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
2
Q
what is the management of tonic clonic seizures
A
first line: sodium valproate
second line: lamotrigine or carbamazepine
3
Q
what are focal seizures
A
these are seizures which start in the temporal lobes and affect hearing, speech, memory and emotions
4
Q
how can focal seizures present
A
hallucinations
memory flashbacks
deja vu
doing strange things on autopilot - lip smacking
5
Q
what is the management of focal seizures
A
first line: carbamazepine or lamotrigine
second line: sodium valproate or levetiracetam
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
7
Q
what is the management for absence seizures
A
first line: sodium valproate or ethosuximide
8
Q
what is an atonic seizure
A
drop attack - sudden lapses in muscle tone
dont normally last longer than 3 minutes
9
Q
what can atonic seizures sometimes be indicative of
A
lennox gastaut syndrome
10
Q
what is the management for atonic seizures
A
first line: sodium valproate
second line: lamotrigine
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
12
Q
what is the management of myoclonic seizures
A
first line: sodium valproate
other options: lamotrigine, levetiracetam, topiramate
13
Q
what are infantile spasms
A
West syndrome - rare disorder starting at 6 months of age characterised by clusters of full body spasms
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
15
Q
what are the treatments of infantile spasms
A
prednisolone
vigabatrin
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
17
Q
what age do febrile convulsions occur in
A
between 6 months and 5 years
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
19
Q
when is MRI brain indicated after a seizure
A
- first seizure in a child under 2
- focal seizures
- no response to first line anti epileptic medications
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
21
Q
what are side effects of sodium valproate
A
teratogenic
liver damage and hepatitis
hair loss
tremor
22
Q
what are side effects of carbamazepine
A
Agranulocytosis
Aplastic anaemia
Induces the P450 system so there are many drug interactions
23
Q
what are side effects of phenytoin
A
folate and vitamin D deficiency
megaloblastic anaemia
osteomalacia
24
Q
what are side effects of ethosuximide
A
night terrors
rashes
25
what are side effects of lamotrigine
stevens-johnson syndrome/DRESS syndrome - life threatening skin rashes
leukopenia
26
what is status epilepticus
It is defined as a seizure lasting more than 5 minutes or 2 or more seizures without regaining consciousness in the interim.
27
how do you treat status epilepticus
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
28
what medical options are there in the community for status epilepticus
buccal midazolam
rectal diazepam
29
what is a simple febrile convulsion
Simple febrile convulsions are generalised, tonic clonic seizures. They last less than 15 minutes and only occur once during a single febrile illness.
30
what are complex febrile convulsions
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.
31
how are febrile convulsions diagnosed
need to exclude other neurological pathology
determine underlying cause of infection
32
what are differential diagnosis for febrile convulsion
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)
33
what is the management for febrile convulsions
identify and manage the underlying infection
control fever with paracetamol and ibuprofen
simple febrile convulsions require no further investigations, complex might
34
what advice would you give to parents on managing a seizure id a further episode occured
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
35
how many children who have had one febrile convulsion will have another
one in three
36
what is the risk of developing epilepsy after a febrile convulsion
1.8% for the general population
2-7.5% after a simple febrile convulsion
10-20% after a complex febrile convulsion
37
what are breath holding spells in children
these are involuntary episodes during which a child holds their breath, usually triggered by something upsetting or scaring them
38
what age do breath holding spells typically occur between
6 and 18 months of age
39
what are the two types of breath holding spell
cyanotic breath holding spells
pallid breath holding spells
40
what are cyanotic breath holding spells
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
41
what is a pallid breath holding spell/reflex anoxic seizure
occurs when a child is startled. the vagus nerve sends a strong signal to the heart which causes it to stop beating.
42
what are symptoms o a reflex anoxic seizure
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
43
what is the management of breath holding spells
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
44
what are causes of headaches in children
tension headaches
migraines
ear nose and throat infection
analgesic headache
problems with vision
raised intercranial pressure
brain tumours
meningitis
encephalitis
carbon monoxide poisoning
45
what are symptoms of tension headache
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
46
what can be triggers for tension headache in children
stress, fear or discomfort
skipping meals
dehydration
infection
47
how do you manage tension headache in children
reassurance
analgesia
regular meals
avoiding dehydration
reducing stress
48
what are the different types of migraine
migraine without aura
migraine with aura
silent migraine - aura without headache
hemiplegic migraine
abdominal migraine
49
what are the symptoms of a migraine
unilateral, severe, throbbing headache
visual aura
photophobia and phonophobia
nausea and vomiting
abdominal pain
50
what is the management of migraines in children
rest, fluids and low stimulus environment
paracetamol
ibuprofen
sumatriptan
antiemetics
51
what are options for migraine prophylaxis in children
propranolol
pizotifen (can cause drowsiness)
topiramate (teratogenic)
52
what is abdominal migraine
it is more common in children and presents with central abdominal pain lasting more than 1 hour with:
nausea and vomiting
anorexia
headache
pallor
53
what infections in children can cause a headache
viral upper respiratory tract infection
otitis media
sinusitis
tonsillitis
54
what is sinusitis
it is a headache associated with inflammation in the ethmoidal, maxillary, frontal or sphenoidal sinuses
55
what is cerebral palsy
permanent neurological problems resulting from damage to the brain around the time of birth
56
what are antenatal causes of cerebral palsy
maternal infections
trauma during pregnancy
57
what are perinatal causes of cerebral palsy
birth asphyxia
pre term birth
58
what are postnatal causes of cerebral palsy
meningitis
severe neonatal jaundice
head injury
59
what are the different types of cerebral palsy
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
60
what are the different patterns of spastic cerebral palsy
monoplegia
hemiplegia
diplegia
quadriplegia
61
what are signs and symptoms of cerebral palsy
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
62
what does a hemiplegic/diplegic gain indicate
an upper motor neurone lesion
63
what does a broad based or ataxic gait indicate
cerebellar lesion
64
what does a high stepping gait indicate
foot drop or lower motor neurone lesion
65
what does a waddling gait indicate
pelvic muscle weakness due to myopathy
66
what does an antalgic gait indicate
limp - localised pain
67
what kind of gait may someone with cerebral palsy present with
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
68
what are complications and associated conditions with cerebral palsy
learning disability
epilepsy
kyphoscoliosis
muscle contractures
hearing and visual impairment
GORD
69
how is cerebral palsy managed
MDT approach
physiotherapy
occupational therapy
speech and language therapy
dieticians
orthopaedic surgeons
paediatricians
social workers
70
what medications may a child with cerebral palsy be taking
muscle relaxants (baclofen) for muscle spasticity and contractures
anti-epileptic drugs
glycopyrronium bromide - drooling
71
what is a squint
refers to misalignment of the eyes (also known as strabismus)
when the eyes arent aligned, it can cause double vision
72
what causes 'lazy eye'
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
73
what is amblyopia
this is when a lazy eye goes untreated and becomes more disconnected from the brain, and the issues becomes worse
74
what are concomitant squints
this is when there is differences in the control of the extra ocular muscles
75
what is a paralytic squint
this is where there is paralysis in one or more of the extra ocular muscles
76
what is esotropia
inward positioned squint - affected eye towards the nose
77
what is exotropia
outward positioned squint (affected eye towards the ear)
78
what is hypertropia
upward moving affected eye
79
what is hypotropia
downward moving affected eye
80
what are causes of squint in children
usually idiopathic
hydrocephalus
cerebral palsy
space occupying lesion
trauma
81
what is the Hirschbergs test
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
what is the cover test
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
what is the management for a squint in a child
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
what is hydrocephalus
build up of CSF abnormally in the brain and spinal cord as a result of either over production or lack of draining/absorption
85
what produces CSF
the choroid plexus (one in each ventricle)
86
how is CSF absorbed into the venous system
by the arachnoid granulations
87
what are congenital causes of hydrocephalus
1. aqueductal stenosis - most common
3. arachnoid cysts - block outflow
3. Arnold-chiari malformation - cerebellum herniated into foramen magnum blocking outflow
4. chromosomal abnormalities/congenital malformations
88
how does hydrocephalus present
in a baby - enlarged and rapidly increasing head circumference
bulging anterior fontanelle
poor feeding and vomiting
poor tone
sleepiness
89
how is hydrocephalus treated
placing a ventriculoperitoneal shunt - drains CSF from ventricles usually into the peritoneal cavity
90
what are VP shunt complications
infection
blockage
excessive drainage
intraventricular haemorrhage during surgery
outgrowing them - typically need replacing every two years
91
what is craniosynostosis
this is when the skull sutures close prematurely resulting in an abnormal shaped head and restriction of the growth of the brain
92
what can craniosynostosis cause if left untreated
can lead to raised intercranial pressure, resulting in developmental delay, cognitive impairment, vomiting, irritability, visual impairment, neurological symptoms and seizures
93
how does a sagittal synostosis present
presents with the sagittal suture fusing early resulting in a head which is long and narrow from the front to back
94
how does a coronal synostosis present
with the coronal suture fusing early causing a head which is bulging on one side of the forehead
95
how does a metopic synostosis present
with the metopic suture fusing early causing a pointy, triangular forehead
96
how does a lambdoid synostosis present
with the lambdoid suture fusing early resulting in a head which is flattened on one side of the occiput
97
how does craniosynostosis present
abnormal head shape depending on the affected cranial suture
anterior fontanelle closure before 1 year
small head in proportion to the body
98
what investigations are done for craniosynostosis
skull x ray
CT head used to confirm diagnosis
99
how is craniosynostosis managed
mild cases: monitor and follow up
severe: surgical reconstruction of the skull
100
what is plagiocephaly
it is flattening of one area of the babies head
101
what is brachycephaly
it is flattening of the back of the head, resulting in a short head from back to front
102
what is positional plagiocephaly
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
how is plagiocephaly/brachycephaly managed
exclude craniosynostosis first
look for congenital muscular torticollis which can cause abnormal head shape
reassurance
plagiocephaly helmets
104
what is congenital muscular torticollis
this is shortening of the sternocleidomastoid muscle on one side which can cause a child to always rest their head on one side
105
what simple measures can be put in place to encourage a baby to not rest on the flattened area of their head
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
what are the issues with plagiocephaly helmets
need to be used for the vast majority of the day
can lead to skin issues - contact dermatitis
cause psychosocial issues
107
what is muscular dystrophy
it is an umbrella term for genetic conditions that cause gradual weakening and wasting of muscles
108
what are the types of muscular dystrophy
Duchennes muscular dystrophy
Beckers muscular dystrophy
Myotonic dystrophy
Facioscapulohumeral muscular dystrophy
Oculopharyngeal muscular dystrophy
Limb-girdle muscular dystrophy
Emery-Dreifuss muscular dystrophy
109
what is Gowers sign
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
how is Duchenne's muscular dystrophy inherited
X linked recessive
111
what is the management of muscular dystrophy
no cure
occupational therapy
physiotherapy
medical appliances - wheelchairs, braces
surgical management of scoliosis
medical management of heart failure
111
what is altered in muscular dystrophy
the dystrophin gene is defective - protein that holds muscles together at a cellular level
112
what age do boys with Duchenne's muscular dystrophy present
present around 3-5 years
113
what are initial symptoms of Duchennes muscular dystrophy
progressive weakness around their pelvis
114
what is the life expectancy of someone with duchennes muscular dystrophy
25 - 35 years
115
what can be given in Duchennes muscular dystrophy to help slow the progression of the disease
oral steroids
creatine is also given to help improve strength
116
what is beckers muscular dystrophy
it is similar to Duchennes however the dystrophin gene is less severely affected and maintains some function
117
what is myotonic dystrophy
it is a genetic disorder that usually presents in adulthood
118
how does myotonic dystrophy normally present
progressive muscle weakness
prolonged muscle contraction
cataracts
cardiac arrhythmias
119
what is spinal muscular atrophy
it is a rare autosomal recessive condition that causes a progressive loss of motor neurones, leading to progressive muscle weakness
120
what motor neurones does spinal muscular atrophy affect
affects the lower motor neurones in the spinal cord
121
what is spinal muscular atrophy type 1
onset in the first few months of life, usually progressing to death within 2 years
122
what is spinal muscular atrophy type 2
onset within the first 18 months, most never walk but survive into adulthood
123
what is spinal muscular atrophy type 3
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
what is spinal muscular atrophy type 4
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
what is the management of spinal muscular atrophy
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
how does depression present
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
what can cause depression in children/adolescents
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
what is the treatment for mild depression in children/adolescents
watchful waiting
advice about healthy habits
follow up within 2 weeks
129
how are children with moderate to severe depression managed
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
when might you admit a child with depression
self harm
suicide
self neglect
safeguarding issue
131
what is generalised anxiety disorder
excessive and disproportional anxiety and worry that negatively impacts the persons every day activities
132
what is the assessment for anxiety
GAD-7 anxiety questionnaire
assess for co-morbid mental health conditions
assess for environmental triggers and contributors
133
how is a child/adolescent with mild anxiety managed
watchful waiting and advice about self help strategies, diet, exercise, avoid alcohol, caffeine and drugs
134
how is moderate to severe anxiety managed in a child/adolescent
referral to CAMHS
counselling
cognitive behavioural therapy
medical management - SSRI
135
what are obsessions
these are unwanted and uncontrolled thoughts and intrusive images that the person finds very difficult to ignore
136
what are compulsions
repetitive actions the person feels they must do, generating anxiety if they are not done
137
what other mental health conditions is OCD strongly related to
anxiety
depression
eating disorders
autism spectrum disorder
phobias
138
how do you treat significant OCD in children/adolescents
referral to CAMHS
patient and carer education
CBT
SSRIs
139
what is autism spectrum disorder
range of symptoms causing a deficit in social interaction, communication and flexible behaviour
140
what social interaction features may be present in someone with autism spectrum disorder
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
what communication features may be present in someone with autism
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
what behaviour features might someone with autism spectrum disorder present with
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
how is autism spectrum disorder managed
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
what is ADHD
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
what are features of ADHD
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
how is ADHD in children managed
education on the disorder
healthy diet and exercise
medication - methylphenidate, dexamphetamine and atomoxetine
147
what are the main types of food disorders that can present in childhood/adolescents
anorexia nervosa, bulimia nervosa, binge eating disorder
148
what is anorexia nervosa
when the person fees overweight despite evidence of normal or low body weight
can cause obsessive restricting of calorie intake to lose weight
149
what are clinical features of anorexia nervosa
weight loss - 15% below expected/BMI < 17.5
amenorrhoea
lanugo hair
hypotension
hypothermia
mood changes
150
why do you get amenorrhoea in anorexia nervosa
due to disruption of hypothalamic pituitary gonadal axis - lack of gonadotropins from the pituitary leading to reduced activity of the ovaries
151
what cardiac complications can you get from anorexia nervosa
arrhythmia
cardiac atrophy
sudden cardiac death
152
what is bulimia nervosa
condition involved binge eating followed by purging by inducing vomiting or taking laxatives to prevent calories being absorbed
153
what are features of bulimia nervosa
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
what is binge eating disorder
episodes where the person excessively overeats, often as an expression of underlying psychological distress - loss of control
155
what may binges involve with binge eating disorder
planned binge involving binge foods
eating very quickly
unrelated to feelings of hunger
becoming uncomfortably full
eating in a dazed state
156
what blood results may you find in someone who has a restrictive eating disorder
anaemia
leukopenia
thrombocytopenia
hypokalaemia
157
what type of anaemia would probably be present in a patient with restrictive eating disorders
normocytic normochromic anaemia because of the reduced bone marrow activity
158
how are eating disorders managed
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
what is refeeding syndrome
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
how is refeeding syndrome managed
slowly reintroducing foods
magnesium, potassium, phosphate and glucose monitoring
fluid balance monitoring
ECG in severe cases
supplementation
161
what are the suspicious personality disorders
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
what are the emotional and impulsive personality disorders
antisocial personality disorder
borderline personality disorder
histrionic personality disorder
narcissistic personality disorder
163
what are the anxious personality disorders
avoidant personality disorder
dependent personality disorder
obsessive compulsive personality disorder
164
what it tourettes syndrome
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
what are premonitory sensations
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
at what age do tics often develop
around or after the age of 5
167
what are examples of simple tics
Clearing throat
Blinking
Head jerking
Sniffing
Grunting
Eye rolling
168
what are examples of complex tics
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
how do you manage a child with Tourettes
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
what is peri-orbital cellulitis
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
what is the usual cause of peri-orbital cellulitis
superficial tissue injury such as an insect bite or a chalazion (cyst caused by blockage of an oil gland in the eyelid)
172
what is orbital cellulitis
this is an infection affecting the muscles and fat within the orbit, posterior or deep to the orbital septum, not involving the globe
173
what is the usual cause of orbital cellulitis
underlying bacterial sinusitis
174
what are risk factors for peri-orbital and orbital cellulitis
childhood - especially males
previous sinus infection
lack of haemophilus influenzae type B vaccination
175
how does peri-orbital cellulitis present
with redness around the eyelid
eyelid oedema
176
how does orbital cellulitis present
severe redness around a swollen eye with ptosis
ocular pain - can be very severe
visual disturbance
proptosis - bulging eye
eyelid oedema
fever
headache
177
what initial investigations need to be done in peri-orbital and orbital cellulitis
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
how is peri-orbital cellulitis treated
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
how is orbital cellulitis treated
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
what is infantile spasms
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
what is the difference between infantile spasms and west syndrome
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
what is the average age for a diagnosis of infantile spasm
between four and seven months of age
183
what are signs/symptoms of infantile spasms
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
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what are causes of infantile spasms
brain injury or infection
issues with brain development
gene mutation
metabolic condition
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how are infantile spasms diagnosed
EEG - hypsarrhythmia
Bloods - glucose
MRI
genetic and metabolic tests
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how are infantile spasms treated
Adrenocorticotropic hormone
oral prednisolone
vigabatrin - anti-seizure medication
ketogenic diet
other anti seizure medication
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what is benign Rolandic epilepsy
it is an epilepsy syndrome affecting children (4-12) and is more common in males
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what are symptoms of benign rolandic epilepsy
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
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what is the treatment for benign rolandic epilepsy
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
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what is juvenile myoclonic epilepsy
it is a type of epilepsy that usually begins during adolescence presenting with myoclonic seizures which develop into tonic clonic seizures
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who is more likely to get juvenile myoclonic epilepsy
more common in women
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what are symptoms of juvenile myoclonic epilepsy
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
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what factors can make seizures more likely in people with juvenile myoclonic epilepsy
inconsistent sleep patterns and being tired
drinking
drinking alcoholic beverages or large amounts of caffeine
stress
flickering lights
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how is juvenile myoclonic epilepsy diagnosed
EEG - 3-6 Hz generalised polyspike and wave discharge
bloods
ECG etc
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how is juvenile myoclonic epilepsy treated
lifestyle and avoidance of triggers
lamotrigine
levetiracetam
if seizures remain uncontrolled seek specalised care
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what is the gross motor function classification system
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
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what is GMFCS level 1
- 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
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what is GMFCS level 2
- they can walk indoors and outdoors
- can climb the stairs with a railing
- they have difficulty on uneven surfaces
- minimally can jump and run
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what is GMFCS level 3
- walks with assisted mobility devices
- can maybe climb the stairs with a railing
- may propel a manual wheelchair
200
What is GMFCS level 4
- waking is severely limited even with assisted devices
- wheelchair most of the time
- may participate in standing transfers
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what is GMFCS level 5
- 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
