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Josh's RC Questions > Neuro SAQ > Flashcards

Neuro SAQ Flashcards

1
Q

14 year old obese boy comes in with 3 day history of headache. On exam, he has bilateral papilledema, Head imaging is normal.
A. What is the most likely diagnosis?
B. What test would you do to confirm?

A

A. Idiopathic intracranial hypertension

B. LP with opening pressure in lateral decubitus with legs extended

  • NOrmal: <120mmH2O newborns, <180mmH2O young children, <250mmH20 older children + adults
  • >250mmH20 in non-obese, non-sedated
  • >280 mmH2O in obese or sedated
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2
Q

Name 3 life-threatening complications of Guillain-Barre Syndrome

A
  1. Paralysis of respiratory muscles leading to respiratory failure. Also unable to control secretions -> aspiration pneumonia
  2. Autonomic instability including cardiac arrhythmias
  3. VTE
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3
Q

8 year old girl has a concussion while playing hockey. She has headaches and cognitive impairment.

a) Describe 2 recommendations you would give for cognitive rest (2 marks)
b) What would you advise regarding return to school (1 mark)?
c) What criteria must be met for her to return to hockey (2 marks)?

A

A.

  1. Complete cognitive rest: no school, no screens, limit cognitive tasks
  2. If no Sx, then can slowly increase cogitive tasks in increments

B. Return to school

  1. Gradual return to school. Start with certain classes or half days, gradually increase until full days
  2. Do not need to be Sx-free to return to school but need accommodations/modifications to schedule to allow school return without Sx exacerbation
  3. If any Sx, return to last previously tolerated step for at least 24H

C. Return to hockey

  1. Must first have full return to school
  2. Ideally should be Sx free for 7-10d before starting activity
  3. Light aerobic exercise, no resistance training -> Sport-specific exercise-> Non-contact drills -> Full-contact drills -> Game play. Each step should tke minimum 24H
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4
Q

A mother comes to you with her 7 month old with concerns that he has an abnormally shaped head. You suspect craniosynostosis which is confirmed with an xray.

A. What is the most common type of craniosynostosis? (1)

B. What would you next? Justify your answer. (2)

A

A. Sagittal suture = scaphocephaly/dolichocephaly

B.

  1. Consult neurosurgery because brain increases in volume significantly in first year of life, so there is risk of high ICP or brain growth inhibition if not surgically corrected earlier
  2. Do thorough history + physical exam for underlying cause, including FHx. Dysmorphisms to suggest genetic etiology. R/O metabolic conditions like hyperthyroidism.
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5
Q

Patient with Duchenne muscular dystrophy. Other than the musculoskeletal manifestations, name other 4 affected organ systems and 1 specific manifestation for each

A
  1. Respiratory -> OSA, pneumonia
  2. Eyes -> cataracts
  3. Heart -> cardiomyopathy
  4. Brain -> intellectual disability
  5. GI -> dysmotility, constipation
  6. Bone -> osteoporosis, scoliosis
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6
Q

Name 4 features of atypical febrile seizures (4)

A
  1. >15min
  2. More than 1 in 24H
  3. Focal seizure
  4. Previous neurological impairment of neurologic deficit after Sz
  5. Age <6mo or >6yo
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7
Q

Picture of teen 15 yo girl with bell’s palsy.

A. What is it?

B. How do we treat it (TWO things)

C. What is the percentage of recovery?

A

A. Bell’s palsy = acute unilateral facial nerve palsy

B.

  1. Corticosteroids +/- antiviral
  2. Eye drops for ocular lubricant

C. 85% recovery fully

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8
Q

FIVE features of a child with basilar migraine

A
  1. Vertigo
  2. Nystagmus
  3. Diplopia
  4. Tinnitus
  5. Ataxia
  6. Occipital H/A
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9
Q

Child with headaches and papilledema – no other focal signs, physical exam normal, no fever… can’t remember all the details… what is the most likely cause of his headache?

A

Increased ICP

Most likely idiopathic intracranial hypertension

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10
Q

List 3 reasons to image a child with headaches.

A
  1. Anbormal neurological exam
  2. H/A worsens on first awakening or wakes child from sleep
  3. Focal neurological Sx develop during H/A
  4. Focal neurological SSx develop druing aura
  5. H/A in <6yo or any child who cannot adequately describe H/A
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11
Q

A 10 year old girl comes in with a history of an inability to brush her hair in the morning, and difficulty walking up stairs. You see this on physical examination. What is her diagnosis?

A

Dermatomyositis

Gottron papules

Dx criteria

  • Classic rash: heliotrope, gottron’s papule, shawl sign (photosensitivity), mechanic’s hands
  • AND 3
    1. Muscle weakness: proximal, symmetric
    2. Increased muscle enzymes: CK, AST, LDH, aldolase
    3. EMG: short, small polyphasic motor unit potentials; fibrillations; positive sharp waves
    4. Bx: inflammation + necrosis

Tx: corticosteroids!

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12
Q

Child with abdominal pain and other symptoms. Likely abdominal migraine. Name 2 other migraine variant conditions.

A
  1. Basilar migraine
  2. Confusional migraine
  3. Hemiplegic migraine
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13
Q

Four complications of DMD in a 7 year old

A
  1. Muscle weakness -> ambulatory difficulty
  2. Respiratory -> pneumonia, SDB
  3. Eyes -> cataracts
  4. Cardiomyopathy
  5. ID
  6. GI -> constipation, GERD
  7. Scoliosis
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14
Q

What are 4 physical exam findings that would be contraindications for a lumbar puncture?

A
  1. Papilledema
  2. Cellulitis at LP site
  3. Bulging fontanelle
  4. Petechiae or purpura (until can determine plt count)
  5. Abnormal pupil size + reactivity
  6. Decorticate or decerebrate
  7. Cushing’s triad

Contraindication for LP

  1. Suspected mass lesion of brain
  2. SSx of impending cerebral herniation
    • Altered resp
    • Abnormal pupil size + reactivity
    • Loss of brainstem reflexes
    • Decorticate or decerebrate posturing
  3. Critical illness (risk of LP inducing cardiopulmonary arres)
  4. Skin infection at site of LP
  5. Thrombocytopenia (<20)
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15
Q

A 13 year old girl was brought to the emergency room last night when she woke up with a severe unilateral headache. She has had similar headaches in the past. Her mother has migraines and she thinks her daughter also has migraines. You see her the next morning at which time she no longer has a headache and her neurological exam is normal. How would you manage her (1 line given).

A
  • Since H/A woke her from sleep, get CT head
  • Consider neurology consult
  • Since she has had 1 functionally impairing migraine (needing to seek medical attention), consider prophylactic therapy
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16
Q

Picture of a teenage girl with unilateral facial paralysis. This patient had viral symptoms a few weeks ago and then presented with facial weakness.

a) What is the likely diagnosis?
b) What are two important steps in your management of her?
c) What would you tell this patient about her prognosis?

A

a) Bell’s palsy (acute unilateral facial nerve palsy)

b)

  1. Corticosteroids +/- antiviral
  2. topical eye drops for ocular lubrication

c) 85% will resolve

17
Q

A girl with developmental delay is on valproate for seizure control. Her mother is concerned because she has been irritable for the last few months and has been vomiting 1-2 times per day. She is now lethargic. What are three investigations you would do?

A
  1. Valproic acid level.
  2. CT scan (bleeds and increased ICP)
  3. Serum AST, ALT, lipase, amylase, liver function. Also lytes, BUN, Cr, gas, glucose, iCa due to the vomiting
  • V - vomiting
  • A - alopecia
  • L - liver failure
  • P - pancreatitis
  • R - retention of fat (wt gain)
  • O -
  • A - appetite increase
  • T - tremor
  • E - edema
18
Q

A 2 year old episodes of transient loss of consciousness when having fights with his sister. They are brief and he is normal afterward.

a) What is the diagnosis?
b) What advice to give to mom about management?

A

A. Breath holding spells

B.

  1. Try to intervene before behaviour escalate. Do not provide increased attention that would reward the behaviour
  2. Reassure that it is self-limited, will outgrow in a few years, make sure environment is safe.
  3. Treat for co-existing iron deficiency anemia
19
Q

A teen presents with headaches lasting hours & associated with nausea. You suspect common migraine.

A. Name 3 characteristics of the headaches you would ask about to confirm your diagnosis of migraine.

B. Name 3 indications for imaging in a child with headaches.

A

A.

  1. Aura
  2. Unilateral or bilateral
  3. Throbbing H/A
  4. Photophobia, phonophobia

B.

  1. Abnormal neurological signs
  2. H/A upon first awakening or waking from sleep
  3. Focal neurological Sx that develop druing H/A
20
Q

Picture of a baby with right facial droop, able to wrinkle forehead, able to close eyes. Identify abnormality.

A

Congenital absence of the depressor angularis oris muscle

  • Facial asymmetry, esp when child cries
  • Often assoc’d with other congenital anomalies, esp heart
21
Q

Ex-29 week prem with hyperreflexia and gross motor delay. Had history of Grade II IVH and PVL. Advise the mother about the likely cause of CP in this child. What would you see on a CT that is specific to this?

A
  • PVLs -> spastic diplegia
  • MRI: loss of volume of periventricular white matter, cystic changes, thin corpus callosum, ventricular dilatation
22
Q

24) Four-month infant who has recurrent extensor and flexor movements, preceded by a sharp cry, often in the early morning. Noted to have hypopigmented patches of skin.

A. What is your diagnosis of his acute problem

B. What test would you use to confirm this?

C. What is his underlying condition?

D. What test would you do to confirm this ?

A
  • Infantile spasms
  • EEG: hypsarrhythmia
  • Tuberous sclerosis
  • Brian MRI

Josh's RC Questions (39 decks)

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