
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Status epilepticus is a seizure lasting > ___ minutes.
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30
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What are the most important features of the physical exam in the child w/convulsions associated w/fever?
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*assessment of ant fontanelle
*assessment for meningismus |
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Why do we check the anterior fontanelle in the child w/convulsions associated w/fever?
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To make sure it's not bulging; could be increased ICP, meningitis, etc.
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How does a family hx of epilepsy affect the prognosis of the pt w/febrile seizure?
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As a predictor of later epilepsy
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How are seizures classified?
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*Generalized
*Focal/partial |
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What is the difference between a simple & complex partial seizure?
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Impairment of consciousness
*there is LOC w/complex |
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When are neuroimaging studies indicated?
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*focal seizures
*EEG evidence of focality in the presence of abnormal neurologic exam *seizures accompanying neurocutaneous disorder |
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What is the most commonly encountered vascular HA in children?
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Migraine w/o aura
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What is the common description of migraine without aura (in children)?
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*bifrontal
*generalized *bitemporal *pounding/throbbing |
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Which medication is an option for infrequent attacks of common migraine?
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NSAIDs
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Which classes of medications are useful in prophylaxis for migraine HAs?
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*BBs (try this first!)
*TCAs (avoid) *CCBs *Divalproex sodium |
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What symptoms are generally associated w/increased ICP?
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*vomiting
*HA *visual dysfunction |
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What common visual disturbance occurs w/increased ICP?
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Diplopia (double vision); lateral... ask how many fingers the pt sees
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What is the diplopia due to?
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Compression of the abducens nerve
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What other symptoms may be present w/ increased ICP?
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*personality changes
*drowsiness *irritability *level of consciousness changes |
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Fasiculations of the tongue on frequently observed in what condition?
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infantile progressive spinal muscular atrophy
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Infants with _______ syndrome are severely floppy & obtunded early in infancy.
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Prader-Willi
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Most peripheral neuropathies in children are which type of neuropathies?
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hereditary sensorimotor
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What condition is associated w/ severe floppiness at birth, with obtundation, difficulty w/sucking & respirations in the neonatal period, areflexia, clubfoot, & weakness of the facial muscles?
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Myotonic dystrophy
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Neonates w/symptomatic passively acquired MG may receive tx with _______.
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Pyridostigmine (Mestinon)
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What symptoms are associated w/ the myopathies?
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*difficulty w/stairs
*diff running (drop foot) *diff toe walking *diff rising from sitting position |
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What items of hx are important in the child w/possible myopathy?
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*has the child lost fxn?
*is weakness accompanied by signs of systemic involvement? *Problems swallowing or chewing? |
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What lab values may be abnormal in myopathies?
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*CK (increased)
*LDH (increased) *AST *ALT |
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What manifestations are associated w/ Duchenne muscular dystrophy?
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*toe walking
*waddling gait *pseudohypertrophy of the calves *pelvic girdle weakness |
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How might weakness in the floppy infant be manifested?
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*a paucity of spontaneous movements
*inability to move an extremity against gravity |
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Which chromosomal disorders are associated w/hypotonia?
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*Down's syndrome
*Prader-Willi syndrome |
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Why might increased ICP in the infant NOT produce papilledema?
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b/c cranial sutures can separate at an early age
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What lab eval is commonly performed on the child w/ a febrile seizure?
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*CBC
*appropriate cultures *UA |
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What factors are associated with an increased risk of recurrence of a febrile seizure?
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*children <18 months
*family hx of febrile seizures *children w/short duration of fever prior to the seizure & those w/lower temp |
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In the child w/a febrile status epilepticus, what factors increase the risk of recurrent afebrile or febrile seizures?
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Children w/neuro impairment prior to the episode of febrile status epilepticus.
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When do benign febrile seizures most commonly occur?
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at the onset of the fever
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How are epileptic seizures generated?
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By abnormal synchronization of neuronal pool discharges caused by numerous acquired or genetic, structural, metabolic, and idiopathic conditions
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Describe some of the physical exam clues that may indicate a focal source of seizure discharge.
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*post-ictal paralysis
*DTR asymmetry *frank hemiparesis *everted foot |
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What are the activation procedures utilized during the EEG that may be used to document abnormality?
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*sleep
*sleep deprivation *photic stimulation *hyperventilation |
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What is the main characteristic of psychogenic seizures?
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Maintenance of consciousness during a generalized tonic or tonic-clonic event & lack of post-ictal phase
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Describe the components of the HA hx.
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*frequency
*duration *dates of origin *character *severity |
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Describe the cycle of events resulting in increased ICP from an intracranial mass.
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Decrease of cerebral blood flow --> cerebral hypoxia --> further vascular dilation --> further increase in IC volume & increase pressure
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What are the most common manifestations of medulloblastoma, astrocytoma, & ependymoma arising near the cerebellum?
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*vomiting
*HA *unsteadiness of gait (ataxia) |
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Tumors of the brainstem arise most commonly from the _____.
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pons
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What is the most common midline tumor? What is its common manifestation?
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*craniopharyngioma
*impaired vision or defects in the peripheral fields of vision |
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What are the endocrine effects of craniopharyngiomas?
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*multiple pituitary hormone deficiencies
*precocious puberty occasionally seen in boys |
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T of F: Duchenne muscular dystrophy occurs equally in boys & girls.
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FALSE!! only occurs in boys
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