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Paediatrics > Neurology > Flashcards

Neurology Flashcards

1
Q

What is the most common cause of headache in children?

A

Migraine without aura

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2
Q

What is the best acute management of a migraine in children?

A

Ibuprofen

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3
Q

Can you use triptans in young people with migraines?

A

Sumitriptan nasal spra can be used in children over 12.

Oral triptans can only be used in those over 18.

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4
Q

What are the first line treatments for preventing migraines in children>

A

Pizotifen (Seratonin antagonist)

Propanolol

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5
Q

What is the definition of a febrile convulsion?

A
  1. A seizure occuring after one month of age
  2. Associated with a febrile illness (not causes by an infection of the CNS)
  3. No previous neonatal seizures or previous unprovoked seizures
  4. Nor meeting criteria for other symptomatic seizures.
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6
Q

In most situations, what type of seizure is a febrile convulsion?

A

Usually a tonic clonic seizure

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7
Q

What is the difference between a simple and a complex febrile convulsion?

A 
Simple 
- Age between 3 months and 6 years
- Tonic Clonic 
- Less than 5  minutes 
- Isolated event with the febrile illness
Complex
- Focal onset 
- More than 10 minutes 
- Recurrent events suring the same febrile illness
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8
Q

What is the definition of febrile status epilepticus?

A

Lasts more that 30 minutes

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9
Q

If you have a simple febrile seizure what is the risk that you will go on to develop epilepsy?

A

2.4%

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10
Q

If you have a simple febrile seizure what is the risk that you will go on to develop epilepsy?

A

6 - 8%

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11
Q

What first aid measures should be performed if a child has a febrile seizure?

A
  • Protect from injury
  • Check airway and clear
  • Place in recovery position
  • If it lasts over 5 minutes rescue medication should be given
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12
Q

What medication should be given for a febrile seizure that has gone on for longer than 5 minutes?

A

Buccal midazalam

Rectal diazepam

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13
Q

Do antipyretics reduce the incidence of febrile seizures?

A

No

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14
Q

If a child has a febrile seizure what is their temperature usually above?

A

38 degrees

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15
Q

A child has a febrile convulsion. Which red flags would make you think that this was more likely to be meningitis?

A
  • History of irritability, poor feeding or lethargy
  • Complex febrile seizure
  • Bulging fontaneel, neck stiffness, photophobia, focal neurological signs
  • Prolonged postictal altered consciousness or neurological defecit
  • Drowsinness
  • Previous or current antibiotic treatment
  • Incomplete immunisations
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16
Q

Below what level of consciousness (GCS and AVPU) would you want to intubate immediately?

A

GCS less than 9

Unresponsive

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17
Q

If a child presents with a depressed level of consciousness, low BP and high HR what fluids do you need?

A

20ml/kg fluid bolus isotonic saline

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18
Q

If a diabetic child presents with a depressed level of consciousness and blood sugar level of 1.2 what fluids do you give?

A

2ml/kg or 10% dextrose

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19
Q

What signs indicate raised ICP in a child?

A 
Bradycardia with hypertension 
Abnormal pupils 
Abnormal breathing pattern
Abnormal posture (decerebrate/decorticate)
Bulging fontanelle in infants
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20
Q

What are contraindications to doing a lumbar puncture?

A
  • Signs of raised ICP
  • GCS below 8 or deteriorating
  • Post ictal period following a seizure
  • Focal neurological signs
  • Signs of circulatory or septic shock
  • CT/MRI suggests CSF pathway obstruction, brain swelling or focal mass lesions.
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21
Q

What drug can be given to help reduce ICP?

22
Q

What is the triad of symptoms in guillain barre syndrome?

A

Progressive ascending motor weakness
Areflexia
Elevated CSF protein

23
Q

What are the symptoms of guillan barre syndrome?

A

Lower back pain
Progressive weakness going from distal to proximal
This progresses rapidly over 4 weeks then there is a plateau phase followed by recovery

24
Q

What investigations can you do if you suspect guillan barre?

A

MRI spine with contrast (excludes other spinal pathologies)
LP: Raised CSF protein
Nerve conduction studies - segmental demyelination

25
Q

What is the treatment of guillan barre in children?

A

Supportive care in acute phase
Immunoglobulins
Prevention of contractures during acute paralytic phase
Rehabilitation

26
Q

A 9 year old child presents to the GP with neck stiffness a headache and a temperature of 39 degrees,

A

Bacterial meningitis

27
Q

What investigation do you need if you suspect bacterial meningitis?

A

Lumbar puncture

28
Q

What is the CSF like in bacterial meningitis?

A

Positive gram stain
High neutrophil count
High protein
Low glucose

29
Q

You see a patient in the GP and the have a rash and symptoms that are suggestive of mennigococcal septicaemia. What should you do in the GP?

A

Transfer as an emergency to hospital (Call 999)

Give IM or IV Benzylpenicillin

30
Q

What is the managements of children in hospital with a petichial rash, fever and raised CRP?

A

IV ceftriaxone

This indicates an increased risk of having bacterial meningitis

31
Q

What blood results do you want in a child who you suspect has bacterial meningitis?

32
Q

When you take the CSF to look for bacterial meningitis in a child what bacteria do you look for and how do you look for it?

A

PCR for N meninngitidis

33
Q

What all are you looking at in the CSF of a child with suspected meningitis?

A 
WCC
Protein 
Glucose 
Gram stain 
Culture
34
Q

What is the empirical antibiotic treatment for children under 3 months with suspected bacterial meningitis?

A

IV cefotaxime and amoxicillin

35
Q

What is the empirical antibiotic treatment for children over 3 months with suspected bacterial meningitis?

A

1st dose of Cefotaxime followed by OD daily ceftriaxone

+/- dexamethasone IV starting before or with first dose of antibiotic

36
Q

What is the treatment for herpes simplex encephalitis

A

IV Acyclovir

37
Q

What antibiotic do you also give if a child with suspected bacterial meningitis has had recent travel outside the UK

A

Vancomycin (in addition to cefotaxime and ceftriaxone)

38
Q

What is the empirical antibiotic treatment for children over 3 months with H influenzae bacterial meningitis?

A

IV ceftriaxone for 10 days

39
Q

What is the empirical antibiotic treatment for children over 3 months with strep pneumoniae meningitis?

A

IV ceftriaxone

40
Q

What is the empirical antibiotic treatment for children under 3 months with haemophilus influenzae bacterial meningitis ?

A

IV cefotaxime for 14 days

41
Q

What is the empirical antibiotic treatment for children under 3 months with L monocytogenes bacterial meningitis?

A

IV amoxicillin + Gentamicin for the first 7 days

42
Q

What is the treatment for suspected bacterial meningitis in a child who in penicllin allergic?

A

Chloramphenical (must measure plasma concentration)

43
Q

What is the potential adverse effect of chloramphenicol?

A

Aplastic anaemia

44
Q

What viruses commonly cause viral meningitis?

A

Enteroviruses
Echoviruses
Coxsackie virus

45
Q

What does the lumbar puncture look like in viral meningitis?

A

WCC raised (mostly lymphocytes)
CSF protein normal (maybe slightly high)
CSF glucose normal)

46
Q

What are the common causes of neonatal meningitis?

A

Group B strep
E Coli
Listeria monocytogenes

47
Q

How do neonates get Group B strep meningitis?

A

Acquired from vaginal colonisation of the mother

48
Q

What is the treatment for neonatal meningitis caused by group B strep?

A

Benzylpenicillin

Gentamicin

49
Q

Who gets intrapartum Benzylypenicillin?

A 
Pre term labour 
Prolonged rupture of membranes 
GBS on vaginal swab/urine 
Fever in labour 
GBS in previous baby
50
Q

What is the treatment for neonatal meningitis caused by E Coli?

A

Cefotaxime and Gentamicin

51
Q

What is the treatment for neonatal meningitis caused by listeria monocytogenes?

A

Amoxicillin and Gentamicin

Paediatrics (14 decks)

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