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Paediatrics > Neurology and MSK > Flashcards

Neurology and MSK Flashcards

1
Q

What is Status Epilepticus?

A

When a person has had 2 seizures within 30 minutes, without returning back to normal

OR

A seizure longer than 5 minutes

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2
Q

What are the causes of Status Epilepticus?

A

Ischaemic Stroke/Intracranial Haemorrhage/Hypoxia

Meningitis/Encephalitis

Acute head trauma

New onset epilepsy

Drug intoxication

Drug withdrawal

Hypoglycaemia/other metabolic disorders

Electrolyte Imbalance

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3
Q

What is the initial management/investigation for Status Epilepticus?

A

A-E

Airway management

Breathing checks - oxygen therapy if needed

Circulation checks

D - don’t ever forget glucose (BM), look for blood loss, pupillary reflexes and accommodation reflex

E - abdo exam and skin exam

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4
Q

What is the 1st line medication for Status Epilepticus?

A

Benzodiazepines

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5
Q

Give three examples of benzodiazepines?

AND

How are they given?

A

Diazepam (Rectally)

Midazolam (Buccal)

Lorazepam

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6
Q

Which benzodiazepine should be given if the patient enter status epilepticus with IV access?

A

IV Lorazepam

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7
Q

What is the second line treatment option for someone still in Status Epilepticus?

A

Phenytoin or Phenobarbitone

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8
Q

What should you do if someone has been in Status Epilepticus for more than 45 mins and is not responding to other treatment?

A

Induce coma using gen anaesthesia

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9
Q

What is the serious risk associated with three doses of Benzodiazepines?

A

Respiratory depression

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10
Q

What is the clinical definition of a Simple Febrile Seizure?

A

Short generalized seizure than lasts < 15 mins

It won’t recur within 24 hours

Occuring during a febrile episode that is not linked to acute problem within the nervous system

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11
Q

In which age are Simple Febrile Seizures more likely to occur?

A

6 months to 5 years

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12
Q

What is the clinical definition of a Complex Febrile Seizure?

A

Focal, generalised or prolonged seizure lasting > 15 mins

Recurring more than once in 24 hours

Usually associated with post-ictal symptoms

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13
Q

What does post-ictal mean?

A

After a seizure

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14
Q

What is Todd’s Palsy?

A

Focal weakness in a part of or all of the body after a seizure. Todd’s palsy usually localised to left or right side of body, and usually subsides fully within 48h.

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15
Q

What is Febrile Status Epilepticus?

A

Complex Febrile Seizure that lasts >30 mins, or has shorter serial seizures, without consciousness regained in between seizures

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16
Q

Why is an EEG not recommended as a diagnostic tool for a child in a Febrile Seizure?

A

It can show epileptic activity in normal people, but can also be normal in many children with epilepsy.

Hence, it is not very sensitive

17
Q

What is Epilepsy defined by?

A

> 2 unprovoked seizure occurring > 24 hours apart

Diagnosis of an epilepsy syndrome

1 unprovoked seizure and a probability of further seizures similar to general recurrence risk (at least 60%) after 2 unprovoked seizures

18
Q

How do you Safety Net a parent with a child who has had Febrile Seizures?

A

Train them on first aid training and what not to do if the child has a seizure again

Looking out for status epilepticus - seizure longer than 5 mins or 30 mins

Call an ambulance if the child enters Status Epilepticus

19
Q

What is Cerebral Palsy?

A

Disorder of movement & posture due to a non-progressive lesion of motor pathways in developing brain.

(non-progressive means it doesn’t get worse)

20
Q

What are the three groups of causes of Cerebral Palsy

AND

Name 2 causes within each group

A

Antenatal - cerebral malformation and congenital infections (rubella, toxoplasmosis and CMV)

Intrapartum (during birth) - birth asphyxia and trauma

Postnatal - intraventricular haemorrhage and encephalitis/meningitis

21
Q

What are the motor clinical features of Cerebral Palsy?

A

Abnormal muscle tone in early years

Delayed motor milestones (struggle. to sit, crawl, walk etc)

Abnormal gait

Feeding difficulty

22
Q

What are the non-motor clincal features of cerebral Palsy?

A

Learning difficulties

Behavioural challenges

Epilepsy

Squints

Hearing difficulties

23
Q

What does Hemiplegia mean?

A

unilateral arm & leg weakness/paralysis

24
Q

What does Diplegia mean?

A

Symmetrical paralysis, e.g. both arms

25
Q

What does Quadripelgia mean?

A

Paralysis of all 4 limbs

26
Q

What is the most common type of Cerebral Palsy?

A

Spastic Cerebral Palsy (70-80%)

27
Q

What is the cause of Spastic Cerebral Palsy?

A

Damage to the upper motor neurons in the pyramidal tract.

It can be bilateral

28
Q

How is Cerebral Palsy managed?

A

MDT

Treatment of spasticity - oral diazepam, oral & intrathecal(into the spinal cord) baclofen, botulinum toxin type A

29
Q

What is Duchenne Muscular Dystrophy?

A

X-linked recessive disease which results in progressive weakness of muscles from the age of 5 onwards. It is the progressive myofibre degeneration and the gradual replacement of muscle by fibrotic tissue.

30
Q

What is the aetiology of Duchenne Muscular Dystrophy (DMD)?

A

Defect in the Dystrophin gene causing the whole protein it codes for to be damaged.

31
Q

Who is more likely to be affected in DMD?

A

Males (because it is x-linked recessive)

32
Q

When is the first clinical feature of DMD usually seen?

A

2-3 years old - awkward gait, causing them to be unable to run properly

33
Q

At age 12, what is the most likely occurrence for males with DMD?

A

They are in a wheelchair

34
Q

What are the diagnostic signs of DMD?

A

High creatinine kinase

Muscle biopsy shows stain positive for dystrophin

35
Q

What is the management of DMD?

A

It is not curable so glucocorticoids to slow down symptom progression

Overnight CPAP (continuous positive airway pressure)

Physiotherapy & muscle conditioning can improve quality of life

36
Q

How is a child’s bone age determined?

A

By doing an XR of their wrist. the carpals of children ossify at different ages. Checking their carpals will help determine the bone age.

37
Q

What is Retts Syndrome?

A

A rare genetic neurological disorder that occurs almost exclusively in girls and leads to severe impairments

38
Q

What is the disease that is caused by Neonatal Jaundice that goes unnoticed, which leads to brain damage?

A

Kernicterus

Paediatrics (10 decks)

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