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CP2 PAEDS > Neurology > Flashcards

Neurology Flashcards

1
Q

What is cerebral palsy?

A

Abnormality of movement + posture –> limited activity

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2
Q

What 5 things is cerebral palsy associated with most?

A 
LD (60%) 
Epilepsy (40%) 
Squints (30%) 
Vision problems (20%) 
Hearing problems (20%)
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3
Q

Majority (80%) causes of cerebral

A

Antenatal

Vascular occlusion
Structural malformation
Cortical migration disorder

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4
Q

2 other types of causes of cerebral palsy

A

Hypoxic ischaemic injury

Postnatal origin

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5
Q

Examples of post-natal origins of cerebral palsy (6)

A 
Preterm 
Meningitis 
Encephalitis 
Trauma 
Hypoglycaemia 
Hydrocephalus
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6
Q

Features cerebral palsy in early childhood (7)

A 
Abnormal limb/trunk posture 
Delayed motor development 
Slow growing head
Feeding difficulties --> oromotor coordination 
Abnormal gait 
Asymmetric hand fct <12m
Remaining primitive reflexes
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7
Q

RF for developing cerebral palsy (12)

A 
LBW
Prematurity 
Multiple pregnancy 
Placental abnormalities 
Birth defects
Meconium aspiration 
Emergency CSC
Birth asphyxia 
Neonatal seizure
Resp distress 
Hypoglycaemia 
Infection in neonatal period
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8
Q

What are the 3 types of CP

A

Spastic
Dyskinetic
Ataxic

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9
Q

What % of CP is spastic?

A

90%

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10
Q

Why does spastic CP occur?

A

Damage to UMN - motor cortex

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11
Q

Sx Spastic CP (think, its UMN)

A 
Uni/bilateral
hypertonia (velocity dependent) 
hyperreflexia
Extensor plantar response
Hypotonia of H+N
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12
Q

What are the 3 types of spastic CP

A

Hemiplegia
Quadriplegia
Diplegia

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13
Q

Features of hemiplegia spastic CP (4)

A

Unilateral involvement arm/leg
Arms worse legs
Face spared
Fisting of hand

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14
Q

Features of quadriplegia spastic CP (4)

A

All 4 limbs affected
Often severe + assoc w/ epilepsy, microcephaly + LD
Trunk involved = opisthonus
Poor head control + decr tone

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15
Q

Opithonus

A

Extensor protrusion –> arching of back

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16
Q

Features of diplegia CP (4)

A

All 4 limbs affects
Legs > arms
Walking abnormal
Hand fct remains normal

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17
Q

What is associated with hemiplegia spastic CP

A

Neonatal stroke

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18
Q

What is associated with quadriplegia spastic CP

A

HIE

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19
Q

What is associated with diplegia spastic CP?

A

Pre-term

Periventricular brain damage

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20
Q

What % CP is dyskinetic

A

6%

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21
Q

What structure is affected in dyskineitc CP

A

Basal ganglia

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22
Q

Most common cause dyskinetic CP

A

HIE

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23
Q

Features dyskinetic CP (4)

A

Variable tone
SOmetimes chorea or athetosis
Normal intellect sometimes
Presents floppy

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24
Q

What is chorea

A

Irregular, sudden + brief non-repetitive movements

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25
Q

What is athetosis

A

Slow writing movements occuring more distally

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26
Q

Features Ataxic CP (4)

A

Hypotonia of limbs + trunk
Poor balance
Delayed motor development
May develop incoordinate movements, intention tremor + ataxic gait

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27
Q

How is ataxic CP acquired

A

Genetically determined

Brain injury

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28
Q

2 main goals of physiotherapy in CP

A

Prevent weakness

Prevent mm rigidity

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29
Q

2 Dx used in CP

A

Diazepam

Baclofen

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30
Q

Use of orthopaedic surgery in CP (4)

A

Last resort - severe spasticty/fixed contractures
Repair scoliosis
Tendon lengthening
Osteotomy to realign limb

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31
Q

Prevalence epilepsy?

A

1/200

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32
Q

Generalised seizures featuers (4)

A

Discharge from both hemi-spheres
No warning
Consciouness loss
Usually symmetrical

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33
Q

Features absence seziures (3)

A

TLOC
Abrupt start + stpo
No motor phenomenon apart from eye flickering

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34
Q

What brings on absence seizures?

A

Hyperventilation

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35
Q

Myoclonic seizures features

A

Brief, repetitive jerking movements

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36
Q

Tonic seizures features

A

Generalised increase in tone

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37
Q

Tonic clone seizures features

A

Rhythmical contraction of mm groups following tonic phase

Lasts seconds/mins following by unconsciousness/deep sleep

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38
Q

Tonic phase of T-C seizures

A

Incr tone, fall to ground, cyanosis

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39
Q

Clonic phase of a T-C seizure

A

Limb jerking, irreg breathing + tongue biting

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40
Q

Atonic seizure features

A

Loss of mm tone –> sudden fall/drop of head

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41
Q

Features focal seziure

A

Can be conscious/not

May proceed into T-C

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42
Q

Frontal seizure features

A

Motor –> clonic movements

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43
Q

Temporal seizure features (3)

A

Auditory/sensory - aura w/ smell/taste
Distortions sound + shape
Lip smacking
Impaired consciousness

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44
Q

Features occipital seizure

A

Distortion of vision

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45
Q

Features parietal seizure

A

Contra-lateral altered sensation

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46
Q

Which focal seizure is the most common?

A

Temporal

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47
Q

What does an EEG identify? (3)

A

Abnormal background
Asymmetry/slowing hence structural abnormalities
Neuronal hyperexcitability

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48
Q

Structural imaging for epilepsy (2)

A

MRI

CT

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49
Q

Indications for structural imaging for epilepsy (2)

A

Neurological signs between seizures

Focal seizure

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50
Q

Functional imaging for epilepsy (2)

A

PET

SPECT

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51
Q

1st line Ix for epilepsy

A

EEG

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52
Q

4 Ix for epilepsy

A

EEG
MRI/CT
Metabolic Ix (developmental regression/feeding issue)
Genetic study (SCNA1)

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53
Q

Rescue therapy in prolonged therapy epilepsy (2)

A

Rectal diazepam

Buccal midalozam

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54
Q

When should anti-epileptic medication be stopped?

A

If seizure free 2 years

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55
Q

1st line Dx TC seizures

A

Valporate or carbamazepine

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56
Q

1st line Dx absence seizures

A

Valporate or ethosuximide

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57
Q

1st line Dx myoclonic seizures

A

Valporate

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58
Q

2nd line Dx generalised seizures

A

Lamotrigine

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59
Q

1st line Dx - focal seizures

A

Carbamazepine, lamotrigine or valporate

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60
Q

SE valporate (2)

A

Incr W
Hair loss
Liver failure (rare)

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61
Q

SE carbamazepine (5)

A 
Rash 
Neutropenia 
Decr Na
Ataxia
Enzyme induction
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62
Q

SE lamotrigrine

63
Q

SE Ethosuximide

64
Q

Non-Dx Tx epilepsy (3)

A

Ketogenic diet
Vagal nn stimulation
Surgery - focal resection/hemispherectomy

65
Q

What is SUDEP?

A

Sudden unexpected death in epilepsy

66
Q

RF SUDEP (2)

A

Poor control

Seizures in sleep

67
Q

Preventing SUDEP (5)

A 
Good AED adherence
Seizure diary 
Avoid triggers 
Bed alarm 
ID jewelry or epilepsy awareness cards
68
Q

What is a febrile seizure?

A

Seizure + fever/viral infection

69
Q

What age range gets febrile seizures?

A

6m –> 5y/o

70
Q

What type of seizure is a febrile seizure usuaully?

71
Q

What % febrile seizures have recurrence?

72
Q

Do febrile seizures affect brain performance?

73
Q

What % chance is there of having a febrile seizure + going on to develop epilepsy

74
Q

Mx febrile seizures (7)

A 
Ensure case isnt > serious (rule out meningitis) 
Inform parents, reassure
DONT - use anti-pyretics, AED or EEG
Recovery position 
Place in safe location 
Stay w/ child 
Call for help >5mins
75
Q

When does expiratory apnoea syndrome occur?

A

In toddlers when upset/tantrum

76
Q

What happens in expiratory apnoea syndrome?

A

Cry –> hold breath –> cyanosed –> brief LOC + rapid recovery

77
Q

Triggers of reflex anoxic seizure (4)

A

Pain
Head trauma
Cold food
Fright

78
Q

What causes reflex anoxic seizures

A

Asystole from vagal inhibition

79
Q

What is Ataxia?

A

Incoordination of mm movements

Lack of balance, staggering gate, difficulty sitting, clumsy

80
Q

What is the most common cause of ataxia?

A

Post infection

81
Q

Causes acute (<72hrs) ataxia (7)

A 
Post infection (varicella, EBV)
Toxins 
Tumour 
Trauma 
Metabolic 
Infection 
Vascular
82
Q

Toxins that can cause acute ataxia (4)

A

Phenytoin
Benzos
Anti-H
Alcohol

83
Q

Causes of episodic/recurrent ataxia (4)

A

Toxin ingestion
Basillar aa migraine
Seizure disorder
Metabolic

84
Q

Causes of chronic ataxia (7)

A 
Tumours 
Hydrocephalus 
Metabolic 
Congenital malformation 
Hereditary 
Ataxic cerebral palsy
85
Q

Examples of hereditary causes of ataxia (2)

A

Freidrich’s ataxia

Ataxia telangiectasia

86
Q

What is Freidrich’s ataxia?

A

Autosomal recessive, worsening ataxia, distal wasting in legs, absent leg reflex

87
Q

What is Ataxia telangiectasia

A

Disorder of DNA repair, autosomal recessive, dystonia + cerebellar signs

88
Q

Ix ataxia (6)

A 
Hx 
CT
Bloods - g, U/E, gluc 
Metabolic screening 
Genetic testing 
Lumbar puncture (hydrocephalus)
89
Q

Symptoms of raised ICP in children (5)

A 
Headache, worse in morning 
Vomiting on waking 
Behaviour change
Visual disturbance
Papilloedema
90
Q

Symptoms of raised ICP in infants

A 
Vomit 
Bulging fontanelle 
Incr head circumference 
Head tilt 
Developmental delay/regression
91
Q

Sx supratentorial tumour (3)

A

Seizures
Hemiplegia
Focal neurology

92
Q

Sx midline tumour (2)

A

VF loss - bitemporal hemianopia

Pit failure - growth failure, diabetes insipidus, incr W

93
Q

Sx cerebellar tumour (3)

A

Ataxia
Co-ordination issues
Abnormal eye movements

94
Q

Sx brainstem tumour (3)

A

CN defect
Pyrimidal tract - motor issues
Cerebellar ataxia
(No Sx incr ICP)

95
Q

When does Bratten’s syndrome begin

96
Q

Features Bratten’s syndrome

A

Gradual onset:

Visual disturbance + seizures –> behaviour, speech + learning regression –> dementia –> death

97
Q

What is Leukodystrophies

A

Disorder in WM of brain b/c incorrect myelin sheath

98
Q

Features leukodystrophies

A

Gradual decline

Loss movement –> speech –> vision –> hearing + behaviour

99
Q

What is Wilsons disease

A

Disorder hepatic Cu deposition

Decr Cu in serum –> incr in Liver –> liver injury

100
Q

Features Wilsons (5)

A 
Acute liver failure --> CLD
Severe depression 
Asymmetrical tremor 
Difficulty speaking, MASK face, clumsy, personality change 
Gait change
101
Q

What is SSPE

A

Subacute sclerosis paencephalitis

Persistent infection w/ immune resistant measles –> progressive encephalitis

102
Q

Prognosis SSPE

A

Death within 5 days

No Tx

103
Q

Progression of SSPE

A

1’ measles <2
6-15 years asymp
Gradual psychological + neuro deterioration

104
Q

When does most of head growth occur ?

A

First 2 years of life

105
Q

When does posterior fontanelle close?

A

By 8 weeks

106
Q

When does anterior fontanelle close?

A

by 12-18 months

107
Q

If there is a rapid incr in head circumference, what must be excluded?

108
Q

What is macrocephaly?

A

Head circumference >98th centile

109
Q

Causes macrocephaly (8)

A 
Tall stature 
Familial 
Incr ICP
Hydrocephalus 
Chronioc subdural haematoma 
Tumour 
NFM 
Cerebral gigantism
110
Q

Ix macrocephaly if fontanelle open

111
Q

Ix macrocephaly if fontanelle closed

112
Q

What is microcephaly?

A

Head circumference <2nd centile

113
Q

Causes microcephaly (4)

A

Familial
Auto recessive
Congenital infection e.g. ZIKA
Insult to brain during development (hypoxia, hypoglycaemia, meningitis)

114
Q

What is Craniosynostosis

A

Premature fusion of 1 or > sutures –> distortion of head shape

115
Q

Which sutures are usually affected by craniosynostosis

116
Q

Appearance of craniosynostosis - sagital suture

A

Long, narrow skull

117
Q

Appearance of craniosynostosis - lambdoid suture

A

Skull asymmetry/flat

118
Q

Key DDx craniosynostosis

A

Plagiocephaly

119
Q

Causes craniosynostosis (2)

A

If Single suture - unknown

Multiple - genetic syndrome

120
Q

S+S craniosynostosis (5)

A

Fused sutures
Unusual shape, headaches
Developmental delay, LD or visual problems

121
Q

What is hydrocephaly

A

Obstruction in flow of CSF –> dilation of ventricles

122
Q

What is obstructive/non-communicating hydrocephaly due to

A

Structure within ventricles or aqueduct blocking flow hence enlargement

123
Q

Causes communicating hydrocephaly (3)

A

Congenital malformation
Posterior fossa neoplasm
Interventricular haemorrhage

124
Q

Congenital malformations causing communicating hdyrocephaly (2)

A

Aqueduct stenosis

Atresia of foramine 4th ventricle

125
Q

2 causes non-obstructive hydrocephaly

A 
Incr CSF prod (choroid plexus tumour) 
Decr resorption (meningitis, haemorrhage)
126
Q

External hydrocephaly

A

Benign enlargement of SAS in infancy

Self-limiting - resolves in following years :)

127
Q

Features hydrocephaly (5)

A 
Large head circumference 
Excessive rate of growth 
Bulging fontanelle 
Distended scalp vv 
Sunset eyes
128
Q

Tx hydrocephaly

A

Insertion ventriculoperitoneal shunt

129
Q

What % migraines have no aura

130
Q

Features migraine w/o aura: (6)

A 
Last 4-72hrs
Usually bilateral
Pulsatile 
Over temporal/frontal area 
\+ N+V, abdo pain, photophobia, phonophobia 
Incr by exercise
131
Q

Tx migraine w/o aura

A

Ibuprofen

Sumitriptan nasal spray

132
Q

Features migraine w/ aura (3)

A

Preceded by; visual, sensory or motor aura
Most common = visual disturbances
Lasts few hrs

133
Q

Tx migraine w/ aura

134
Q

Features of tension headache (4)

A

Symmetrical
Gradual onset
Tight/band pressure
No other Sx

135
Q

What can a 2’ headache be due to? (6)

A 
Head/neck trauma 
Vascular malformation or haemorrhage 
Incr ICP
HTN
Substance use/withdrawal 
Meningitis/encephalitis
136
Q

Red flags - headache (4)

A

Worse when lying down, night time waking or worse in morning
Morning vom
CHanges mood, personality, performance
Neuro defects, papilloedema

137
Q

Cause of subdural haematoma (2)

A

Shaken baby syndrome

Falling from >3m

138
Q

Sx subdural haematoma (8)

A 
Headache
Confusion 
Hemiparesis 
Lethargy
Pupils asymmetrical 
Convulsions 
Incr ICP
? Retinal haemorrhages
139
Q

Features of myopathies

A

Mm weakness (usually proximal)
Wasting
Gait

140
Q

How to diagnose myopathies (3)

A

Creatinine phosphokinase **
Mm biopsy
Genetic testing

141
Q

Sx myotonic dystrophy (6)

A 
Myotonia - prolonged mm contraction 
Slurred speech 
Temporary locking of jaw 
Cataracts 
Cardiac arrhythmias 
Wasting - LL, hands, neck + face
142
Q

Features of congenital mm dystrophy (2)

A

@ birth
Weakness, hypotonia + contractures
Proximal weakness

143
Q

Features of neuropathies

A

Motor weakness

Sensory - impaired perception/loss reflexes

144
Q

How to Ix neuropathies (3)

A

Nn conduction studies
DNA testing
Electromyography

145
Q

What precedes Guillian-Barre

A

2-3 weeks prev - URTI/GE (campy)

146
Q

Features GB (4)

A

Ascending symmetrical loss reflexes + autonomic involvement
Abnorm sensory in legs
Bulbar mm - difficulty chewing + swallowing
? resp depression

147
Q

What % GB recover

148
Q

Mx GB

A

Supportive therapy

149
Q

Charcot-Marie tooth cause

A

Hereditary (AD)

150
Q

Features CMTooth (2)

A

Symmetrical + slowly progressive mm wasting in distal –> proximal pattern
50% - spinal issues e.g. scoliosis

151
Q

Medical Mx chronic pain

A

Local - anaesthetic, nn blocks
Analgesia
Sedatives - midalozam, NO, GA
Neuropathic - AED or anti-D

152
Q

Mild analgesia for chronic pain (2)

A

Paracetamol

NSAIDS

153
Q

Mod analgesia for chronic pain (2)

A

Codeine

NSAIDS

154
Q

Strong analgesia for chronic pain

CP2 PAEDS (18 decks)

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