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NP- Phase 3a Medicine > Paeds- Neuro and Psych > Flashcards

Paeds- Neuro and Psych Flashcards

1
Q

what is cerebral palsy?

A

chronic disorder of movement and posture causing activity limitation attributed to non-progressive disturbances that occurred in the developing foetal brain

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2
Q

antenatal causes of cerebral palsy

A
  • vascular occlusion
  • cerebral malformation
  • congenital infection (rubella, toxoplasmosis)
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3
Q

postnatal causes of cerebral palsy

A

meningitis, encephalitis, encephalopathy

head trauma

intraventricular haemorrhage

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4
Q

clinical presentation of cerebral palsy

A
  • abnormal limb/ trunk tone and posture
  • delayed motor milestones
  • abnormal gait when walking
  • feeding difficulties
  • learning difficulties
  • speech/ language difficulties
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5
Q

describe the Gross Motor Function Classification (GMFCS)

A

1- walks without limitations

2- walks with limitations

3- walks using handheld mobility device

4- self mobility with limitations- may use powered mobility

5- manual wheelchair transportation

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6
Q

how is cerebral palsy diagnosed ?

A

clinical examination

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7
Q

what are the 4 clinical subtypes of cerebral palsy?

A
  • mixed pattern
  • spastic (90%)
  • dyskinetic (6%)
  • ataxic (4%)
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8
Q

describe spastic cerebral palsy

A
  • damage to UMN (corticospinal/ pyramidal)
  • hypertonia
  • brisk deep tendon reflexes
  • clasp knife reflexes
  • spastic hemiplegia
  • rare- quadriplegia
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9
Q

describe dyskinetic cerebral palsy

A
  • chorea, athetosis and dystonia
  • basal ganglia damage
  • primitive motor reflex patterns
  • intellect unimpaired
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10
Q

what is athetosis and when is it commonly seen?

A

slow writhing movements distally (e.g fanning fingers)

seen in dyskinetic cerebral palsy

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11
Q

describe ataxic cerebral palsy

A
  • cerebellum damage- result in difficulty with coordinated movement
  • poor balance, delayed motor development, trunk and limb hypertonia
  • intention tremor
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12
Q

what can be given to manage spasticity in a patient with cerebral palsy?

A
  • oral diazepam
  • baclofen
  • botulinum toxin
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13
Q

what is autism?

A

A complex developmental condition that includes a range of possible
developmental impairments in reciprocal social interaction and communication as well as a stereotyped, repetitive or limited behavioural repertoire

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14
Q

what is autism defined by?

A
  • presence of abnormal/ impaired development presenting before the age of 3
  • abnormal functioning in all 3 areas of psychopathology- social interaction, impairment of language, restricted and repetitive behaviour
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15
Q

how does autism present clinically?

A
  • communication difficulties- lack of desire to communicate, disordered, repetition, poor non-verbal communication
  • no social awareness
  • poor social interactions
  • lack of empathy
  • rigidity of thought
  • obsessions
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16
Q

what medical problems are associated with autism?

A
  • epilepsy
  • visual and hearing impairment
  • mental health- depression, anxiety, OCD, ADHD
  • sleep disorders
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17
Q

how is autism managed? (non- pharmalogical)

A
  • behavioural intervention
  • speech therapy
  • school liaison
  • aids- timetables, written instructions etc
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18
Q

how is autism managed pharmacologically?

A

risipiridone- agression

melatonin- sleep

SSRI’s= repetitive behaviour

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19
Q

what features must be present to diagnose ADHD?

A
  • 6/9 inattentive symptoms
  • 6/9 hyperactive symptoms

also must:

  • present before 12
  • developmentally inappropriate
  • several symptoms in 2 or more settings
  • clear evidence that symptoms interfere with functioning (e.g. academic ability)
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20
Q

aetiology of ADHD

A
  • CNS insults
  • genetic
  • acquired brain injury- prematurity, fetal alcohol syndrome
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21
Q

what are the 3 core symptoms of ADHD?

A
  • inattention
  • hyperactivity
  • impulsivity
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22
Q

describe the inattentive symptoms of ADHD

A
  • easily distracted
  • does not listen
  • forgetful
  • difficult to follow instructions
  • difficulty organising tasks
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23
Q

describe the hyperactive symptoms of ADHD

A
  • squirms and fidgets
  • cannot remain seated
  • runs/ climbs all the time
  • always ‘on the go’
  • talks excessively
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24
Q

describe the impulsive symptoms of ADHD

A
  • blurts out answers before question has been completed
  • difficulty awaiting turn
  • interrupts or intrudes others
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25
Q

describe the clinical picture of ADHD in primary school children (6-12)

A
  • distractibility
  • motor restlessness
  • impulsive and disruptive
  • learning disorders
  • agressive
  • low self esteem
  • rejection by peers
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26
Q

describe the clinical picture of ADHD in adolescents (13-17)

A
  • difficulty in planning and organisation
  • persistent inattention
  • associated- aggressive, antisocial, alcohol and drug problems, emotional problems, sexually inappropriate
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27
Q

describe the clinical picture of ADHD in adults

A
  • mental disorders- autism, antisocial
  • lack of achievement
  • crime
  • drugs/ alcohol
  • impulsive spending
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28
Q

how is ADHD managed non-pharmaceutically?

A

education

school support

CBT

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29
Q

how is ADHD managed pharmaceutically?

A

methlyphenidate (Ritalin)- first line

Atomoxetine

Lisdexamfetamine- only used when unresponsive to max dose of the other 2

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30
Q

what is a seizure?

A

transient occurence of signs and symptoms due to abnormal excessive neuronal activity in the brain

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31
Q

what is syncope?

A

sudden reduction in cerebral perfusion with oxygenated blood either secondary to reduced cerebral blood flow or reduced O2 content

32
Q

what can cause paroxysmal non-epileptic events (go through each system)

A

cardiac- arrhythmia, syncope

GI- GORD

Neuro- migraine, Tic, sleep related

Psych- pseudo-seizure

Behavioural- day dreaming

33
Q

features of a simple febrile seizure

A

less than 15 mins

generalised seizure

no recurrence within 24h

complete recovery in 1h

34
Q

features of a complex febrile seizure

A

15-30 mins

focal seizure

repeat seizures within 24h

35
Q

how does does febrile status epilepticus last?

A

over 30 mins

36
Q

define febrile seizures

A

Seizures occurring in children aged 6 months to 6 years, associated with fever and raised temperature (>37.8 axilla temp), without other underlying causes such as CNS infection or electrolyte imbalance

37
Q

what is a simple febrile seizure?

A

generalised, tonic-clonic seizures lasting less than 15 minutes that do not recur within 24 hours or within the same febrile illness

patient is drowsy for > 1 hour after seizure

38
Q

what is a complex febrile seizure?

A

one or more of:

  • focal features at onset/ during
  • duration of more than 15 mins
  • recurrence within same illness
39
Q

what is febrile status epilepticus?

A

febrile seizure lasting for longer than 30 mins

40
Q

if a patient presented with focal CNS signs and a history of epilepsy with a seizure lasting longer than 15 minutes what would you be concerned about?

A

meningo-encephalitis

CNS lesion

epilepsy

trauma

metabolic (low glucose, calcium or magnesium)

41
Q

when should a child presenting with a febrile seizure be urgently referred?

A
  • first febrile seizure
  • lasting over 5 mins
  • drowsy for 1 hour after
  • previous history of febrile seizure
  • age under 18 months
  • complex seizure
  • recent antibiotic use
42
Q

how is a patient presenting with a febrile seizure investigated?

A
  • developmental screen
  • cause of fever? infective
  • LP- if under 18 months
43
Q

what are some contra-indications for performing a LP in a paeds patient?

A
  • reducing consciousness (GCS<13)
  • septic shock
  • suspected meningococcal disease
  • signs of raised ICP
  • focal neurology
  • bleeding tendency
44
Q

how would you treat a febrile seizure lasting over 5 minutes?

A

diazepam, midazoloam, lorazepam

45
Q

what is reflex anoxic seizure?

A

paroxysmal, self limited brief (15 seconds) asytole

occurs in infants and toddlers (6 months- 2 years)

46
Q

what can trigger a reflex anoxic seizure?

A
  • pain/ discomfort
  • cold foods
  • fright
  • fever
47
Q

how does a reflex anoxic seizure present clinically?

A
  • stops breathing following trigger
  • deathly pale
  • falls to floor
  • clinic movements
  • urinary incontinence
  • brief- recovers quickly
48
Q

explain the pathophysiology of a reflex anoxic seizure

A
  • cardiac asytole from vagal inhibition

- slow wave discharge seen on ECG

49
Q

how is a reflex anoxic seizure diagnosed?

A

vagal excitation tests w/ continuous EEG + ECG

50
Q

how is a reflex anoxic seizure differentiated from epilepsy?

A

NO TONGUE BITING

51
Q

how is a patient presenting with a reflex anoxic seizure managed?

A
  • check ferritin
  • no drugs needed
  • pacemaker

usually self limiting ! no medical treatment needed

52
Q

describe breath holding episodes

A
  • occur when toddler is upset
  • child cries, holds breath and goes blue
  • can lose consciousness but recovers rapidly
  • resolves spontaneously
53
Q

define childhood epilepsy

A

chronic, neurological disorder characterised by recurrent unprovoked seizures, consisting of transient signs and/or symptoms associated with excessive neuronal activity in the brain

54
Q

which types of childhood epilepsy are classified as generalised?

A
  • absent
  • myoclonic
  • tonic
  • tonic-clonic
  • atonic
55
Q

describe absent childhood epilepsy

A
  • transient LoC (less than 30s)
  • abrupt onset + termination
  • no motor phenomena
  • eyelid flickering
  • stare momentarily and stop moving
  • will only recall that they missed something- ‘puzzled’
56
Q

describe the aetiology of absent childhood epilepsy

A

2/3rd female

4-12 years old

57
Q

describe myoclonic childhood epliepsy

A

brief, often repetitive, jerking movements

58
Q

what is a tonic-clonic seizure?

A
  • tonic- rigid, falls to ground, cyanotic
  • clonic- contractions, jerking, irregular breathing, tongue biting, incontinence

episode followed by unconsciousness/ deep sleep for several hours

59
Q

describe an atonic seizure

A

transient loss of muscle tone causing drop to the floor/ drop of head

60
Q

what types of seizure are described as focal/ partial?

A

frontal

temporal

occipital

parietal

61
Q

describe a frontal seizure

A

motor phenomena- clonic movements

asymmetrical

62
Q

describe a temporal seizure

A
  • auditory/ smell/ taste
  • lip smacking, plucking at clothes
  • Deja vu and Jamais vu
  • longer
63
Q

describe an occipital seizure

A

distortion of vision

64
Q

describe a parietal seizure

A

contralateral altered sensation

65
Q

how are generalised seizures managed?

A

1st- valproate/ carbamazepine

2nd- lamotrigine

66
Q

how are focal seizures managed?

A

1st- carbamazepine/ valporate/ lamotrigine

2nd- topiramate, gabapentin, tigabine, bigatrin

67
Q

what can be given to a patient with prolonged seizures?

A

rectal diazepam

68
Q

when is therapy for paediatric patients with epilepsy discontinued?

A

after 2 years without a seizure

69
Q

how is status epilepticus managed?

A
  • supportive ! ABC etc

drugs:

  • ABC
  • IV lorazepam after 5 mins
  • repeat lorazepam after 15 mins
  • IV Phenytoin- 20 mins

if not stable after this refer to PICU

70
Q

what are the 3 components of West syndrome?

A

infantile spasms

hypsarrythmia- EEG

general learning disability

71
Q

aetiology of West Syndrome

A
  • prenatal conditions
  • hypoxia, ischaemia, meningitis, encephalitis, trauma, intracranial haemorhage
  • idioathpic
72
Q

describe the epidemiology of West syndrome

A

4-7 months

confined to infants

73
Q

describe the spasms seen in West Syndrome

A
  • clusters of head nodding and arm jerks
  • sudden, rapid, tonic contraction of trunk and limb muscles
  • contraction relaxation up to 2s
  • occur just before sleep or on waking up
74
Q

other than spasms, describe the other features of West Syndrome

A
  • learning disabilities
  • hypo-pigmented skin lesions
  • mild/moderate growth restriction
75
Q

how is West syndrome diagnosed?

A

EEG- hypsarrythmia

76
Q

describe the treatment pathway of West Syndrome

A
  • vigabatrin
  • ACTH- adrenocrticotropic hormone
  • prednisolone

however it has a poor prognosis

NP- Phase 3a Medicine (22 decks)

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