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phase 3a - paediatrics > Neuro > Flashcards

Neuro Flashcards

1
Q

What are some causes of gross motor delay?

A
  • Cerebral palsy
  • Ataxia
  • Myopathy
  • Spina bifida
  • Visual impairment
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2
Q

What are some causes of fine motor delay?

A
  • Dyspraxia
  • Cerebral palsy
  • Muscular dystrophy
  • Visual impairment
  • Congenital ataxia (rare)
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3
Q

What are some causes of global developmental delay?

A
  • Down’s syndrome
  • Fragile X syndrome
  • Rett syndrome
  • Foetal alcohol syndrome
  • Metabolic disorders
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4
Q

What are some causes of language delay?

A
  • Specific social circumstances - multiple languages, siblings do all talking
  • Hearing impairment
  • Learning disability
  • Neglect
  • Autism
  • Cerebral palsy
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5
Q

What is a potential management option for language delay?

A

SALT, audiology and health visitor; consider referring to safeguarding

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6
Q

What are potential causes of personal and social delay?

A
  • Emotional and social neglect
  • Parenting issues
  • Autism
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7
Q

What is a febrile convulsion?

A

Seizure occurring in a child with a high fever

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8
Q

What age children will experience febrile convulsions?

A

6 months to 5 years of age

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9
Q

What characterizes a simple febrile convulsion?

A

Generalized, tonic clonic seizure; <15 minutes - only during single febrile illness

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10
Q

What characterizes a complex febrile convulsion?

A

Partial or focal seizure; >15 minutes, multiple times during same febrile illness

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11
Q

What is the typical presentation of a patient with a febrile convulsion (consider age too)?

A

~18 months, 2-5 minute tonic-clonic seizure during high fever. Fever caused by underlying viral infection (e.g. tonsillitis)

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12
Q

What are key differentials to consider when a child presents with a possible febrile convulsion?

A
  • Epilepsy
  • Meningitis, encephalitis, other neuro issue (e.g. cerebral malaria)
  • IC space occupying lesions (e.g. brain tumour, IC haemorrhage)
  • Syncopal episode
  • Electrolyte abnormalities
  • Trauma (consider safeguarding)
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13
Q

What would prompt an ambulance to be called when a child suffers a possible febrile convulsion?

A

> 5 minutes (1st episode should be trip to hospital anyway)

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14
Q

Which carries higher risk of future epilepsy development: simple/complex febrile convulsions?

A

Simple slightly higher than gen. population
Complex 10-20% higher (worse prognosis)

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15
Q

What are the clinical feature of generalized tonic-clonic seizure?

A
  • Tonic-clonic
  • Tongue biting
  • Incontinence
  • Groaning
  • Irregular breathing
  • Post-ictal period
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16
Q

What is the 1st line management for generalized tonic-clonic seizure?

A

Sodium valproate

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17
Q

What is the 2nd line management for generalized tonic-clonic seizure?

A

Lamotrigine, carbamazepine

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18
Q

What are the clinical features of focal seizures?

A
  • Temporal lobe; hearing, speech, memory emotions (hallucinations, memory flashback, déjà vu, autopilot)
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19
Q

What is the 1st line management for focal seizures?

A

Carbamazepine
Lamotrigine

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20
Q

What is the 2nd line management for focal seizures?

A

Sodium valproate
Levetiracetam

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21
Q

What characterizes a absence seizure?

A

Blank and staring into space before returning to normal after around 10-20 seconds.

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22
Q

What is the 1st line management for absence seizure?

A

Sodium valproate or ethosuximide

23
Q

What characterizes a atonic seizure?

A

Drop attack, usually <3 minutes

24
Q

What is the 1st line management for a atonic seizure?

A

Sodium valproate

25
Q

What is the 2nd line management for a atonic seizure?

A

Lamotrigine

26
Q

What are the clinical features of myoclonic seizure?

A

Sudden, brief muscle contractions - jumping (often as part of juvenile myoclonic epilepsy)

27
Q

What is the 1st line for a myoclonic seizure treatment?

A

Sodium valproate

28
Q

What is the treatment for infantile spasms?

A

Often carries poor prognosis
Pred, vigabatrin

29
Q

What are investigations that are performed for a child who has suffered seizures?

A

EEG, MRI
ECG, blood electrolytes, blood glucose, blood cultures/urine cultures/LP.

30
Q

When should an EEG be considered for a patient suffering seizures?

A

After 2nd simple tonic-clonic seizure

31
Q

What would lead to an MRI being requested for a patient suffering a seizure?

A

1st seizure child <1 year old
Focal seizure
No response to 1st line anti-epileptic medication

32
Q

What should be given should the patient be in status epilepticus and suffering seizures for 10 minutes?

A

IV Lorazepam

33
Q

A patient suffering status epilepticus who has become more stable and after lorazepam should be given?

A

IV phenytoin or phenobarbital (+intubate and ventilate)

34
Q

What is status epilepticus?

A

> 5 minute seizure or 2 or more seizures without regaining consciousness

35
Q

What are side effects of sodium valproate?

A
  • Teratogenic - try to avoid in pregnancy age girls
  • Liver damage and hepatitis
  • Hair loss
  • Tremor
36
Q

What are the side effects of carbamazepine?

A
  • Agranulocytosis
  • Aplastic anaemia
  • P450 system induction so beware of many drug interactions
37
Q

Which system can be stimulated as a side effect of carbamazepine?

A

P450 system

38
Q

What are the side effects of phenytoin?

A
  • Folate and vitamin D deficiency
  • Megaloblastic anaemia
  • Osteomalacia
39
Q

Which types of anaemia is caused by carbamazepine and phenytoin respectively?

A

Carbamazepine - aplastic anaemia
Phenytoin - megaloblastic anaemia

40
Q

What are the side effects of ethosuximide?

A

Night terrors
Rashes

41
Q

What are the side effects of Lamotrigine?

A
  • Steven-Johnson syndrome
  • DRESS syndrome
  • Leukopenia
42
Q

What is cerebral palsy?

A

Permanent non progressive condition resulting from damage to the brain around the time of birth
(huge range in symptom severity)

43
Q

What are antenatal causes of cerebral palsy?

A
  1. Maternal infection
  2. Trauma during pregnancy
44
Q

What are perinatal causes of cerebral palsy?

A
  1. Birth asphyxia
  2. Pre-term birth
45
Q

What are postnatal causes of cerebral palsy?

A
  1. Meningitis
  2. Severe neonatal jaundice
  3. Head injury
46
Q

Pathophysiology of spastic hypertonia?

A

Damage to the UMN causing increased tone

47
Q

What is the pathophysiology of dyskinetic cerebral palsy?

A

Basal ganglia are damaged - athetoid movements, oro-motor problems; hyper/hypotonia

48
Q

What is the pathophysiology of ataxic cerebral palsy?

A

Cerebellum damage - coordinated movement problems

49
Q

What is the pathophysiology of mixed cerebral palsy?

A

Spastic, dyskinetic and/or ataxic features mix

50
Q

Name the patterns of cerebral palsy?

A

Monoplegia - one limb
Hemiplegia - one side of the body
Diplegia - four limbs mostly legs
Quadriplegia - four limbs affected more severely (seizures, speech disturbance, other impairments).

51
Q

What is the tale-tale sign of a potential cerebral palsy diagnosis?

A

Hand preference prior to 18 months

52
Q

What may be found on neurological examination for a patient with cerebral palsy?

A

Increased muscle tone and spasticity in legs
Hemiplegic/diplegic gait
UMN signs (muscle bulk preserved, hypertonia, slightly reduced power, brisk reflexes)
Athetoid movements
Cerebellar involvement - coordination may need testing

53
Q

Who may be involved in the care of a complex cerebral palsy patient?

A

MDT to include:
- Physio
- OT
- SALT (consider NGT or PEG)
- Dietician
- Orthopaedic surgeon
- Paediatrician (medication control)
- Social worker
- Charity and support group

54
Q

What medication may be prescribed by a paediatrician for a cerebral palsy patient?

A

Muscle relaxants - baclofen
Anti-epileptic medication
Glycopyrronium bromide (drooling)

phase 3a - paediatrics (11 decks)

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