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Paediatrics > Neurology > Flashcards

Neurology Flashcards

1
Q

What are the different types of seizures?

A
  • Generalised tonic clonic
  • Focal seizures - mainly temporal lobe
  • Absence seizures
  • Atonic seizures - drop attacks
  • Myoclonic seizures
  • Infantile spasms
  • Febrile convulsions
  • Benign rolandic seizures
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2
Q

Generalised tonic clonic seizure:
- CF
- Treatment

A

CF - loss of conc, muscle tensing and then jerking movements, tongue biting, incontinence, irreg breathing, post ictal period
1st line - Na valproate
2nd line - lamotrigine or carbamazepine

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3
Q

Focal seizures:
CF
Treatment

A

CF - most commonly temporal lobes, hallucinations, memory flashbacks, deja vu
1st line - carbamazepine or lamotrigine
2nd line - Na valproate, levetiracetam

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4
Q

Absence seizures:
- CF
- Treat

A

CF - children, pt blank and stares into space and then back to normal, unresponsive, sec long
1st line - Na valproate or ethosuximide

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5
Q

Atonic seizures:
- CF
- Treat

A

Drop attacks = brief lapses in muscle tone, ~3mins.
1st line - Na valproate
2nd line - lamotrigine

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6
Q

Myoclonic seizures:
- CF
- Treat

A

CF - sudden brief muscle contractions, pt conc
1st line - Na valproate
2nd line - lamotrigine, levetiracetam, topiramate

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7
Q

What are infantile spasms? How are they treated?

A

Infantile spasms/West syndrome - clusters of full body spasms, poor prognosis.
1/3 die by 25, 1/3 seizure free.
Treat - pred and vigabatrin

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8
Q

What are the ix into childhood epilepsy?

A
  • Hx, pt allowed one seizure before being ix for epilepsy
  • EEG
  • MRI brain to rule out structural problem
  • ECG
  • Bloods - electrolytes, hypoglycaemia, cultures
  • LP and urine cultures if suspect sepsis, encephalitis or meningitis
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9
Q

How do you manage a pt having a seizure?

A

Safe position, recovery if possible w something soft under head
Remove any obstacles
Start timer
Call ambulance if >5 mins

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10
Q

SE of Na Valproate

A

Teratogenic
Hepatitis
Hair loss
Tremor

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11
Q

SE of carbamazepine

A

Agranulocyotosis
Aplastic anaemia

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12
Q

SE of phenyotin

A

Folate def - megaloblastic anaemia
Vit d def - osteomalacia

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13
Q

SE of ethosuximide

A

Night terrors and rashes

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14
Q

SE of lamotrigine

A

Steven Johnson syndrome
Leukopenia

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15
Q

What is muscular dystrophy?

A

Muscles break down and become weaker over time - most commonly called Duchenne muscular dystrophy.
Caused by mutations = no dystrophin, X linked recessive so mainly in males w females being carriers.

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16
Q

What is the presentation of Duchenne’s muscular dystrophy?

A
  • Muscle wasting and weakness in early childhood
  • Wheelchair bound before puberty and die from resp failure by early twenties
  • Bulky muscles eg. calves - muscle replaced by fat
  • Child slips through their hands - loose muscles in shoulder
  • Gower’s sign - walk their arms up their legs when getting up = proximal muscle weakness
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17
Q

How is Duchenne’s muscular dystrophy diagnosed?

A

Genetic testing is gold standard, used to be muscle biopsy
CK as first line test to screen for muscular dystrophy

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18
Q

What is the management of muscular dystrophy?

A

No cure, just giving person highest QOL for longest time possible. Oral steroids and creatine supplementation can reduce progression by a few years.
Duchenne - die in twenties
Becker’s - die in thirties

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19
Q

What is spinal muscular atrophy? What are the types?

A

Autosomal recessive progressive loss of motor neurones = progressive muscular weakness. Affects LMN in spinal cord.
SMA type 1 - onset in first few months, death w/i 2 years
SMA type 2 - onset w/i first 18 months, never walk but survive into adulthood
SMA type 3 - onset after first year of life, walk but then loose ability, normal life expectancy
SMA type 4 - onset 20s, ability to walk short distances, significant fatigue

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20
Q

What are the neuro signs of SMA?

A

LMN signs:
- Fasciculations
- Atrophy
- Hypotonia
- Weakness
- Reduced or absent reflexes

21
Q

What is the management of SMA?

A
  • No cure
  • PT to maximise strength or muscles and resp func
  • Splints, braces, wheelchair
  • NIV resp support, esp when sleeping
  • Tracheo and mechanical ventilation in SMA type 1
  • PEG needed if unsafe swallow
22
Q

What are breath holding spells and what are the types?

A

Involuntary episode of holding breath when triggered by something upsetting or scary at ~6-18m.
1. Cyanotic breath holding spells
2. Pallid breath holding spells/reflex anoxic seizures

23
Q

What are cyanotic breath holding spells?

A

Upset, crying child - let out long cry, stop breathing = cyanotic and unconc.
W/i a minute they regain conc and start breathing, will be a bit tired and lethargic after episode.

24
Q

What are reflex anoxic seizures?

A

Child is startled = vagus nerve sends signals to heart to stop it beating = suddenly pale, LOC and then seizure twitching, w/i 30 secs heart restarts and child conc again.

25
Q

What is craniosynostosis?

A

Skull sutures close prematurely = abnormal head shapes and restriction of brain growth = raised ICP = develop delay, cog impairment, vom, visual impair, neuro sx and seizures

26
Q

What are the ix into craniosynostosis? What is the management?

A

Skull XR, CT head if doubt
Manage - severe = surgical reconstruction

27
Q

What are some differentials for headache in children?

A

Tension headache
Migraine
ENT infection/URTI
Analgesic over use headache
Visual issues
Raised ICP
Brain tumours
Meningitis and encephalitis
CO poisoning

28
Q

What is the management of migraine in children?

A
  • Rest, fluids, dark room
  • Paracetamol and ibuprofen
  • Sumatriptan
  • Antiemetics - prochlorperazine, cyclizine
    Prophylaxis - propanolol (not in asthma), pizotifen, topiramate
29
Q

What is normal CSF physiology?

A

x4 ventricles - x2 lateral, and a third and fourth ventricle, all contain CSF which is make in choroid plexuses.
Arachnoid granulations collect CSF and absorb it into venous system.

30
Q

What are some causes of hydrocephalus?

A

Hydrocephalus = excess CSF:
- Aqueductal stenosis - prob w drainage - most common cause
- Arachnoid cysts can block outflow of CSF
- Chromosomal abnorm and congenital malformations can cause obstruction

31
Q

What are the CF and signs of hydrocephalus?

A
  • Enlarged and increasing occipito frontal circumferance
  • Bulging ant fontanelle
  • Poor feeding and vom
  • Poor tone
  • Sleepiness
32
Q

What is the management of hydrocephalus?

A

VP shunt - normally drains CSF into peritoneal cavity where it will be absorbed

33
Q

What are the complications of VP shunt?

A

Infection
Blockage
Excessive drainage
IV haemorrhage
Outgrowth - need to be replaced every 2 years as child grows

34
Q

What are some causes of raised ICP in children?

A
  • Brain tumour
  • Hydrocephalus
  • ## Intracranial infection
35
Q

What are the signs of a sloppy child?

A
  • Infant slides through hands when held upright under arms
  • Flops like a rag doll
  • When pulling up to sit there is head lag
36
Q

Central vs peripheral hypotonia?

A

Central - global hypotonia, have antigravity movements, poor truncal tone but normal limb tone, brisk tendon reflexes
Peripheral - global hypotonia, weak or absent antigravity movements, reduced tendon reflexes

37
Q

What are some causes of floppy infant?

A
  • HIE
  • Intracranial haemorrhage
  • Hypothyroid
  • Metabolic errors
  • Trisomy 21, Prader Willi syndrome - dysmorphic features
  • Spinal cord injury
  • Neonatal myasthenia gravis
  • Myotonic dystropy
38
Q

What causes extradural haemorrhage and what are the CF?

A

Cause - direct head trauma, middle meningeal artery bleeds
CF - lucid interval and then reduced conc, +/- epilepsy, can have dilation of ipsilateral pupil, other CN palsies

39
Q

What is the management of extradural haemorrhage?

A

IV fluid resus
Evacuation of haematoma and arrest bleeding

40
Q

What causes subdural haematoma?

A

Tearing of bridging veins as they cross subdural space - non accidental injury !!!!! shaking and direct trauma in infants and toddlers.
Have retinal haemorrhages also if shaking.

41
Q

What are the features of SAH in children?

A

Really not v common - more in adults.
Thunderclap headache, seizure, reduced conc, coma, vom.
CT scan +/- LP, usually caused by aneurysm or malformation of blood vessels.
Treat = neurosurg or interventional radiology

42
Q

What are the CF of neurofibromatosis T1?

A
  • Cafe au lait
  • Neurofibroma
  • Optic glioma = visual impairment
  • FH
  • Axillary freckling
  • Can give ADHD
43
Q

What is spina bifida?

A

Neural tube defect = incomplete develop of spinal column = herniation of spinal cord

44
Q

What are the different types of spina bifida?

A

Spina bifida occulta - incomplete fusion of vertebrae but no herniation of spinal cord, small tuft of hair overlying site
Meningocele - incomplete fusion of vertebrae w meningeal sac herniation, just contains CSF
Myelomeningocele - incomplete fusion of vertebrae w herniation of meningeal sac containing CSK and spinal cord, other defects

45
Q

What are the associations of myelomeningocele?

A
  • Variable paresis of lower limbs w hypotonia
  • Muscle imbalance
  • Sensory loss
  • Bladder and bowel denervation
  • Scoliosis
  • Hydrocephalus
    Manage all in management
46
Q

What features associated w headache suggest SOL?

A
  • Visual field defects
  • CN palsy
  • Abnormal gait
  • Growth failure
  • Cranial bruits
  • Early or late puberty
  • Papilloedema
  • Change in personality
    Red flags - headache worse w lying down or coughing, wakes child. up in night, early morning vom, change in personality or beaviour
47
Q

What are some SE of pizotifen?

A
  • Is a tricyclic so fatal in overdose
  • Weight gain and sleepiness
48
Q

What is benign rolandic epilepsy?

A

Seizures at night - focal = unilateral face and upper limb motor sx w no LOC

Paediatrics (15 decks)

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