Neurology

Question 1

4 patterns of headaches in childhood

Answer 1

isolated acute
recurrent acute
chronic progressive
chronic non-progressive

Question 2

Typical episode of headache questions

Answer 2

any warning?
location?
severity?
duration?
frequency?

Question 3

headache examination

Answer 3

growth, OFC, bp
sinuses, teeth, vision 
fundoscopy 
visual fields 
cranial bruit
focal signs

Question 4

pointers to childhood migraine

Answer 4

associated abdo pain, N&V
Focal symptoms before/during/after - tingling
aggravated by light/noise
relation to fatigue/stress
helped by sleep, quiet
FH

Question 5

Migraine vs TTH location

Answer 5

migraine is hemicranial

TTH - diffuse, symmetrical

Question 6

pointers to raised ICP

Answer 6

aggravated by coughing, bending

woken from sleep

Question 7

Indications for neuroimaging

Answer 7

cerebellar dysfunction
raised ICP
new focal neurological deficit eg new squint
seizures - esp focal

Question 8

managing migraine

Answer 8

acute attack - triptans

prevent - amitriptyline, valproate, propanolol

Question 9

TTH treatment

Answer 9

reassure, MDT, underlying stress
simple analgesia
amitriptyline?

Question 10

convulsion

Answer 10

fit where there is a prominent motor activity

Question 11

Epileptic seizure

Answer 11

abnormal excessive hypersynchronous discharge from neurons

Question 12

Non epileptic seizures

Answer 12

syncope 
parasomnias 
psychogenic 
hypoglycaemia
reflex anoxic seizures - preceded by trauma

Question 13

What is a febrile convulsion?

Answer 13

3 months - 5 years
fever
no intracranial infection or defined cause

Question 14

commonest cause of acute symptomatic seizure in childhood

Answer 14

febrile convulsion

Question 15

jerk/shake seizure types

Answer 15

myoclonic, clonic, spasm

Question 16

stiff seizure type

Answer 16

tonic

Question 17

fall seizure type

Answer 17

atonic/tonic/myoclonic

Question 18

chemical trigger of epileptic fit

Answer 18

decreased inhibition - GABA
Excessive excitation - glutamate
excess Na and Ca influx

Question 19

Child epilepsies vs adult epilepsies

Answer 19

idiopathic
most generalised
can be subtle

Question 20

Role of EEG

Answer 20

interictal has limited value

seizure type, aetiology

Question 21

Diagnosing epilepsy

Answer 21

history 
video recording 
EEG in seizure
MRI brain 
genetics eg tuberous sclerosis 
metabolic tests

Question 22

Epilepsy drug treatment

Answer 22

sodium valproate - generalised (not girls)
carbamazepine - focal 
lamotrigine, steroids, immunoglobulins
VNS
Surgery

Question 23

When to suspect NM disorder

Answer 23

baby floppy from birth 
slips from hands 
alert but less motor activity
delayed milestones
able to walk but frequent falls

Question 24

Sign which indicates pelvic girdle weakness

Answer 24

Gower’s

Question 25

Appearance of child with NM disorder

Answer 25

calf muscle hypertrophy
poor balance
belly sticks out
walk on tip toes

Question 26

problem in Duchenne

Answer 26

dystrophin gene

Question 27

elevate …. in Duchenne

Answer 27

creatinine kinase