Psych/Neuro Flashcards
investigations when possible diagnosis of Autism
- school observation
- ADI-R
- ADOS-2
- DISCO
what 3 functional domains does the ADI-R focus on
- language and communication
- reciprocal social interactions
- restricted, repetitive and stereotyped behaviours and interests
DISCO stands for
diagnostic interview for social and communication disorders
MRI scan findings in those with autism
brain enlargement - especially in occipital, parietal and temporal lobes;
could be due to neuronal death, increased neurogenesis or even increased production of glial cells or vasculature
what does Sally-Anne test assess
theory of mind
licensed pharmacological treatment for aggressive behaviour in children
Risperidone
psychotherapy for both parents and autistic patient
- CBT
- behavioural management programmes
- TEACCH
- Educational psychology
medications used as adjuncts for ASD to psychological interventions
SSRI
Risperidone antipsychotic
Melatonin - help to reduce sleep latency
how is pain illicit in a child for GCS assessment
pressing hand on supra-orbital notch; beneath the end of the eyebrow with thumb
differentials for a 2 year old with seizures
- febrile convulsion
- epilepsy
- encephalitis/meningitis
- sepsis
- brain tumour
- metabolic disorders
immediate management of seizure
ABC assessment
High flow oxygen
blood glucose measurement
management of status epilepticus
- High flow oxygen, ABC, Bm
- Midazolam
- Lorazepam
- Phenytoin (over 20 mins)
- RSI with thiopentone (if seizure has lasted longer than 30 mins)
when to do RSI with theopentone for status epilepticus
seizure lasting longer than 30 minutes
how long does a simple febrile seizure last
< 15 mins
differences between simple and complex febrile seizures
simple
- last less than 15 mins
- resolve within 24 hours
- no neurological deficits
- fever present
following what seizure may a Tods palsy occur
and
what is a Tods palsy
following a complex febrile seizure
Tods palsy = focal weakness in part or all of body following a seizure and usually subsides after 48 hours
3 indications for an urgent CT head/MRI
- encephalitis/coma
- suspected raised ICP
- progressive neurological deficit
indications for elective MRI
- child < 2 years
- focal neurological deficits
- focal epilepsy
- assoc. learning difficulties
- epilepsy resistant to full doses of appropriate drugs
when to do an elective EEG
- development of language regression
- strong suspicion of epilepsy
definition of epilepsy
recurrent transient paroxysmal attacks of disturbed consciousness and sensorimotor function resulting from abnormal electrophysiological discharges of cerebral neurones
5 types of generalised seizures
- tonic clonic
- absene/petit mal
- myoclonic
- tonic
- atonic/akinetic
feature of a partial seizure
aura = describes the effects of initial focal electrical events e.g. unusual smell, tingling in a limb, strange inner feeling
types of partial seizures
- simple partial
- complex partial
what does early hand preference before 12 months indicate a higher risk of
higher risk of hemiplegia on non dominant side
causes of delayed walking
- duchennes
- spina bifida
- developmental dysplasia of hip
- rickets
- cerebral palsy
name for the life long condition that affects movement and coordination caused by a problem with the brain that occurs before, during or soon after a birth
cerebral palsy
symptoms of cerebral palsy
- delay in reading developmental milestones
- too stiff/too floppy
- weak arms/legs
- fidgety/clumsy
- waling on tip toes
- swallowing and learning difficulties
causes of cerebral palsy
- bleeding into brain
- decreased oxygen supply to brain
- meningitis
- brain injury
- damaged brain during or soon after birth
MRI finding in cerebral palsy
periventricular leucomalacia
typical presentation of cerebral palsy
- poor feeding
- floppy at birth/hypotonia
- fits in a neonate
- delayed meeting developmental milestones
4 common presentations of cerebral palsy
- hemiplegia
- diplegia
- quadriplegic
- dyskinetic
features of scissoring gait in cerebral palsy
- talipes equinovarus deformity
- adduction of hips with scissoring
- plantar flexion of feet
- inward pointing knees
- assoc. rotation and swaying of trunk
- tip toeing
charity for supporting cerebral palsy
scope
what is scope and what does it offer?
charity for cerebral palsy
offers
- support info for families
- support groups
- online community
chemical that is
- neurotoxic
- high levels can result in respiratory signs
ammonia
2 types of inborn errors of metabolism
- urea cycle disorders
- organic acidaemias
features of urea cycle disorder
- high ammonia
- liver dysfunction
- metabolic alkalosis
acid base imbalance caused by urea cycle disorders
metabolic alkalosis
due to high ammonia acting as a respiratory stimulant
acid base imbalance from organic acidaemias
mixed metabolic acidosis + high ammonia
ammonia scavenging medications
- Na benzoate
- Na Phenylbutyrate
what is metabolic acidosis corrected by
IV Na Bicarb
serious complication of high ammonia
mild cerebral oedema causing seizures
9 common conditions that the heel prick test tests for
- cystic fibrosis
- MSUD
- sickle cell
- hypothyroidism
- PKU
- MCAD
- homocystinuria
- isovolemic acidaemia
- glutamic aciduria
treatment of PKU
phenylalanine free diet, supervised by specialist dietician and paediatrician
standardised questionnaire to assess for ADHD
Conner’s rating scale
protective factors for cerebral palsy
- Mg Sulfate
- abx
- corticosteroids
what is periventricular leukomalacia
cystic changes occuring in the periventricular white matter; caused by infection/inflammation resulting in prematurity and MRI change
global developmental delay
significant delay in milestones in 2 or more areas (more/=2 SD below the mean)
risk factors for cerebral palsy
- prematurity
- intrauterine infections
- birth asphyxia
- meningitis
- CP arrest
what is ataxic gait characterised by
shaky movements, imbalances, caused by cerebellar damage
what is spastic gait characterised by
muscles appear tight and stiff… due to damage to motor cortex
what is dyskinetic gait characterised by
involuntary movements; due to damage to basal ganglia
most common type of cerebral palsy
spastic
3 medx to manage hypertonia
- baclofen
- diazepam
- botulinum toxin
3 key features of autism
- communication difficulties
- social interaction difficulties
- inflexible thinking
cause of autism
- unknown
- positive fhx
- assoc. with other medx conditions
what is CAHMS role in autism
helping families understand their child and put in strategies to cope with their behaviour
3 features of ADHD
- inattention
- hyperactivity
- impulsivity
cause of ADHD
- genetic factors
- head injury
- prematurity
- low birth weight
duration of symptoms for a diagnosis of ADHD
6 symptoms of inattention + 6 symptoms of hyperactivity present in 2 situations for more than 6 months
who does the ADHD assessment
- psychiatrist
- paediatrician
- social worker
- learning disability specialist
rating scale for ADHD
conners scale
charities that support ADHD
Young minds
ADDiss
CNS stimulants for ADHD treatment
- Methylphenidate
- Dexamphetamine
side effects of Methylphenidate
- abdo pain
- insomnia
- headaches
- weight loss
non pharmacological treatments for ADHD
- behavioural interventions: star charts + focused praise,
- organisational skills
- time management
- anger + stress management
- attention deficit disorder information + support service
