Neurology

Question 1

what is involved in the neurological examination of a child?

Answer 1

observation of the child 
appearance 
gait 
head size 
skin findings 

other neurological examination depending on age

Question 2

what patterns of headache require further investigations?

Answer 2

isolated acute

chronic progressive

Question 3

what are the different patterns of headaches?

Answer 3

isolated acute
acute recurrent
chronic progressive
chronic non-progressive

Question 4

what questions would you ask in the history regarding a typical episode of their headache?

Answer 4

any warning? (aura)
location?
severity?
duration?
frequency?

Question 5

what is involve in the clinical examination of a child with headache?

Answer 5

growth parameters, OFC
blood pressure 
sinuses, teeth
visual acuity 
fundoscopy 
visual fields 
cranial bruit 
focal neurological signs 
cognitive and emotional status

Question 6

what is the most likely cause if a child presents with a headache and their growth is plautus?

Answer 6

craniopharyngioma

Question 7

what is the difference in the distribution of a migraine vs tendon headache?

Answer 7

migraine - hemicranial pain

tendon - diffuse, symmetrical, band-like

Question 8

describe features of a migraine.

Answer 8

hemicranial pain 
throbbing. pulsatile 
aggravated by light, noise 
relived by rest 
may go into dark, quiet room, lie down 
visual, sensory, olfactory aura 
positive family history 
abdominal pain ,nausea, vomiting

Question 9

what features of a headache would indicate raised intracranial pressure?

Answer 9

aggravated by physical activity, lying down, coughing

woken up by sleep by headache +/- vomiting

Question 10

when would you refer a child for neuroimaging with a headache?

Answer 10

features of cerebellar dysfunction
features of raised intracranial pressure
new focal neurological deficit e.g. squint
seizures
personality change
unexplained deterioration at work

Question 11

what is the management of migraines?

Answer 11

immediate relief - triptans

preventative - propanolol, topiramate, amitryptilline

Question 12

when would you give a child preventative medication for migraine?

Answer 12

> 1 per week

Question 13

what is the management for a tension type headache in a child?

Answer 13

analgesia i.e. paracetamol
prevention i.e. amitryptilline
attention to psychological or emotional problems
aim to reassure that its nothing serious

Question 14

what is an epileptic seizure?

Answer 14

an abnormal excessive hyper-synchronous discharge from a group of (cortical) neurones

Question 15

what is an anoxic seizure and in what age group pis it most common?

Answer 15

commonly in toddlers
secondary seizure triggered by an environmental stimulus which stimulates the vagal nerve causing a brief stoppage of the heart

Question 16

what is the most common age group for a febrile seizure?

Answer 16

3 months - 5 years

Question 17

what is the commonest cause of an acute symptomatic seizure in childhood?

Answer 17

febrile seizure

Question 18

what is the mechanism of an epileptic fit?

Answer 18

chemically triggered by;

• decreased inhibition
• excessive excitation
• excessive influx of Na and Ca ions

summation of multitude of electrical potentials result in depolarisation of many neurones which can lead to seizures

Question 19

what is the use of an EEG?

Answer 19

helpful in confirming epilepsy after clinical diagnosis

useful in identifying seizure types, seizure syndrome, and etiology

Question 20

what genetic condition can be the cause of epilepsy?

Answer 20

tuberous sclerosis

Question 21

what is the management for focal and generalised epilepsy in children?

Answer 21

focal - 1st line Na valproate or levetiracetam (girls)

generalised - 1st line Carbamazepine

Question 22

what non-drug treatments are there for epilepsy?

Answer 22

ketogenic diet 
surgery 
vagal nerve stimulation 
immunoglobulins 
steroids

Question 23

when does the anterior and posterior fontanelles fuse?

Answer 23

posterior - 2-3 months

anterior - 18-24 months

Question 24

what is mild and moderate/severe microcephaly?

Answer 24

mild OFC < 2SD

moderate/severe OFC > 2SD

Question 25

what is craniosynostosis?

Answer 25

cranial stature fuse too early

doesn’t allow your head to grow

Question 26

what is a cardinal presenting feature of a motor neurone problem?

Answer 26

muscle weakness

floppy

Question 27

what features in a child would you suspect a motor neurone disorder?

Answer 27

floppy from both 
slips from the hands 
paucity of limb movements 
alert but less motor activity
delayed motor milestones 
able tow all but frequent falls

Question 28

what are features of duchesses muscular dystrophy?

Answer 28

waddling gait 
calf hypertrophy 
gower's sign positive 
elevated creatinine kinase (>10000)
cardiomyopathy
respiratory involvement in teens

Question 29

what is the anatomical abnormality in spinal muscular atrophy?

Answer 29

anterior horn cell

Question 30

would you find fasciculation in a neuropathy or myopathy?

Answer 30

neuropathy

Question 31

are reflexes lost early in neuropathy or myopathy?

Answer 31

neuropathy

spared until late in myopathy

Question 32

what is scaphocephaly?

Answer 32

boat shaped skull

Question 33

what is brachycephaly ?

Answer 33

short head or flat at the back

Question 34

what is plagiocephaly?

Answer 34

flat head

Question 35

what is deformational plagiocephaly ?

Answer 35

deformation of the skull due to the position of the baby in utero - benign