Neuro and musc Flashcards
What are the indications of a CT in children?
CT in an hour if one of the follow:
- more than 3 episodes of vomiting
- LOC for more than 5 mins
- high impact trauma/injury
- abnormal drowsiness
- amnesia >5 mins
CT in an hour if one or more of the follow: NAI GCS less than 14 GCS less than 15 2 hours after basal skull fracture focal neurological deficit bruising in child under 1 and 5 cm laceration suspected open/depressed skull fracture
what is the treatment for west syndrome?
vigabatrin and steroids
What are the side effects of anti epileptic drugs?
Valporate - weight gain, hair loss, liver failure
Lamotrigine - severe skin rash (steven johns syndrome) EXACERBATES MYOCLONIC SEIZURES
Carbamazepine - rash, neutropenia, SIADH (hyponatraemia) EXACERBATES ABSENT SEIZURES
Levetericitam - sedation (rare)
Name some causes of myoclonic seizures in children
3-12 yr - Benign rolandic epilepsy - happen during sleep, face and upper limb seizures, hyper-salivation
12-18 yr - juvenile myoclonic epilepsy - happens after waking up
progressive myoclonic epilepsy - gets worse
When do you admit a febrile seizure?
first seizure last longer than 15 mins happened more than once in 24 hours unknown cause under 18 months
How do you differentiate between transient synovitis and septic arthritis?
septic Temp >38 ESR>40 WCC>12 unable to weight-bare
What are the 3 types of JIA?
systemic - hepatosplenomegaly, fever, malaise, salmon pink rash
polyarticular - painful swollen joints, small and large joints, can be ANA +
pauciarticular - painful swollen joints <5 joints, large joints, can be ANA +
How do you treat osteomyelitis and septic arthritis?
Fluclox IV
Pen allergic - clindamycin
MRSA - vancomycin
grame -ve - cefotaxime
surgical debridement/joint wash out
Sepctic - IV 2 weeks, oral 4 weeks
OM - IV until CPR stable for 2 days then oral
What is osteochondritis dissecans?
pain after exercise, catching locking, giving way - caused by reduced blood flow = avascular necrosis
What is chondromalacia patella?
posterior degenration of patella cartilage - pain on running, getting up, painless at first but gets painful on REPEATED USE
What is Osgood-Schlatter?
inflammation of patella tendon - frequent small fracture - overuse injury = REST, NSAIDS, ICE PACKS
How do you manage perthes?
<6 monitor and manage with splints
>6 surgery
How do you manage JIA?
NSAIDS
steroids
DMARDS - methotrexate, sulfasalazine
TNF alpha inhibitors
What is the difference between transient synovitis and reactive arthritis?
TS - hip joint, under 3 MUST BE RAPID ASSESSED, after URTI
RA - preceded by GI infection
describe the difference in presentation between extradural, subdural and such arachnoid haemorrages?
extradural - LUCID phase, then deteriorate quickly, usually from direct trauma affecting middle meningieal artery
subdural - gradual deterioration, caused by NAI (shaken baby syndrome)
subarachnoid - RAPID ONSET HEADACHE, rare in children, caused by aneurysm or AVM - DO NOT DUE LP
What are the causes of intraventricular haemorrhage?
ECMO - in prems or congenital CMV infection
How to babies with intraventricular haemorrhage present?
drowsy, apnoea, absent moro reflex, low tone, tense fontanelle
How do you manage intraventricular haemorrhage?
fluid replacement
anticonvulsants
acetazolamide
Ventriculo-peritineal shunt if hydrocephalus
What are the 2 types of hydrocephalus and their causes?
Communicating - obstruction after CSF exits ventricles
meningitis, SAH
Non communicating - obstruction in ventricles
- can be acquired or congenital
CONGENITAL - aqueduct stenosis, dandy walker malformation (4th ventricle enlarged), Chiari malformation
ACQUIRED - aqueduct stenosis
What are the signs and symptoms of hydrocephalus?
ACUTE - vomiting, impaired consiousness
CHRONIC - failure to thrive, developmental delay, increased skull circumference, tense fontanelle
What is the management for Tics?
Conservative - sleep hygiene and stress management
Exposure response prevention - deal with the feeling before tic so they can get used to it
Medication
- anti psychotics - risperidone
- clonidine - ticks and adhd
- clonazepam
- tetrabenazine - treat tics caused by huntingtons
- botulinum
what is the pathogenesis of duchennes?
x linked
deletion of dystrophin
lack of connection between cytoskeleton and ECM
influx of ca2+ breaks down calmodulin which releases free radicals = myofibre necrosis
present 1-3yrs and diagnosed at 5 yrs, life expectancy 35
What are some signs and symptoms of duchennes?
waddling gait, tip toeing, decreased tone, mount stairs one at a time, runs slowly and tires easily
How do you manage duchennes?
physio
CPAP due to weak intercostale muscles
steroids
heart protecting meds - carvediol
surgery if needed to strengthen achilles heal or scoliosis
how is myotonic dystrophy different to duchennes?
progressive loss, starting from small muscle to large whereas duchennes affects large muscles
adult onset - 20-30years
What is the diagnostic criteria for neurofibromatosis type 1?
> 6 cafe au lait spots
1 neurofibroma
optic glioma/ visual impariment
What is tuberous sclerosis?
cutaneous signs - ash leaf patch, angiofibromata (butterfly facial distribution)
neurological - infantile spasms and seizures
can cause development of nodules in the brain - subependymal giant cell astrocytoma
