DRUNK (altered) BABIES
GIVE 6 DIFFERENTIALS FOR AMS IN A CHILD
A - AMMONIA, ALCOHOL, ATYPICAL MIGRAINE, ABUSE
E - ELECTROLYTES, EPILEPSY, ENCEPHALITIS
I - INSULIN, INTUSSUSCEPTION, INBORN ERRORS OF METABOLISM
O - OXYGEN, OPIATES, OVERDOSE
U - UREMIA
T - TRAUMA, TUMOR
I - INFECTION
P - POISONING, PSYCHIATRIC
S - SEIZURE, SEPSIS, SUBARACHNOID HEMORRHAGE
ARE "PRIMARY" HEADACHES ASSOCIATED WITH BADNESS?
NO
THESE ARE MIGRAINES, TENSION, CLUSTER HEADACHES
"SECONDARY" HEADACHES MAY BE DUE TO THE BADNESS - TUMORS, BLEEDS (TRAUMA, AVM), ETC.
ATAXIA CAUSED BY DYSFUNCTION OF THE ____ WILL BE ASSOCIATED WITH NYSTAGMUS
CEREBELLUM
DISEASES OF WHAT THINGS MAY CAUSE VERTIGO?
EAR, 8TH CRANIAL NERVE, NECK, BRAINSTEM OR EYE
GIVE 2 RISK FACTORS FOR PEDIATRIC STROKE
SICKLE CELL
STRUCTURAL CARDIAC DISEASE
HOMOCYSTINURIA
MOYAMOYA DISEASE
AVM
A CHILD PRESENTS WITH WORSENING LOWER EXTREMITY PAIN, PARESTHESIAS AND NOW WEAKNESS. HE STARTED COMPLAINING OF HIS LEGS HURTING A WEEK AGO AFTER A URI AND TODAY HIS MOM NOTICED HE HAD TROUBLE WALKING. WHAT MIGHT HE HAVE?
TRANSVERSE MYELITIS
TYPICALLY PROGRESSES OVER HOURS TO DAYS AFTER AN INFECTION. WILL HAVE PAIN, PARESTHESIAS WITH WEAKNESS AND POSSIBLY URINARY RETENTION.
SPECIFIC INFECTIONS ASSOCIATED WITH IT ARE EBV, CMV, MEASLES, CAMPYLOBACTER JEJUNI, MYCOPLASMA PNEUMONIAE
LP CAN HELP IN EVALUATION BUT SHOULD BE DONE AFTER AN MRI - DON'T DELAY IMAGING IN ANYTHING THAT PRESENTS WITH SYMPTOMS OF POSSIBLE SPINAL CORD COMPRESSION
VITAL SIGNS CAN CLUE YOU IN TO POSSIBLE DIAGNOSIS, T/F
TRUE
HYPERPNEA - SALICYLATES
HYPERPNEA AND TACHYCARDIA - DKA
BRADYCARDIA, IRREGULAR RESPIRATIONS, WIDE PULSE PRESSURE (CUSHING'S TRIAD) - INCREASED ICP
WHAT ARE THE 2 MOST COMMON CAUSES OF PEDIATRIC HEADACHES SEEN IN THE ED?
VIRAL ILLNESSES, DEHYDRATION
PAPILLEDEMA OR CRANIAL NERVEL PALSIES SUGGEST WHAT?
HYDROCEPHALUS OR CNS LESION
GIVE 5 CAUSES OF CENTRAL VERTIGO
AVM
BRAIN ABSCESS
CHIARI MALFORMATIONS
DEMYELINATING DISORDERS
ENCEPHALITIS
MENINGITIS
MIGRAINE
NEOPLASM
SEIZURES
TRAUMA
HEMORRHAGIC STROKE IS MORE COMMON IN KIDS THAN ISCHEMIC STROKE, T/F
TRUE
OFTEN CAUSED BY WHAT?
A CHILD PRESENTS WITH LOW BACK PAIN AND TROUBLE WALKING. HE IS FEBRILE. YOU LP IMMEDIATELY WITHOUT DOING ANY OTHER TESTS AND JUST GET A RETURN OF PUS. WHAT CONDITION DO THEY LIKELY HAVE THAT YOU CLEARLY DIDN'T CONSIDER?
EPIDURAL ABSCESS
TYPICALLY HEMATOGENOUS SPREAD
NEVER LP ANYONE IF YOU SUSPECT SPINAL CORD COMPRESSION
ABSENCE OF FEVER IN A NEONATE RULES OUT POSSIBILITY OF BACTERIAL INFECTION, T/F
FALSE
HEADACHES THAT WAKE A CHILD FROM SLEEP, ARE PRESENT ON WAKING OR ASSOCIATED WITH EARLY MORNING EMESIS ARE CONCERNING FOR WHAT?
ANYTHING THAT CAN INCREASE ICP
MASSES, HYDROCEPHALUS
WHY DO THESE CAUSE WORSE SYMPTOMS AT NIGHT OR EARLY IN THE AM?
GIVE 5 CAUSES OF PEDIATRIC ATAXIA
ACUTE CEREBELLAR ATAXIA
ACUTE POST-INFECTIOUS DEMYELINATING ENCEPHALOMYELITIS
BRAINSTEM ENCEPHALITIS
DRUGS
GUILLAIN-BARRE SYNDROME
METABOLIC DISORDERS
SEIZURE
STROKE
NEOPLASM
VERTEBRAL ARTERY DISSECTION
METABOLIC DISORDERS
MS
OPSOCLONUS-MYOCLONUS SYNDROME
NAME 2 DISEASES THAT CAUSE VERTIGO WITH HEARING LOSS
MENIERES
LABYRINTHITIS
OR OTOTOXIC DRUGS
CHILDREN WILL PRESENT WITH SIMILAR STROKE-LIKE SYMPTOMS AS ADULTS MOST OF THE TIME, T/F
FALSE
TYPICALLY THE PRESENTATION WILL INVOLVE LESS SPECIFIC SYMPTOMS LIKE HEADACHE, SEIZURES, AMS OR ALTERED LOC (BECAUSE MEDICINE IS FAIR LIKE THAT)
SEIZURES OCCUR AT STROKE ONSET IN 20% OF PATIENTS, ESPECIALLY UNDER THE AGE OF 6
SPINAL CORD TUMORS WILL ALWAYS CAUSE PAIN, T/F
FALSE
SYMPTOMS WILL TYPICALLY BE SLOW IN ONSET WITHOUT ASSOCIATED PAIN
YOU SHOULD DELAY YOUR LP UNTIL YOU ARE ABLE TO START ANTIBIOTICS AND ANTIVIRAL MEDICATION, T/F
FALSE
YOU DO AN LP ON A CHILD WITH A HEADACHE. YOU ACTUALLY GO THROUGH THE TROUBLE OF GETTING AN OPENING PRESSURE (GOOD FOR YOU). THE PRESSURE IS 30 CM H2O. WHAT DOES THIS MEAN?
IT MEANS IT IS ELEVATED
SHOULD YOU CT SOMEONE FIRST IF YOU ARE CONCERNED ABOUT A MASS LESION?
LET'S SAY YOU DID CT FIRST IN THIS CASE AND CT WAS NEGATIVE. THEIR CSF HAS NORMAL PROTEIN AND GLUCOSE LEVELS. WHAT DO THEY LIKELY HAVE?
CHAPTER RECOMMENDS IMAGING OF THE VENOUS SINUSES WHEN EVALUATING FOR IIH TO RULE OUT CEREBRAL SINOVENOUS THROMBOSIS AS IT CAN HAVE SIMILAR PRESENTATION
THIS IS THE CAUSE OF ABOUT 40% OF CASES OF ATAXIA IN CHILDREN
ACUTE CEREBELLAR ATAXIA
BOYS>GIRLS
2-4 YO
HX OF RECENT ILLNESS, BUT COMMONLY RELATED TO VARICELLA VIRUS
THOUGHT TO BE DUE TO AUTOIMMUNE DISORDER CAUSING CEREBELLAR DEMYELINATION
VESTIBULAR NEURONITIS CAUSES HEARING LOSS T/F
FALSE
TYPICALLY FOLLOWS A VIRAL URI
SHOULD YOU CALL A CODE STROKE IF A 4 YO COMES IN WITH SYMPTOM ONSET 2 HOURS AGO, AND YOU HAVE CONCERN FOR CVA?
YES
THROMBOLYTICS AND THROMBECTOMY ARE BEING UTILIZED MORE THESE DAYS IN CHILDREN. IF THEY'RE WITHIN IN THE WINDOW AND CANDIDATES FOR EITHER THEN CALL PEDS NEURO
CONSIDER BLOOD TRANSFUSION IN SICKLERS
WHAT'S THE MOST COMMON BUG THAT CAUSES EPIDURAL ABSCESS?
S. AUREUS
IN ADDITION TO ANTIBIOTICS, WHAT ELSE SHOULD YOU GIVE AN INFANT WHO IS FEBRILE WITH FOCAL NEURO DEFICITS?
ANTIVIRALS
HSV MAY CAUSE FOCAL DEFICITS IN ADDITION TO FEVERS AND ALTERED MENTATION
HOW LONG MIGHT A PEDIATRIC MIGRAINE LAST?
2-72 HOURS
TYPICALLY BILATERAL VS UNILATERAL
OCCIPITAL HEADACHES IN CHILDREN ARE RARE AND SHOULD RAISE CONCERN FOR SOMETHING ELSE OTHER THAN MIGRAINE
THE MAJORITY OF CHILDHOOD BRAIN TUMORS INVOLVE THE BRAINSTEM AND CEREBELLUM, T/F
TRUE
TYPICALLY ATAXIA WILL BE SLOW AND PROGRESSIVE, BUT THERE CAN BE ACUTE, SUDDEN CHANGES
HOW CAN YOU TEST VESTIBULAR FUNCTION IN A KIDDO?
HAVE THEM HOP
HAVE THEM STAND FROM A SEATED POSITION ON THE FLOOR
DO THESE WITH EYES OPEN AND THEN WITH EYES CLOSED
THIS WILL CAUSE A TRANSIENT, SYMMETRIC, ASCENDING PARALYSIS
GUILLAIN-BARRE SYNDROME
WILL PATIENTS HAVE MOTOR OR SENSORY DEFICITS?
WILL THEIR DTR'S BE INTACT?
WHAT ARE THE NAMES OF THOSE 2 NERDS WHO DESCRIBED THAT TRIAD OF OCULOMOTOR PALSIES, ATAXIA AND AREFLEXIA?
WHAT WILL BE ABNORMAL IN THEIR LP?
"A "20-30-40 rule" has been proposed [23,30]. The rule advocates the initiation of ventilatory support when the FVC is less than 20 mL/kg, the MIP is less negative than -30 cm H2O (eg, -20 cm H2O), or the MEP is less than 40 cm H2O"
TORTICOLLIS MAY BE ASSOCIATED WITH WHAT?
POSTERIOR FOSSA LESIONS
"PAROXYSMAL TORTICOLLIS" DEFINED AS RECURRENT EPISODES OF HEAD TILT ASSOCIATED WITH HEADACHE, NAUSEA AND VOMITING.
"DIAGNOSIS OF EXCLUSION"
THIS TYPE OF MIGRAINE CAN CAUSE ATAXIA
BASILAR MIGRAINE
MOST OF THE TIME YOU WILL BE ABLE TO DETERMINE THE CAUSE OF VERTIGO IN THE ED, T/F
FALSE
A MOM BRINGS A FLOPPY BABY IN. THEY HAD BEEN CONSTIPATED AND HAVING SOME POOR FEEDING, BUT NOW THEY JUST BE FLOPPIN AND WAY WORSER. THEY ARE AFEBRILE. WHAT DO YOU THINK, DR. HOUSE, RESIDENT EXTRAORDINAIRE?
BOTULISM
CANNED FOODS, SPECIFICALLY HONEY MAY BE A RESERVOIR FOR THE TOXIN. CAN ALSO OCCUR FROM DUST PARTICLES IN THE GROUND FROM THINGS LIKE CONSTRUCTION SITES.
TYPICALLY INSIDIOUS IN ONSET STARTING WITH CONSTIPATION. THEY WILL EVENTUALLY HAVE TROUBLE FEEDING, LETHARGY, HYPOTONIA AND WEAKNESS
GIVE THE TRIAD ASSOCIATED WITH THE MILLER-FISHER VARIANT OF GBS
ATAXIA, AREFLEXIA, OPHTHALMOPLEGIA OF VERTICAL GAZE
WHAT CONDITION WILL CAUSE WAXING AND WANING WEAKNESS OF MUSCLES THAT IS WORSE WITH REPETITIVE USE?
MYASTHENIA GRAVIS
3 TYPES IN KIDS. NEONATAL, CONGENITAL AND JUVENILE
JUVENILE TYPICALLY AFFECTS SCHOOL AGE FEMALES
WHAT LABS SHOULD YOU GET IF YOU ARE CONCERNED FOR AN INBORN ERROR OF METABOLISM?
GLUCOSE, LACTATE, KETONES, AMMONIA
IF ALL 4 OF THESE ARE NORMAL THEN THE LIKELIHOOD OF AN INBORN ERROR AS A CAUSE OF ATAXIA (OR ANYTHING ELSE) IS LOW