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Paediatrics > Paeds Neuro > Flashcards

Paeds Neuro Flashcards

1
Q

Idiopathic generalised epilepsy encompasses which three main types?

A

Myoclonic
Absence
Primary generalised tonic clonic

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2
Q

Focal epilepsy encompasses which three main types?

A

Focal aware
Focal impaired awareness
Focal to bilateral tonic clonic (aka secondary tonic clonic)

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3
Q

Daydreaming at school. Among your differentials is ADHD, ASD and childhood absence epilepsy. What else is important to exclude?

A

hearing difficulties!

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4
Q

What is a convulsion?

A

seizure with motor components

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5
Q

Brief generalised tonic clonic with rapid rise in fever. Affects children 6 months - 6yrs. Parental reassurance and buccal midazolam for >5mins. What are these?

A

Febrile convulsions

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6
Q

Name three symptoms of benign paroxysmal vertigo

A

nystagmus, unsteadiness, falling

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7
Q

Expiratory apnoea leading to syncope. Precipitated by anger / crying. What’s this called and what happens?

A

Blue breath-holding spells.

Go blue, stiff, then limp. Rapid recovery.

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8
Q

Toddlers with FHx have head bump, fright or ice cream and get a funny turn with spasms. What’s this called and what happens?

A

Reflex aystolic syncope

Cardiac asystole then quick recovery!

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9
Q

Name 3 features of frontal lobe focal seizures.

A

Jacksonian march, fencing, adversive (eyes & head to one side)

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10
Q

Name 4 features of temporal lobe focal seizures.

A

smell changes
taste changes
automatism (eg lip-smacking, picking at clothes)
deja-vu

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11
Q

Name a feature of occipital lobe focal seizures.

A

Stereotyped visual hallucinations

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12
Q

Name a feature of parietal lobe focal seizures.

A

Dysaesthesia (altered sensation)

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13
Q

Name three investigations for suspected epilepsy

A

ECG
EEG
MRI/CT brain

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14
Q

Can give valproate or lamotrigine for generalised. Also carbamazepine for primary generalisd tonic clonic. Which ones should you avoid carabamazepine in?

A

Absence

Myoclonic

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15
Q

What is first line med for focal epilepsy?

A

carbamazepine

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16
Q

What is first line med for absence?

A

ethosuximide

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17
Q

Name 3 side effects of valproate.

A

teratogenic
weight gain
hair loss

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18
Q

Name 2 side effects of carbamazepine.

A

rash

ataxia

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19
Q

Name 3 side effects of lamotrigine.

A

rash
ataxia
insomnia

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20
Q

Apart from medications, name three other options for epileptic seizure control.

A

ketogenic diet
vagal nerve stimulation
lobectomy

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21
Q

Which syndrome is cannabis oil (cannabidiol) said to be beneficial in?

A

Lennox Gastaut (if treatment resistant)

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22
Q

Hi. There are a number of “Childhood Epilepsy Syndromes”. Please list 6.

A
  1. Infantile spasms (salaam)
  2. Lennox-Gastaut
  3. Childhood absence epilepsy
  4. Benign rolandic epilepsy
  5. Juvenile absence epilepsy
  6. Juvenile myoclonic epilepsy
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23
Q

<1yr old with extension of arms like praying. What’s this? Prognosis?

A

Infantile spasms. salaam syndrome.

bad –> LD, continuing epilepsy

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24
Q

Little girl gets this type of seizure when she blows on a windmill (hyperventilation). What’s this?

A

childhood absence epilepsy [4-12yrs]

developmentally normal but may affect schooling. most grow out of it, some go on to juvenile absence/myoclonic

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25
Q

EEG shows 3Hz spike & wave discharges. What’s this?

A

absence

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26
Q

What do infantile spasms (salaam syndrome) show on EEG?

A

Hyps arrhythmia

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27
Q

Can be childhood absence epilepsy or juvenile absence epilepsy. What’s the different ages?

A

childhood absence - 4-12yrs
juvenile absence - teens

childhood - most grow out of it. Juvenile - lifelong Rx.

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28
Q

Where is the Rolandic area in the brain?

A

centro-temporal

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29
Q

What does EEG show in Benign Rolandic Rpilepsy?

A

centro-temporal spikes

30
Q

Benign Rolandic Epilepsy causes tonic-clonic or abnormal tongue/face. What age group does Benign Rolandic Epilepsy affect and what is the prognosis like?

A

4-10yrs

common, may not AEDs, goes away in adolescence

31
Q

Teenager is clumsy after waking, throwing cereal about in the morning. What’s this? Prognosis?

A

juvenile myoclonic epilepsy

lifelong treatment

32
Q

What is second line for all?

A

clobazam

33
Q

how do you always start epilepsy therapy?

A

monotherapy at minimum dose

34
Q

What’s the difference between acute symptomatic seizures and epileptic seizures?

A

they are PROVOKED! by acute cortical brain injury

35
Q

Name 6 causes of acute symptomatic seizures.

A 
infection (meningitis)
stroke
trauma
hypoglycaemia
hypoCa
hypoMg
36
Q

Define status epilepticus.

A

continuous seizures >5min

or repeated seizures without full recovery for >5min

37
Q

What are the two types of status epilepticus

A

Convulsive

Non-convulsive

38
Q

How to prevent status - at 0 min.

A

high flow O2

DON’T EVER FORGET GLUCOSE

39
Q

How to manage status - at 5 min.

A

IV lorazepam OR buccal mizazolam (or rectal diazepam)

40
Q

How to manage status - at 15 min.

A

more IV lorazepam.

call for senior help.

41
Q

How to manage status - at 25 min.

A

anaesthetic advice.

consider IV phenytoin.

42
Q

How to manage status at 45 min!

A

rapid sequence induction of anaesthesia with THIOPENTAL.

43
Q

What is cerebral palsy? (4 parts of definition)

A

A permanent disorder
of movement, tone and motor function
due to a NON-PROGRESSIVE abnormality
in the developing brain

44
Q

In terms of causes of cerebral palsy what percentages are antenatal, perinatal and postnatal?

A

80% antenatal
10% perinatal
10% postnatal

45
Q

Give me some Antenatal causes of cerebral palsy (80%)

A

Cerebrovascular haemorrhage or ischaemia
Structural maldevelopment of brain during gestation
Genetic syndromes
Congenital infections

46
Q

What is the main Perinatal cause of cerebral palsy? (10%)

A

HIE - hypoxic ischaemic injury before/during delivery

47
Q

What kind of brain injury are preterms particularly susceptible to, which can cause cerebral palsy?

A 
periventricular leukomalacia
(secondary to interventricular haemorrhage)
48
Q

Give me some Postnatal causes of cerebral palsy? (10%)

A

meningitis, encephalitis, encepatholopathy, hydrocephalus
head trauma,
hypoglycaemia
kernicterus

49
Q

What are the 3 types of cerebral palsy?

A

Spastic (90%)
Dyskinetic (6%)
Ataxic (4%)

50
Q

Which type of cerebral palsy is due to damage of UPPER MOTOR NEURONES?

A

Spastic (90%)

51
Q

A child with cerebral palsy has brisk reflexes, and increased limb tone with is CLASP-knife (velocity dependent). What kind of cerebral palsy is this?

A

Spastic (90%)

52
Q

A child has a weak arm and leg on the left side. Fisted hand, flexed arm, and tiptoe walk on the left, as well as increased tone. What type of cerebral palsy?

A

Spastic hemiplegia

GMFCS 1-2

53
Q

A 5 level clinical classification system that describes the movement abilities of people with cerebral palsy. What’s this?

A

GMFCS - Gross Motor Function Classification System

54
Q

A child has poor trunk tone, poor head control, ospisthotonos, and severe weakness in all four limbs. He also has seizures and intellectual impairement. Hx hypoxic ischaemic encephalopathy. What type of cerebral palsy does this sound like?

A

Spastic quadriplegia

(GFMCS 4-5) :(

55
Q

A child has some weakness in four limbs but much more weak in the legs. Abnormal walking but good hand function and cognition. Hx periventricular leukomalacia. What type of cerebral palsy does this sound like?

A

Spastic diplegia

GFMCS 1-3
(mainly just bottom half)

56
Q

Involuntary controlled movements due to damage of basal ganglia (extra-pyramidal). What type of cerebral palsy is this?

A

Dyskinetic (6%)

GFMCS 4-5

57
Q

Slow writhing distal movements e.g. finger fanning (seen in dyskinetic cerebral palsy), are known as?

A

Athetosis

58
Q

In dyskinetic cerebral palsy, intellect is often unimpaired and abnormal movements may only appear at 1yr old. Often, persistent primitive reflexes. True or false?

A

True

59
Q

Name three motor abnormalities that can occur in dyskinetic cerebral palsy.

A

Chorea
Athetosis
Dystonia

+ persistent primitive reflexes

60
Q

Which types of cerebral palsy are both quite bad with GFMCS 4-5?

A

Spastic quadriplegia

Dyskinetic

61
Q

This type of cerebral palsy is either genetic or acquired through damage to the cerebellum. ?

A

Ataxic! (4%)

62
Q

Symmetrical hypotonia, poor balance, lack of co-ordination, and intention tremor. What type of cerebral palsy does this sound like?

A

Ataxic (4%)

63
Q

What is Level 1 of GFMCS?

A

walks without limitations

64
Q

Level 1 of GFMCS is ‘walks without limitations’. What is Level 2?

A

walks with limitations

65
Q

What is Level 3 of GFMCS?

A

handheld mobility device

66
Q

Level 3 of GFMCS is handheld mobility device. What is Level 4?

A

powered mobility

67
Q

Level 4 of GFMCS is powered mobility. What is Level 5?

A

manual wheelchair (pushed by someone else)

68
Q

If a child with cerebral palsy has bad hypertonia, such as contractures affecting ability to walk, what might help?

A

Botox injections every 6 months.

69
Q

How do you diagnose cerebral palsy?

A

clinical

may want to do MRI brain to exclude other stuff

70
Q

Which professionals may be involved in the care of a child with cerebral palsy?

A 
child development services
specialist health visitor
paediatrician
neuro rehab
orthoptics
orthotics
SALT
psychologist
OT
physio
social worker (advice on benefits, day nursery placement, voluntary support agencies)
71
Q

Give me some EARLY FLAGS of cerebral palsy.

A

delayed motor milestones
slowing of head growth
feeding difficulties (in-coordination, gagging, vomiting)
persistent primitive reflexes
asymmetric hand function before 12 months!!!

72
Q

Asymmetric hand function before 12 months could be early feature of….

A

cerebral palsy

Paediatrics (14 decks)

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