Paeds Neuro + Psych (+ dev milestones) Flashcards
1
Q
What are 4 domains of developmental milestones
A
Gross motor
Fine motor
Language
Personal and social
2
Q
What are the developmental milestones for a 2 month old
A
Gross motor:
Fine motor: fix and follow w eyes
Language: cooing
Personal and social: smile
3
Q
What are the developmental milestones for a 4 month old
A
Gross motor: keep head prone, roll over
Fine motor: rattle shake
Language: cooing
Personal and social: laugh
4
Q
What are the developmental milestones for a 6 month old
A
Gross motor: maintain sitting position
Fine motor: palmer grasp
Language: noises with consonants
Personal and social: curious and engaged with people
5
Q
What are the developmental milestones for a 9 month old
A
Gross motor: sit unsupported & start crawling
Fine motor: scissor grip
Language: babble sounds like talking
Personal and social: cautious about strangers
6
Q
What are the developmental milestones for a 12 month old
A
Gross motor: stand on two legs (cruising)
Fine motor: pincer grip
Language: single words
Personal and social: waves bye claps hands, engages with others
7
Q
What are the developmental milestones for a 18 month old
A
Gross motor: walk unaided, squat and pick things from floor
Fine motor: use spoon to bring food to mouth, tower of 4 bricks
Language: has 5-10 words
Personal and social: imitates activities
8
Q
What are the developmental milestones for a 2 year old
A
Gross motor: run kick a ball
Fine motor: tower of 8 bricks, draw line
Language: combine 2 word phrases
Personal and social: parallel play, dry by day
9
Q
What are the developmental milestones for a 3 year old
A
Gross motor: climb stairs one foot at time
Fine motor: circle and build bridge
Language: basic sentences
Personal and social: seek other children to play
10
Q
What are the developmental milestones for a 4 year old
A
Gross motor: hop climb and descend stairs like adult
Fine motor: draw cross and square and build steps
Language: tells stories
Personal and social: best friend, dry by night, imaginative play, dresses self
11
Q
What are red flags for developmental milestones
A
- Lost developmental milestones
- Not able to hold an object at 5 months
- Not sitting unsupported at 12 months
- Not standing independently, No words and No interest in others at 18 months
- Not walking independently at 2 years
- Not running at 2.5 years
12
Q
What are two components of language
A
Expressive language
Receptive language
13
Q
What is Dyslexia
A
specific difficulty in reading, writing and spelling.
14
Q
what is Dysgraphia
A
specific difficulty in writing.
15
Q
what is Dyspraxia
A
developmental co-ordination disorder
delayed gross and fine motor skills
16
Q
What is auditory processing disorder
A
specific difficulty in processing auditory information
17
Q
What is a Non-verbal learning disability
A
specific difficulty in processing non-verbal information, such as body language and facial expressions
18
Q
What is a Profound and multiple learning disability
A
severe difficulties across multiple areas, often requiring help with all aspects of daily life.
19
Q
What IQ is a mild learning diability
A
55 – 70
20
Q
What IQ is a moderate learning diability
A
40 – 55
21
Q
What IQ is a severe learning diability
A
25 – 40
22
Q
What IQ is a profound learning diability
A
under 25
23
Q
What are RF for learning disability.
A
Family history
abuse, neglect, psychological trauma and toxins
24
Q
What conditions are strongly associated with learning disability
A
- Genetic disorders such as Downs syndrome
- Antenatal problems, such as fetal alcohol syndrome and maternal chickenpox
- Problems at birth, such as prematurity and hypoxic ischaemic encephalopathy
- Early childhood meningitis
- Autism
- Epilepsy
25
who might be involved in management of child with a learning disability
Health visitors
Social workers
Schools
Educational psychologists
Paediatricians, GPs and nurses
Occupational therapists
Speech and language therapists
26
What is Safeguarding
involves all aspects of ensuring the welfare of a child
27
What is Child protection
involves the process of protecting a child that is at risk of or suffering harm
28
What provides the legal framework for child safeguarding
Children Act 1989
29
what is a "child is need"
refers to a child that is likely to need supportive services to maintain their health and development, or is disabled
30
What are types of abuse
Physical
Emotional
Sexual
Neglect
Financial
Identity
31
What are RF for abuse
Domestic violence
Previously abused parent
Mental health problems
Emotional volatility in the household
Social, psychological or economic stress
Disability in the child
Learning disability in the parents
Alcohol misuse
Substance misuse
Non-engagement with services
32
What are possible signs of abuse
- Change in behaviour or extreme emotional states
- Dissociative disorders (feeling separated from their thoughts or identity)
- Bullying, self harm or suicidal behaviours
- Unusually sexualised behaviours
- Unusual behaviour during examination
- Poor hygiene
- Poor physical or emotional development
- Missing appointments or not complying with treatments
33
What is available in NHS organisations to assist with safeguarding concerns
safeguarding team or safeguarding lead
34
where are safeguarding cases referred to
children’s services (social services)
If the child is in immediate danger the police may need to be involved
35
What measures can be arranged to help support families of children with safe guarding concerns.
- Home visit programmes to support parents
- Parenting programmes to help parents develop parenting skills and manage their child’s behaviour
- Attachment-based interventions to help parents bond and nurture their child
- Child–parent psychotherapy
- Parent–child interaction therapy
- Multi-systemic therapy for child abuse and neglect (MST-CAN)
- Cognitive behavioural therapy for children that have suffered trauma or sexual abuse
36
What is Global developmental delay
child displaying slow development in all developmental domains
37
What conditions are associated with global developmental delay
Down’s syndrome
Fragile X syndrome
Fetal alcohol syndrome
Rett syndrome
Metabolic disorders
38
What conditions are associated with gross motor delay
Cerebral palsy
Ataxia
Myopathy
Spina bifida
Visual impairment
39
What conditions are associated with fine motor delay
Dyspraxia
Cerebral palsy
Muscular dystrophy
Visual impairment
Congenital ataxia (rare)
40
What conditions are associated with language delay
Specific social circumstances, for example exposure to multiple languages or siblings that do all the talking
Hearing impairment
Learning disability
Neglect
Autism
Cerebral palsy
41
How is language delay managed
referral to speech and language, audiology and the health visitor.
Referral to safeguarding is required if neglect is a concern.
42
What may personal and social delay indicate
Emotional and social neglect
Parenting issues
Autism
43
What are febrile convulsions
type of seizure that occurs in children with a high fever
only in children ages of 6 months and 5 years
44
What are Simple febrile convulsions
generalised, tonic clonic seizures
last less than 15 minutes
only occur once during a single febrile illness
45
What are complex febrile convulsions
consist of partial or focal seizures
last more than 15 minutes
or occur multiple times during the same febrile illness.
46
What are DDx for febrile seizures
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
47
What is the fever in febrile convulsions usually caused by
an underlying viral illness or bacterial infection such as tonsillitis.
48
How is febrile seizures diagnosed
diagnosis of exclusion
49
How are febrile seizures managed
ID & manage the underlying source of infection
first = trip to hospital for assessment
simple = do not require further investigations.
complex = further investigation
50
How are seizure episodes manahed
stay with the child
safe place
recovery position
don't pout anything in mouth
call ambulance if >5 min seizure
show how to give PR diazepam or buccal midazolam
51
what is prognosis for febrile seizures
no lasting damage
1/3 will have another
52
What is the risk of developing epilepsy in normal population, after a simple febrile seizure and after complex febrile seizure
1.8% for the general population
2-7.5% after a simple febrile convulsion
10-20% after a complex febrile convulsion
53
What is Epilepsy
umbrella term for a condition where there is a tendency to have seizures
54
What are Seizures
transient episodes of abnormal electrical activity in the brai
55
What are tonic clonic seizures
loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) movements
associated tongue biting, incontinence, groaning and irregular breathing.
56
What is the peroid after seizure called and what are symptoms
post-ictal period
confused, drowsy and feels irritable or low
57
What is the Management of tonic-clonic seizures
First line: sodium valproate
Second line: lamotrigine or carbamazepine
58
What are focal seizures
seizure that starts in one of the lobes of the brain
temporal, frontal, occipital, parietal
59
How do Temporal lobe focal seizures present
typically a rising epigastric sensation
Hallucinations
Déjà vu
automatisms (e.g. lip smacking/grabbing/plucking) are common
60
What are Absence seizures
patient becomes blank, stares into space and then abruptly returns to normal
unaware of their surroundings and won’t respond
last 10-20 seconds
typically in children
61
WHat is the management of focal seizures
First line:
Lamotrigine or Levetiracetam
Second line: carbamazepine
62
What is management of absence seizures
ethosuximide
63
What is difference between atonic and myoclonic seizures
Atonic = lapses in muscle tone
myoclonic = brief muscle contraction
64
What are Febrile Convulsions NOT caused by
epilepsy or other underlying neurological pathology (such as meningitis or tumours).
65
What is management for atonic and myoclonic seizures
men: sodium valproate
women: lamotrigine (tonic)
levetiracetam (myoclonic)
66
How is epilepsy investigated
electroencephalogram (EEG)
ECG to exclude problems in the heart.
Blood electrolytes including sodium, potassium, calcium and magnesium
Blood glucose for hypoglycaemia and diabetes
Blood cultures, urine cultures and lumbar puncture where sepsis, encephalitis or meningitis is suspected
67
When are children NOT investigated for epilepsy
Children are allowed one simple seizure before being investigated for epilepsy.
68
When is MRI brain considered for epilepsy
The first seizure is in children under 2 years
Focal seizures
There is no response to first line anti-epileptic medications
69
When is an EEG performed for epilepsy
after the second simple tonic-clonic seizure
70
What is general advice for parents of children with epilepsy
Take showers rather than baths
Be very cautious with swimming unless seizures are well controlled and they are closely supervised
Be cautious with heights
Be cautious with traffic
Be cautious with any heavy, hot or electrical equipment
71
What anti-epileptic drugs is teratogenic
Sodium Valproate
72
When is Sodium Valproate not first line anti-epileptic drug
in focal seizures
73
What are SE of Sodium Valproate
Teratogenic, so patients need careful advice about contraception
Liver damage and hepatitis
Hair loss
Tremor
74
how does Sodium Valproate work
increases GABA levels by inhibiting the enzyme GABA transaminase, which breaks down GABA
75
Are SE of Carbamazepine
Agranulocytosis
Aplastic anaemia
Induces the P450 system so there are many drug interactions
76
What are SE of phenytoin
Folate and vitamin D deficiency
Megaloblastic anaemia (folate deficiency)
Osteomalacia (vitamin D deficiency)
77
What are SE of Ethosuximide
Night terrors
Rashes
78
What are SE of Lamotrigine
* Stevens-Johnson syndrome or DRESS syndrome.
* Leukopenia -> dec WCC
79
What is Status Epilepticus
a seizure lasting more than 5 minutes or 2 or more seizures without regaining consciousness in the interim.
Medical emergency
80
What is management of Status Epilepticus in hospital
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
ABCDE
81
what is final step for management of Status Epilepticus
IV levetiracetam, phenytoin or sodium valproate
intubation and ventilation to secure airway
82
What is management of Status Epilepticus in community
Buccal midazolam
Rectal diazepam
83
What is cerebral palsy
non progressive permanent neurological problems resulting from damage to the brain around the time of birt
84
What are antenatal causes of cerebral palsy
cerebral malformation and congenital infection (rubella, toxoplasmosis, CMV)
85
What are perinatal causes of cerebral palsy
Birth asphyxia
Pre-term birth
Birth Trauma
86
What are postnatal causes of cerebral palsy
* Meningitis
* intraventricular haemorrhage
* Severe neonatal jaundice
* Head injury
87
what is spastic cerebral palsy
hypertonia (increased tone) and reduced function resulting from damage to upper motor neurones
88
What are the 4 types of cerebral palsy
Spastic
Dyskinetic
Ataxic
Mixed
89
what is dyskinetic cerebral palsy
athetoid (slow withering flexed) movements and oro-motor problems.
Damage to basal ganglia and the substantia nigra
90
what is ataxic cerebral palsy
problems with coordinated movement resulting from damage to the cerebellum
91
what is mixed cerebral palsy
a mix of spastic, dyskinetic and/or ataxic features
92
what is another name for Spastic CP
pyramidal CP
93
what is another name for Dyskinetic CP
athetoid CP and extrapyramidal CP.
94
What is Monoplegia CP
one limb affected
95
What is Hemiplegia CP
one side of the body affected
96
What is Diplegia CP
four limbs are affects, but mostly the legs
97
What is Quadriplegia CP
four limbs are affected more severely, often with seizures, speech disturbance and other impairments
98
What are signs and symptoms of cerebral palsy during development
Failure to meet milestones
Increased or decreased tone, generally or in specific limbs
Hand preference below 18 months is a key sign to remember for exams
Problems with coordination, speech or walking
Feeding or swallowing problems
Learning difficulties
99
What does a Hemiplegic / diplegic gait indicates
an upper motor neurone lesion
100
What does a High stepping gait indicates
indicates foot drop or a lower motor neurone lesion
101
What does a Broad based gait / ataxic gait indicates
indicates a cerebellar lesion
102
What does a Waddling gait indicates
indicates pelvic muscle weakness due to myopathy
103
How does a Upper Motor Neurone lesion present on expection
Inspection : muscle bulk preserved
Tone: hypertonia
Power: slightly reduced
Reflexes: brisk
104
What does a Antalgic gait indicates
indicates localised pain
105
How does a Lower Motor Neurone lesion present on expection
Inspection: reduced muscle bulk with fasciculations
Tone: hypotonia
Power: dramatically reduced
Reflexes: reduced
106
What is a DDx for a UMN lesion
acquired brain injury or a tumour.
107
What gait is associated commonly with CP
hemiplegic or diplegic gait
108
How does CP gait present
The leg will be extended with plantar flexion of the feet and toes.
This means they have to swing the leg around in a large semicircle when moving their leg from behind them to in front
109
How will CP present on examination
Like UMN lesion
good muscle bulk, increased tone, brisk reflexes and slightly reduced power
110
What are complications and associated conditions with CP
Learning disability
Epilepsy
Kyphoscoliosis
Muscle contractures
Hearing and visual impairment
Gastro-oesophageal reflux
111
What do athetoid movements indicate
extrapyramidal (basal ganglia) involvement
112
What is the management for cerebral palsy
MDT team approach
Physiotherapy
Occupational therapy
Speech and language therapy
Dieticians
Orthopaedic surgeons
Paediatricians
Social workers
Charities and support groups
113
What medication can be given to children with cerebral palsy
- Muscle relaxants (e.g. baclofen) for muscle spasticity and contractures
- Anti-epileptic drugs for seizures
- Glycopyrronium bromide for excessive drooling
114
What is ADHD
extreme end of “hyperactivity” and inability to concentrate (“attention deficit“).
It affects the person’s ability to carry out everyday tasks, develop normal skills and perform well in school.
115
When is hyperactivity and attention deficit suggestive of an environmental problem rather than ADHD
ADHD = Features should be consistent across various settings
116
What are features for ADHD
Very short attention span
Quickly moving from one 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
117
How is ADHD diagnosed
A detailed assessment should be carried out by a specialist in childhood behavioural problems
118
How is ADHD managed
coordinated by a specialist in ADHD
Parental and child education
education about parental strategies to manage the child
healthy diet & exercise
Medication after conservative management has failed or severe cases
119
What are medication options for ADHD
central nervous system stimulants.
- Methylphenidate (“Ritalin“)
- Dexamfetamine
- Atomoxetine
120
What is Autistic spectrum disorder
range of people affected by a deficit in social interaction, communication and flexible behaviour.
121
What two previous diagnoses were grouped in Autistic spectrum disorder
Aspergers syndrome and autistic disorder
122
What was Asperger syndrome
normal intelligence and ability to function in everyday life but displaying difficulties with reading emotions and responding to others
123
What are autism social interaction features
Lack of eye contact
Delay in smiling
Avoids physical contact
Unable to read non-verbal cues
Difficulty establishing friendships
Not displaying a desire to share attention (i.e. not playing with others)
124
What are autism behaviour features
* 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 change in routine
* Extremely restricted food preferences
125
What are autism communication features
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 behaviour
Repetitive use of words or phrases
126
How is autism diagnosis made
made by specialist in autism.
paediatric psychiatrist or paediatrician with an interest in development and behaviour.
diagnosis can be made before the age of 3 years.
involves a detailed history and assessment of the child’s behaviour and communication
127
How is Autism managed
MDT team
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
128
Name 3 eating disorders
Anorexia nervosa
Bulimia nervosa
Binge eating disorder
129
What are eating disorders
psychiatric conditions involving an unhealthy and distorted obsession with body image and food
130
Who are eating disorders more common in
women and young ppl
131
What is anorexia nervosa
person feels they are overweight despite evidence of normal or low body weight
obsessively restricting calorie intake to lose weight
132
What are features of anorexia nervosa
* Weight loss (e.g., 15% below expected or BMI less than 17.5)
* Amenorrhoea (absent periods)
* Lanugo hair (fine, soft hair across most of the body)
* Hypotension (low blood pressure)
* Hypothermia (low body temperature)
* Mood changes, including anxiety and depression
133
What are complications of anorexia nervosa
Cardiac complications include arrhythmia, cardiac atrophy and sudden cardiac death.
Low bone mineral density is another complication.
134
What is Bulimia Nervosa
binge eating, followed by purging by inducing vomiting or taking laxatives to prevent the calories from being absorbed.
often have a normal/flucuating body weight
135
what are features of bulimia nervosa
Erosion of teeth
Swollen salivary glands
Mouth ulcers
Gastro-oesophageal reflux
Calluses on the knuckles where they have been scraped across the teeth (called Russell’s sign)
136
What blood gas may indicate bulima
alkalosis after repeated vomiting of hydrochloric acid from the stomach
137
What are possible blood test findings in restrictive eating disorders
Anaemia (low haemoglobin)
Leucopenia (low white cell count)
Thrombocytopenia (low platelets)
Hypokalaemia (low potassium – due to vomiting or excessive laxatives)
anorexia --> G’s and C's raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
138
What can reduced bone marrow activity cause
- normocytic normochromic anaemia
- leucopenia (with low neutrophils and low lymphocytes)
- thrombocytopenia.
139
what is first line treatment for anorexia
'anorexia focused family therapy' as the first-line treatment.
The second-line treatment is cognitive behavioural therapy.
140
what is refeeding syndrome
occurs when someone with an extended severe nutritional deficit resumes eating
suspected in anyon w minimal intake over 5 days
During prolonged starvation, intracellular potassium, phosphate and magnesium are depleted.
During refeeding, various mechanisms shift magnesium, potassium and phosphate OUT of the blood and sodium INTO the blood
141
what are the electrolyte effects in refeeding sydrome
Hypomagnesaemia (low serum magnesium)
Hypokalaemia (low serum potassium)
Hypophosphataemia (low serum phosphate)
Fluid overload (due to water following the extra sodium into the extracellular space)
142
how is refeeding sydrome managed
according to the local protocol under specialist supervision:
- re-feed at no more than 50% of requirements for the first 2 days.
- Magnesium, potassium, phosphate and glucose monitoring
- Fluid balance monitoring
- ECG monitoring in severe cases
- Supplementation with electrolytes and vitamins, particularly B vitamins and thiamine
143
what is fatal risk of refeeding syndrome
arrhythmia and heart failure
144
how is severity of anxiety assessed
GAD-7 anxiety questionnaire
