Neurology and Psychiatry Flashcards
Cerebral palsy, Duchenne's Muscular Dystrophy, Autism, RAD, Conduct Disorder
What is a common cause of cerebral palsy in the antenatal period?
Maternal infections
Which of the following is NOT typically associated with the postnatal aetiology of cerebral palsy?
A) Severe neonatal jaundice
B) Meningitis
C) Birth asphyxia
D) Head injury
Birth asphyxia
Which type of cerebral palsy is characterised by slow writhing, and convoluted movements of the fingers, hands, and toes?
Dyskinetic
What is a clinical sign commonly observed in a child with cerebral palsy?
Reduced power with increased tone and reflexes (Spasticity)
What is a common management option for managing spasticity in children with cerebral palsy?
Oral baclofen
What is a potential complication of cerebral palsy?
Severe learning difficulties
Which type of cerebral palsy involves a lack of voluntary muscle control?
Ataxic
Which medication is used to manage spasticity in cerebral palsy?
Diazepam + Baclofen
A 13-month-old girl is referred to paediatrics by her GP due to concerns that she is still not attempting to ‘pull to stand’. She was born at 29 weeks by emergency cesarean section due to foetal bradycardia and weighed 1.1kg at birth.
On examination, she appears healthy and engaged. She responds to her name and has 7 meaningful words. She can drink from a cup using both hands. When put on the floor, she commando crawls to move around. Upper limb tone is normal however lower limb tone is significantly increased.
Based on this patient’s symptoms, in which part of the brain/nervous system has damage occurred?
Spastic cerebral palsy results from damage to upper motor neurons
= Upper motor neurons in the periventricular white matter
A 12-month-old child is brought to the paediatric clinic following a referral from their GP. The parents report that the child demonstrates slow, twisting movements of the hands and arms, with varying intensity that tends to increase during periods of excitement. They also observe difficulties with oral manipulation of food, as well as challenges in chewing and swallowing solid foods. The child was born at 36 weeks gestation after a prolonged and difficult labour involving multiple attempts at forceps delivery.
What area of the brain is most likely affected?
Dyskinetic cerebral palsy typically manifests as athetoid movements and oro-motor problems
= Basal ganglia and the substantia nigra
A 12-month-old baby with cerebral palsy is brought to the GP with her mother for a routine checkup. The mother reports feeding difficulties and has concerns about developmental delay. She also mentions continuous slow writhing movements of her limbs throughout the day.
Based on the type of cerebral palsy seen in this child, what area of the brain is affected?
Dyskinetic cerebral palsy results from damage to the basal ganglia and the substantia nigra
You review a 7-year-old girl who has cerebral palsy. She is having ongoing problems with spasticity in her legs which is causing pain and contractures. On speaking to her mother you ascertain that she is having regular physiotherapy, using the appropriate orthoses and has tried oral diazepam in the past. Which one of the following treatments may she be offered to try and improve her symptoms?
Baclofen
What is Duchenne’s Muscular Dystrophy?
X-linked recessive condition = malformation of the dystrophin gene (only boys)
Causes muscle weakness and wasting
Children with proximal muscle weakness use a specific technique to stand up from a lying position
This is called what?
Gower’s sign
A concerned mother brings her 4-year-old son to see the GP, worried about his walking and balance. The child learned to walk around 2 years old, much the same as his older sister. However, over the last few months, his mum has noticed that he has become reluctant to walk and often trips or falls when he does.
On examination, the child is slim built but has disproportionately large calves. When asked to walk across the room he does so on his tiptoes. Gowers test is positive.
What investigation is considered most appropriate to confirm the likely diagnosis?
Genetic analysis
A 2 1/2-year-old boy is brought to the GP because his parents are worried that he is walking strangely. They have noticed that over the last 6 months, he has started waddling when he walks.
He likes playing outside but often has tantrums when he can’t keep up with his twin sister.
It also takes him ages to climb the stairs, and when his mum picks him up she feels like he might slip through her hands. He is growing well. He learned to walk at 19 months of age; his sister walked at 13 months. Otherwise, he is generally well.
On inspection, he has large bulky calf muscles but examination is otherwise normal
What is the inheritance of this child’s condition?
X linked recessive
What are the key features of autistic spectrum disorder?
- Lack of eye contact
- Delay in smiling
- Avoids physical contact
- Repetitive use of words or phrases
- Anxiety and distress with experiences outside their normal routine
What is a common repetitive behaviour in children with autism?
Self-stimulating movements such as hand-flapping
What is a key feature of the inhibited subtype of Reactive Attachment Disorder (RAD)?
Avoidance of social interactions and resistance to comfort
What behaviours are characteristic of a child with the disinhibited subtype of RAD??
Excessive familiarity with strangers and lack of selectivity in attachment
Children with RAD may demonstrate what during interactions with caregivers?
Lack of distress in situations where distress would normally be expected
What is a key difference between Conduct Disorder and Reactive Attachment Disorder (RAD)?
Children with Conduct Disorder can form relationships with peers and adults, while those with RAD struggle to do so
What risk factor is most commonly associated with the development of Conduct Disorder?
Emotional neglect or abuse
Wha condition is often co-morbid with Conduct Disorder?
Attention Deficit Hyperactivity Disorder (ADHD)
