Seizures and CP

Question 1

Define febrile seizures

Answer 1

Occur between 6m to 6years with no underlying neurological disease

Question 2

Define status epilepticus

Answer 2

Ongoing seizures more than 5 minutes or multiple seizures without returning to normal

Question 3

Define partial seizures and 2 subdivisions

Answer 3

Involve only one hemisphere
Simple - no impaired consciousness
Complex- impaired consciousness

Question 4

Define generalized seizures

Answer 4

Involve both hemispheres and associated with loss of consciousness

Question 5

Describe history in epilepsy x10

Answer 5

Classification of seizure
Prodromal symptoms and aura
Initial localizing signs
Description of all manifestations of the seizure
Duration, frequency, time of occurrence in the day
Date and time of last seizure
Predisposing factors and postictal events

Question 6

Physical exam inspection x3

Answer 6

Dysmorphic features
Diagnostic rashes
Asymmetry - in long standing hemiplegia

Question 7

Investigations in epilepsy x4

Answer 7

Electroencephalogram to characterize seizure
Biological evaluation of electrolytes
Blood glucose level
Brain imaging

Question 8

Indication for brain imaging x3

Answer 8

Focal signs- abnormal neurological findings
Developmental delay or regression
Seizure that are difficult to control

Question 9

Common problems in management of epilepsy x3

Answer 9

Increased frequency and worsening of seizures
Intractable seizures- not responsive to treatment
Seizures changing in nature

Question 10

Differential diagnosis of epilepsy x3

Answer 10

Syncope ie passing out
Breath holding attacks
Undiagnosed structural lesions eg tumor

Question 11

State 5 problems that may arise with epilepsy medication

Answer 11

Wrong drug, wrong dose, adverse drug interactions, wrong diagnosis, poor compliance

Question 12

Management during a seizure x4

Answer 12

Lie the child on the back
Dont put objects in mouth
Move any nearby objects that may be harmful
Have a time plan to seek medical attention

Question 13

Causes of intercurrent problems affecting management of seizures x2

Answer 13

Intercurrent infection - UTI
Electrolyte imbalance induced by drugs

Question 14

How to explain treatment to parents x4

Answer 14

Reasons for recommending treatment
Benefits and possible side effects
Probable duration

Question 15

Why monotherapy is important x2

Answer 15

Some drugs reduce efficacy of others
Some drugs metabolize the other drug

Question 16

Criteria for stopping seizure treatment x2

Answer 16

Seizure free for 2 to 4 years
Individualized risk benefit assessment

Question 17

Factors affecting increased probability of seizure recurrence after stopping treatment x3

Answer 17

Abnormal neurological signs
Mixed type seizure
Focal seizures/ seizures originally difficult to treat

Question 18

Anticonvulsants for generalized tonic clonic seizures x4

Answer 18

Carbamazepine
Phenobarbitone
Valproate
Phenytoin

Question 19

Anticonvulsants for absent seizures x3

Answer 19

Ethosuximide
Valproate
Clonazepam

Question 20

Anticonvulsants for simple and complex partial seizures x3

Answer 20

Carbamazepine
Valproate
Phenytoin

Question 21

Describe infantile seizures and their treatment

Answer 21

They look like a startle- stiff arms and legs with head bent forwards
Prednisolone

Question 22

Side effects of anticonvulsants x5

Answer 22

Acute toxicities eg nystagmus and ataxia
Chronic toxicities- teratogenicity, hematological effects
Acute idiosyncratic (abnormal physical reaction) reactions eg stevens johnson syndrome
Drug interactions between anticonvulsants
Drug interactions with other drugs

Question 23

Risk factors of febrile seizure x2

Answer 23

Age 6-60months
Temperature greater or equal to 38 degrees

Question 24

Characteristics of febrile seizures x4

Answer 24

Generalized
Usually tonic clonic
Lasting for maximum of 15 minutes
Non recurrent within a period of 24 hours

Question 25

Define a complex febrile seizure x3

Answer 25

Prolonged - greater than 15 minutes Focal and or generalized Recurs within 24 hours

Question 26

Febrile status epilepticus

Answer 26

Febrile seizures for greater than 30 minutes

Question 27

Define cerebral palsy

Answer 27

A non progressive disorder of motion and posture secondary to an insult in the developing brain

Question 28

General nursing management for CP x4

Answer 28

Tube feeding Attention to toileting Attention to skin for pressure sores Treatment for GERD

Question 29

Purpose of physiotherapy in CP x3

Answer 29

Prevent contractures Maintain range of movement and function Optimize ability to cope with activities and daily living

Question 30

Function of splinting (1) and orthoses x2

Answer 30

Splinting to prevent contractures Orthoses to improve function and prevent deformities

Question 31

Social implications of CP x4

Answer 31

Neglected siblings Behavioral disorders Burdens on parents More time spent on child

Question 32

Common eye problems associated with CP x3

Answer 32

Squint Visual fields defects Decreased visual acuity

Question 33

Drug classes for treatment of CP x3

Answer 33

Anticonvulsants Antispastics - diazepam Anticholinergics - atropine for excessive drooling

Question 34

Prenatal causes of CP x8

Answer 34

Mother Antenatal bleeding Toxaemia of pregnancy Infection Radiation Hypoxia Baby - hydrocephalus, cerebral malformations, hypoxia, genetic factors

Question 35

Perinatal causes of CP x5

Answer 35

HIE Asphyxia Prematurity Cerebral birth trauma Kernicterus - brain damage due to high bilirubin in blood

Question 36

Postnatal causes of CP x5

Answer 36

Hypoxia Infection Head trauma Toxin or drugs Vascular - stroke, thrombosis, embolism

Question 37

Gross motor assessment in CP x5

Answer 37

Assess sitting ability Ventral suspension When lying supine, pull to sit Assess tone by holding up vertically under axilla Place in prone position (on tummy) to detect back arching

Question 38

Complications of CP x5

Answer 38

Intellectual impairment Hearing, visual and speech abnormalities Malnutrition

Question 39

CP investigations x3

Answer 39

TORCH screening in infants CT and MRI

Question 40

Management team involved in cp x7

Answer 40

Social worker Occupational therapist Physiotherapist Speech therapist Orthopaedic surgeon Psychologist Remedial teachers Neurologist

Question 41

Causes (2) of nutritional problems and effect

Answer 41

GERD Inability to swallow Failure to thrive

Question 42

Orthopaedic procedures in CP x3

Answer 42

Improve cosmesis Correction of deformities Improve of deformities

Question 43

CP demonstrations on physical exam x7

Answer 43

Pull to sit Assess sitting Standard gait exam Prone position to check for back arching Vertical and ventral suspension Muscle bulb tone power reflexes

Question 44

Assessing for Complications of CP x5

Answer 44

Vision loss Hearing loss Microcephaly Kyphosis inspect back Chest infection therefore auscultate Constipation palpate abdomen