Nervous system

Question 1

4 types of cerebral palsy

Answer 1

Spastic - increased tone, pathological reflexes
Athetoid - hyperkenesis - stormy movements - increased intermittent activity
Ataxic - loss of orderly co-ordination
Mixed

Question 2

Management of cerebral palsy

Answer 2

MDT - physio, OT, SALT, play/education therapists
Splints, mobility aids

Muscle relaxant - Baclofen, botox

Question 3

Clinical features of a febrile fit?

Answer 3

Children aged 6 months - 5yrs
High temperature
Generalised tonic-clonic seizure - usually the only event in that episode of illness

May be with tongue biting, inconitence, post-ictal drownsiness

if >15 mins, with focal signs - complex
If >30 mins - febrile status epilepticus

Question 4

Advice to give with febrile fits?

Answer 4

cant prevent with anti-pyretics
Dont advice cooling measures - cold baths, sponges

Likely to recur but in another episode of illness
No increased risk of developing epilepsy - same as general population

Question 5

Common types of epilepsies?

Answer 5

Petit mal (absence seizures)
Infantile spasms - think West syndrome
Tonic-clonic
Myotonic-  muscle spasms affecting one part of the body
Atonic - postural drops
Focal - specific part of the brain
Temporal - disturbed smell, sounds

Question 6

Stepwise management of active seizure?

Answer 6

1) make safe, protect head, START TIMER
2) 5 mins - buccal midazolam/rectal diazepam
- after 5 mins repeat, and call ambulance at 10 mins
3) Phenytoin/phenybarbitone infusion
4) Rectal paraldehyde
5) RSI with Thiopentone

Question 7

IHS criteria for diagnosis of migraine without aura?

Answer 7

5 attacks, lasting 2 - 72hrs
\+uni/bilateral
throbbing
moderate-severe intensity
aggravated by routine activity
N+V+ photophobia

Question 8

What is important to exclude in plagiocephaly and what is its management

Answer 8

Lamboid synostosis (fused suture)

Mx is reassurance, tummy time - will get less as the child gets older, spends more time upright
Helmet therapy not recommended

Question 9

Clinical features of muscular dystrophy?

Answer 9

X-linked recessive
Progressive, degenerative muscle weakness
Gower’s sign, calf hypertrophy

Loss of walking by age 12
On ventilatory support by age 25-30

Question 10

Management of DMD?

Answer 10

Low dose corticosteroid therapy (Pred 0.75mg/Kg)
Physio + exercise
Cardioprotective drugs - lisinopril
Surgery for contractures