Principle 2 Flashcards
Types of febrile seizures
_______ febrile seizures
________ febrile seizures
Simple
Complex
Difference between simple and complex febrile seizures
Duration
Reoccurrence
Location
<15mins ; >15mins
Does not within 24hrs; Does within 24hrs
Primarily generalized ; primarily focal
Some epilepsy syndromes typically start with FS, they include:
•___________ epilepsy with febrile seizures plus (GEFS+)
•______________ epilepsy of infancy (a.k.a. ———- syndrome)
•______________ epilepsy secondary to mesial temporal sclerosis
Generalized
Severe myocionic
Temporal lobe
Pneumonia: is _______________________ caused by ____________
Pneumonitis: is a general term for _____________________ , from any cause
inflammation of the lung parenchyma
microorganisms
inflammation of the lungs
Types of Asphyxia
Asphyxia ______ (_____ asphyxia)
Asphyxia _______ (_______ asphyxia)
livida ; blue
palida ; white
The two types are actually a continuum:
• Asphyxia Livida : Ocurs when the hypoxemia results in ________ (due to increased concentration of ______________________)
• Asphyxia Palida: occurs, if there is ________________ , due to _____________ which makes the baby appear pale
cyanosis ; deoxygenated hemoglobin
no intervention; circulatory collapse
Drugs to treat Apenea?
IV aminophylline, caffeine citrate
While patients may remember their
(aura or automatisms?) , they are usually amnesic to their (aura or automatisms?)
aura
automatisms
Old terms : new terms
Partial Seizures
•Simple partial seizure
• Complex partial seizure
• Secondary generalized seizure
Focal seizures
• Focal aware seizure
• Focal impaired awareness seizure
• Focal to bilateral seizure
________________ seizure (Focal aware seizure)
•Results from abnormal electrical discharge from _______________________________.
•Consciousness is classically _________ in this type of seizure
•Symptoms may be motor, sensory, autonomic or psychic
Simple partial
a focus on one cerebral hemisphere.
preserved
__________ Seizures (Focal impaired awareness seizure)
•Starts from a focus on one cerebral hemisphere, usually the _________ lobe
•characteristically ______ consciousness and this is usually preceded by ____/______
Complex Partial
temporal
impairs
Aura; automatisms
Treatment for focal or partial seizures??
Carbamazepine
Sodium valproate
____________ Seizures (Focal to bilateral seizure)
•Simple or complex partial seizure may _______ , from its focus, to involve the ________________ ; thus, said to have secondarily generalized
Secondarily Generalized
spread; whole brain
Secondary generalized seizures
The spread si classically described as progression from ______ to _______ to ________ (called ________________)
face
Arm
Leg
Jacksonian march
Myoclonic Seizure
Myoclonic seizure is characterized by sudden ____________ followed by very brief (<___ sec) _______________ movements of limbs and trunk
____________ is regained immediately after, and the child may frown or cry
loss of consciousness
1 ; arrhythmic jerking
Consciousness
West syndrome: a triad of ________, ______________ and ___________
infantile spasm
developmental regression
hypsarrhythmia
Difference between typical and atypical absence seizures
Patient neither change posture nor drop objects being held
Patient makes minor movements such as blinking, lip smacking, tagging on the clothes etc.
________ epilepsy : Most common epilepsy syndrome in childhood
Rolandic
Most common cause of status epilepticus in children is??
Sudden withdrawal of Anti-Epileptic drug
___________ and ___________ congenital heart defects rarely cause heart failure
Atrial Septal Defect (ASD) and Tetralogy of Fallot (TOF)
Peripheral edema usually involves the ________ and _________ in infants, and the _______ and ________ in older children. Occasionally the whole body is involved (____________)
eye lids and sacrum
feet and leg
anasarca
Heart failure in children
Cardiac Biomarkers: ventricular dilation in heart failure causes elevated ______________ (>100 pg/mL) and ____________________ . This differentiates HF from a primary respiratory process
Brain Natriuretic Peptide
N-terminal proBNP (NT-proBNP)
____________ accounts for approximately 90% of nephrotic syndrome cases in children
Idiopathic NS
Pneumonia is usually preceded by days of ????
upper respiratory tract infection (URTI)
About 85% of children with NS have ________________ type
minimal change NS (MCNS)
Infections
Children with NS are specially susceptible to infection, for the following reasons:
•___________
•Impaired _________ of microorganisms (due to urinary loss of complement factors ____,______ etc, and alternative pathway factors _____ and ____)
Hypoglobulinemia
opsonization
C3, C5
B and D
Investigations in nephrotic syndrome
Spot urine protein: creatinine ratio: should be >____ for NS (______________urine is used)
2
first morning
Indications for renal biopsy in NS
- ___________ nephrotic syndrome
-Age ___________
-Recurrent ___________
-Associated renal insufficiency
-Hypo ___________ (___________), positive ANA or dsDNA
-Relevant family history of ___________ or symptoms of ___________
Steroid resistant
<1yror>8yr
gross hematuria
Hypocomplimentemia (low C3/C4),
kidney disease ; systemic disease
Complications of Long-term Steroid:
__________ appearance, ________, ________, hypertension, growth delay, osteopenia, hyperglycemia, avascular necrosis etc.
cushingoid
cataract
infection
Steroid resistant NS is caused by _________ in about 80% of cases
FSGS
Possible Outcomes of Corticosteroid Therapy
Response: is attainment of remission within first ________ of corticosteroid therapy
•Remission: presence of ______ protein on urine dipstick (or urine protein: creatinine ratio of <0.2) for _______ consecutive days
*Relapse: is presence of >____ protein on urine dipstick (or urine protein: creatinine of >2) for ____ consecutive days
•Steroid Resistance: is failure to achieve remission after _______ of corticosteroids
4 wk
<1+
3
3+;3
8 wk
Signs of raised intracranial pressure: ___________ , ___________, ___________ fontanel or diastasis of sutures, ___________ (___________, ptosis) or ___________ paralysis, ___________ or ___________ posturing, stupor, coma, or signs of herniation.
headache, vomiting
bulging ; oculomotor; anisocoria,
abducens ; decorticate
decerebrate
Why we give corticosteroids in meningitis
It inhibits production of TNF-a, thus improves overall patient outcome
Treat T ICP:______° head-up, _________ or _________ 1g/kg, hyperventilation etc.
30-45
oral glycerol
IV mannitol
In meningitis
Treat seizures: abort with IV _______ (0.1-0.2 mg/kg/dose); prevent recurrence with IV __________ (Loading: 15-20 mg/kg and Maintenance: 5 mg/kg/24hr)
diazepam
phenytoin
Physiological jaundice appears when??
after the first 24-36 hr of life
1g of meconium contains _____ of bilirubin
5mg
Pathological Jaundice
Manifests within the ___________ of life
first 24-36 hr
Causes of Enhanced Entero-hepatic circulation
-Broad-spectrum antibiotic therapy
-______________ nutrition (hyper-alimentation)
-_______________ (Pyloric stenosis, Hirschsprung disease)
-_______nutrition
Total parenteral nutrition
Gl obstruction
Undernutrition
Neonatal jaundice appears cephalic-caudally
Face at ____mg/dL
Mid-abdomen at ____mg/dL
Foot at ____mg/dL
5
15
20
Contraindication for phototherapy?
Personal or family history of porphyria
If caffeine citrate and aminophylline don’t work??
Give doxapram
Fetal risk factors of RDS
__________
Hypothermia (cold stress)
_______
_____ sex
_______ race
________ of a set of twin
Prematurity
Hypothermia (cold stress)
Asphyxia
M a l e s e x
White race
Second of a set of twin
Distance between the infants skin and the light source should not be > _____ cm (may be reduced to ______ cm, if temperature homeostasis is monitored)
50
10-20
When adequately delivered, phototherapy should lower bilirubin by ______ mg/di over _____hr
1-2
4- 6
Total blood volume is assumed to be:
•_____ml/kg in preterms
• ____ ml/kg in terms
100
80
Apnea: is _________________ for > ________ or for any duration if accompanied by ________ and _________
cessation of breathing
20 sec
cyanosis and bradycardia
Classification of apnea
_______ Apnea
_______ Apnea
_______ Apnea
Central Apnea
Obstructive Apnea
Mixed Apnea:
Clinical Features of apnea
Onset is usually between ______ of life
It does not occur in the _______ and rare in the _______ of life
It may occur in fairly active babies
It may be accompanied by bradycardia, pallor, cyanosis and hypotonia
3-7 days
first 24 hr
first 48 hr
TRANSIENT TACHYPNEA OF THE NEWBORN (TTN)
This is a self-limiting condition, most commonly found in (term or preterm?) infants delivered via __________
• Etiology: ____________ of ___________
Term
caesarean section
slow resorption
fetal lung fluid
MECONIUM ASPIRATION SYNDROME (MAS)
This is primarily a disease of ________ and __________ infants
•Risk factors: fetal distress, intrauterine __________,__________, or _________
term and postterm
asphyxia, hypoxia or acidosis
Meconium Aspiration Syndrome
Etiology: ______________ into the _________ (either in utero or with the first breath) causing ____________________________
aspiration of meconium
lungs
small airway obstruction
PERSISTENT PULMONARY HYPERTENSION OF THE NEWBORN (PPHN) - This primarily affects ________________________ infants
term and postterm
