Podcast
Questions and Answers
Which of the following is NOT recommended for the treatment of bacterial meningitis in an infant less than 6 weeks old?
Which of the following is NOT recommended for the treatment of bacterial meningitis in an infant less than 6 weeks old?
- Vancomycin
- Ceftriaxone
- Ampicillin
- Acyclovir (correct)
What is the hallmark sign of a concussion?
What is the hallmark sign of a concussion?
- Nausea and vomiting
- Loss of consciousness
- Confusion and amnesia (correct)
- Severe headache
Which of the following is a potential complication of meningitis?
Which of the following is a potential complication of meningitis?
- Increased intracranial pressure
- Seizures
- Cranial nerve palsies
- All of the above (correct)
What is the appropriate treatment for viral meningitis?
What is the appropriate treatment for viral meningitis?
Which of the following is NOT a clinical manifestation of a concussion?
Which of the following is NOT a clinical manifestation of a concussion?
Which sign suggests meningeal irritation?
Which sign suggests meningeal irritation?
What is the recommended prophylactic treatment for individuals in close contact with a patient with Neisseria meningitides?
What is the recommended prophylactic treatment for individuals in close contact with a patient with Neisseria meningitides?
What is the mechanism of injury for a concussion?
What is the mechanism of injury for a concussion?
Which of the following is a risk factor for developing a concussion?
Which of the following is a risk factor for developing a concussion?
What is the most effective way to prevent meningitis?
What is the most effective way to prevent meningitis?
Which of the following factors increases the risk of developmental delays in children?
Which of the following factors increases the risk of developmental delays in children?
What is the most common cause of febrile seizures?
What is the most common cause of febrile seizures?
What is the recommended drug therapy for a child experiencing their first febrile seizure?
What is the recommended drug therapy for a child experiencing their first febrile seizure?
Which of these is NOT a possible cause of seizures?
Which of these is NOT a possible cause of seizures?
What is the recommended treatment for a child experiencing a second febrile seizure?
What is the recommended treatment for a child experiencing a second febrile seizure?
Which of the following is a common bacterial cause of meningitis in newborns?
Which of the following is a common bacterial cause of meningitis in newborns?
What is NOT a common cause of viral meningitis in children?
What is NOT a common cause of viral meningitis in children?
Which of the following is a common cause of febrile seizures in children?
Which of the following is a common cause of febrile seizures in children?
Which of the following is a symptom that may appear late after a concussion?
Which of the following is a symptom that may appear late after a concussion?
What should be done for a patient who is unconscious after a suspected concussion?
What should be done for a patient who is unconscious after a suspected concussion?
Which of the following is a key part of the neurological examination after a concussion?
Which of the following is a key part of the neurological examination after a concussion?
What is a potential consequence of experiencing a second concussion before the first has healed?
What is a potential consequence of experiencing a second concussion before the first has healed?
Which of these findings indicates a serious concern during a concussion evaluation?
Which of these findings indicates a serious concern during a concussion evaluation?
What are some emergency signs that require immediate medical attention after a concussion?
What are some emergency signs that require immediate medical attention after a concussion?
What is the minimum waiting period mandated by law before an athlete can return to play after a concussion?
What is the minimum waiting period mandated by law before an athlete can return to play after a concussion?
Which of the following describes the hallmark signs of a concussion?
Which of the following describes the hallmark signs of a concussion?
Which cranial nerves are responsible for innervating the extraocular muscles of the eye?
Which cranial nerves are responsible for innervating the extraocular muscles of the eye?
Which of the following symptoms is considered a late sign of concussion rather than an early one?
Which of the following symptoms is considered a late sign of concussion rather than an early one?
What are the three steps involved in the Return to Play decision after a concussion?
What are the three steps involved in the Return to Play decision after a concussion?
Which of the following conditions after a concussion would NOT warrant a visit to the emergency department?
Which of the following conditions after a concussion would NOT warrant a visit to the emergency department?
Which symptoms indicate that an athlete should not return to play after a concussion?
Which symptoms indicate that an athlete should not return to play after a concussion?
Which of these factors increases the risk of bacterial meningitis?
Which of these factors increases the risk of bacterial meningitis?
What is the definitive test for diagnosing meningitis?
What is the definitive test for diagnosing meningitis?
Which of these findings is NOT associated with bacterial meningitis?
Which of these findings is NOT associated with bacterial meningitis?
What is the classic triad of symptoms associated with meningitis?
What is the classic triad of symptoms associated with meningitis?
What is Kernig's sign?
What is Kernig's sign?
Why is a CT scan performed before a lumbar puncture?
Why is a CT scan performed before a lumbar puncture?
Which of these viral infections has seen a decline in occurrence due to vaccine development?
Which of these viral infections has seen a decline in occurrence due to vaccine development?
Which of these CSF findings is a characteristic of bacterial meningitis?
Which of these CSF findings is a characteristic of bacterial meningitis?
A child is presenting with a decreased level of consciousness and irritability. Which part of the neurological exam should be prioritized to assess these symptoms?
A child is presenting with a decreased level of consciousness and irritability. Which part of the neurological exam should be prioritized to assess these symptoms?
What is the significance of a positive Babinski reflex in a child who can already walk?
What is the significance of a positive Babinski reflex in a child who can already walk?
A child presents with a history of injuries that required resuscitation. Which element of the neurological assessment should be focused on?
A child presents with a history of injuries that required resuscitation. Which element of the neurological assessment should be focused on?
What is the purpose of performing a lumbar puncture in a child with suspected meningitis?
What is the purpose of performing a lumbar puncture in a child with suspected meningitis?
What is the primary significance of the 'Gower's sign' observed in a child?
What is the primary significance of the 'Gower's sign' observed in a child?
A child with febrile seizures has a seizure lasting 20 minutes with recurrence. How should this seizure be classified?
A child with febrile seizures has a seizure lasting 20 minutes with recurrence. How should this seizure be classified?
Which of these is NOT a typical characteristic of a simple febrile seizure?
Which of these is NOT a typical characteristic of a simple febrile seizure?
What is the most common type of seizure seen in children?
What is the most common type of seizure seen in children?
Which of the following is NOT a potential risk factor for developing febrile seizures?
Which of the following is NOT a potential risk factor for developing febrile seizures?
Which of these is the gold standard diagnostic test for evaluating neurological conditions?
Which of these is the gold standard diagnostic test for evaluating neurological conditions?
Which of the following is a common cause of viral meningitis in children?
Which of the following is a common cause of viral meningitis in children?
Which of the following is NOT a risk factor for febrile seizures?
Which of the following is NOT a risk factor for febrile seizures?
Which of the following is a possible complication of meningitis?
Which of the following is a possible complication of meningitis?
Which of the following medications is a PRIMARY anticonvulsant option for a child experiencing their first febrile seizure?
Which of the following medications is a PRIMARY anticonvulsant option for a child experiencing their first febrile seizure?
What is the recommended treatment for reducing fever in a child experiencing a febrile seizure?
What is the recommended treatment for reducing fever in a child experiencing a febrile seizure?
When assessing a patient for neurological concerns, which of these is NOT a component of the neurological exam?
When assessing a patient for neurological concerns, which of these is NOT a component of the neurological exam?
A patient presents with a sudden onset of headache, double vision, and balance problems. What is the most likely area of the nervous system involved?
A patient presents with a sudden onset of headache, double vision, and balance problems. What is the most likely area of the nervous system involved?
What is the primary purpose of understanding the anatomy and physiology of the central and peripheral nervous systems in the context of neurological assessment?
What is the primary purpose of understanding the anatomy and physiology of the central and peripheral nervous systems in the context of neurological assessment?
Which of these is a key factor in determining the severity of a neurological condition?
Which of these is a key factor in determining the severity of a neurological condition?
When taking a patient's neurological history, which of these is NOT a recommended question to ask?
When taking a patient's neurological history, which of these is NOT a recommended question to ask?
Which symptom is NOT considered a late sign of concussion?
Which symptom is NOT considered a late sign of concussion?
What immediate evaluation should be performed if a person is unconscious after a suspected concussion?
What immediate evaluation should be performed if a person is unconscious after a suspected concussion?
What diagnostic test is NOT typically involved in the immediate evaluation of a concussion?
What diagnostic test is NOT typically involved in the immediate evaluation of a concussion?
Which finding during a neurological exam indicates a serious concern for a concussion?
Which finding during a neurological exam indicates a serious concern for a concussion?
Which of the following is a key complication of reconcussing before the first concussion has fully healed?
Which of the following is a key complication of reconcussing before the first concussion has fully healed?
Which symptom would most likely prompt immediate medical attention after a concussion?
Which symptom would most likely prompt immediate medical attention after a concussion?
What is the purpose of the three-step decision process in the Return to Play protocol?
What is the purpose of the three-step decision process in the Return to Play protocol?
Which cranial nerve is NOT involved in the innervation of the extraocular muscles?
Which cranial nerve is NOT involved in the innervation of the extraocular muscles?
Which of the following is true regarding symptoms of a concussion?
Which of the following is true regarding symptoms of a concussion?
Which combination of symptoms indicates that an athlete should not return to play?
Which combination of symptoms indicates that an athlete should not return to play?
What could be a potential indicator of a complication following a concussion?
What could be a potential indicator of a complication following a concussion?
What is the most common age group for cases of bacterial meningitis?
What is the most common age group for cases of bacterial meningitis?
Which of the following should NOT be included in the assessment after a concussion?
Which of the following should NOT be included in the assessment after a concussion?
What is a critical factor to determine before allowing an athlete to return to play?
What is a critical factor to determine before allowing an athlete to return to play?
Which of the following diagnostic tests provides definitive evidence for bacterial meningitis?
Which of the following diagnostic tests provides definitive evidence for bacterial meningitis?
What is a clinical manifestation indicative of increased intracranial pressure in newborns?
What is a clinical manifestation indicative of increased intracranial pressure in newborns?
Which statement correctly describes the incidence of bacterial meningitis among different races?
Which statement correctly describes the incidence of bacterial meningitis among different races?
What critical sign is tested when evaluating for Kernig's sign?
What critical sign is tested when evaluating for Kernig's sign?
In which situations is a CT scan recommended prior to performing a lumbar puncture?
In which situations is a CT scan recommended prior to performing a lumbar puncture?
Which of the following describes the typical findings in cerebrospinal fluid (CSF) during bacterial meningitis?
Which of the following describes the typical findings in cerebrospinal fluid (CSF) during bacterial meningitis?
What is a common environmental factor that increases the risk of meningitis?
What is a common environmental factor that increases the risk of meningitis?
What are possible behavioral changes indicating neurological deficits in newborns?
What are possible behavioral changes indicating neurological deficits in newborns?
Which of the following conditions is associated with increased muscle tone in children?
Which of the following conditions is associated with increased muscle tone in children?
What does the presence of primitive reflexes in a child suggest?
What does the presence of primitive reflexes in a child suggest?
Which diagnostic test is considered the gold standard for neurological evaluation?
Which diagnostic test is considered the gold standard for neurological evaluation?
What indicates a need for further assessment when performing a neurological examination?
What indicates a need for further assessment when performing a neurological examination?
What is a typical duration for a simple febrile seizure?
What is a typical duration for a simple febrile seizure?
What findings are typically observed in a child experiencing a complex febrile seizure?
What findings are typically observed in a child experiencing a complex febrile seizure?
What does a positive Kernig sign indicate in a physical examination?
What does a positive Kernig sign indicate in a physical examination?
Which factor is NOT considered a risk for developing febrile seizures?
Which factor is NOT considered a risk for developing febrile seizures?
What type of medical history is critical to gather during a neurological assessment?
What type of medical history is critical to gather during a neurological assessment?
Which of the following is a potential complication of bacterial meningitis?
Which of the following is a potential complication of bacterial meningitis?
A teenager who has sustained a concussion is at increased risk for another concussion. Which of the following factors contributes to this increased risk?
A teenager who has sustained a concussion is at increased risk for another concussion. Which of the following factors contributes to this increased risk?
What is the recommended treatment for viral meningitis?
What is the recommended treatment for viral meningitis?
What is the primary mechanism of injury in a concussion?
What is the primary mechanism of injury in a concussion?
Which of the following symptoms is NOT a typical early symptom of a concussion?
Which of the following symptoms is NOT a typical early symptom of a concussion?
Which of the following is a recommended preventive measure against meningitis?
Which of the following is a recommended preventive measure against meningitis?
Which of the following medications is NOT typically used to treat bacterial meningitis in children over 6 weeks old?
Which of the following medications is NOT typically used to treat bacterial meningitis in children over 6 weeks old?
Which of the following is NOT a sign of meningeal irritation?
Which of the following is NOT a sign of meningeal irritation?
What is the recommended prophylactic treatment for individuals who have been in close contact with a patient with Neisseria meningitides?
What is the recommended prophylactic treatment for individuals who have been in close contact with a patient with Neisseria meningitides?
Which of the following is NOT a typical characteristic of a simple febrile seizure?
Which of the following is NOT a typical characteristic of a simple febrile seizure?
Which of the following is NOT a possible symptom that could appear days to weeks after a concussion?
Which of the following is NOT a possible symptom that could appear days to weeks after a concussion?
Which diagnostic test is recommended for a patient with concussion who loses consciousness?
Which diagnostic test is recommended for a patient with concussion who loses consciousness?
What is the potential consequence of a second concussion before the brain fully recovers from the first?
What is the potential consequence of a second concussion before the brain fully recovers from the first?
Which of the following is NOT a recommended treatment for a concussion?
Which of the following is NOT a recommended treatment for a concussion?
Which of the following neurological tests is NOT mentioned in the text as part of a concussion evaluation?
Which of the following neurological tests is NOT mentioned in the text as part of a concussion evaluation?
Which of the following is a typical CSF finding indicative of bacterial meningitis?
Which of the following is a typical CSF finding indicative of bacterial meningitis?
Why is CT scan performed before lumbar puncture in a patient with suspected meningitis?
Why is CT scan performed before lumbar puncture in a patient with suspected meningitis?
A patient presents with a stiff neck, fever, and headache. Which clinical sign is most indicative of meningeal irritation?
A patient presents with a stiff neck, fever, and headache. Which clinical sign is most indicative of meningeal irritation?
Which of the following is a risk factor associated with an increased incidence of bacterial meningitis?
Which of the following is a risk factor associated with an increased incidence of bacterial meningitis?
Which of the following is NOT a typical clinical manifestation of meningitis?
Which of the following is NOT a typical clinical manifestation of meningitis?
Which of the following signs is considered a positive Kernig's sign?
Which of the following signs is considered a positive Kernig's sign?
Which of the following is a hallmark sign of a concussion?
Which of the following is a hallmark sign of a concussion?
Which of the following is a characteristic of viral meningitis?
Which of the following is a characteristic of viral meningitis?
Which of the following is a late sign of concussion?
Which of the following is a late sign of concussion?
Which of the following is a condition that increases the risk of meningitis?
Which of the following is a condition that increases the risk of meningitis?
Which of the following is NOT a recommended step in the return to play decision after a concussion?
Which of the following is NOT a recommended step in the return to play decision after a concussion?
Which of the following symptoms after a concussion would NOT warrant a visit to the emergency department?
Which of the following symptoms after a concussion would NOT warrant a visit to the emergency department?
Which of the following is a condition that would NOT typically lead to a concussion?
Which of the following is a condition that would NOT typically lead to a concussion?
What is the most common viral cause of aseptic meningitis?
What is the most common viral cause of aseptic meningitis?
Which of the following is a tertiary option for drug therapy in a child experiencing a first febrile seizure?
Which of the following is a tertiary option for drug therapy in a child experiencing a first febrile seizure?
Which of the following is NOT a symptom that would typically delay an athlete's return to play after a concussion?
Which of the following is NOT a symptom that would typically delay an athlete's return to play after a concussion?
Which of the following statements about return to play after a concussion is FALSE?
Which of the following statements about return to play after a concussion is FALSE?
Which of the following is NOT a potential cause of seizures?
Which of the following is NOT a potential cause of seizures?
What is a common age range for children who experience febrile seizures?
What is a common age range for children who experience febrile seizures?
Which of the following is a risk factor for developing developmental delays in children?
Which of the following is a risk factor for developing developmental delays in children?
Which of the following is a recommended treatment for a child experiencing a febrile seizure?
Which of the following is a recommended treatment for a child experiencing a febrile seizure?
Which of the following is NOT a common sign of bacterial meningitis?
Which of the following is NOT a common sign of bacterial meningitis?
A child presents with a sudden onset of vomiting and headache, accompanied by a positive Babinski reflex. Which of the following is the most likely explanation for these symptoms?
A child presents with a sudden onset of vomiting and headache, accompanied by a positive Babinski reflex. Which of the following is the most likely explanation for these symptoms?
Which of the following age groups is most likely to experience a febrile seizure?
Which of the following age groups is most likely to experience a febrile seizure?
What is the most common cause of febrile seizures in children?
What is the most common cause of febrile seizures in children?
Which of the following is NOT a recommended treatment for a child experiencing their first febrile seizure?
Which of the following is NOT a recommended treatment for a child experiencing their first febrile seizure?
What is the recommended initial treatment option for a child experiencing a first febrile seizure?
What is the recommended initial treatment option for a child experiencing a first febrile seizure?
Which of the following is a potential complication of a febrile seizure?
Which of the following is a potential complication of a febrile seizure?
A patient presents with meningeal irritation. Which sign suggests a positive Brudzinski's sign?
A patient presents with meningeal irritation. Which sign suggests a positive Brudzinski's sign?
What is the recommended treatment for a child diagnosed with bacterial meningitis who is older than 6 weeks?
What is the recommended treatment for a child diagnosed with bacterial meningitis who is older than 6 weeks?
A child with bacterial meningitis requires immediate treatment to prevent which of the following complications?
A child with bacterial meningitis requires immediate treatment to prevent which of the following complications?
What is the recommended prophylactic treatment for individuals in close contact with a patient diagnosed with Neisseria meningitidis?
What is the recommended prophylactic treatment for individuals in close contact with a patient diagnosed with Neisseria meningitidis?
Which of the following factors increases the risk of developing a concussion?
Which of the following factors increases the risk of developing a concussion?
A child with suspected meningitis undergoes a lumbar puncture. Which of the following CSF findings would be characteristic of bacterial meningitis?
A child with suspected meningitis undergoes a lumbar puncture. Which of the following CSF findings would be characteristic of bacterial meningitis?
What should an athlete present with in order to be eligible for Return to Play after a concussion?
What should an athlete present with in order to be eligible for Return to Play after a concussion?
Which of the following is NOT a sign indicating the need for immediate medical attention after a concussion?
Which of the following is NOT a sign indicating the need for immediate medical attention after a concussion?
Which cranial nerve is primarily responsible for innervating the upper eyelid muscle?
Which cranial nerve is primarily responsible for innervating the upper eyelid muscle?
What is considered a hallmark sign of concussion that may arise immediately or shortly after injury?
What is considered a hallmark sign of concussion that may arise immediately or shortly after injury?
Which of the following is part of Step 2 in the Return to Play decision process?
Which of the following is part of Step 2 in the Return to Play decision process?
What should be the first step for medical evaluation following a concussion in an athlete?
What should be the first step for medical evaluation following a concussion in an athlete?
What is a key decision modifier in the Return to Play process?
What is a key decision modifier in the Return to Play process?
Which of the following is a symptom that may indicate worsening conditions after a concussion?
Which of the following is a symptom that may indicate worsening conditions after a concussion?
What is the classic triad of symptoms associated with pediatric bacterial meningitis?
What is the classic triad of symptoms associated with pediatric bacterial meningitis?
Which of the following is a significant risk factor for the occurrence of viral infections?
Which of the following is a significant risk factor for the occurrence of viral infections?
Which statement best describes the findings in a lumbar puncture for bacterial meningitis?
Which statement best describes the findings in a lumbar puncture for bacterial meningitis?
What does a positive Brudzinski's sign indicate?
What does a positive Brudzinski's sign indicate?
Which age group shows the highest incidence of bacterial meningitis cases?
Which age group shows the highest incidence of bacterial meningitis cases?
What is indicated by severe irritability and inconsolable crying in a newborn?
What is indicated by severe irritability and inconsolable crying in a newborn?
Which of the following factors increases the risk of developing viral infections?
Which of the following factors increases the risk of developing viral infections?
Which physical finding is often associated with increased intracranial pressure in newborns?
Which physical finding is often associated with increased intracranial pressure in newborns?
Which of the following is considered a primitive reflex that, if returned after walking, is abnormal?
Which of the following is considered a primitive reflex that, if returned after walking, is abnormal?
Which aspect of medical history is crucial when assessing for neurological deficits?
Which aspect of medical history is crucial when assessing for neurological deficits?
What type of diagnostic study is considered the gold standard for providing information on neurological conditions?
What type of diagnostic study is considered the gold standard for providing information on neurological conditions?
In a child with encephalitis, changes in motor function might present as what condition?
In a child with encephalitis, changes in motor function might present as what condition?
Which symptom is commonly associated with febrile seizures in children?
Which symptom is commonly associated with febrile seizures in children?
What is the significance of examining growth patterns like height and weight during a neurological evaluation?
What is the significance of examining growth patterns like height and weight during a neurological evaluation?
What condition involves a child with cerebral palsy exhibiting increased muscle tone?
What condition involves a child with cerebral palsy exhibiting increased muscle tone?
Which cranial nerve assessment involves testing the sense of smell?
Which cranial nerve assessment involves testing the sense of smell?
What type of seizure is characterized by lasting longer than 15 minutes and possibly recurring?
What type of seizure is characterized by lasting longer than 15 minutes and possibly recurring?
Which test is specifically designed to evaluate brain activity over time?
Which test is specifically designed to evaluate brain activity over time?
Flashcards
Reflexive Responses
Reflexive Responses
Involuntary reactions like vomiting or returning primitive reflexes, indicating abnormal neurological function.
Behavior Changes
Behavior Changes
Alterations in mood or consciousness, such as irritability or lack of attention, often signaling neurological issues.
Motor Function Changes
Motor Function Changes
Variations in movement coordination or muscle tone, often indicating neurological impairment.
Cranial Nerves Exam
Cranial Nerves Exam
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Deep Tendon Reflexes
Deep Tendon Reflexes
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Lumbar Puncture
Lumbar Puncture
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Febrile Seizure
Febrile Seizure
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Functional Health History
Functional Health History
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Evoked Response Tests
Evoked Response Tests
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Cranial Bruit
Cranial Bruit
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NICU Stay
NICU Stay
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Febrile Seizure Age Range
Febrile Seizure Age Range
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ROSEOLA
ROSEOLA
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Fever after Immunization
Fever after Immunization
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Meningitis Definition
Meningitis Definition
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Differential Diagnosis for Seizures
Differential Diagnosis for Seizures
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Drug Therapy for Febrile Seizures
Drug Therapy for Febrile Seizures
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Anticonvulsant Options
Anticonvulsant Options
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Concussion Symptoms
Concussion Symptoms
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Physical Findings of Concussion
Physical Findings of Concussion
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Diagnostic Tests for Concussion
Diagnostic Tests for Concussion
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Second Impact Syndrome
Second Impact Syndrome
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Return to Play Protocol
Return to Play Protocol
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HIB Vaccine Impact
HIB Vaccine Impact
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Parasitic Occurrence
Parasitic Occurrence
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Bacterial Infection Rate
Bacterial Infection Rate
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Risk Factors for Meningitis
Risk Factors for Meningitis
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Classic Triad Symptoms
Classic Triad Symptoms
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Kernig’s Sign
Kernig’s Sign
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Brudzinski’s Sign
Brudzinski’s Sign
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Diagnostic Tests for Meningitis
Diagnostic Tests for Meningitis
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Brudzinski Sign
Brudzinski Sign
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Meningitis Treatment
Meningitis Treatment
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Viral Meningitis Care
Viral Meningitis Care
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Bacterial Meningitis Antibiotics
Bacterial Meningitis Antibiotics
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ICP Monitoring
ICP Monitoring
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Concussion Definition
Concussion Definition
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Concussion Incidence
Concussion Incidence
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Signs of Concussion
Signs of Concussion
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Concussion Recovery
Concussion Recovery
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Meningitis Complications
Meningitis Complications
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Concussion Hallmark Signs
Concussion Hallmark Signs
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Minimum Waiting Period
Minimum Waiting Period
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Cranial Nerves for Eye Muscles
Cranial Nerves for Eye Muscles
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Cranial Nerve Testing
Cranial Nerve Testing
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Emergency Symptoms Post-Concussion
Emergency Symptoms Post-Concussion
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Importance of Medical Evaluation
Importance of Medical Evaluation
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Central Nervous System (CNS)
Central Nervous System (CNS)
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OLDCART for Symptoms
OLDCART for Symptoms
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Sensory Deficits
Sensory Deficits
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Headache Characteristics
Headache Characteristics
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Neurological Referral
Neurological Referral
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Ataxia
Ataxia
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Spasticity
Spasticity
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Primitive Reflexes
Primitive Reflexes
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Family Disease History
Family Disease History
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Milestone Loss
Milestone Loss
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Cranial Nerve Assessment
Cranial Nerve Assessment
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Electroencephalogram (EEG)
Electroencephalogram (EEG)
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Febrile Seizure Duration
Febrile Seizure Duration
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Meningitis Symptoms
Meningitis Symptoms
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Febrile Seizure Risk
Febrile Seizure Risk
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Roseola and Febrile Seizures
Roseola and Febrile Seizures
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Differential Diagnosis
Differential Diagnosis
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Initial Febrile Seizure Treatment
Initial Febrile Seizure Treatment
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Anticonvulsant for Children
Anticonvulsant for Children
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Meningitis Pathogens
Meningitis Pathogens
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Late Symptoms of Concussion
Late Symptoms of Concussion
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Diagnostic Tests After Concussion
Diagnostic Tests After Concussion
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Concussion Complications
Concussion Complications
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Occurence of Meningitis
Occurence of Meningitis
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Bacterial Meningitis Risk Factors
Bacterial Meningitis Risk Factors
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Altered Mental Status
Altered Mental Status
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Newborn Symptoms of Meningitis
Newborn Symptoms of Meningitis
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Follow Up After Concussion
Follow Up After Concussion
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Signs for Emergency Care
Signs for Emergency Care
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Symptoms of Concussion
Symptoms of Concussion
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Persistent Symptoms
Persistent Symptoms
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Emergency Symptoms
Emergency Symptoms
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Meningitis Risk Factors
Meningitis Risk Factors
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Classic Triad of Meningitis
Classic Triad of Meningitis
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Newborn Meningitis Symptoms
Newborn Meningitis Symptoms
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Lumbar Puncture Purpose
Lumbar Puncture Purpose
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Bacterial vs. Viral Meningitis
Bacterial vs. Viral Meningitis
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Age Prevalence for Meningitis
Age Prevalence for Meningitis
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Emergency Signs Post-Concussion
Emergency Signs Post-Concussion
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Concussion Recovery Time
Concussion Recovery Time
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Concussion Follow Up
Concussion Follow Up
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Concussion and Irritability
Concussion and Irritability
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Primitive Reflexes Return
Primitive Reflexes Return
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Neuro Exam Order
Neuro Exam Order
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Febrile Seizure Types
Febrile Seizure Types
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Common Cause of Febrile Seizure
Common Cause of Febrile Seizure
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Treatment for Febrile Seizure
Treatment for Febrile Seizure
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Immediate Febrile Seizure Care
Immediate Febrile Seizure Care
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Bacterial Causes of Meningitis
Bacterial Causes of Meningitis
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Signs of Meningitis
Signs of Meningitis
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Bacterial Meningitis Treatment
Bacterial Meningitis Treatment
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Complications of Meningitis
Complications of Meningitis
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Immunization for Meningitis
Immunization for Meningitis
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CNS Influence
CNS Influence
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OLDCART
OLDCART
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Febrile Seizure Treatment
Febrile Seizure Treatment
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Meningitis Etiology
Meningitis Etiology
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Common Causes of Meningitis
Common Causes of Meningitis
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Referral for Febrile Seizure
Referral for Febrile Seizure
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Febrile Seizure Recurrence Risk
Febrile Seizure Recurrence Risk
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Occurrence of Viral Meningitis
Occurrence of Viral Meningitis
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Symptoms in Newborns
Symptoms in Newborns
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Emergency Symptoms for Meningitis
Emergency Symptoms for Meningitis
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Gower’s Sign
Gower’s Sign
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Autonomic Nervous System
Autonomic Nervous System
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Functional Health Context
Functional Health Context
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MRI
MRI
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Study Notes
Neurological Disorders
- Neurological disorders significantly impact a child's overall health.
- Identifying normal and abnormal neurologic function, and knowing when to refer to specialists, is crucial for healthcare providers.
- Extensive knowledge of Central and Peripheral Nervous System anatomy and physiology is essential (Burns, chapter 28).
History
-
Onset/Symptoms (OLDCART):
- Pain/headache characteristics (dull, sharp, etc.), time of day, changes in vision (double vision, photophobia), and balance problems are key aspects.
- Sensory deficits encompassing hearing, taste, vision, smell, vertigo, and numbness/tingling should be noted.
- Injury details: time of occurrence, type (accidental vs. non-accidental), and treatment provided are important.
- Reflexive responses: vomiting (a potential tumor sign), coughing, returning of primitive reflexes (abnormal), tics, and clonus are indicators.
- Behavior changes: loss of control (LOC), irritability in newborns with neuro deficits, stupor, lack of attention (adolescents), and emotional liability are crucial details to obtain.
- Motor and balance changes: ataxia (child with encephalitis), spasticity (cerebral palsy), changes in muscle tone are essential observations.
-
History continued:
- Medical history encompasses maternal, paternal, birth history (traumatic, preterm, full term), and childhood illnesses/injuries.
- Family history of genetic disorders, consanguinity, intellectual functioning, and migraine history should be considered.
- Developmental history focusing on the loss of milestones in language, gross/fine motor skills, and social skills should be noted.
- Functional health assessment includes safety, nutrition, elimination, activity, communication, and sleep.
- Social context regarding family composition, culture, financial status, and social support is critical.
- Review of Systems, including growth patterns (height, weight, BMI), should be included.
Neurological Exam
- The examination proceeds from higher to lower levels of functioning.
- Cerebral function assessment includes testing cortical functions.
- Cranial nerves (I-XII): testing each nerve is important (critical for certification).
- Evaluate motor function (Gait, posture, coordination, balance, strength, symmetry), including Gower's sign, muscle tone, involuntary movements, and reflexes, symmetry (key).
- Assess sensory function including pain sensation, stereognosis, and identifying objects in the hand.
- Deep tendon reflexes, superficial reflexes, and primitive reflexes should be tested (abnormal reflexes warrant investigation). Assessing symmetry is critical.
Physical Exam Continued
- Examining the Cranium:
- Head circumference (up to 2 or 36 months).
- Inspect for asymmetry or abnormal size variations.
- Auscultate for cranial bruits.
- Palpate for cracked pot sounds and injuries to the anterior fontanelle.
- Autonomic Nervous System:
- Vital signs (BP, sweating, body temperature) are important in identifying autonomic function alterations.
- Meningeal Signs:
- Assess for Positive Kernig and Brudzinski signs. Important to perform these for meningeal infections.
Diagnostic Studies
- Labs: Blood tests (CBC, LFTs, serum glucose, drug levels) for indicators of systemic disease, infection, or inflammation are critical in evaluating neurologic function.
- MRI: Gold standard imaging for detailed information.
- Lumbar Puncture: Cerebrospinal fluid (CSF) analysis for meningitis/encephalitis.
- Evoked Response Tests: Electroencephalogram (EEG) evaluates brain activity.
- Brain Auditory Evoked Response (BAER) for visual interpretation.
- Somatosensory Evoked Potential studies (SSEP).
- Electromyogram (EMG) assesses muscle activity and brain interpretation of stimuli.
Febrile Seizure
- This is the most common type of seizure in children.
- Characterized by brief, generalized, clonic, or tonic seizures.
- Occurring concurrently with rapid fever (102.2°F or higher/39.0°C).
- Often accompanied by minimal post-ictal confusion.
- Simple febrile seizures last less than 15 minutes.
- Complex febrile seizures last longer than 15 minutes and can recur.
- Epilepsy involves multiple seizures leading to brain damage, lasting minutes to hours.
Etiology/Incidence
- Unclear causes including underlying CNS problems.
- Familial tendencies (sibling/parent with febrile seizures) increase the risk.
- Preexisting risk factors (NICU stay >30 days, developmental delays, daycare) may increase risk.
- Children aged 6 months to 60 months are most susceptible
- Boys are more commonly affected.
- Evaluate for low sodium levels. Low sodium levels should be monitored.
- Familial incidence increases risk.
Facts
- Post-immunization fevers, especially with MMR, commonly occur 8-14 days after immunization.
- Fevers resulting from viral or bacterial infections can cause febrile seizures.
- Roseola is a common cause of febrile seizures.
- Referrals to neurologists are required for proper diagnosis and treatment initiation. CPR is critical knowledge. AEDs are typically prescribed, especially after a second seizure.
Differential Diagnosis
- Possible causes of seizures include sepsis, meningitis, metabolic/toxic encephalopathy, hypoglycemia (especially in adolescents, anoxia, trauma, and tumors, and hemorrhages.
- Differentiating febrile delirium from seizures is crucial.
Treatment for Febrile Seizures
- Initiate drug therapy rapidly to reduce seizure duration.
- Use antipyretics like ibuprofen or acetaminophen to control fever.
- Primary anticonvulsant choice: diazepam, with dosage dependent on age.
- Secondary options like fosphenytoin (Cerebyx). Tertiary options are diazepam and lorazepam IV.
Meningitis
- Etiology:
- Viral: Enteroviruses (90% of cases), herpes simplex virus type 2, varicella-zoster virus, important to differentiate from bacterial.
- Bacterial: Neonates - group B strep, E. coli, Listeria monocytogenes, other bacterial considerations include viral variations.
- Older children: Neisseria meningitides, strep pneumonia, Haemophilus influenza type B (pre-vaccine era).
- Parasitic causes are also possible.
Occurrence of Meningitis
- Viral meningitis is more common in the late summer and fall (10.9 per 100,000).
- Bacterial meningitis occurrence rate is 3 per 100,000 annually.
- Risk factors include crowding, prolonged exposure in daycare, military, or college dormitories, and compromised immune systems.
- Most cases occur before the age of 5 years, with reduced incidence where vaccination rates are high.
- Variations in occurrence exist between different races.
- Viral meningitis has a higher occurrence rate in males.
Clinical Manifestations of Meningitis
- Classic triad: severe headache, nuchal rigidity (stiff neck), and high fever. Testing of neck extension in infants.
- Altered mental status: confusion, extreme irritability, sleepiness, abnormal high-pitched cry.
- Seizures, sensitivity to light.
Physical Findings of Meningitis
- Newborns: inconsolable crying, excessive sleepiness and irritability, poor feeding, bulging fontanels suggest increased ICP, stiff neck, Kernig's sign, Brudzinski's Sign.
- Diagnostic tests: lumbar puncture (LP) for cloudy CSF, low glucose, elevated WBC count (especially in bacterial cases), elevated protein levels (greater in bacterial cases), and cultures/gram stains. Blood tests (CBC, CMP, blood cultures, C-reactive protein, ESR). Evaluate for potential tumors/abscesses via CT or MRI.
Kernig's and Brudzinski's Signs
- Kernig's Sign: Pain and resistance with flexing the hip and extending the knee. Bilateral positivity suggests a greater likelihood of meningeal irritation.
- Brudzinski's Sign: Involuntary flexion of the hips and knees when the neck is flexed.
Concussion (p. 885)
- Alteration in mental status: after a blow to the head. Loss of consciousness may not always occur.
- Etiology: TBI from bump, blow, or jolt to the head. Rapid back-and-forth head movement during falls, MVA, players colliding.
- Occurrence: ~135,000 sports-related concussions each year in children (ages 5-18). Increased risk in athletes who have had a concussion previously. More likely for children and teens to have a more prolonged recovery than adults.
Clinical Manifestations of Concussion
- Hallmark signs: confusion, amnesia immediately or minutes after head injury.
- Early symptoms (minutes-hours): confusion, headache, dizziness/vertigo, balance issues, lack of awareness, nausea, and vomiting; no loss of consciousness.
- Late symptoms (days-weeks): persistent headache, lightheadedness, poor attention, fatigue, irritability, photosensitivity, anxiety, depression.
Physical Findings of Concussion
- Vacant stare, delayed verbal and motor responses, confusion, disorientation, slurred speech, incoordination, memory deficits, emotional disturbance (if any unconsciousness) warrant evaluation.
Diagnostic tests and Treatment of Concussion
- Diagnostic tests: Sideline/immediate evaluation (ABCs) CT if appropriate. Orientation questions, attention (digits/months), memory recall, neurological tests, evaluation of pupils, coordination, sensation, cranial nerves II, IV, VI, VII (EOMs-extraocular movements, facial movements), GCS and SCAT5 (Sport Concussion Assessment Tool). Assess for Unequal pupils, drowsiness, worsening headache, weakness, numbness, repeated vomiting, slurred speech, increased confusion, inability to recognize people/places, loss of consciousness
- Treatment: Remove athlete from activity. Monitor neurologic changes. Should be evaluated in the ED if loss of consciousness, GCS <15, recurrent vomiting, abnormal bleeding. Explain to coaches/parents.
- Athletes need to be cleared of symptoms to return to play.
Complications of Concussion
- Seizures (immediately or days later)
- Second impact syndrome: repeat concussion before recovery from previous one. Increased risk of long-term complications such as brain damage, swelling, or even death.
- Depression.
- Blood clots in the brain (rare).
- Headaches.
Follow-up after Concussion
- Repeat impact test (immediate, cognitive testing)
- Call or go to ED for significant symptoms (unequal pupils, drowsiness, worsening headache, weakness, numbnes, repeated vomiting, slurred speech, increased confusion, inability to recognize people/places, loss of consciousness).
Return to Play after Concussion
- State laws vary. Minimum 7 days waiting period after concussion. Athletes must demonstrate symptom-free status.
- Return to play is a 3-step process.
- Step 1: PCP assessment of medical factors for healing.
- Step 2: PCP evaluation of participation risk (protective factors - equipment, helmets).
- Step 3: Decision modifiers (return considerations).
Important Clinical Question (Example)
- A 14-year-old male was treated in the office after being tackled during a football scrimmage. Clinical manifestations of a concussion include confusion and amnesia, key manifestations (nausea, vomiting, headache, irritability).
Cranial Nerve Innervation of the Eyes
- Cranial nerves III, IV, and VI innervate the extraocular muscles for eye movement, eyelid drooping assessment, pupillary equality, and accommodation. Important to test for equality/symmetry of pupils for accurate assessment.
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Description
Test your knowledge on the treatment and signs of meningitis and concussions in infants and children. This quiz covers critical aspects including clinical manifestations, complications, and preventive measures. It's essential for anyone studying pediatric healthcare.
