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MBChB IV Paediatrics > Neurodevelopment > Flashcards

Neurodevelopment Flashcards

1
Q

Autism red flag signs

A

12 months

  • no babbling
  • no pointing or waving
  • no single words
  • no spontaneous 2 word phrases
  • any loss of any language or social skills
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2
Q

Side effects of Ritalin

A

headache and stomachache
suppression of appetite
can cause insomnia
hearing defects need to be referred first

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3
Q

Epilepsy

A

enduring predisposition to generate seizure with neurological cognitive psychological and social consequences
- at least 2 unprovoked / reflex seizures > 24 hours apart
- one unprovoked/ reflex seizure + a probability >/= 60% of further seizures over the next 10 year
- diagnosis of an epilepsy syndrome
recurrent unprovoked seizures

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4
Q

Treatment of epilepsy

A

First line
absence - sodium valproate
focal and generalised TC - carbamazepine

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5
Q

Side effects of drugs

A

Phenobarbitone - increases hyperactivity
Valproate - liver toxicity
Carbamazepine - exacerbates absence and myoclonic seizures
Phenytoin - worsen MG, headache, N and V
Lamotrogine - N/V
Benzodiazepines - induce T/C seizures in LGS

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6
Q

Status epilepticus

A

seizures for 30 minutes or remains unconscious between seizures
DONT wait 30 min before treating
start on flow chart if fitting for 10 min

  1. Maintain vital function - ABC
  2. Stop convulsions - drugs
    - IV line
    - draw blood
    - give bolus glucose
    - see the two tables for the drugs to be given
  3. Determine the cause
  4. Prevent more convulsions

Step 1 = Lorazepam (Ativan) or Diazepam (Valium)
Step 2 = Phenytoin (Epanutin) or Sodium Valproate (Epilim) - 20mg/kg
Step 3 = Thiopentone infusion or Midazolam or Propofol

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7
Q

Neonate treatment

A

Step 1 = phenobarbitone or lorazepam
Step 2 = phenytoin - NO VALPROATE
Step 3 = thiopentone or midazolam infusion

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8
Q

Febrile seizures

A

6m-3-4(5) years
fever without evidence of intracranial infection
average age onset 18 to 22 months
boys more girls
1/3 have at least one recurrence
2% risk developing epilepsy
fever can come after seizure
simple - GTC, < 15min, no recurrence in 24hr
complex - focal, > 15min, cluster 2 or more within 24hr

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9
Q

Management febrile seizures

A 
identify underlying disease - LP 
CT/ MRI - NOT simple 
routine EEG seldom necessary 
LT use AED not indicated unless complex - phenobarbitone or sodium valproate 
rectal diazepam 
antipyretics?
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10
Q

Contraindication to LP

A

decreased level of consciousness Glascow < 13
focal deficit - unequal pupils
too sick - haemodynamically unstable or respiratory compromise
septicaemia with petechiae or purpura
low platelets - bleeding disorder
local infection
relative CI - increased ICP
absolutely CI if following is seen on CT - midline shift, loss of cisterns, mass in post fossa
BUT
do blood cultures and start treatment

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11
Q

Clinical signs of raised ICP

A

Papilloedema
decreased LOC
pushing reflex

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12
Q

CSF findings

A

bacterial - predominantly neutrophils
increased protein decreased glucose
viral - predominantly lymphocytes
mildly increased protein WNL glucose
TBM - predominantly lymphocytes -
severely increased protein
decreased glucose

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13
Q

Causes of aseptic meningitis

A 
Partially treated meningitis 
TBM 
viral meningitis 
leukaemia 
uncommon infections 
- syphillis 
- mycoplasma 
- toxoplasmosis
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14
Q

Coma

A 
Unarousable for at least 1 hour 
total unawareness with closed eyes 
lack of wakefulness 
lack of movement 
noxious stimuli - inappropriate responses
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15
Q

Persistent vegetative state

A

wakeful unconsciousness diagnosed 1 month after onset of coma
or a period of at least 3 months is required in a baby younger than 6 months
sleep and wake cycles are present
brainstem function and spinal reflexes are present
no cortical fx
autonomic fx is preserved
may shed tears

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16
Q

Complications of TBM

A 
Communicating hydrocephalus 
Brain abscess 
Brain oedema 
SIADH 
Convulsions 
Subdural effusions 
Deafness and blindness 
Learning problems
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17
Q

Tics

A

most common movement disorder in children
sudden twitches, movements or sounds
motor, vocal or sensory
involuntary but CAN be suppressed
aggravated by stress/anxiety/fatigue
provisional tic disorder - motor or vocal tics less 12 months in a row
persistent or chronic tic disorder - motor or vocal tics for more than a year
Tourette syndrome - at least 2 motor and at least one vocal tic for at least a year

treatment rarely needed - can give haloperidol or risperidone

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18
Q

PANDAS

A 
Paediatric Autoimmune Neuropsychiatric Disorder Associated with Strep infection 
tics and dystonia 
post GABHS infections 
auto-antibody at basal ganglia 
- prepubertal 
- tics or OCD 
- sudden onset/fluctuating course 
- Associated with GABHS infection 
- neurological abn
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19
Q

Developmental regression

A 
SSPE 
AIDS 
Anti-epileptic drugs 
Corticosteroids 
SLE 
Sturge Weber 
TBM 
Sickle cell 
Huntington 
Spinocerebellar ataxia 
HAS CHILD LOST ANY SKILL THAT HE HAD PREVIOUSLY ACQUIRED? 
IT IS NEVER OK TO LOSE ANY PREVIOUS MILESTONES 
RECOGNISE AND REFER
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20
Q

How does the neural system develop?

A 
Neurulation
Prosencephalization
Neuronal proliferation
Migration
Formation of gyri 
Organization
Myelination
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21
Q

Name preconceptual risk factors to neurodevelopment

A

Poor maternal health
Epilepsy
Genetic predisposition

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22
Q

Name antenatal risk factors to neurodevelopment

A

Poor maternal health
Toxins
Infections

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23
Q

Name postnatal risk factors to neurodevelopment

A

Environmental factors
Infections
Trauma

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24
Q

Discuss complications of an issue in each neurodevelopmental stage

A

Neuralation - NTD
Prosencephalization - holoprosencephaly spectrum (Dandy walker, hydrocephaly)
Hindbrain - cerebellar + rhombencephalic abnormalities
Neuronal proliferation - microcephaly, macrocephaly
Migration - gyral formation (schizencephaly, lisencephaly, pachygyria) , heterotopia
Organization (autism, schizophrenia, depression)
Myelination (dysmyelination, demyelination)

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25
Q

What is the spectrum of holoprosencephaly?

A

Alobar
Semilobar
Lobar
Middle interhemispheric variant (MIHV)

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26
Q

Name causes of microcephaly

A 
AR (microcephaly vera)
AD
X-linked recessive
Teratogenic
Syndromic
Perinatal hypoxia
Intrauterine infections
Chromosomal abnormalities
Familial
Severe metabolic disorders
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27
Q

Name causes of macrocephaly

A 
Isolated macrocephaly
Assoc growth disturbance
Neurocutaneous syndrome
Chromosomal abnormalities
Hemimegalencephaly 
Hydrocephalus
Storage disorder
SOL
Familial
Sotos syndrome
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28
Q

Give examples of neurocutaneous syndromes

A

Neurofibromatosis

Sturge Weber

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29
Q

What is Dandy Walker syndrome?

A

A brain malformation that occurs during embryonic development of the cerebellum and 4th ventricle

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30
Q

How are neurons organized?

A 
Differentiation
Alignment
Orientation
Layering
Synaptogenesis
Cell death
Glial proliferation
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31
Q

What is a common disorder of myelination?

A

Periventricular leukomalacia in spastic diplegia

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32
Q

What is your approach to a neurodevelopmental examination?

A 
History
General impressions
Higher functions
Head and face
Cranial nerves
Neck and back
Signs of ICP
Motor system
Sensory system
Basal ganglia
Cerebellar function
Autonomic system
Markers
Developmental assessment
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33
Q

What are neurodevelopmental warning signs?

A
  1. Inconsolable crying
  2. Bruxism
  3. Hand admiration after 20w
  4. Everything to mouth after 9m
  5. Purposeless throwing of toys after 9m
  6. Self-stimulating behaviour
  7. Self-injurious behaviour
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34
Q

What should you look at for higher functions?

A 
Sensorium
Behaviour
Mood
Thought content
Communication and speech
Intellectual ability
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35
Q

Name head shapes and their causes

A

Plagiocephaly
Scaphocephaly
Brachycephaly

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36
Q

What kinds of fontanels can you have?

A

Late closure
Bulging
Tense
Sunken

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37
Q

What causes a tense fontanel?

A

Raised ICP

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38
Q

Name causes of late anterior fontanel closure

A 
Hydrocephalus
T21
Hypothyroidism
Rickets
Skeletal dysplasia
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39
Q

What causes overriding sutures?

A

Craniosynostosis

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40
Q

Name myopathic facial features

A

Restricted eye movements
Long thin face
Drooping mouth
Lack of expression

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41
Q

What are you looking for on the back in a neuro examination?

A

Spinal dysraphism
Scoliosis
Kyphosis
Lordosis

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42
Q

Name causes of meningeal irritation

A

Meningitis
SAH
Apical pneumonia
Pyelonephritis

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43
Q

What are the signs of raised ICP?

A 
Headache
Vomiting
Diplopia
Bulging fontanel
Papilloedema
McEwan cracked pot
Cushing response
Sun setting sign
44
Q

What are you looking for concerning gait in a neuro examination?

A 
Broad vs narrow based
Toe/flat foot walking
Foot eversion
Limping
Hemiplegia (circumduction)
Ataxic
Waddling
Slapping
45
Q

Explain a diplegic gait and who presents with one?

A

Adduction of the legs
Flexion of the wrists

CP patients

46
Q

Explain a waddling gait and who presents with one?

A

Issue with pelvic stabilising muscles

Myopathic gait

47
Q

What is a neuropathic gait also known as?

A

Equine gait

48
Q

Name signs of proximal upper limb weakness

A

Shoulder falls through
Cannot wheelbarrow walk
Cannot press against wall

49
Q

Name signs of distal upper limb weakness

A

Cannot pull self up when held by hands

50
Q

Name signs of proximal lower limb weakness

A

Gower’s

Cannot climb stairs

51
Q

Name signs of distal lower limb weakness

A

Cannot stand on toes

52
Q

What is the sensory innervation of the lateral surface of the arm?

53
Q

What is the sensory innervation of the tip of the thumb?

54
Q

What is the sensory innervation of the web of the index finger?

55
Q

What is the sensory innervation of the tip of the little finger?

56
Q

What is the sensory innervation of medial surface of the lower arm?

57
Q

What is the sensory innervation of the medial surface of the upper arm?

58
Q

What is the sensory innervation of the inguinal ligament?

59
Q

What is the sensory innervation of the middle of the anterior thigh?

60
Q

What is the sensory innervation of the medial aspect of the knee?

61
Q

What is the sensory innervation of the medial aspect of the calf?

62
Q

What is the sensory innervation of the lateral aspect of the calf?

63
Q

What is the sensory innervation of the sole of the foot?

64
Q

What is the sensory innervation of the axilla?

65
Q

What is the sensory innervation of the lower edge of ribs and xiphisternum?

66
Q

What is the sensory innervation of the skin of the umbilicus?

67
Q

What is the sensory innervation of the skin of the pubis?

68
Q

What do you look for in the legs in cerebellar exam?

A

Dysmetria
Heel on shin
Pendullar reflexes

69
Q

What do you look for in the trunk in cerebellar exam?

70
Q

What do you look for in the eyes in cerebellar exam?

A

Nystagmus

Opsoclonus

71
Q

What do you look for in the arms in cerebellar exam?

A

Dysmetria
Intention tremor
Finger-nose test
Dysdiadochokinesia

72
Q

What do you look for in the speech in the cerebellar exam?

A

Slow

Slurred

73
Q

How do you assess autonomic dysfunction in neuro exam?

A

Sphincter control
BP
Sweating
Horner’s

74
Q

What disease markers should you look for?

A

Neurofibromatosis
Sturge Weber
Tuberous sclerosis
Hypomelanosis

75
Q

How can you assess development?

A 
Gross motor = GMFCS
Fine motor = MACS
Hearing and language = CFCS
Cognition = DQ and IQ
Psychosocial/emotional = behaviour
76
Q

Name signs of visual impairment

A 
Nystagmus
Strabismus
Clumsiness
Does not reach out
Does not fixate at 4mo
Photophobia
Rubbing of eyes
Regression in school work
77
Q

Give an approach to abnormal movements

A

Slow

  • dystonia
  • athetosis
Fast
1. Stereotyped 
Rhythmic 
- tremor
- stereotypies
Non-rhythmic
- tics
2. Non stereotyped 
- chorea
- myoclonus
78
Q

Where is a tic most common?

A

Face (central musculature)

79
Q

How do you diagnose Tourette syndrome?

A

At least 2 motor and 1 vocal tic >1 year

80
Q

How do you describe a tremor?

A

Rapid
Rhythmical
Frequency and amplitude

81
Q

What is important about stereotypies?

A

Can be distracted

82
Q

How do you describe chorea?

A

Arrhythmical, asymmetrical

Sudden, random movements

83
Q

What are 2 signs of chorea?

A

Milkmaid grip

Jack in the box tongue

84
Q

What must you do for a patient with Sydenham’s chorea?

A

Cardiac imaging

Penicillin prophylaxis

85
Q

How would you describe dystonia?

A

Involuntary sustained/intermittent muscle contractions using twisting or reptitive movements
Can be painful

86
Q

Name causes of dystonia

A

Primary
- genetic (primary torsion dystonia)

Secondary

  • metabolic
  • drug induced
  • brain injury
87
Q

How can you identify that a dystonia is primary?

A

Imaging is normal

88
Q

What are the main features of cerebellar pathology?

A 
Ataxic gait
Abnormal head posture
Ocular motor dysfunction
Hypotonia
Dysarthria
Intention tremor
Dysmetria
89
Q

Name causes of ataxia

A

Acute

  • cerebellitis
  • intoxication
  • tumour

Chronic non-progressive

  • ataxic CP
  • congenital malformation
  • prematurity

Chronic progressive

  • spinocerebellar ataxia (SCA)
  • ataxia telangiectasia
  • Friedrich’s ataxia
90
Q

What is the most common cause of acute ataxia seen in children?

A

Post varicella cerebellitis

91
Q

What is the most common cause of chronic progressive ataxia seen in children?

A

Ataxia telangiectasia

92
Q

Discuss approach to LMN examination

A 
Gait
Pull up
Shoulder girdle
Tone
Reflexes 
- remember ankle and compare sides
Power 
- eliminate gravity if needed 
- assess feet in 4 directions
Motor
Tongue
93
Q

Discuss the neurological examination of the newborn

A 
Response to light
Response to sound
Move head to assess eye CN
Rooting
Arm traction
Arm recoil
Scarf sign
Flex hips
Leg traction
Leg recoil
Popliteal angle
Heel to ear
Neck tone
Head lag
Head control
Prone
Ventral suspension
Vertical suspension
DTR
Moro reflex
Plantar reflex
Galant reflex
Stepping
Fontanelles
Sutures
94
Q

What must you remember to check in the 6month old?

A

Assym neck tone
Landau reflex
Lateral prop

95
Q

Synostosis of which suture causes scaphocephaly?

96
Q

Synostosis of which suture causes brachycephaly?

97
Q

When is clonus in a 3mo normal?

A

Few beats = normal

Sustained = abnormal

98
Q

When does rooting reflex integrate?

99
Q

When does Moro reflex integrate? What does it indicate if it has not integrated by this time?

A

5mo

UMN lesion

100
Q

When does galant reflex integrate?

101
Q

When does plantar grasp reflex integrate?

102
Q

When does palmar grasp reflex integrate?

103
Q

When does ATN reflex integrate? What does it indicate if it has not integrated by this time?

A

6mo

UMN lesion

104
Q

What does asymmetry with arm recoil indicate?

A

Erb’s palsy

105
Q

What does consistent fisting >3mo indicate?

A

UMN lesion

106
Q

Why is Babinski normal in children <1y?

A

Incomplete myelination

107
Q

What is creeping?

A

Crawling but with trunk off the ground

MBChB IV Paediatrics (81 decks)

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