Neuro

Question 1

Absence seizures

Answer 1

Females

Periods of absence/ stop what they are doing  but they remain conscious 
Can be misdiagnosed as 
- ADHD
- Behavioural problems
- Hearing problems 
- NAI 

EEG - 3Hz spike and wave
Hearing test
ADHD assessment

Management
Valproate
Ethosux
Not carbemazapine

Prognosis

• can –> JME in later life
• Can –> tonic clonic

Question 2

prognosis of absence

Answer 2

10% –> JME

can also –> tonic clonic

Question 3

JME

Answer 3

Presentation
Throwing their cornflakes - jerky movements
Teens - females
can be absence seizure in childhood then –> JME
can also have absence + TC

EEG - polyspike and wave

Management
Valproate

Not associated with other conditions later in life but need to be on lifelong Rx

Question 4

West syndrome

Answer 4

Salaam attacks - can be up to 50 times
lasts 1-2 seconds per jerk
INFANTILE SPASMS - 4-6 months

EEG - hypsarrythmia

Management
Vigabatrin

Prognosis - poor
progressive mental handicap

Question 5

Febrile seizure

Answer 5

when there is a RAPID RISE in temp
eg remember roseola infantum

Give paracetamol to bring temp down

partial = 1-2% risk of developing epilepsy
Complex = 2-4% risk of developing epilepsy
Future febrile seizure risk 1/3

Tonic clonic risk in later life

Management
buccal midaz
rectal diazepam

When to worry 
>1hr to recover 
Partial seizure 
1st seizure 
>1 in 24hrs 
>15m

Question 6

Lennox gestau

Answer 6

Ketogenic diet

Question 7

ADHD

Presentation

Answer 7

epidemiology
4-7%
Males

1) Inattention
2) Hyperactivity
3) Impulsivity

Investigations
- School nurse reports, school reports, home report

Management 
- watch and monitor for 10 weeks 
- ADHD parenting program 
- Pharmacological 
methylphenidate (trial for 6w)
Lisdexamphetamine 

Monitor weight as can cause reduced appetite and weight loss, stunted growth
Cardiotoxic - do ECG

Question 8

Autism

Answer 8

Triad

1) Global language +communication impairment
2) Impaired social skills
3) Repetitive, ritualistic

Investigations

Management
timetables
parenting therapy
Applied behavioural analysis

Complications

• Learning difficulties
• Seizures

Question 9

Congenital cataracts

Answer 9

associated with rubella
Loss of light reflex
done

Question 10

Squints

Answer 10

Aetiology
- 60% hereditary

Types
Concomitant - imbalance of extra-ocular muscles - usually convergent

Paraplegic - paralysis of one or more extra ocular muscles (rarer) - sinister - can be due to SOL

Investigations

• Cover test
• Corneal light reflex - should reflect back symmetrically
• visual acuity test
• MRI if suspect sinister lesion

Management 
- prevent amblyopia 
Patch 
Glasses 
Prism 
Surgery - to cut the muscles

Question 11

Cerebral palsy

Types + presentation

Answer 11

Types 
1) Spastic 
Damage to the motor cortex - UMN - cerebral malformation eg maternal infection 
Symptoms 
- ^tone, ^ reflexes, upping plantars, clasp knife 
Types 
- Hemiplregic - tip toe walk
- Diplegic - PVL - knock knee 
- Quadraplegic - extensor posturing 

2) Dyskinetic 
Problem in the basal ganglia + extrapyramidal tracts - associated with HIE 
- Chorea 
- Athetosis - writhing movement 
- Dystonia 

3) Ataxic - lesion in the Cerebellum
- Broad gait
- Hypotonia
- Poor balance

4) Mixed (in the name babes)

Question 12

Cerebral palsy
definition
early presentation

Answer 12

Non progressive disorder of movement and posture that occurs in the developing CNS

Early presentation

1) Poor feeding
2) Delayed motor miles stones
3) Asymmetrical hand use <1
4) Hypotonia
5) Abnormal gait
6) Persistent primitive reflexes

Question 13

Cerebral palsy aetiology

Answer 13

Antenatal 80%
- Infection 
- Genetics 
- Vascular occlusion 
Birth 
- Cord compression 
- Uterine rupture 
- (HIE)
Post birth
- trauma 
- meningitis 
- PVL
- BPD 
- Kernicterus