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Pediatrics Flashcards

1
Q

What is the definition of epilepsy?

A

The occurrence of at least 2 unprovoked seizures (regardless of the type)

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2
Q

What is the definition of seizure?

A

The clinical manifestation of abnormal hypersynchronous d/c of the cortical neurons

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3
Q

What are the two general classifications of seizures?

A

Generalized

Partial

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4
Q

What are the 6 types of generalized seizures?

A
  • Absence
  • Myoclonic
  • Atonic
  • Tonic
  • Clonic
  • Tonic-clonic
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5
Q

What are absence seizures?

A

Staring episodes with cessation of activity

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6
Q

What are myoclonic seizures?

A

Brief jerking muscle movements

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7
Q

What are atonic seizures?

A

Loss of tone for a few seconds (could be whole body or only partial)

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8
Q

What are clonic seizures?

A

Regularly repeated muscle jerks

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9
Q

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

A

No alteration of consciousness with simple

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10
Q

What are the five characteristics used to define epilepsy syndromes?

A
  • Seizure type
  • Age of onset
  • Course
  • EEG abnormalities
  • Drug of choice
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11
Q

What are the characteristics of childhood absence epilepsy?

A

Brief staring spells with impairment of awareness and cessation of activity without loss of tone

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12
Q

What is the duration of childhood absence seizures?

A

Usually less than 20 seconds

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13
Q

What is the frequency of absence seizures?

A

Multiple times/day

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14
Q

What usually provokes absence seizures?

A

Hyperventilation

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15
Q

Is there a postictal state with absence seizures?

A

No

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16
Q

Is there a loss of muscle tone with absence seizures?

A

No

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17
Q

What age do absence seizures begin?

A

School aged (4-14 years)

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18
Q

What is the prognosis of absence seizures?

A

Usually self limited–resolve by age 18 years

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19
Q

What is the most important thing to ask in the history of seizures?

A

Any h/o developmental abnormalities

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20
Q

What are the EEG findings of absence seizures?

A

3 Hz spike and slow wave discharges

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21
Q

What is the treatment for absence seizures (3)? Which is the first choice?

A
  • Ethosuximide
  • Valproic acid
  • Lamotrigine
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22
Q

What gender is usually affected with absence seizures?

A

Females

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23
Q

Are absence seizures generalized or partial?

A

Generalized

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24
Q

What is benign childhood epilepsy with centrotemporal spikes (rolandic epilepsy)?

A

Infrequent, partial seizures that manifest with tingling in the mouth, on the face, drooling, dysphagia, speech arrest

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25
Q

How common are generalized tonic-clonic seizures with benign childhood epilepsy with centrotemporal spikes?

A

Rare

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26
Q

When do seizures occur with benign childhood epilepsy with centrotemporal spikes?

A

During sleep or upon waking

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27
Q

What is the prognosis for benign childhood epilepsy with centrotemporal spikes?

A

Usually resolve with puberty, and has no effect on development

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28
Q

What are the imaging findings of benign childhood epilepsy with centrotemporal spikes?

A

Normal

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29
Q

What are the drugs of choice to treat benign childhood epilepsy with centrotemporal spikes (2)?

A

Carbamazepine

Oxcarbazepine

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30
Q

What is the MOA of carbamazepine?

A

Na channel blocker and GABA receptor agonist

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31
Q

What are the EEG findings of benign childhood epilepsy with centrotemporal spikes?

A

Centrotemporal spikes

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32
Q

What are the facial s/sx of benign childhood epilepsy with centrotemporal spikes?

A
  • Tingling of the mouth
  • Drooling
  • Dysphagia
  • Speech arrest
33
Q

What are the UE findings of benign childhood epilepsy with centrotemporal spikes?

A

Unilateral UE movement

34
Q

What is the general age range for benign childhood epilepsy with centrotemporal spikes?

A

2-12 years

35
Q

True or false: benign childhood epilepsy with centrotemporal spikes usually appears on both hemispheres

A

False–usually unilateral

36
Q

What is juvenile myoclonic epilepsy?

A

Myoclonic jerking seizures that usually happen in the morning, and is without LOC

37
Q

What is the usual age of onset for juvenile myoclonic epilepsy?

A

12-18 years

38
Q

What are the EEG findings of juvenile myoclonic epilepsy?

A

3-6 Hz polyspikes and waves (many small spike, and then a slow wave in all leads)

39
Q

How can juvenile myoclonic epilepsy be provoked?

A

Photic stimulation

40
Q

Is there LOC with juvenile myoclonic epilepsy?

A

Usually not

41
Q

What are the usual triggers of juvenile myoclonic epilepsy? (4)

A
  • AM wakening
  • Lack of sleep
  • Fatigue
  • EtOH
42
Q

What is the prognosis for juvenile myoclonic epilepsy?

A

Requires lifelong treatment, but good response to meds, and no developmental issues

43
Q

What is the treatment for juvenile myoclonic epilepsy? (3) Which is the drug of choice?

A
  • Valproic acid
  • Levetiracetam
  • Lamotrigine
44
Q

True or false: Juvenile myoclonic epilepsy is a lifelong disease

45
Q

Does juvenile myoclonic epilepsy usually manifest as a generalized seizure or partial?

A

Generalized

46
Q

What are the side effects of valproic acid?

A

Teratogenic effects
PCOS
Hirsutism

47
Q

What percent of juvenile myoclonic epilepsy have GTCs? What in particular provokes them?

A

85%–usually brought about by a lack of sleep

48
Q

What is a febrile seizure?

A

Fever of more than 38 C and seizure in the absence of CNS infection

49
Q

What ages do febrile seizures usually happen?

A

in children between 3 months and 6 years

50
Q

What must be r/o with febrile seizures?

A

Meningitis

51
Q

True or false: patients with febrile seizures usually have no previous h/o afebrile seizures

52
Q

What is the most common type of seizure in children?

53
Q

True or false: a febrile seizure, by definition, has to occur in the absence of a CNS infection

54
Q

What is a simple febrile seizure?

A

Generalized seizure of less than 15 minutes duration, that occurs one time in 24 hours

55
Q

What is a complex febrile seizure?

A

Foal, more than 15 minutes in duration, or more than one seizure in a 24 hour period

56
Q

Are febrile seizures found more often in viral or bacterial infections?

57
Q

What is the recurrence risk of febrile seizures?

58
Q

What are the two immunizations that should be given to children who have febrile seizures?

59
Q

How do you differentiate between a febrile seizure and a seizure 2/2 meningitis (lab, sign, symptom)?

A
  • LP
  • Meningeal signs
  • Prolonged postictal state with meningitis
60
Q

When should an LP be done in the workup of a febrile seizure? (2)

A
  • 6-12 months old if not fully vaccinated for HiB or strep pneumonia
  • Taking Abx
61
Q

Prolonged postictal state with a febrile seizure suggests what? What should be done?

A

Meningitis

LP

62
Q

True or false: CBC, CMP, Ca, and Mg should be checked with febrile seizures

63
Q

True or false: brain imaging and/or an EEG should be obtained with febrile seizures

64
Q

When is neuroimaging indicated for a febrile seizure?

A
  • Focal neuro deficits
  • Macrocephaly
  • S/sx of increase ICP
65
Q

True or false: and EEG is NOT indicated for a simple febrile seizure

A

True–but may be indicated in complex febrile seizures

66
Q

What is the treatment for febrile seizures? When is it indicated?

A

Benzos–if lasting more than 5 minutes

67
Q

True or false: prophylactic medications should be given in cases of febrile seizures

68
Q

What is the prognosis for febrile seizures?

69
Q

What are the risk factors for the development of febrile seizures? (4)

A
  • h/o complex febrile seizures
  • Abnormal neuro exam
  • Developmental delay
  • Family h/o epilepsy
70
Q

What is infantile spasm?

A

-Epileptic spasm that usually starts in infancy.

71
Q

What is the prognosis for infantile spasms?

A

Severe problem with developmental delay

72
Q

What is the usual presentation of infantile spasms?

A

Sudden flexion of legs, arms, neck and head

Extension rarely

73
Q

What is the most common type of infantile spasm: flexion, extension, or mixed

A

Mixed–Flexion of the head and arms, with extension of the legs

74
Q

Are infantile spasms usually singleton, or multiple?

75
Q

When in the day do infantile spasms usually occur?

A

Awakening from sleep

76
Q

What is the prognosis of infantile spasms?

A

Usually associated with developmental arrest or regression

77
Q

3 Hz spike and slow wave discharges on EEG = what type of seizure?

A

Absence seizure

78
Q

3-6 Hz polyspikes and waves = what type of seizure?

A

Juvenile Myoclonic Epilepsy

79
Q

Which type of childhood seizure can be provoked with hyperventilation, and which with photic stimulation?

A

Absence = hyperventilation

Juvenile Myoclonic epilepsy = photic

Neurology (23 decks)

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