Neurology

Question 1

Examination of a child with headache is to rule out secondary cause for the headache.
What are some of the things to assess?

Answer 1

Growth parameters
Sinuses, teeth, visual acuity
Fundoscopy
Visual fields (craniopharyngioma)
Cranial bruit
Focal neurological signs
Cognitive and emotional status
BP

->ENT exam of sinuses, teeth and eyes is to see if the headache is referred pain

Question 2

Examination in headache is usually normal.

Features of childhood migraine?

Answer 2

Associated abdominal pain, nausea, vomiting
Focal symptoms before, after, during e.g. visual disturbances, paraesthesia, weakness
Aggravated by bright light/noise
Relation to stress or tiredness
Helped by sleep, rest or a dark, quiet room
FH

Question 3

If you are worried about raised ICP, what are some questions you can ask?

Answer 3

Headache worse on coughing, straining to have a poo or benidng?
Woken from sleep with headache +/- vomiting?

Question 4

Indications that a headache needs neuroimaging?

Answer 4

Features of cerebellar dysfunction
Features of raised ICP
New focal neurological deficit
Seizures
Personality change
Unexplained deterioration in school work

Question 5

Treatment for acute migraines?

Answer 5

Pain relief
Triptans in older children

Question 6

Treatment to prevent migraines?

Answer 6

If patient gets migraine at least once per week:

Pizotifen
Propranolol
Amitriptyline
Topiramate
Valproate

Question 7

Treatment for tension type headaches?

Answer 7

Simple analgesia

Amitriptyline can be considered as prophylaxis/prevention

Question 8

Syncope?

Answer 8

Faint

Question 9

Convulsion?

Answer 9

Seizure where there is prominent motor activity

Question 10

Epilepsy?

Answer 10

A tendency to recurrent, unprovoked epileptic seizures

->a seizure is not necessarily epileptic

Question 11

What is a febrile convulsion?

Answer 11

A seizure occurring in infancy or childhood, usually associated with fever.
No evidence of intracranial infection.

->commonest cause of acute systematic seizure in childhood

Question 12

If a parent describes their child as having a seizure and they appeared stiff, what kind of seizure may it be?

Answer 12

Usually a tonic seizure

->increased tone, so tonic

Question 13

If a parent describes their child as having a seizure and they appeared to be jerking or shaking, what kind of seizure may it be?

Answer 13

Clonic
Myoclonic
Spasms

Question 14

If a parent describes their child as having a seizure and they fell, what kind of seizure could it be?

Answer 14

Atonic
Tonic
Myoclonic

Question 15

What is the chemical trigger or an epileptic fit?

Answer 15

Decreased inhibition- GABA
Excessive excitation- glutamate and aspartate
Excessive influx of sodium and calcium ions

Question 16

What are the main two types of epileptic seizures?

Answer 16

Partial seizure
Generalised seizure

Question 17

Which investigation is good at identifying the type of seizure someone may be experiencing?

Answer 17

EEG

Question 18

How is a diagnosis of epilepsy made?

Answer 18

Really thorough history about seizure
Even better if video

ECG if convulsive seizures
EEG
MRI brain sometimes to determine aetiology

Question 19

What does taking an ECG in convulsive seizures rule out?

Answer 19

Long QT syndrome

Question 20

First line treatment of epilepsy in children?

Answer 20

Anti-epilecptics

->this supresses seizures, not treat underlying cause. Should onl;y be considered if diagnosis is clear, even if you have to wait to start treatment

Question 21

Anti-epileptics are chosen depending on the age, gender and seizure type of the childen.

All anti-epileptics cause side effects. Give some examples.

Answer 21

Drowsiness
Effect on learning, cognition and behaviour

Question 22

First line anti-epileptic for focal epilepsies?

Answer 22

Carbamazepine

Question 23

First line anti-epileptic for generalised epilepsies?

Answer 23

Sodium valproate- not for girls.
Levetiracetam

Question 24

What are the characteristics of an absence seizure?

Answer 24

Very brief and abrupt
Eyes roll upwards

Question 25

What are the characteristics of a myoclonic seizure?

Answer 25

Very brief jerk, sometime patients don't even notice Common to drop things and cause injury to themself

Question 26

What are the characteristics of an atonic seizure?

Answer 26

Sudden and abrupt loss of tone, hence A-TONIC. e.g. a child sitting at a table falls forward and hits head off table ->would recommend the videos showing the different types of seizures .....girl ik you ain't gonna watch them dw, just useful

Question 27

What are the characteristics of a generalised tonic-clonic seizure?

Answer 27

Tonic phase precedes clonic phase Eyes are usually open ->Lucy, this one looks terrifying. I feel like if we see one, we will end up crying

Question 28

Which fontanelle closes first?

Answer 28

Posterior fontanelle

Question 29

When does the posterior fontanelle close?

Answer 29

2-3months

Question 30

When does the anterior fontanelle close?

Answer 30

1-3yrs of age, usually 18 months

Question 31

Plagiocephaly?

Answer 31

Flat headed

Question 32

Branchycephaly?

Answer 32

Short head or flat at back

Question 33

Scaphocephaly?

Answer 33

Boat shaped skull

Question 34

What happens in craniosynostosis?

Answer 34

Sutures of the skull have closed too early

Question 35

What are some of the signs that a child may have a neuromuscular disorder?

Answer 35

Baby 'floppy' from birth Paucity of limb movements Alert, but less motor activity Delayed motor milestones Able to walk but frequent falls

Question 36

Which gender is affected by Duchenne-Muscular Dystrophy?

Answer 36

Males

Question 37

Describe the genetics behind Duchenne-Muscular Dystrophy.

Answer 37

X-linked Xp21, dystrophin gene

Question 38

Which sign is positive in Duchenne-Muscular Dystrophy?

Answer 38

Grower's sign ->how quickly can the infant get up after lying flat on the ground

Question 39

Signs of Duchenne-Muscular Dystrophy?

Answer 39

Symmetrical proximal weakness Waddling gait Calf hypertrophy Grower's sign positive ->calf muscles are actually weak despite hypertrophy

Question 40

Which other systems does Duchenne-Muscular Dystrophy cause issues with?

Answer 40

Cardiovascular- cardiomyopathy Respiratory- in teens

Question 41

If a baby has muscle weakness all over the face, what may be the cause?

Answer 41

Myopathic facies

Question 42

Summarise the differences between neuropathy and myopathy.

Answer 42

Neuropathy: -distal weakness -may have motor and sensory symptoms -reflexes lost early -fasciculations may be present -myocardial dysfunction is not commonly a feature Myopathy: -usually proximal weakness -usually pure motor symptoms -reflexes preserved until late -fasciculations not typical -may have accompanying cardiac dysfunction