Abuse, Depression and Faints/Fits

Question 1

What are the 4 categories of child abuse?

Answer 1

1) Physical: Bruises, injury, scratches, burns, fractures
2) Emotional: Relationships (^ in criticism, V in warmth)
3) Sexual abuse: Behaviour change, physical symptoms e.g. bleeding, STI and pregnancy
4) Neglect: Care doesn’t meet needs of child (Most common!)

Question 2

How is child abuse revealed?

Answer 2

1) Disclosure
2) Incidental findings
3) Observation e.g. detected at school

Question 3

What is management for an abused child?

Answer 3

1) Thorough history: Good documentation and check for discrepancies
2) Examination: Use of body charts
3) Social services assessment +/- police input.
4) Tests: FBC, clotting, swabs, bone profile, skeletal survey.

Question 4

What are the main symptoms of depression?

Answer 4

Loss of interest.
Fatigue.
Poor sleep.
Reduced appetite.
Low concentration.
Feelings of guilt and self blame.
Low confidence.
Agitated.
Hopeless.

Question 5

What are the medical and non-medical treatment of depression?

Answer 5

Non-medical: Education, CBT, IPT and family therapy.

Medical: fluoxetine, sertraline, citalopram.

Question 6

What are disposing factors for developing depression?

Answer 6

Family history.
Stress in pregnancy.
Poor attachment.
Poverty.
Isolation.

Question 7

What are precipitating factors for developing depression?

Answer 7

Trauma.
Drugs.
Infections.
Puberty.
Exam stress.
Sexual abuse.
Bullying.

Question 8

What are perpetuating factors for developing depression?

Answer 8

Chronic illness.
Malnutrition.
Ongoing neglect.
Ongoing poverty.

Question 9

What is a seizure?

Answer 9

A convulsion caused by a paroxysmal discharge of cerebral neurones.

Question 10

What is an epileptic seizure?

Answer 10

Excessive, unsynchronised neuronal discharges in the brain cause paroxysmal changes in behaviour, sensation or cognitive processes

Question 11

What is the duration for an epileptic seizure?

Answer 11

30-120 seconds

Question 12

What are the main signs of epileptic seizures?

Answer 12

1) Movement
2) Tongue biting
3) Head turning
4) Muscle pain

Question 13

What are febrile convulsions?

Answer 13

Febrile convulsions are epileptic seizures accompanied by fever. They usually occur early in viral infection and tend to be brief generalised tonic-clonic seizures.

Question 14

What are the length and signs of non-epileptic seizures?

Answer 14

1-20 minutes
- Eyes/closed
- Talking/crying
- Pelvic thrusting

Question 15

What is the first line AED offered to those suffering from focal seizures?

Answer 15

Carbamazepine.
Surgery may also be offered.

Question 16

What are examples of generalised seizures?

Answer 16

1) Tonic-clonic (Generalised)
2) Atonic
3) Tonic
4) Myoclonic
5) Absence

Question 17

When would you see each type of generalised seizure?

Answer 17

Myoclonic: Isolated muscle jerking
Tonic: Generalised increase in tone
Atonic: Transient loss of muscle tone
Generalised T-C: Sudden onset rigid phase followed by a convulsion in which the muscles jerk rhythmically.

Question 18

What is the first line AED for suffering from focal seizures?

Answer 18

Sodium Valproate

Question 19

What investigations must you do if presenting with seizures?

Answer 19

Eye witness account/video is invaluable!
ECG.
EEG.
MRI or CT.

Question 20

Why must you do an ECG in those suffering from seizures?

Answer 20

To check for arrhythmia as the cause e.g. long-QT syndrome.

Question 21

What are the potential side effects of AED’s?

Answer 21

Cognitive disturbances
Heart disease.
Drug interactions.
Teratogenic.

Question 22

Name 3 conditions that are commonly diagnosed as being epilepsy.

Answer 22

Sandifer syndrome.
Benign neonatal sleep myoclonus.
Syncope.

Question 23

What is syncope?

Answer 23

Insufficient blood/O2 supply to the brain causes paroxysmal changes in behaviour, sensation and cognitive processes.

Question 24

What non-neurological disease is sandifer syndrome associated with?

Answer 24

GORD.
Patients present with GORD and a characteristic neck movement disorder.