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Paediatrics > Paediatric Neurology > Flashcards

Paediatric Neurology Flashcards

1
Q

What should be examined when investigating headaches?

A 
Growth parameters, OFC, BP
Sinuses, teeth, visual acuity 
Fundoscopy 
Visual fields (craniopharyngioma)
Cranial bruit 
Focal neurological signs 
cognitive and emotional status
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2
Q

What are the features to examine when taking a migraine history?

A

Associated abdominal pain, nausea, vomiting
Focal symptoms/ signs before, during, after, attack; visual disturbance, paraesthesia, weakness
Pallor
Aggravated by bright light/ noise
Relation to fatigue/stress
Helped by sleep/rest/ dark, quiet room
Family history

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3
Q

What are the features that point to raised intracranial pressure?

A

Aggravated by activities that raise ICP (coughing, straining at school, bending)
Woken from sleep by headache

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4
Q

What features point to analgesic overuse headache?

A

Headache is back before allowed to sue another dose
Paracetamol/NSAIDs
particular problem with compound analgesics (cocodamol)

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5
Q

What are the indications for neuroimaging?

A 
Features of cerebellar dysfunction 
Features of raised ICP 
New focal neurological deficit 
Seizure, esp focal 
Personality change 
Unexplained deterioration of school work
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6
Q

What is the management for migraines?

A

Effective pain relief, triptans (acute attack)

Pizotifen, Propanolol, amytriptyline, topiramate, valproate (preventative)

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7
Q

What is the management for tension type headaches?

A 
Simple analgesia (acute attack) 
Amitriptyline (Prevention)
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8
Q

What is a convulsion?

A

Seizure where there is no prominent motor activity

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9
Q

What is an epileptic seizure?

A

An abnormal excessive hyper synchronous discharge from a group of neurons

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10
Q

What can cause non-epileptic seizures in children?

A 
Acute symptomatic seizures (hypoxia ischaemia, hypoglycaemia, infection, trauma) 
Reflex anoxic seizure 
Syncope 
Parasomnias
Behavioural stereotypies 
Psychogenic seizures
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11
Q

What is a febrile convulsion?

A

Event occurring in infancy, associated with fever but without evidence of intracranial infection or defined cause for the seizure

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12
Q

How are epileptic seizures chemically triggered?

A 
Decreased inhibition (gama-amino-butyric acid, GABA)
Excessive excitation (glutamate and aspartate) 
Excessive influx of Na and Ca ions
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13
Q

What are the features of a generalised epileptic seizures?

A

Involves both sides of cerebral hemisphere
Loss of consciousness and awareness/ gap in memory from the start
No warning
Different types (absence, myoclonic, tonic clonic)

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14
Q

What are the features of a focal (partial) epileptic seizure?

A

Involves one cortical lobe or part of it, can be preceded by aura
Simple partial: no LOC, involving one side/part of body
Complex partial: Associated with LOC or awareness

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15
Q

How is a diagnosis of epilepsy made in children?

A 
History 
Video recording of event 
ECG in convulsive patients 
EEG 
MRI brain 
Metabolic tests
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16
Q

How is epilepsy managed in children?

A

Anti-epileptic drugs
Vagus nerve stimulation
Surgery

17
Q

What anti-epileptic drugs can be used in children?

A

Sodium valproate
Carbamazapine
Lamotrigine

18
Q

When should you suspect a neuromuscular disorder in a child?

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
19
Q

What are myotonias?

A

Delayed relaxation of skeletal muscle after voluntary contraction or electrical stimulation

20
Q

What are myopathies?

A

Muscle weakness due to dysfunction of the muscle fibres

21
Q

What are common muscular dystrophies?

A

Duchenne MD
Becker MD
Limb girdle MD

22
Q

What are the clinical signs of Duchenne MD?

A 
Delayed gross motor skills 
Symmetrical proximal weakness (waddling gait, calf hypertrophy, Gower's sign +ve)
Elevated creatinine kinase levels 
Cardiomyopathy 
Respiratory involvement in teens
23
Q

What are the features of myopathies?

A

Developmental delay
Hypotonia of variable degree
Proximal and distal muscle weakness
Creatinine kinase normal to high

24
Q

What are the causes of myopathies?

A 
Congenital 
Metabolic (glycogen storage, mitochondrial) 
Infection 
Drugs/toxins 
Autoimmune
25
Q

What are the different types of myotonias?

A 
Myotonic dystrophy (AD)
Myotonia congenita (AD)
Parammyotonia congenita  (AD/AR)
26
Q

What are the features of myotonias?

A 
Motor developmental delay 
Infantile hypotonia and developmental delay 
Muscle stiffness and cramps 
Endocrinopathies 
Cardiac dysarrhythmias
27
Q

What are the features of hereditary neuropathies?

A

Symmetrical distal polyneuropathy
Both motor and sensory manifestations
Clumsiness, weakness, loss of fine motor control
Distal muscle wasting and weakness, foot drop, wrist drop, absent DTR

28
Q

What is the management for hereditary motor sensory neuropathy (HMSN)?

A

Supportive

Gabapentin

Paediatrics (20 decks)

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