Neuro and musc

Question 1

What are the indications of a CT in children?

Answer 1

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

Question 2

what is the treatment for west syndrome?

Answer 2

vigabatrin and steroids

Question 3

What are the side effects of anti epileptic drugs?

Answer 3

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)

Question 4

Name some causes of myoclonic seizures in children

Answer 4

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

Question 5

When do you admit a febrile seizure?

Answer 5

first seizure
last longer than 15 mins 
happened more than once in 24 hours
unknown cause 
under 18 months

Question 6

How do you differentiate between transient synovitis and septic arthritis?

Answer 6

septic 
Temp >38
ESR>40
WCC>12 
unable to weight-bare

Question 7

What are the 3 types of JIA?

Answer 7

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 +

Question 8

How do you treat osteomyelitis and septic arthritis?

Answer 8

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

Question 9

What is osteochondritis dissecans?

Answer 9

pain after exercise, catching locking, giving way - caused by reduced blood flow = avascular necrosis

Question 10

What is chondromalacia patella?

Answer 10

posterior degenration of patella cartilage - pain on running, getting up, painless at first but gets painful on REPEATED USE

Question 11

What is Osgood-Schlatter?

Answer 11

inflammation of patella tendon - frequent small fracture - overuse injury = REST, NSAIDS, ICE PACKS

Question 12

How do you manage perthes?

Answer 12

<6 monitor and manage with splints

>6 surgery

Question 13

How do you manage JIA?

Answer 13

NSAIDS
steroids
DMARDS - methotrexate, sulfasalazine
TNF alpha inhibitors

Question 14

What is the difference between transient synovitis and reactive arthritis?

Answer 14

TS - hip joint, under 3 MUST BE RAPID ASSESSED, after URTI

RA - preceded by GI infection

Question 15

describe the difference in presentation between extradural, subdural and such arachnoid haemorrages?

Answer 15

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

Question 16

What are the causes of intraventricular haemorrhage?

Answer 16

ECMO - in prems or congenital CMV infection

Question 17

How to babies with intraventricular haemorrhage present?

Answer 17

drowsy, apnoea, absent moro reflex, low tone, tense fontanelle

Question 18

How do you manage intraventricular haemorrhage?

Answer 18

fluid replacement
anticonvulsants
acetazolamide
Ventriculo-peritineal shunt if hydrocephalus

Question 19

What are the 2 types of hydrocephalus and their causes?

Answer 19

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

Question 20

What are the signs and symptoms of hydrocephalus?

Answer 20

ACUTE - vomiting, impaired consiousness

CHRONIC - failure to thrive, developmental delay, increased skull circumference, tense fontanelle

Question 21

What is the management for Tics?

Answer 21

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

Question 22

what is the pathogenesis of duchennes?

Answer 22

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

Question 23

What are some signs and symptoms of duchennes?

Answer 23

waddling gait, tip toeing, decreased tone, mount stairs one at a time, runs slowly and tires easily

Question 24

How do you manage duchennes?

Answer 24

physio
CPAP due to weak intercostale muscles
steroids
heart protecting meds - carvediol

surgery if needed to strengthen achilles heal or scoliosis

Question 25

how is myotonic dystrophy different to duchennes?

Answer 25

progressive loss, starting from small muscle to large whereas duchennes affects large muscles
adult onset - 20-30years

Question 26

What is the diagnostic criteria for neurofibromatosis type 1?

Answer 26

> 6 cafe au lait spots
1 neurofibroma
optic glioma/ visual impariment

Question 27

What is tuberous sclerosis?

Answer 27

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