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Paedriatrics > Neurology > Flashcards

Neurology Flashcards

1
Q

What is important in a neurological consultation in paediatrics?

A

Interactive
Avoid medical language
Time course of symptoms CRUCIAL
Perinatal, developmental, Fox

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2
Q

What is important in a developmental Hx in neurology?

A 
Motor milestones: gross and fine motor
Speech and language
Early cognitive development
Play - symbolic play and social behaviour
Self-help skills
Vision and hearing assessment
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3
Q

What should you observe in a neurological examination of a child?

A 
Appearance
Gait
Head skin
Skin findings
Observe
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4
Q

What is the second most common cancer in children?

A

Brain

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5
Q

What are the different types of headache disorder in children?

A

Isolated acute
Recurrent acute
Chronic progressive
Chronic non-progressive

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6
Q

What are the two worrying headache disorders in children?

A

Isolated acute

Chronic progressive

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7
Q

What should you ask in a recurrent or chronic headache Hx?

A

More than one type of headache?

Typical episode: warning, location, severity, duration, frequency

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8
Q

What should you examine in a headache exam?

A 
Growth parameters, OFC, BP
Sinues, teeth, visual acuity
Fundoscopy
Visual fields
Cranial bruit
Focal neurological signs
Cognitive and emotional status
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9
Q

What is the OFC?

A

Occipitofrontal Circumference (OFC)

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10
Q

What are indicators of childhood migraine?

A 
Associated abdominal pain, nausea, vomiting
Focal symptoms
Signs before/during/after: visual disturbance, parenthesis, weaknes
Pallor
Aggravated by bright light/noise
Relation to fatigue/stress
Helped by sleep/rest/dark, quiet room
FHx positive
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11
Q

What are signs it is a migraine as opposed to a tension headache?

A 
Hemicranial pain
Throbbing/pulsatile
Abdo pain, nausea, vomiting
Relieved by rest
Photophobia/phonophobia
Visual, sensory, motor aura
FHx positive
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12
Q

What are signs it is a tension headache as opposed to migraine?

A

Diffuse, symmetrical
Band-like distribution
Present most of the time
Constant ache

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13
Q

What is suggestive of raised intracranial pressure?

A

Aggravated by activities that raise ICP: coughing, straining at stool, bending
Woken from sleep with headache +/- vomiting

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14
Q

What is suggestive of an analgesic overuse headache?

A

Headache back before allowed another dose
Paracetamol/NSAIDs
Compound analgesics - cocodamol

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15
Q

What are activities that can raise ICP?

A

Coughing, straining at stool, bending

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16
Q

What are indications for neuroimaging?

A 
Features of cerebellar dysfunction
Features of raised ICP
New focal neurological deficits e.g. squint
Seizures (esp. focal)
Personality change
Unexplained deterioration of school work
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17
Q

What is the management for an acute attack migraine?

A

Pain relief

Triptans

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18
Q

What is the preventative management for migraines?

A 
Pizotifen
Propranolol
Amitryptyline
Topiramate
Valproate
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19
Q

What is the management for tension headaches?

A 
Reassure no sinister cause
MDT management
Underlying problems
Acute attacks: analgesia
Discourage analgesics in chronic TTH
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20
Q

What is a preventative treatment for TTH?

A

Amitriptyline

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21
Q

What is a convulsion?

A

Seizure where there is prominent motor activity

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22
Q

What is an epileptic seizure?

A

An abnormal excessive hyper synchronous discharge from a group of (cortical) neurons

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23
Q

What is epilepsy?

A

A tendency to recurrent, unprovoked (spontaneous) epileptic seizures

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24
Q

How is epilepsy diagnosed?

A

Clinically - with EEG for supportive evidence

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25
Q

What is a seizure not necessarily?

A

Epileptic

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26
Q

What are examples of non-epileptic seizures and other mimics in children?

A 
Acute symptomatic seizures
Reflex anoxic seizure
Syncope
Parasomnias
Behaviour stereotypies
Psychogenic non-epileptic seizures (PNES)
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27
Q

What can acute symptomatic seizures be due to?

A

Hypoxia-ischaemia
Hypoglycaemia
Infection
Trauma

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28
Q

What is a febrile convulsion?

A

A seizure occurring in infancy/childhood usually between 3mo-5yr associated with fever but no evidence of intracranial infection or defined cause for seizure

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29
Q

What is the commonest cause of acute symptomatic seizure in childhood?

A

Febrile convulsion

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30
Q

How can you distinguish between different seizure types?

A

Jerk/shake: clonic, myoclonic, spasms
Stiff: tonic
Fall: atonic/tonic/myoclonic
Vacant attack: absence, complex partial seizure

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31
Q

What are epileptic fits chemically triggered by?

A

Decreased inhibition
Excessive excitation
Excessive influx of Na and Ca ions

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32
Q

What are the two main types of epileptic seizure?

A

Partial seizure

Generalised seizure

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33
Q

What type of seizure are the majority of seizures?

A

Generalised

34
Q

What are the subtle types of seizure?

A

Absences, myoclonus, drop attacks

35
Q

What questions should you ask when diagnosing epilepsy?

A 
Is the paroxysmal event epileptic in nature?
Is it epilepsy?
What seizure type is it?
What is the epilepsy syndrome?
What is the ethology?
What are the effects on the child?
36
Q

Why does the EEG have limited value in diagnosing epilepsy?

A

Low sensitivity

False positives

37
Q

What is the EEG useful for in diagnosing seizures?

A

Seizure type
Seizure syndrome
Etiology

38
Q

What do you use for a diagnosis of epilepsy?

A 
History
Video
EEG in convulsive seizures
Interictal/ictal EEG
MRI brain
Genetics
Metabolic tests
39
Q

What is the management of epilepsy in children?

A

Anti-epileptic drugs (AED)

40
Q

What is the role of AED?

A

To control seizures

41
Q

How should you start children on AED’s?

A

Slow upward titration until side-effects manifest of drug inefficient

42
Q

What should be considered when selecting AEDs?

A

Age
Gender
Type of seizures and epilepsy

43
Q

What can some of the side effects of AEDs be?

A

CNS
Drowsiness
Effect on learning, cognition, behaviour

44
Q

What are first line AEDs for generalised epilepsies?

A

Sodium valproate

Levetiracetam

45
Q

What are first line AEDs for focal epilepsies?

A

Carbamazepine

46
Q

What are other therapies for seizures/epilepsy?

A

Steroids
Immunoglobulins
Ketogenic diet (drug-resistant epilepsies)

47
Q

What are epilepsy management options which are not drugs?

A

Vagus nerve stimulation (VNS)

Surgery

48
Q

What are examples of head size problems?

A

Macrocephaly

Microcephaly

49
Q

When does the posterior fontanelle usually close?

A

2-3 months after birth

50
Q

When does the anterior fontanelle usually close?

A

1-3 years

51
Q

What is the head measurement roughly down between birth-3yrs in any child with neurological/developmental symptoms?

A

Occipitofrontal circumference (OFC)

52
Q

When is microcephaly diagnosed as mild?

A

OFC <2 SD

53
Q

When is microcephaly diagnosed as moderate/severe?

A

OFC <3 SD

54
Q

What should you consider when diagnosing microcephaly?

A

Prenatal or postnatal onset?
Timing of onset?
Causes? (genetic/environmental)

55
Q

What is the definition of macrocephaly?

A

OFC >2 SD

56
Q

What should you consider when diagnosing macrocephaly?

A 
Is it crossing gentiles upwards?
Sutures?
Fontanelles?
Familial?
Hydrocephalus?
Large brain?
Development?
Other physical abnormalities?
57
Q

What is the term for ‘flat head’?

A

Plagiocephaly

58
Q

What is the term for ‘short head or flat at back’?

A

Brachycephaly

59
Q

What is the term for ‘boat shaped skull’?

A

Scaphocephaly

60
Q

What is craniosynostosis?

A

The bones in a baby’s skull join together too early

61
Q

When should you suspect a NM disorder?

A 
Baby floppy from birth
Slips from hands
Paucity of limb movements
Alert, but less motor activity
Delayed motor milestones
Able to walk but frequent falls
62
Q

What gene does Duchenne Muscular Dystrophy affect?

A

Xp21

Dystrophin gene

63
Q

What are the signs/symptoms of Duchennes?

A 
Delayed gross motor skills
Symmetrical proximal weakness
Elevated creatinine kinase levels
Cardiomyopathy
Respiratory involvement in teens
64
Q

What are the levels of creatinine kinase usually like in Duchennes?

A

High

>1000

65
Q

What are the signs of symmetrical proximal weakness in Duchenne’s Muscular Dystrophy?

A

Waddling gait
Calf hypertrophy
Gower’s sign positive

66
Q

What is Gower’s sign?

A

The sign describes a patient that has to use their hands and arms to “walk” up their own body from a squatting position due to lack of hip and thigh muscle strength.

67
Q

What are physical signs of Duchenne’s?

A 
Shoulders/arms back when walking
Sway back
Weak butt muscles
Knees may bend back to take weight
Thick lower leg muscles - fat not strong
Tight heel cord (contracture)
Belly sticks out
Poor balance
Falls often
Clumsy walking
Weak muscles in front leg cause foot drop
Tip toe contractures
68
Q

What are examples of muscle neuromuscular conditions?

A

Muscular dystrophies
Myopathies - congenital and inflammatory
Myotonic syndromes

69
Q

What is an example of a neuromuscular junction problem?

A

Myasthenic syndromes

70
Q

What are examples of nerve neuromuscular conditions?

A

Hereditary or acquired neuropathies

71
Q

What is an example of a anterior horn cell neuromuscular condition?

A

Spinal muscular atrophy

72
Q

Where is the site of weakness in a neuropathy?

A

Distal weakness

73
Q

Where is the site of weakness in a myopathy?

A

Usually proximal

74
Q

What are the reflexes like in a neuropathy?

A

Reflexes lost early

75
Q

What are the reflexes like in a myopathy?

A

Reflexes preserved until late

76
Q

Are fasciculations common in neuropathies?

A

May be present

77
Q

Are fasciculations common in myopathies?

A

Not typical

78
Q

Are contractures a feature of neuropathies?

A

Not a feature

79
Q

Are contractures a features of myopathies?

A

Yes

80
Q

Is myocardial dysfunction a feature of neuropathy?

A

Not a typical feature

81
Q

Is myocardial dysfunction a feature of myopathy?

A

May have accompanying cardiac dysfunction with dystrophies

Paedriatrics (19 decks)

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