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Phase 3a Jemima > Paediatrics - Neurology and CAMHS > Flashcards

Paediatrics - Neurology and CAMHS Flashcards

1
Q

what is a generalised tonic clonic seizure

A

loss of consciousness combined with muscle tensing and jerking movements.
may be associated with tongue biting, incontinence, groaning and irregular breathing

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2
Q

what is the management of tonic clonic seizures

A

first line: sodium valproate
second line: lamotrigine or carbamazepine

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3
Q

what are focal seizures

A

these are seizures which start in the temporal lobes and affect hearing, speech, memory and emotions

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4
Q

how can focal seizures present

A

hallucinations
memory flashbacks
deja vu
doing strange things on autopilot - lip smacking

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5
Q

what is the management of focal seizures

A

first line: carbamazepine or lamotrigine
second line: sodium valproate or levetiracetam

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6
Q

what is an absence seizure

A

typically happen in childhood
blank, staring into space and abruptly returns to normal. during the episode they are unaware of their surroundings and wont respond

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7
Q

what is the management for absence seizures

A

first line: sodium valproate or ethosuximide

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8
Q

what is an atonic seizure

A

drop attack - sudden lapses in muscle tone
dont normally last longer than 3 minutes

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9
Q

what can atonic seizures sometimes be indicative of

A

lennox gastaut syndrome

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10
Q

what is the management for atonic seizures

A

first line: sodium valproate
second line: lamotrigine

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11
Q

what is a myoclonic seizure

A

it is sudden brief muscle contractions - patient normally remains awake during the episode
typically happen as part of juvenile myoclonic epilepsy

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12
Q

what is the management of myoclonic seizures

A

first line: sodium valproate
other options: lamotrigine, levetiracetam, topiramate

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13
Q

what are infantile spasms

A

West syndrome - rare disorder starting at 6 months of age characterised by clusters of full body spasms

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14
Q

what is the prognosis of infantile spasms

A

poor prognosis - 1/3 die by the age of 25 however 1/3 are seizure free

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15
Q

what are the treatments of infantile spasms

A

prednisolone
vigabatrin

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16
Q

what are febrile convulsions

A

seizures that occur in children whilst they are having a fever
not caused by epilepsy or other underlying neurological pathology

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17
Q

what age do febrile convulsions occur in

A

between 6 months and 5 years

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18
Q

how is epilepsy diagnosed

A

good history of the seizure
EEG performed after the second seizure
MRI brain
ECG
blood electrolytes
blood glucose
blood cultures, urine cultures and LP

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19
Q

when is MRI brain indicated after a seizure

A
  1. first seizure in a child under 2
  2. focal seizures
  3. no response to first line anti epileptic medications
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20
Q

what advice should be given where a seizure might put a child in danger and what they can do to stay safe

A

take showers over baths
be cautious with swimming unless seizures are well controlled and closely supervised
be cautious with heights
be cautious with traffic
be cautious with any heavy, hot or electrical equipment
older teenagers with epilepsy will need to avoid driving unless they meet specific criteria

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21
Q

what are side effects of sodium valproate

A

teratogenic
liver damage and hepatitis
hair loss
tremor

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22
Q

what are side effects of carbamazepine

A

Agranulocytosis
Aplastic anaemia
Induces the P450 system so there are many drug interactions

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23
Q

what are side effects of phenytoin

A

folate and vitamin D deficiency
megaloblastic anaemia
osteomalacia

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24
Q

what are side effects of ethosuximide

A

night terrors
rashes

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25
Q

what are side effects of lamotrigine

A

stevens-johnson syndrome/DRESS syndrome - life threatening skin rashes
leukopenia

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26
Q

what is status epilepticus

A

It is defined as a seizure lasting more than 5 minutes or 2 or more seizures without regaining consciousness in the interim.

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27
Q

how do you treat status epilepticus

A

ABCDE
Secure the airway
Give high-concentration oxygen
Assess cardiac and respiratory function
Check blood glucose levels
Gain intravenous access (insert a cannula)
IV lorazepam, repeated after 10 minutes if the seizure continues
If the seizures persist the final step is an infusion of IV phenobarbital or phenytoin. At this point intubation and ventilation to secure the airway

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28
Q

what medical options are there in the community for status epilepticus

A

buccal midazolam
rectal diazepam

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29
Q

what is a simple febrile convulsion

A

Simple febrile convulsions are generalised, tonic clonic seizures. They last less than 15 minutes and only occur once during a single febrile illness.

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30
Q

what are complex febrile convulsions

A

Febrile convulsions can be described as complex when they consist of partial or focal seizures, last more than 15 minutes or occur multiple times during the same febrile illness.

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31
Q

how are febrile convulsions diagnosed

A

need to exclude other neurological pathology
determine underlying cause of infection

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32
Q

what are differential diagnosis for febrile convulsion

A

Epilepsy
Meningitis, encephalitis or another neurological infection such as cerebral malaria
Intracranial space occupying lesions, for example brain tumours or intracranial haemorrhage
Syncopal episode
Electrolyte abnormalities
Trauma (always think about non accidental injury)

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33
Q

what is the management for febrile convulsions

A

identify and manage the underlying infection
control fever with paracetamol and ibuprofen
simple febrile convulsions require no further investigations, complex might

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34
Q

what advice would you give to parents on managing a seizure id a further episode occured

A
  1. Stay with the child
  2. Put the child in a safe place, for example on a carpeted floor with a pillow under their head
  3. Place them in the recovery position and away from potential sources of injury
  4. Don’t put anything in their mouth
  5. Call an ambulance if the seizure lasts more than 5 minutes
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35
Q

how many children who have had one febrile convulsion will have another

A

one in three

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36
Q

what is the risk of developing epilepsy after a febrile convulsion

A

1.8% for the general population
2-7.5% after a simple febrile convulsion
10-20% after a complex febrile convulsion

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37
Q

what are breath holding spells in children

A

these are involuntary episodes during which a child holds their breath, usually triggered by something upsetting or scaring them

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38
Q

what age do breath holding spells typically occur between

A

6 and 18 months of age

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39
Q

what are the two types of breath holding spell

A

cyanotic breath holding spells
pallid breath holding spells

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40
Q

what are cyanotic breath holding spells

A

occur when a child is very upset, worked up and crying.
after a long cry they stop breathing, become cyanotic and loose consciousness
within a minute they regain consciousness and begin breathing again

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41
Q

what is a pallid breath holding spell/reflex anoxic seizure

A

occurs when a child is startled. the vagus nerve sends a strong signal to the heart which causes it to stop beating.

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42
Q

what are symptoms o a reflex anoxic seizure

A

the child will suddenly go pale, lose consciousness and may have some seizure like muscle twitching
within 30 seconds the heart restarts and the child regains consciousness

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43
Q

what is the management of breath holding spells

A

after excluding other pathology its about educating and reassuring parents about the spells
may be due to iron deficiency anaemia do treating the child if they are deficient can help minimise further episodes

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44
Q

what are causes of headaches in children

A

tension headaches
migraines
ear nose and throat infection
analgesic headache
problems with vision
raised intercranial pressure
brain tumours
meningitis
encephalitis
carbon monoxide poisoning

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45
Q

what are symptoms of tension headache

A

mild ache across forehead and pain or pressure in a band like pattern around the head.
typically symmetrical
can be non specific in younger children, they may become quiet, stop playing and go pale or tired

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46
Q

what can be triggers for tension headache in children

A

stress, fear or discomfort
skipping meals
dehydration
infection

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47
Q

how do you manage tension headache in children

A

reassurance
analgesia
regular meals
avoiding dehydration
reducing stress

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48
Q

what are the different types of migraine

A

migraine without aura
migraine with aura
silent migraine - aura without headache
hemiplegic migraine
abdominal migraine

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49
Q

what are the symptoms of a migraine

A

unilateral, severe, throbbing headache
visual aura
photophobia and phonophobia
nausea and vomiting
abdominal pain

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50
Q

what is the management of migraines in children

A

rest, fluids and low stimulus environment
paracetamol
ibuprofen
sumatriptan
antiemetics

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51
Q

what are options for migraine prophylaxis in children

A

propranolol
pizotifen (can cause drowsiness)
topiramate (teratogenic)

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52
Q

what is abdominal migraine

A

it is more common in children and presents with central abdominal pain lasting more than 1 hour with:
nausea and vomiting
anorexia
headache
pallor

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53
Q

what infections in children can cause a headache

A

viral upper respiratory tract infection
otitis media
sinusitis
tonsillitis

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54
Q

what is sinusitis

A

it is a headache associated with inflammation in the ethmoidal, maxillary, frontal or sphenoidal sinuses

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55
Q

what is cerebral palsy

A

permanent neurological problems resulting from damage to the brain around the time of birth

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56
Q

what are antenatal causes of cerebral palsy

A

maternal infections
trauma during pregnancy

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57
Q

what are perinatal causes of cerebral palsy

A

birth asphyxia
pre term birth

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58
Q

what are postnatal causes of cerebral palsy

A

meningitis
severe neonatal jaundice
head injury

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59
Q

what are the different types of cerebral palsy

A

spastic: hypertonia, and reduced function
dyskinetic: problems controlling muscle tone, hyper and hypotonia, athetoid movements and oro-motor issues
ataxic: issues with coordinated movement
mixed: spastic, dyskinetic and ataxic

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60
Q

what are the different patterns of spastic cerebral palsy

A

monoplegia
hemiplegia
diplegia
quadriplegia

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61
Q

what are signs and symptoms of cerebral palsy

A

failure to meet milestones
increased or decreased tone, generally or in specific limbs
hand preference below 18 months
problems with coordination, speech, walking
feeding or swallowing issues
learning difficulties

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62
Q

what does a hemiplegic/diplegic gain indicate

A

an upper motor neurone lesion

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63
Q

what does a broad based or ataxic gait indicate

A

cerebellar lesion

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64
Q

what does a high stepping gait indicate

A

foot drop or lower motor neurone lesion

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65
Q

what does a waddling gait indicate

A

pelvic muscle weakness due to myopathy

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66
Q

what does an antalgic gait indicate

A

limp - localised pain

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67
Q

what kind of gait may someone with cerebral palsy present with

A

a hemiplegic or diplegic gait caused by increased muscle tone and spasticity in the legs - legs extended with plantar flexion of feet and toes
will have signs of upper motor neurone lesion

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68
Q

what are complications and associated conditions with cerebral palsy

A

learning disability
epilepsy
kyphoscoliosis
muscle contractures
hearing and visual impairment
GORD

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69
Q

how is cerebral palsy managed

A

MDT approach
physiotherapy
occupational therapy
speech and language therapy
dieticians
orthopaedic surgeons
paediatricians
social workers

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70
Q

what medications may a child with cerebral palsy be taking

A

muscle relaxants (baclofen) for muscle spasticity and contractures
anti-epileptic drugs
glycopyrronium bromide - drooling

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71
Q

what is a squint

A

refers to misalignment of the eyes (also known as strabismus)
when the eyes arent aligned, it can cause double vision

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72
Q

what causes ‘lazy eye’

A

in childhood before the eyes have fully established their connections to the brain, the brain will cope with the misalignment of the eyes by reducing the signal from the less dominant eye. this results in one eye they use to see and one they ignore

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73
Q

what is amblyopia

A

this is when a lazy eye goes untreated and becomes more disconnected from the brain, and the issues becomes worse

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74
Q

what are concomitant squints

A

this is when there is differences in the control of the extra ocular muscles

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75
Q

what is a paralytic squint

A

this is where there is paralysis in one or more of the extra ocular muscles

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76
Q

what is esotropia

A

inward positioned squint - affected eye towards the nose

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77
Q

what is exotropia

A

outward positioned squint (affected eye towards the ear)

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78
Q

what is hypertropia

A

upward moving affected eye

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79
Q

what is hypotropia

A

downward moving affected eye

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80
Q

what are causes of squint in children

A

usually idiopathic
hydrocephalus
cerebral palsy
space occupying lesion
trauma

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81
Q

what is the Hirschbergs test

A

shine a pen torch at the patient from 1m away
when they look at it, look at the reflection of the light source on their cornea
the reflection should be central and symmetrical
deviation indicates a squint

82
Q

what is the cover test

A

cover one eye and ask patient to focus on an object in front of them
move the cover across to the opposite eye and watch the movement of the previously covered eye
if this moves inwards, it had drifted outwards when covered (exotropia) and if it moves outward it had drifted inward when covered (esotropia)

83
Q

what is the management for a squint in a child

A

treatment needs to start before 8 as visual fields are still developing
occlusive patch - cover good eye
atropine drops in the good eye to blur vision
referral to opthamologist

84
Q

what is hydrocephalus

A

build up of CSF abnormally in the brain and spinal cord as a result of either over production or lack of draining/absorption

85
Q

what produces CSF

A

the choroid plexus (one in each ventricle)

86
Q

how is CSF absorbed into the venous system

A

by the arachnoid granulations

87
Q

what are congenital causes of hydrocephalus

A
  1. aqueductal stenosis - most common
  2. arachnoid cysts - block outflow
  3. Arnold-chiari malformation - cerebellum herniated into foramen magnum blocking outflow
  4. chromosomal abnormalities/congenital malformations
88
Q

how does hydrocephalus present

A

in a baby - enlarged and rapidly increasing head circumference
bulging anterior fontanelle
poor feeding and vomiting
poor tone
sleepiness

89
Q

how is hydrocephalus treated

A

placing a ventriculoperitoneal shunt - drains CSF from ventricles usually into the peritoneal cavity

90
Q

what are VP shunt complications

A

infection
blockage
excessive drainage
intraventricular haemorrhage during surgery
outgrowing them - typically need replacing every two years

91
Q

what is craniosynostosis

A

this is when the skull sutures close prematurely resulting in an abnormal shaped head and restriction of the growth of the brain

92
Q

what can craniosynostosis cause if left untreated

A

can lead to raised intercranial pressure, resulting in developmental delay, cognitive impairment, vomiting, irritability, visual impairment, neurological symptoms and seizures

93
Q

how does a sagittal synostosis present

A

presents with the sagittal suture fusing early resulting in a head which is long and narrow from the front to back

94
Q

how does a coronal synostosis present

A

with the coronal suture fusing early causing a head which is bulging on one side of the forehead

95
Q

how does a metopic synostosis present

A

with the metopic suture fusing early causing a pointy, triangular forehead

96
Q

how does a lambdoid synostosis present

A

with the lambdoid suture fusing early resulting in a head which is flattened on one side of the occiput

97
Q

how does craniosynostosis present

A

abnormal head shape depending on the affected cranial suture
anterior fontanelle closure before 1 year
small head in proportion to the body

98
Q

what investigations are done for craniosynostosis

A

skull x ray
CT head used to confirm diagnosis

99
Q

how is craniosynostosis managed

A

mild cases: monitor and follow up
severe: surgical reconstruction of the skull

100
Q

what is plagiocephaly

A

it is flattening of one area of the babies head

101
Q

what is brachycephaly

A

it is flattening of the back of the head, resulting in a short head from back to front

102
Q

what is positional plagiocephaly

A

it is when a baby has a tendency to rest their head on a particular point resulting in the skull bones and sutures moulding with gravity to create an abnormal shaped head

103
Q

how is plagiocephaly/brachycephaly managed

A

exclude craniosynostosis first
look for congenital muscular torticollis which can cause abnormal head shape
reassurance
plagiocephaly helmets

104
Q

what is congenital muscular torticollis

A

this is shortening of the sternocleidomastoid muscle on one side which can cause a child to always rest their head on one side

105
Q

what simple measures can be put in place to encourage a baby to not rest on the flattened area of their head

A

Positioning them on the rounded side for sleep
Supervised tummy time
Using rolled towels or other props
Minimising time in pushchairs and car seats

106
Q

what are the issues with plagiocephaly helmets

A

need to be used for the vast majority of the day
can lead to skin issues - contact dermatitis
cause psychosocial issues

107
Q

what is muscular dystrophy

A

it is an umbrella term for genetic conditions that cause gradual weakening and wasting of muscles

108
Q

what are the types of muscular dystrophy

A

Duchennes muscular dystrophy
Beckers muscular dystrophy
Myotonic dystrophy
Facioscapulohumeral muscular dystrophy
Oculopharyngeal muscular dystrophy
Limb-girdle muscular dystrophy
Emery-Dreifuss muscular dystrophy

109
Q

what is Gowers sign

A

this is seen in children with proximal muscle weakness
- children will stand up by pushing their hips up first and then walking their hands up their legs

110
Q

how is Duchenne’s muscular dystrophy inherited

A

X linked recessive

111
Q

what is the management of muscular dystrophy

A

no cure
occupational therapy
physiotherapy
medical appliances - wheelchairs, braces
surgical management of scoliosis
medical management of heart failure

111
Q

what is altered in muscular dystrophy

A

the dystrophin gene is defective - protein that holds muscles together at a cellular level

112
Q

what age do boys with Duchenne’s muscular dystrophy present

A

present around 3-5 years

113
Q

what are initial symptoms of Duchennes muscular dystrophy

A

progressive weakness around their pelvis

114
Q

what is the life expectancy of someone with duchennes muscular dystrophy

A

25 - 35 years

115
Q

what can be given in Duchennes muscular dystrophy to help slow the progression of the disease

A

oral steroids
creatine is also given to help improve strength

116
Q

what is beckers muscular dystrophy

A

it is similar to Duchennes however the dystrophin gene is less severely affected and maintains some function

117
Q

what is myotonic dystrophy

A

it is a genetic disorder that usually presents in adulthood

118
Q

how does myotonic dystrophy normally present

A

progressive muscle weakness
prolonged muscle contraction
cataracts
cardiac arrhythmias

119
Q

what is spinal muscular atrophy

A

it is a rare autosomal recessive condition that causes a progressive loss of motor neurones, leading to progressive muscle weakness

120
Q

what motor neurones does spinal muscular atrophy affect

A

affects the lower motor neurones in the spinal cord

121
Q

what is spinal muscular atrophy type 1

A

onset in the first few months of life, usually progressing to death within 2 years

122
Q

what is spinal muscular atrophy type 2

A

onset within the first 18 months, most never walk but survive into adulthood

123
Q

what is spinal muscular atrophy type 3

A

onset AFTER the first year of life, most walk without support but then loose that ability
respiratory muscles are less affected and life expectancy is close to normal

124
Q

what is spinal muscular atrophy type 4

A

onset in the 20s, most will retain the ability to walk short distances but will require a wheelchair for mobility
everyday tasks can lead to significant fatigue
respiratory muscles and life expectancy are not affected

125
Q

what is the management of spinal muscular atrophy

A

no cure - supportive with MDT
physiotherapy
splints, braces and wheelchairs
non invasive ventilation
children with SMA type 1 may require tracheostomy with mechanical ventilation
PEG feeding tube

126
Q

how does depression present

A

Low mood
anhedonia
low energy
anxiety and worry
clinginess
irritability
avoiding social situations
hopelessness about the future
poor sleep
early morning waking
poor appetite or over eating
poor concentration
physical symptoms

127
Q

what can cause depression in children/adolescents

A

loss of family member
home environment
family relationships
sexual relationships
school situations or pressure
bullying
drugs and alcohol
family history
parental depression
parental drug use and alcohol use
history of abuse and neglect

128
Q

what is the treatment for mild depression in children/adolescents

A

watchful waiting
advice about healthy habits
follow up within 2 weeks

129
Q

how are children with moderate to severe depression managed

A

referral to CAMHS
full assessment to establish diagnosis
psychological therapy - CBT, non directive supportive therapy, interpersonal therapy, family therapy
fluoxetine - first line in children
sertraline or citalopram - second line

130
Q

when might you admit a child with depression

A

self harm
suicide
self neglect
safeguarding issue

131
Q

what is generalised anxiety disorder

A

excessive and disproportional anxiety and worry that negatively impacts the persons every day activities

132
Q

what is the assessment for anxiety

A

GAD-7 anxiety questionnaire
assess for co-morbid mental health conditions
assess for environmental triggers and contributors

133
Q

how is a child/adolescent with mild anxiety managed

A

watchful waiting and advice about self help strategies, diet, exercise, avoid alcohol, caffeine and drugs

134
Q

how is moderate to severe anxiety managed in a child/adolescent

A

referral to CAMHS
counselling
cognitive behavioural therapy
medical management - SSRI

135
Q

what are obsessions

A

these are unwanted and uncontrolled thoughts and intrusive images that the person finds very difficult to ignore

136
Q

what are compulsions

A

repetitive actions the person feels they must do, generating anxiety if they are not done

137
Q

what other mental health conditions is OCD strongly related to

A

anxiety
depression
eating disorders
autism spectrum disorder
phobias

138
Q

how do you treat significant OCD in children/adolescents

A

referral to CAMHS
patient and carer education
CBT
SSRIs

139
Q

what is autism spectrum disorder

A

range of symptoms causing a deficit in social interaction, communication and flexible behaviour

140
Q

what social interaction features may be present in someone with autism spectrum disorder

A

lack of eye contact
delay in smiling
avoids physical contact
unable to read non verbal ques
difficulty establishing friendships
not displaying a desire to share attention

141
Q

what communication features may be present in someone with autism

A

delay, absence or regression in language development
lack of appropriate non verbal communication such as smiling, eye contact, responding to others and sharing interest
difficulty with imaginative or imitative play
repetitive use of words or phrases

142
Q

what behaviour features might someone with autism spectrum disorder present with

A

greater interest in objects, numbers or patterns than people
stereotypical repetitive movements
intensive and deep interests that are persistent and rigid
repetitive behaviour and fixed routines
anxiety and distress with experiences outside their normal routine
extremely restricted food preference

143
Q

how is autism spectrum disorder managed

A

MDT approach
Child psychology and child and adolescent psychiatry (CAMHS)
Speech and language specialists
Dietician
Paediatrician
Social workers
Specially trained educators and special school environments
Charities such as the national autistic society

144
Q

what is ADHD

A

it is extreme hyperactivity and inability to concentrate which affects the persons ability to carry out every day tasks, develop normal skills and perform well in school
- features consistent across various settings

145
Q

what are features of ADHD

A

very short attention span
quicky moving from activity to another
quickly losing interest in a task and not being able to persist with challenging tasks
constantly moving or fidgeting
impulsive behaviour
disruptive or rule breaking

146
Q

how is ADHD in children managed

A

education on the disorder
healthy diet and exercise
medication - methylphenidate, dexamphetamine and atomoxetine

147
Q

what are the main types of food disorders that can present in childhood/adolescents

A

anorexia nervosa, bulimia nervosa, binge eating disorder

148
Q

what is anorexia nervosa

A

when the person fees overweight despite evidence of normal or low body weight
can cause obsessive restricting of calorie intake to lose weight

149
Q

what are clinical features of anorexia nervosa

A

weight loss - 15% below expected/BMI < 17.5
amenorrhoea
lanugo hair
hypotension
hypothermia
mood changes

150
Q

why do you get amenorrhoea in anorexia nervosa

A

due to disruption of hypothalamic pituitary gonadal axis - lack of gonadotropins from the pituitary leading to reduced activity of the ovaries

151
Q

what cardiac complications can you get from anorexia nervosa

A

arrhythmia
cardiac atrophy
sudden cardiac death

152
Q

what is bulimia nervosa

A

condition involved binge eating followed by purging by inducing vomiting or taking laxatives to prevent calories being absorbed

153
Q

what are features of bulimia nervosa

A

erosion of teeth
swollen salivary glands
mouth ulcers
gastro-oesophageal reflux
calluses on the knuckles - russells sign
alkalosis due to repeated vomiting of hydrochloric acid

154
Q

what is binge eating disorder

A

episodes where the person excessively overeats, often as an expression of underlying psychological distress - loss of control

155
Q

what may binges involve with binge eating disorder

A

planned binge involving binge foods
eating very quickly
unrelated to feelings of hunger
becoming uncomfortably full
eating in a dazed state

156
Q

what blood results may you find in someone who has a restrictive eating disorder

A

anaemia
leukopenia
thrombocytopenia
hypokalaemia

157
Q

what type of anaemia would probably be present in a patient with restrictive eating disorders

A

normocytic normochromic anaemia because of the reduced bone marrow activity

158
Q

how are eating disorders managed

A

self help resources
psychological therapies - CBT
addressing psychological factors such as depression, anxiety and relationships
severe cases require compulsory admission for observed refeeding and monitoring for refeeding syndrome

159
Q

what is refeeding syndrome

A

occurs when someone with an extended severe nutritional deficit resumes eating
- due to intracellular potassium, phosphate and magnesium depletions which during refeeding and increase in carbohydrates causes hypomagnesaemia, hypokalaemia, hypophosphataemia and fluid overload

160
Q

how is refeeding syndrome managed

A

slowly reintroducing foods
magnesium, potassium, phosphate and glucose monitoring
fluid balance monitoring
ECG in severe cases
supplementation

161
Q

what are the suspicious personality disorders

A

paranoid personality disorder
schizoid personality disorder - lack of interest or desire to form relationships with others
schizotypal personality disorder - unusual beliefs, thoughts and behaviours as well as social anxiety

162
Q

what are the emotional and impulsive personality disorders

A

antisocial personality disorder
borderline personality disorder
histrionic personality disorder
narcissistic personality disorder

163
Q

what are the anxious personality disorders

A

avoidant personality disorder
dependent personality disorder
obsessive compulsive personality disorder

164
Q

what it tourettes syndrome

A

development of tics that are persistent for over one year, which are involuntary movements or sounds that the child performed repetitively throughout the day

165
Q

what are premonitory sensations

A

the more someone suppresses the urge to tic the more the urge increases , and will perform the tic to get relief from the urge

166
Q

at what age do tics often develop

A

around or after the age of 5

167
Q

what are examples of simple tics

A

Clearing throat
Blinking
Head jerking
Sniffing
Grunting
Eye rolling

168
Q

what are examples of complex tics

A

performing physical movements such as twirling on the spot or touching objects
Copropraxia - making obscene gestures
Coprolalia - saying obscene words
echolalia - repeating words other people say

169
Q

how do you manage a child with Tourettes

A

mild - reassurance and monitoring, taking measures to reduce stress, anxiety and triggers
severe - referral to specialist, habit reversal training, exposure with response prevention, medications

170
Q

what is peri-orbital cellulitis

A

it is an infectious process occurring in the eyelid tissues superficial to the orbital septum
- inflammation remains confined to the soft tissue layers
- ocular function remains intact

171
Q

what is the usual cause of peri-orbital cellulitis

A

superficial tissue injury such as an insect bite or a chalazion (cyst caused by blockage of an oil gland in the eyelid)

172
Q

what is orbital cellulitis

A

this is an infection affecting the muscles and fat within the orbit, posterior or deep to the orbital septum, not involving the globe

173
Q

what is the usual cause of orbital cellulitis

A

underlying bacterial sinusitis

174
Q

what are risk factors for peri-orbital and orbital cellulitis

A

childhood - especially males
previous sinus infection
lack of haemophilus influenzae type B vaccination

175
Q

how does peri-orbital cellulitis present

A

with redness around the eyelid
eyelid oedema

176
Q

how does orbital cellulitis present

A

severe redness around a swollen eye with ptosis
ocular pain - can be very severe
visual disturbance
proptosis - bulging eye
eyelid oedema
fever
headache

177
Q

what initial investigations need to be done in peri-orbital and orbital cellulitis

A

clinical examination - ophthalmological examination
CT sinus and orbits with contrast - more often in orbital cellulitis
bloods - white cell count, blood culture (maybe)
microbiology swab
Lumbar puncture if meningeal signs develop

178
Q

how is peri-orbital cellulitis treated

A

if organism not identified: empirical IV antibiotic if severe. Cefotaxime (50-200mg/kg/day) or clindamycin (20-40mg/kg/day) or cefuroxime and metronidazole
consider incision, drainage and culture if abscess present
consider empirical antifungal therapy
once organism known switch to targeted antibiotic

179
Q

how is orbital cellulitis treated

A

empirical antibiotics IV - cefotaxime (50-200mg/kg/day), clindamycin (20-40mg/kg/day) or cefuroxime with metronidazole. If MRSA is suspected treat the vancomycin plus cefotaxime and clindamycin
consider nasal decongestant
consider antifungal therapy
consider orbitotomy and surgical drainage of abscess if needed

180
Q

what is infantile spasms

A

form of epilepsy that affects babies typically under 12 months
look like breif spells of tensing or jerking and often happen in a cluster or series

181
Q

what is the difference between infantile spasms and west syndrome

A

west syndrome happens when a baby has a combination of symptoms:
infantile spasms
abnormal brain wave patterns called hypsarrhythmia
developmental delays or developmental regression

182
Q

what is the average age for a diagnosis of infantile spasm

A

between four and seven months of age

183
Q

what are signs/symptoms of infantile spasms

A

babies body will stiffen or tense up for a few seconds
arch back, arms and legs may bend forward
lasts 5-10 seconds
eye rolling
belly tensing
chin movements
grimacing
head nodding
loss of developmental milestones previously reached
loss of social interaction and smiling
increased fussiness or silence

184
Q

what are causes of infantile spasms

A

brain injury or infection
issues with brain development
gene mutation
metabolic condition

185
Q

how are infantile spasms diagnosed

A

EEG - hypsarrhythmia
Bloods - glucose
MRI
genetic and metabolic tests

186
Q

how are infantile spasms treated

A

Adrenocorticotropic hormone
oral prednisolone
vigabatrin - anti-seizure medication
ketogenic diet
other anti seizure medication

187
Q

what is benign Rolandic epilepsy

A

it is an epilepsy syndrome affecting children (4-12) and is more common in males

188
Q

what are symptoms of benign rolandic epilepsy

A

brief seizures lasting no more than 2 minutes
infrequently and most often at night
child may maintain awareness during seizure
twitching, numbness or tingling of face or tongue
may interfere with speech and cause drooling
seizures spread and become generalised

189
Q

what is the treatment for benign rolandic epilepsy

A

in some cases resolves on its own by the time the child is a teenager
may be prescribed levetiracetam, valproic acid or oxcarbazepine in cases where sleep is affected or there is mental deficiencies caused by the illness such as difficult reading

190
Q

what is juvenile myoclonic epilepsy

A

it is a type of epilepsy that usually begins during adolescence presenting with myoclonic seizures which develop into tonic clonic seizures

191
Q

who is more likely to get juvenile myoclonic epilepsy

A

more common in women

192
Q

what are symptoms of juvenile myoclonic epilepsy

A

myoclonic seizure that can happen at any time - more likely when they wake up, or are overly tired
sudden quick small jerks of arms, shoulders and less often the legs
can occur in clusters

193
Q

what factors can make seizures more likely in people with juvenile myoclonic epilepsy

A

inconsistent sleep patterns and being tired
drinking
drinking alcoholic beverages or large amounts of caffeine
stress
flickering lights

194
Q

how is juvenile myoclonic epilepsy diagnosed

A

EEG - 3-6 Hz generalised polyspike and wave discharge
bloods
ECG etc

195
Q

how is juvenile myoclonic epilepsy treated

A

lifestyle and avoidance of triggers
lamotrigine
levetiracetam
if seizures remain uncontrolled seek specalised care

196
Q

what is the gross motor function classification system

A

it is a classification system which looks at the motor function of a child with cerebral palsy and gives an idea about what mobility aids a child might need

197
Q

what is GMFCS level 1

A
  • can walk outdoors and indoors
  • can climb stairs without using hands for support
  • can run and jump
  • has issues with balance and coordination, reduced speed
198
Q

what is GMFCS level 2

A
  • they can walk indoors and outdoors
  • can climb the stairs with a railing
  • they have difficulty on uneven surfaces
  • minimally can jump and run
199
Q

what is GMFCS level 3

A
  • walks with assisted mobility devices
  • can maybe climb the stairs with a railing
  • may propel a manual wheelchair
200
Q

What is GMFCS level 4

A
  • waking is severely limited even with assisted devices
  • wheelchair most of the time
  • may participate in standing transfers
201
Q

what is GMFCS level 5

A
  • physical impairments which restrict voluntary movement, head and neck control and posture
  • impairment in all areas of motor function
  • cant sit or stand independently
  • cant independently walk

Phase 3a Jemima (16 decks)

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