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Year 5 - Paediatrics > Paeds NEURO > Flashcards

Paeds NEURO Flashcards

1
Q

What is a reflex anoxic seizure?

A

Episodes of tonic clonic fitting due to cardiac asystole secondary to vagal inhibition

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2
Q

What are the causes of reflex anoxic seizure?

A

Can be triggered by pain, head trauma, cold food (ice cream), fright, fever

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3
Q

What is a febrile convulsion?

A

A seizure and fever in the absence of intracranial infection

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4
Q

What is the age group that can be affected by febrile convulsions?

A

6m to 3y

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5
Q

What are the signs and symptoms of febrile convulsions?

A

Generalised tonic clonic seizure on background of fever

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6
Q

What is the difference between a simple and complex febrile seizure?

A

Simple: do not cause brain damage and no increased risk of epilepsy

Complex: focal, <15 mins, repeated in same illness, increased risk of subsequent epilepsy

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7
Q

What investigations should be done following a febrile seizure?

A

Identify and manage the cause of fever

No other main investigations (don’t do an EEG)

May potentially want to screen for meningitis/ encephalitis, do a urine MC+S and blood glucose

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8
Q

How should febrile convulsion be managed during the seizure?

A

Protect from injury and do not restrain

If seizure lasts <5 minutes do nothing

If seizure lasts >5 mins and no drugs are available, call an ambulance

If drugs are available: after 5 mins administer PR diazepam OR buccal midazolam

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9
Q

When should an ambulance be called for febrile convulsion?

A

1st seizure - of any duration or cause
Seizure lasts >5 mins with no drugs
Breathing difficuties

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10
Q

Which children should be admitted to hospital following a febrile convulsion?

A

First febrile seizure<18 months old

Diagnostic uncertainty about the cause

Complex febrile seizure

Currently on Abx

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11
Q

What system is used to classify seizures?

A

International League Against Epilepsy 2017

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12
Q

What is the correct name for an absence seizure these days?

A

Generalised non-motor seizure

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13
Q

What is the difference in symptoms between tonic-clonic and myoclonic?

A

Tonic clonic is the big one with violent muscle contractions, eyes rollingback, tongue biting, incontinence and both aura and post-ictal phenomena

Myoclonic = brief arrhythmic muscular jerking movement

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14
Q

What is the most common form of childhood epilepsy?

A

Benign Rolandic Epilepsy - myoclonic seizures in a 3-12 year old

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15
Q

What are the 3 different types of myoclonic epilepsy

A

Benign rolandic (3-12y)
Juvenile myoclonic epilepsy (12-18y)
Progressive myoclonic epilepsy

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16
Q

What is the other name for benign rolandic seizures?

A

Sylvian seizures

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17
Q

What are the signs and symptoms of benign rolandic epilepsy?

A

Myoclonic seizures during sleep involving face and UL with hypersalivation

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18
Q

What are the signs and symptoms of juvenile myoclonic epilepsy?

A

Myoclonic seizures involving upper body just after waking up and beginning after puberty

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19
Q

What is progressive myoclonic epilepsy?

A

Rare syndromes of combination of myoclonc and tonic-clonic seizures, with patient deteriorating over time

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20
Q

For what type of epilepsy is treatment not usually given?

A

Benign Rolandic Epilepsy

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21
Q

What type of antiepileptic actually exacerbates myoclonic seizures?

A

Lamotrigine

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22
Q

What type of antiepileptic actually exacerbates absence seizures?

A

Carbamazapine

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23
Q

What is the 1st line for rescue therapy for prolonged epileptic seizures?

A

Buccal midazolam

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24
Q

Which antiepleptic drug requires monitoring?

A

Carbamazapine

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25
Q

After how long seizure-free can antiepileptic therapy be stopped?

A

2 years

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26
Q

Recall 2 Side effects of valporate

A

Weight gain, hair loss

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27
Q

How is status epilepticus defined?

A

1 seizure lasting >5 mins OR
>2 seizures within a 5 min period without the person returning to normal between them 1 febrile seizures lasting >30 mins

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28
Q

What is the age range of peak incidence for infantile spasm?

A

3-8 months

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29
Q

What is an infantile spasm?

A

Sudden, rapid, tonic contraction of trunk and limb muscles with gradual relaxation over 0.5-2 seconds

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30
Q

What is a ‘Salaam’ attack?

A

Head goes down and arms go up in the air

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31
Q

How should West Syndrome be investigated?

A

EEG - shows hypoarrhythmias

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32
Q

What is the prognosis for West syndrome?

A

Poor

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33
Q

How should West syndrome be managed?

A

Vigabatrin or corticosteroids

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34
Q

What investigations should be done for vasovagal syncope?

A

Lying and standing BP with ECG if indicated

FBC (to query anaemia/ bleeding)

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35
Q

What are the indications for CT head in children?

A

Head injury + at least 1 of:
- suspected NAI
- post-traumatic seizure
- GCS <14
- Suspected skull fracture
- Focal neurology
OR
2 other risk factors
(LOC >5 mins, abnormal drowsiness, >3 episodes of vomiting, high-impact injury, amnesia > 5 mins)

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36
Q

Give 2 signs of tear of the MMA

A

Battle sign
Racoon eyes

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37
Q

What are the signs and symptoms of extradural haemorrhage?

A

Lucid interval followed by deterioration
Potential focal neurology

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38
Q

How should extradural haemorrhage be managed?

A

Fluid resuscitation to correct hypovolaemia
Evacuation of haematoma and arrest bleeding

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39
Q

What is the cause of subdural haemorrhage?

A

Tear in vein as it crosses subdural space

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40
Q

What is the main symptom of subdural?

A

Gradually decreasing GCS

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41
Q

What is often the cause of subdural in infants?

A

NAI

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42
Q

Which infants are most at risk of intraventricular haemorrhage?

A

Premature babies due to VLBW

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43
Q

What are the 2 main causes of intraventricular haemorrhage in infants?

A

ECMO in preterm babies with ARDS
Congenital CMV infection

ECMO = extracorporeal membrane oxygenation

44
Q

Recall the signs and symptoms of intraventricular haemorrhage

A

Sleepiness and lethargy, apnoea, reduced
Moro reflex, low tone, tense fontanelle

45
Q

Which investigation is used to diagnose intraventricular haemorrhage in a baby?

A

Trans-fontanelle USS

46
Q

How should intraventricular haemorrhage be treated in a baby?

A

Fluids
Anticonvulsant
Acetazolamide (to reduce CSF) and LP
Ventriculo-peritoneal shunt if hydrocephalus

47
Q

What is the difference between communicating and non-communicating hydrocephalus?

A

Communicatig: CSF flow obstructed after it enters the ventricles
Non-communicating: flow of CSF is obstructed WITHIN the ventricles

48
Q

What are the 2 causes of communicating hydrocephalus?

A

Meningitis
SAH

49
Q

What are the possible causes of non-communicating hydrocephalus?

A

Aqueduct stenosis:
Congenital causes: Dandy-Walker malformation or Chiari malformation

Acquired: IVH/ tumour

50
Q

What is the sunset sign?

A

Eyes appear to be driven down bilaterally - sign of raised ICP

51
Q

What are the 2 key investigations for hydrocephalus?

A

Cranial USS
Measurement of head circumference

52
Q

What is the first line management for hydrocephalus?

A

Ventriculoperitoneal shunt

53
Q

What is the second line management for hydrocephalus?

A

Furosemide - to inhibit CSF production

54
Q

What % of migraines have aura?

A

10%

55
Q

Is migraine likely to be UL or BL?

A

Could be either

56
Q

What are the symptoms of cluster headaches?

A

UL (eyes/ side of face) sharp throbbing pain, causing swelling/ watering inclusters

57
Q

What are some signs that migraine is secondary to something more sinister?

A

Visual field defects, gait or cranial nerve abnormalities, growth failure, papilloedema, early morning headache

58
Q

If simple analgesia doesn’t work, what is the 2nd line pain med in migraines?

A

Nasal sumatriptan

59
Q

Recall 2 prophylactic medications for migraine

A

Topiramate
Propranolol

60
Q

What is Tourette’s?

A

Chronic and multiple tics - starting before 18y old and persisting >1 year

61
Q

What are the 3 types of tic?

A

Motor, vocal or phonic

62
Q

Recall 2 therapies that are useful in tics

A
  1. Habit reversal therapy (learn movements to ‘compete’ with tics)
  2. Exposure with response prevention - help the child get used to the unpleasant feeling before a tic so that they can stop the tic occuring
63
Q

What is the first line medication for tic disorder?

A

Antipsychotics - eg risperidone

64
Q

Which form of MEN is NF1 associated with?

A

MEN2

65
Q

Recall some signs and symptoms of NF1

A

Café au lait spots
Neurofibroma
Axillary freckles
Lisch nodule

66
Q

What is tuberous sclerosis?

A

Rare genetic condition that causes mainly benign tumours to develop in different parts of the body

67
Q

Recall 3 cutaneous features of tuberous sclerosis

A

“Ash leaf” patch
Shagreen patches (rough skin on lumbar spine)
Angiofibromata (butterfly facial distribution)

68
Q

Recall some neurological features of tuberous sclerosis

A

Infantile spasms
Focal epilepsy
Intellectual disability (often with ASD)

69
Q

Why is there a risk of hydrocephalus in tuberous sclerosis?

A

Development of subependymal giant cell astrocytoma

70
Q

Which investigations are useful for diagnosing tuberous sclerosis?

A

CT/ MRI

71
Q

What is the layman’s term for the haemangioma in Sturge Weber syndrome?

A

Port wine stain

72
Q

Where does the haemangiomatous facial lesion present in Sturge Weber Syndrome?

A

Trigeminal nerve distribution

73
Q

Recall some signs and symptoms of Sturge Weber Syndrome

A

Epilepsy
Contralateral hemiplegia
Phaeochromocytoma
Intellectual disability
Glaucoma

74
Q

How should Sturge Weber Syndrome diagnosis be confirmed?

A

MRI

75
Q

What are the 3 symptoms that may present via somatisation?

A

Abdo pain
Reucrrent headaches
Limb pain

76
Q

What is Apley’s rule?

A

The further the pain is from the umbilicus, the more likely the pain is of an organic nature

77
Q

What is the 1st line management for somatisation?

A

Promote communication between family and children
Pain-coping skills ie relaxation techniques for headaches

78
Q

What should be done if 1st line treatments for somatisation fail?

A

Referral to CAMHS

79
Q

Which type of developmental delay has the best prognosis?

A

Isolated delay (global has association with syndromes that have poorer prognosis)

80
Q

Which is more common in children out of hypermetropia and myopia?

A

Hypermetropia

81
Q

What is the cause of Retinopathy of Prematurity?

A

Vascular proliferation leads to retinal detachment –> fibrosis and blindness

82
Q

What is the main RF for retinopathy of prematurity?

A

Uncontrolled use of high concentrations of oxygen

83
Q

What are the 2 key signs of retinopathy of prematurity?

A

Unusual eye movements
White pupils

84
Q

What is the first line treatment of retinopathy of prematurity?

A

Laser photocoagulation

85
Q

What is strabismus?

A

Abnormal alignment of eyes

86
Q

At what age is strabismus diagnosed?

A

1-4 years

87
Q

What are the 2 types of strabismus?

A

Non-paralytic (refractive error in one or more eyes)
Paralytic (squinting eye could be caused by motor nerve paralysis or SOL - 3rd nerve palsy)

88
Q

How should strabismus be managed?

A

1st line = glasses
2nd line = eye patching
3rd line = eye drops
4th line = eye muscle surgery

89
Q

Which burn pattern is typical of NAI?

A

Glove and stocking

90
Q

Which type of long bone fracture is indicative of NAI?

A

Spiral fractures

91
Q

What is the classic triad of features in shaken-baby syndrome?

A
  1. Retinal haemorrhages
  2. CT showing brain swelling/ encephalopathy
  3. CT showing subdural haematoma
92
Q

What needs to be ruled out in suspected NAI?

A

Leukaemia, ITP and haemophilia

93
Q

What is the definition of SIDS?

A

Deaths which remain unexplained after a post-mortem

94
Q

What is the peak age for SIDS?

A

2-4 months

95
Q

Recall some important risk factors for SIDS

A

Front-sleeping baby
Prematurity, LBW, male, maternal smoking, microenvironment (pillow, heat)

96
Q

For how long should parents share a room with baby?

A

6 months

97
Q

Which organisation provides support for SIDS?

A

Lullaby Trust

98
Q

When do fontanelle close by?

A

1 year usually, can be as late as 2

99
Q

What should be given before buccal midazolam in a fitting child?

A

Oxygen

100
Q

Why shouldn’t metoclopramide be given to children?

A

Can give oculogyric crises

101
Q

Recall the 5 points of the Fraser guidelines

A
  1. YP understands professional’s advice
  2. YP cannot be persuaded to inform parents
  3. YP is likely to begin/ continue having sex regardless of contraception
  4. Physical/ mental wellbeing likely to suffer from lack of contraception
  5. YP’s BI require them
102
Q

What % of children who have a febrile convulsion will have one again?

A

33-50%

103
Q

Does the absence of papilloedema on fundoscopy exclude a diagnosis of raised ICP?

A

No - papilloedema may take between hours and weeks to develop

104
Q

At what point in a fever/illness will febrile convulsions normally occur?

A

Typically quite early on in the rise in fever

105
Q

What is the typical duration of febrile convulsions?

A

Less than 15 minutes - a prolonged seizure would raise suspicion of a more serious infection

106
Q

What is a common cause of febrile convulsions?

A

Roseola (HHV6)

Often minor viral infections such as:
Otitis media
Tonsilitis
UTI

Year 5 - Paediatrics (15 decks)

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