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Medicine > Pediatrics/Neurology > Flashcards

Pediatrics/Neurology Flashcards

1
Q

EEG indication in seizure

A

1st time, non febrile seizure

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2
Q

Infantile spasm

A

Onset:4_8m
Brief,repeated symmetric contractions of neck. Trunk,ext.
Salam attack
Lasting 10 -30s

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3
Q

Infantile spasms..associated with:

A

Developmental delay

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4
Q

Another name for infantile spasms

A

West syndrome

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5
Q

Infantile spasms etiology

A

20% unknown: good response to Rx

80%: poor response

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6
Q

Infantile spasms

Can develop into

A

West syndrome

Lennox gastaut

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7
Q

Infantile spasms

EEG

A

Hypsarrhythmia

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8
Q

Rx for infantile spasms

A

ACTH
Vigabatrin
BZD

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9
Q

Lennox gastaut syndrome age

A

3 - 5 yr

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10
Q

Triad forLGS

A

1) multiple seizure types
2) diffuse cognitive dysfunction
3) slow generalized spike. & slow wave EEG

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11
Q

Rx for LGS

A

Valproic acid
BZD
Ketogenic diet

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12
Q

Prognosis of LGS

A

POOR

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13
Q

Juvenile myoclonic epilepsy

A

Janz
12 -16 y
Autosomal dominant, variable penetrance

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14
Q

Juvenile myoclonic epilepsy manifestation

A

Particularly in the morning

Frequently as gtc

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15
Q

Juvenile myoclonic epilepsy EEG

A

3.5-6Hz irregular spike and wave, increase with photic stimulating

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16
Q

Juvenile myoclonic epilepsy Rx

A

Lifelong valproic acid

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17
Q

Juvenile myoclonic epilepsy prognosis

A

Excellent

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18
Q

Absence

A 
Multiple per day generalized or resolve
6-7y
F>M
Strong genetic predisposition 
<30s
No post ictal
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19
Q

Absence EEG

A

3/s

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20
Q

Absence Rx

A

Valproic acid

Ethosuximide

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21
Q

Benign focal epilepsy

A

5-10y
16%of all nonfebrile seizures
Focal motor seizure usually in sleep wake transition state

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22
Q

Benign focal epilepsy consciousness

A

Conscious but aphasic post-ictally

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23
Q

Benign focal epilepsy prognosis

A

Remit in adolescence

No sequel

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24
Q

Benign focal epilepsy EEG

A

Normal background

Spikes in centrotemporal area

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25
Q

Benign focal epilepsy Rx

A

Infrequent : no

Frequent : carbamazepine

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26
Q

When anticonvulsant should be initiated

A

> 2 unprovoked afebrile seizures within 6-12m

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27
Q

When D/C anticonvulsant?

A

Free of seizure for2yrs

Wean over 4-6m

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28
Q

MCC of seizure in children

A

febrile seizure

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29
Q

frequency of febrile seizure

A

3-5% of all children

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30
Q

sex predisposition of febrile seizure

A

M>F

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31
Q

peak age for febrile seizure

A

6m-6y

32
Q

percentage of simple and complex

A

simple: 70-80%
complex: 20-30%

33
Q

complex febrile seizure

A

1) duration: >15min
2) focal onset or focal features during seizure
3) recurrent seizure >1 in 24h
4) previous neurological impairment or neurological def.

34
Q

risk factors for recurrence of febrile seizure

A

33% recurrence, 75%recur within 1 yr
.50% if <1yr
family hx of febrile seizure

35
Q

risk factors for development of epilepsy (for febrile seizure)

A

developmental or neurological abn. prior to seizure
family hx of complex seizure
multiple simple febrile seizure

36
Q

LP and septic w/u for febrile seizure

A

strongly consider if 18m if meningeal signs

37
Q

EEG for febrile seizure

A

not warranted unless:
complex febrile seizure or
abn. neurologic finding

38
Q

% of febrile seizure that develop epilepsy

A

9% in children with multiple risk factors
2% in child with febrile simple seizure
1% general population

39
Q

prophylaxis of febrile seizure

A

not recommended

40
Q

Rx for recurrent or prolonged seizure

A

rectal or sublingual lorazepam

41
Q

Red flags for headache

A
  1. new headache
  2. worst of their lives
  3. acute onset
  4. FND
  5. constitutional Sx
  6. worse in morning
  7. worse with bending over, coughing, straining
  8. change in level of consciousness
42
Q

CT or MRI for headache

A

if history or PhE reveals red flags

43
Q

sex predisposition of migraine

A

F>M after puberty

44
Q

inheritance of migraine

A

AD with incomplete penetrance

45
Q

common

classic migraine

A

common: without aura
classic: with aura

46
Q

Sx of migraine in infancy

A

irritability
sleepiness
pallor
vomiting

47
Q

from what age can children use sumatriptan?

A

> 12 yr

48
Q

red flags for tension headache

A 
sudden mood changes
disturbed sleep
fatigue
withdrawal from social activities
chronic systemic sign( weight loss, FND, anorexia)
49
Q

organic headache

A

red flags
and
occipital headache

50
Q

causes of hypotonia that respond to rapid treatment

A 
hypokalemia
hypermagnesemia
acidemia
toxin, drug
hypoglycemia
seizure
infection
intracranial bleeding
hydrocephalus
51
Q

neurocutaneous syndromes, associated with which tumors?

A

CNS
PNS
Viscera
Skin

52
Q

likelihood of MR in neurocutaneous syndromes

A

younger the child at presentation the more likely they are to develop MR

53
Q

NF1 genetics

A

AD

50% new mutation

54
Q

another name for NF1

A

von Recklinghausen dis.

55
Q

NF1 clinical manifestation

A

learning disorders
abn. speech development
seizure

56
Q

Dx of NF1

A

2 or more of:

1) >=6 cafe-au-lait spots(>5mm if prepubertal,>1.5cm post pubertal)
2) >2 neurofibroma of any type or 1 plexiform
3) >2 Lisch nodules
4) optic glioma
5) freckling in the axillary or inguinal region
6) a distinctive bony lesion
7) a 1st degree relative with confirmed NF!

57
Q

NF2 genetics

A

AD

58
Q

NF2 tumors

A

intracranial, spinal tumors

59
Q

Dx of NF2

A

bilateral vestibular schwannomas
or
a 1st degree relative with NF2 and either a neurofibroma, meningioma, glioma, or schwannomas

60
Q

eye in NF2

A

posterior subcapsular cataracts

61
Q

Rx of NF2

A

monitoring for tumor development

surgery

62
Q

Sturge weber syndrome

A

port wine nevus associated angiomatous malformations of brain causing contralateral hemiparesis and hemiatrophy

63
Q

Sturge weber syndrome association

A

seizure
glaucoma
MR

64
Q

TS genetics

A

AD, 50% new mutations

65
Q

TS characteristics

A

adenoma cebaceum
shagreen patch
ash leaf

66
Q

TS associations

A

cardiac rhabdomyoma
kidney angiomyolipoma
MR
seizure

67
Q

TS CT and MRI

A

calcification within the subependymal nodules

68
Q

ADEM peak age

A

5-8 yr

69
Q

ADEM sex predisposition

A

M>F

70
Q

pathophysiology of ADEM

A

immune-mediated

similar to MS

71
Q

clinical scenario of ADEM

A

2d to 4w after a clinically evident infection or vaccination

72
Q

clinical presentation of ADEM

A 
headache, N/V
pyrexia, malaise
rapid onset encephalopathy
multifocal deficit
seizure
pyramidal syndrome
cerebellar ataxia
brainstem involvement
73
Q

LP in ADEM

A

variable pleocytosis and oligoclonal banding

74
Q

MRI in ADEM

A

large, multifocal, poorly marginated regions of demyelination affecting bilateral subcortical white matter, and deep grey matter(thalamus, basal ganglia)
lesions show complete or partial resolution on follow up

75
Q

Rx of ADEM

A

high dose corticosteroids

76
Q

prognosis of ADEM

A

favourable, though some residual deficit often exist

Medicine (3 decks)

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