Paeds - Neuro and psych

Question 1

Autism aetiology and clinical features

Answer 1

75% male
< 3 years
Family Hx

Associated conditions

• Fragile X
• Rett’s syndrome

1. Global impairment of language
2. Impairment of social relationships
3. Ritualistic and compulsive phenomena

Asperger’s = Milder impairment

Comorbidities

• Learning and attention difficulties
• Seizures

Question 2

Autism management

Answer 2

Applied behavioural analysis - Reduces ritualistic behaviour

Develop language and social skills

ASD parenting classes

Question 3

ADHD epidemiology + triad

Answer 3

80% male
Diagnosis aged 3-7

Family Hx
Environment
CNS insult
Neurochemical

Inattention
Impulsivity
Hyperactivity

Question 4

ADHD management

Answer 4

10-week watch and wait
History from teacher, parent, school nurse and reports

CAMHS referral

ADHD parenting programme

Drug therapy in children > 5

Methylphenidate - 6 week trial
- Dopamine/norepinephrine re-uptake inhibitor

Question 5

Methylphenidate side effects

Answer 5

Abdo pain
Nausea
Dyspnoea

Cardiotoxic - Baseline ECG required

Monitor weight and height every 6 months

Question 6

Bulimia nervosa

Answer 6

Binge eating followed by intentional vomiting or other purgative behaviours

• Laxatives
• Diuretics
• Exercise

Question 7

Bulimia nervose diagnosis

Answer 7

1. Recurrent episodes of binge eating
2. Lack of control during episode
3. Recurrent inappropriate compensatory behaviours
4. Both occur once a week for 3 months
5. Self-evaluation unduly influenced by bodyweight
6. Disturbance does not occur exclusively during episodes of anorexia nervosa

Question 8

Bulimia nervosa management

Answer 8

Bulimia-nervosa-focused guided self-help

CBT-ED

Family therapy - BN

SSRI - Fluoxetine

Question 9

Febrile convulsions presentation

Answer 9

6 months - 5 years

Early in viral infection - Temperature rises rapidly

Brief - Lasting less than 5 minutes

Tonic-clonic

Question 10

Febrile convulsions management and prognosis

Answer 10

Buccal midazolam
Rectal diazepam

Refer to paediatrics if…

• First seizure
• Complex seizure

Partial - 1-2% epilepsy risk
Complex - 4-12% epilepsy risk
Future febrile seizure risk - 1/3

Question 11

Seizures in children

Answer 11

Absence 
Febrile convulsions
JME 
West syndrome 
Lennox gastaut syndrome

Question 12

Juvenile myoclonic epilepsy

Answer 12

Females - Teens
History of absence seizures

Myoclonic jerks - Throwing things

EEG - Polyspike and wave

Management - Valproate