Pediatrics - Exam 5

What is a sudden, transient disturbance of brain function, manifested by involuntary motor, sensory, autonomic or psychic phenomena alone or in combination? It is often accompanies by alterations or loss of consciousness.

Seizure

What is characterized by recurrent, unprovoked seizures (2 seizures that are separated by at least 24 hours) that often have interictal electroencephalographic changes?

Epilepsy

If deja vu is present, a seizure is suggested to be in the...

Temporal lobe

T/F: Every child with new onset unprovoked seizures needs an EEG.

True

1 multiple choice option

T/F: Emergent imaging is necessary following a seizure even in the absence of trauma or acute abnormality on exam.

False

1 multiple choice option

Children with epileptic syndromes (infantile spasms, Lennox-Gastaut) need an ____________ because 60-80% will have an abnormality.

MRI

What is a hypsarrhythmia and when is it seen?

High amplitude spikes with slow waves and chaotic background (Infantile spasms)

T/F: A normal EEG rules our epilepsy.

False

1 multiple choice option

What is an absence seizure?

Lapse of consciousness or vacant stares lasting 5-10 seconds

What is the first line treatment for absence seizures?

Ethosuximide (Zarontin)

What type of seizure is characterized by an abrupt, symmetrical adduction or flexion of limbs with flexion of head and trunk OR abduction and extensor movements like a moro reflex, currently seen in ages 3-18 months?

Epileptic spasm/infantile spasms

What is the mainstay of treatment for infantile spasms and when should it be started?

hormonal therapy with corticotropin (ACTH) or oral glucocorticoids; should be started within 3 days

What is the treatment of choice for infantile spasms in patients with tuberous sclerosis?

Vigabatrin

What is characterized by multiple seizure types, severe seizures of childhood, treatment resistant epilepsy, and intellectual disability?

Lennox-Gastaut Syndrome

What type of seizures are required for a diagnosis of Lennox-Gastaut?

Tonic seizures plus at least one additional type (usually atypical absence)

What is the first-line treatment for patients with Lennox-Gastaut syndrome?

Valproate

What is the most common childhood seizure?

Febrile seizure

Why should physical activity be encouraged in patients with epilepsy?

may reduce the overall seizure burden/ lowers seizure threshold

What gene mutation is responsible for neurofibromatosis in 50%?

NF1 gene

Children with 6 or more cafe-au-late spots and no other findings should be followed as 95% will develop ________________ by 8 years of age.

Neurofibromatosis type 1

What is seen in 15% of patients with neurofibromatosis?

optic gliomas

What are the diagnostic criteria for neurofibromatosis? Two or more must be present for diagnosis.

1) >6 cafe-au-lait spots 5mm in diameter

2) nerve sheath tumors

3) axillary or inguinal freckling

4) optic pathway glioma

5) 2 or more Lisch nodules (iris hamartomas)

6) bony lesions

7) first degree relative with NF type 1

What presents with fever, malaise, and impaired heart, lung, liver, or renal function? They may have headache, stiff neck, hypothermia, or changes in mental status?

Meningitis

What two signs are positive if there is meningeal irritation?

Kernig and Brudzinski

CSF shows WBC with predominant PMNs, high protein, and low glucose. What type of meningitis does this patient have?

Bacterial

CSF shows WBC with predominant lymphs, high protein, and low glucose. What type of meningitis is this?

Fungal

CSF shows EBC with predominant lymphs, high protein, and normal glucose. What type of meningitis is this?

Viral or partially treated bacterial

What are the cause of viral meningitis in 85% of cases?

Non-polio enteroviruses

What are the most common causes of bacterial meningitis in the neonatal period?

Group B strep and E. Coli

What are the most common causes beyond the neonatal period?

Strep pneumo, Neisseria meningitidis, H. flu B

What is the treatment for neonates with meningitis?

Ampicillin and gentamicin

What is the treatment for kids <3 months with meningitis?

Ampicillin and cefotaxime

What is the treatment for kids >3 months with meningitis?

Ceftriaxone and vancomycin

What is the classic triad of symptoms seen with a brain tumor?

Morning headache, vomiting, and papilledema

What is the most common solid tumor of childhood? They make up 25% of all childhood cancers

Brain tumor

What is the most common brain tumor of childhood?

Astrocytoma

What are the most common headaches in children?

Migraine and tension

What is the most common craniosynostosis?

Sagittal Synostosis

What is the least common craniosynostosis?

Metopic Synostosis - Trigonal

When does the moro reflex disappear?

5-6 months

When does the palmar grasp reflex disappear?

5-6 months

When does the plantar grasp reflex disappear?

9-10 months

When does the rooting reflex disappear?

2-3 months

Why is it not appropriate to document PERRLA in young infants?

They do not accommodate until about 9 months.

What is the Moro reflex?

Startle reflex

What is normal IQ?

90-109

What is the triad of symptoms seen with Attention Deficit Hyperactivity Disorder (ADHD)?

Impulsivity, inattention, and hyperactivity

What are some signs a child may have hyper-impulsive ADHD?

Fidgety, difficulty remaining seated in class, excessive running or climbing, blurting out answers, difficulty with quiet activities, difficulty waiting turn, interrupting

What are some signs a child may have inattentive ADHD?

Failure to give attention when spoken to directly, failure to follow instructions, difficulty organizing tasks, losing utensils, easily distracted, forgetfulness in daily activities

What are some medication treatment options for kids with ADHD?

Stimulants, clonidine, guanfacine, atomoxetine (stattera)

________ enhance both dopamine and norepinephrine neurotransmission which seems to increase impulse control. Negative side effects include decreased appetite, insomnia, and cardiac problems.

Stimulants

What is the term for deficits in social communication/social interaction across multiple contexts?

Autism spectrum disorder

What is a screening tool for autism spectrum disorder that is used at 18-24 months?

MCHAT-R

What is the third most common chronic illness of adolescence in the US? Children involved in gymnastics, figure skating, and ballet are at increased risk.

Anorexia Nervosa

What disorder has patterns of negative, hostile, and defiant behavior lasting at least 6 months? They may lose temper, argue with adults, and defy rules, blame others for their mistakes, or be easily annoyed.

Oppositional Defiant Disorder

What behavior can NOT be present for a diagnosis of oppositional defiant disorder?

Harming animals or individuals, destruction of property, or theft

What disorder might a kid have if they are defying authority, violating the rights of others or societal norms, and are aggressive toward persons, animals, or property?

Conduct disorder

Describe the typical patient for conduct disorder.

A boy with a turbulent home life and academic difficulty

What is the first symptom of bipolar disorder in 70% of patients?

Depression

T/F: ADHD and depression are highly comorbid.

True

1 multiple choice option

What disorder causes dysphoric mood, mood lability, irritability, depressed appearance, changes in sleep/appetite/concentration/activity, suicidal ideation, or feelings of hopelessness?

Depression

What screening tool is used for assessment and monitoring patients with depression?

PHQ-9

T/F: In adolescence, females are 5 times as likely as males to have depression.

True

1 multiple choice option

What is the most significant risk of depression?

Suicide

In 2007, what was the third leading cause of death among children and adolescents in the US?

Suicide

Adolescent _______ attempt suicide 3 times more often but the number of completed suicides are 3 times higher in _________.

Girls, Boys

What is usually the first growth plate to close?

Elbow

In pediatrics, which is stronger- ligaments or bones?

Ligaments

What kind of fracture is from a unicortical force and is a stable fracture?

Buckle/Torus fracture

What type of fracture is a unicortical fracture that results from a bending force?

Greenstick fracture

What type of fracture is an extension fracture of the distal radius that has dorsal angulation?

Colles fracture

What type of fracture is through the epiphyseal plate with no non-displaced fracture is evident on x-ray?

Salter Harris I

What type of fracture is through the epiphyseal plate and extends into the metaphysis?

Salter Harris II

What type of Salter Harris fracture is the most common?

Salter Harris II

What type of fracture is through the epiphyseal plate and extends into the epiphysis and into the joint?

Salter Harris III

What type of fracture is through the epiphyseal plate and extends though the metaphysis and epiphysis?

Salter Harris IV

What type of fracture is a compression/crush injury to the epiphyseal plate?

Salter Harris V

What is one of the most common fractures of childhood and is the most commonly fractured bone during delivery?

Clavicle fracture

What is another name for osteogenesis imperfecta?

Brittle bone disease

What is an autosomal dominant defect (COL1A1) that results in weak muscles, brittle bones/teeth, a curved spine, and hearing loss due to a defect in type 1 collagen?

Osteogenesis imperfecta

What confirms the diagnosis of dominant osteogenesis imperfecta?

Type 1 collagen study (but a negative study foes not rule out OI)

What is manifested by short stature, bone deformities, recurrent fractures, blue scleral hue, hearing loss, and skin laxity?

Osteogenesis imperfecta

What is the most common form of osteogenesis imperfecta?

Type I (mild)

What type of osteogenesis imperfecta is severe and usually leads to death in the first year of life?

Type II

What type of osteogenesis imperfecta has fractures starting very early in life and can have severe bone deformities? Many become wheelchair bound and have a shortened life expectancy.

Type III

What type of osteogenesis imperfecta is similar to type I but often requires braces and crutched to walk? Life expectancy is near normal.

Type IV

What should always be ruled out in a kid you suspect may have osteogenesis imperfecta?

Child abuse

When diagnosing OI, a sequence analysis of cDNA is done to look for mutations in COL1A1/COL1A2 which requires a ______________.

Skin biopsy for fibroblast cultures

What are some red flags for child abuse?

- long bone fx in non-ambulatory kids

- buckle handle fx

- fx of sternum, scapula, or spinous process

- multiple fx in various stages of healing

- inconsistent history

What is abnormal lateral curvature of the spine (in the coronal plane)?

Scoliosis

What is the most common type of scoliosis?

Idiopathic (adolescent - >10)

What is dextroscoliosis?

Convexity to the right

What is levoscoliosis and what is it often associated with?

Convexity to the left - spinal tumors or fistulas

If you have a patient with left thoracic scoliosis, what should you order to rule out neuromuscular etiology?

MRI

What are some risk factors for scoliosis progression?

-Skeletal immaturity

- curve location (lumbar curves progress faster)

- curve magnitude (large curves progress more)

What measurement is used for diagnosing scoliosis?

COBB angle

When is surgical intervention needed for scoliosis?

Curves >40 degrees

What is Scheuermann's disease?

Structural kyphosis and adolescent back pain generally seen in males 14-17 due to anterior wedging at three consecutive vertebral bodies

Shmorl's nodes on x-ray are a sign of....

Scheuermann's disease

What is equinus?

plantar flexion of the forefoot, hindfoot, or entire foot