CLIPP 19

Question 1

what ages is toxin ingestion most likley

Answer 1

9m and 3y

Question 2

epilepsy defn

Answer 2

2+ unprovoked seizures

Question 3

30-40% kids with meningitis can present w/ __ and may only see _ on exam

Answer 3

seizure activity - may only see fever and irritability on exam

Question 4

common causes of encephalitis in kids are

Answer 4

enterovirus, herpes

Question 5

intussusception is usually involving

Answer 5

TI telescoping into colon and in between colicky states can have lethargy and near-unresponsiveness, as well as vol loss due to vomiting and third spacing–>AMS ~ to dehydration

Question 6

breath holding spells can lead to

Answer 6

syncope - there is a precip event typically that upsets child and this leads to crying and hyper vent and expiratory apnea –>pale and cyanotic and brief LOC and limp

• typically these self resolve but occ., can lead to brief ten seizure due to hypoxia
• no post octal state in syncope due to beaht holding

Question 7

most common type of seizure in kids

Answer 7

tonic clonic aka grand map -this type of seizure event begins abruptly with tonic (rigid) stiffening of all extremities and upward deviation of the eyes.
Clonic jerks of all extremities follow the tonic phase.
Finally, the child becomes flaccid and urinary incontinence may occur.

Question 8

simple partial

Answer 8

start in one extremity or on one side but can spread making it hard to distinguish from tonic clonic

Question 9

complx partial

Answer 9

alteration of consciousness is hallmark -
Signs and symptoms of this type of seizure tend to localize around the eyes (glassy-eyed), the mouth (lip-smacking, drooling, gurgling), and the abdomen (nausea and vomiting).
Automatisms are quasi-purposeful motor or verbal behaviors that are repeated inappropriately and commonly accompany complex partial seizures.
Complex partial seizures often last 30 seconds to 2 minutes and are associated with a postictal phase of confusion, sleep, or headache.
Secondary generalization can occur in up to one third of children, so it is important to question witnesses about initial features to help differentiate a complex partial seizure from a generalized seizure

Question 10

what age ~ do petit mal seizures start

Answer 10

3 yo, characterized by loss of environmental awareness (“staring off into space”) and automatisms (e.g., eye-fluttering or lip-smacking).
While these are generalized seizures, children usually regain their consciousness more quickly than the postictal phase seen in a generalized tonic-clonic seizure.
Absence seizures are not associated with loss of tone or urinary continence.
Absence seizures can be precipitated by hyperventilation or photic stimulation.

Question 11

petit mal =

Answer 11

absence

Question 12

which type of seizure is typically not assoc w loss of tone or urianry incont

Answer 12

absence/petit

Question 13

things that can help u distinguish seizure from seizure like activity

Answer 13

A history of alteration of consciousness or loss of consciousness
Incontinence
Deviation of the eyes
Often rhythmic motor movements that cannot be stopped by touching or holding the child
A postictal state.
To address these issues, you may want to ask whether the child was distractible, and if the event could be interrupted. In addition, children who are old enough to verbalize may describe an aura or “premonition” prior to the onset of a seizure, or caregivers may be able to articulate unusual behavior just prior to the even

Question 14

febrile seizures are /are not tonic clonic - typical ages, what does presence of fever mean, assoc between fever and seizure

Answer 14

are tonic clonic, 6m to 5y, fever may cause seizure or may coincidentally be there, can be viral benign infectetion that causes fever that causes seizure, or can have infection that causes not just fever but also seizure

Question 15

if pt w seizure has a fever you must

Answer 15

investigate both the sources of seizure and of fevr

Question 16

rapid seizure recovery makes this unlikely

Answer 16

hypoglycemia

Question 17

presence of fever means these measurement

Answer 17

(temperature > 38 degrees C or 100.4 degrees F)

Question 18

what time periods are key for things that can cause seiure

Answer 18

prenatal, peri and neonatal

Question 19

stoops and recovers, uses 4-6words consistently, follows basic commands, uses spoon and cup w/ occas. spilling = by which age should you reach all these

Answer 19

Abnormalities in neurodevelopmental maturation could suggest serious underlying disease in a child with seizures. On the other hand, you would expect most children with febrile seizures to be developmentally normal.

Pre-existing developmental abnormalities are a risk factor for subsequent epilepsy.

Question 20

Pre-existing developmental abnormalities are a risk factor for subsequent _

Answer 20

epilepsy

Question 21

are febrile seizures hereditary

Answer 21

yes- 8q13-21 (often called FEB1), 19p (FEB2), 2q 23-24 (FEB3) and others.

Question 22

febrile seizures often occur on fever day _ w/ fever > degrees and are often this type of seizure

Answer 22

1, 38, generalized

Question 23

seizure related to head injury typically occurs _ hours after injury

Answer 23

1-2

Question 24

symptomatic vs idiopathic epilepsy

Answer 24

symptomatic = kid w/ epilepsy w/ developmental delay due to development, congenital or acquired disorders
idiopathic = kid w/ epilepsy who is developmentally normal

Question 25

duration of seizures w/ breath holding spells

Answer 25

generally quite brief

Question 26

seizure from brain tumor or other intracranial mass typically presents as this type of seizure

Answer 26

partial

Question 27

occult bacteremi

Answer 27

febrile kids w/o discernible foci of infection may have this - usually due to strep pneumo. hib uncommon here now due to vaccine. undiagnosed, can lead to serious bacterial infxn (septic arhtirirst, osteomyel, pneumonia, uti, bacterial gastro, meningitis. occult is also a type of sbi)

Question 28

meningitis in young kids

Answer 28

clinical signs and sx of this can be subtle thus it stays on the ddx even if meningieal signs are (-)

Question 29

viral culture thing to remember

Answer 29

takes at least 2 days to return. can do direct antigen testing etc that is faster if needed

Question 30

when doing UA/UC

Answer 30

specimen only is as good s the samepl -thus have to cath typically. typically do in females <12 months if not circ.

Question 31

Sometimes a _ is performed before a lumbar puncture in the work-up for infection. This is only necessary when there are concerns for elevated intracranial pressure.

Answer 31

CT

Question 32

_ and _ have characteristic EEG findings of _ and _

Answer 32

absence seizures and infantile spasms have characteristic EEG findings such as 3-Hz spike-and-wave pattern and hypsarrhythmia,

Question 33

CT vs MRI in epilepsy work up

Answer 33

CT for calcifications like in tuberous sclerosis, CMV
MRI frequently performed in epilepsy evaluation - more likely to be abnormal in kids w/ focal rather than generalized or febrile seizures, and has better rez than CT thus can better ID temporal sclerosis, vascular malformation and parnecyhmal malformation

Question 34

LP - spine level, what you feel as dr, opening pressure

Answer 34

L3-4 or L4-5, feel a pop except in neonates, drip the fluid into tubes don’t aspirate it ,opening pressure not of value of pt is struggling , and less accurate if neck nd thighs are flexed

Question 35

meningitis complicatiosn

Answer 35

stroke, subdural effusion, siadh. also sequelae like dvpt delay, seizure, hearing loss

Question 36

meningits tx

Answer 36

3rd gen IV ceph + vanc for 7-14 days. often given pending culture results and in serious cases, even before cultures drawn

Question 37

cause of bacterial men in immunized 2 month to 2 yo=

and in yonger infants =

Answer 37

SP, NM

Ecoli, GBS (agalactie)

Question 38

truamatic tap

Answer 38

needle penetrates blood vessel. wbc typically mean infection but in traumatic tap mean its from blood contaminant. hard to sometimes differentiate traumatic from hemorrhage. if can’t determine if the tap is truatmic or truly illness, admit for iv abx til csf culture is neg.
Often a RBC/WBC ratio of approximately 250:1 is used. This can be generated by looking at the patient’s CBC and dividing the RBC count (in millions/microliter) by WBC (in thousands/microliter). - helps determine true deg. of csf leukocytosi but is rough estimator.

Question 39

viram meningitis LP results in terms of csf protein, glucose, wbc, csf glucose:blood glucose ratio

Answer 39

protein, glucose and ratio are normal
wbc are high

Patients with viral meningitis (often caused by enteroviruses) will have a CSF pleocytosis (D), usually with a CSF WBC count ranging from 20 to 200 WBC/hpf.

Lymphocytes are generally predominant, but some patients may have a predominance of CSF polymorphonuclear cells in the first 24 to 48 hours of their infection.
Patients with meningoencephalitis due to herpes virus may also have an elevated RBC count in the CSF.

Question 40

classification of febrile seizure

Answer 40

simple vs complex (not the same as simple and partial!)

simple= more common, less tha n15 min, once in a 24h period , generalized

Question 41

if kid has first febrile seizure under 12 months, risk of recurrence is _ vs if after 12 montsh

Answer 41

50%, 30%

Question 42

epilepsy and debrile seizures

Answer 42

if many recurrent early febrile seizures, can up the chance of epilsepy . This is to be compared to essentially the same risk as the normal population in a child with one or two simple febrile seizures and no other features.

Question 43

This medication is effective in preventing recurrence of simple febrile seizures but also has a high side effect profile.

Answer 43

primidone

Question 44

This medication is effective in preventing recurrence of simple febrile seizures but carries with it the dreaded side effect of hepatotoxicity.

Answer 44

valproic acid

Question 45

Has not been shown effective in preventing febrile seizure recurrence.

Answer 45

carbamez, phentyotin

Question 46

given at the start of the febrile illness, can be effective in preventing recurrent febrile seizures.

Answer 46

diazepam - but since some fevers might have sizure as presenting sx, its not always effective - also the SE profile can cloud impacts of CNS disease thus it is not reocmmended

Question 47

– is effective in preventing recurrence of simple febrile seizures when given regularly and the drug levels remain in therapeutic range.
Studies have shown that there is poor adherence to therapy and serious side effects in at least 20% of patients.

Answer 47

phenobarb

Question 48

do ibu and tylnole help rpevent recurrent febile seizure

Answer 48

no

Question 49

bulging fontanelle can mean

Answer 49

roseola

Question 50

common febrile rash illness of infants and young children under 2 years of age.

Answer 50

roseola aka Roseola infantum (also known as exanthem subitum, or sixth disease or hhv6)

Question 51

Primary– infection is associated with approximately 20% to 30% of first febrile seizures in children.

Answer 51

HHV6

Question 52

ABsence vs generalized seiure recovery

Answer 52

both are generalized seizures but in absence, you recover within 30ish seconds

Question 53

ETEC

Answer 53

is the strain of E. coli that commonly causes traveler’s diarrhea, a noninvasive infection without WBCs in the stool. Diarrhea is typically watery and contains no blood.

Question 54

organism that can –>seizure

Answer 54

Shigella sonnei causes bloody diarrhea and WBCs in the stool on Wright stain. Rarely, children infected with Shigella can suffer from seizures due to neurotoxin release.

Question 55

is rota virus assoc w/ seiure

Answer 55

Rotavirus is the most common cause of infectious gastroenteritis. It is an RNA virus that does not cause WBCs to appear in the stool, and typically does not cause bloody diarrhea. Diagnosis is made using ELISA. Rotavirus is not associated with seizures.

Question 56

eeg indicatiins

Answer 56

recuuent focal or complex seizure