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Paeds (Owen) > Neuro > Flashcards

Neuro Flashcards

1
Q

What are gross motor skills

A

Truncal and major limb muscles which help mobility

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2
Q

What are fine motor skills

A

Fine movements- using hands mainly
Also encompasses vision

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3
Q

If patient has speech problems what is important to check first

A

Check auditory system

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4
Q

Which develops first hearing or expressive development

A

Hearing

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5
Q

What are primitive reflexes

A

Reflexes we are born with but we lose at 3 months

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6
Q

What are the primitive reflexes

A

Sucking and rooting
Palmar grasp
Stepping
Asymmetric tonic reflex (ATNR)
mORO
Babinski

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7
Q

Which is worse neonatally hypothermia, hypoglycaemia or hypoxia

A

Hypoglycaemia is the worst
Then hypoxia and hypothermia

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8
Q

What is the sucking and rooting reflex

A

If tickle side of mouth, baby will try to suck it

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9
Q

Evolutionary purpose of sucking and rooting

A

First evolved as means can not go hypoglycaemic

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10
Q

What is the palmar grasp

A

If stimulate the palm then baby will try to grab it
Disappears by 1 year

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11
Q

What is the stepping reflex

A

If hold baby up will lift foot up as if taking step

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12
Q

What is the asymmetic tonic neck reflex

A

If turn babies neck then will get extension on that side of the body

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13
Q

What is the moro reflex

A

If move baby or hears loud noise will extend arms upwards then move them back to body

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14
Q

Why is babinskis reflex significant in babies

A

Myelin not formed properly by age of 1 so get positive babinskis

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15
Q

What are the protective reflexes

A

Head righting and parachute
Need to develop these before can attain motor development

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16
Q

What is head righting

A

If baby is sat and move the baby it will move neck to make sure its neck remains perpendicular

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17
Q

When should babies develop head righting

A

4-6 months

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18
Q

What is the parachute reflex

A

If when try to stand outstretch arms to protect the head

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19
Q

When should develop parachute reflex

A

7-9 MONTHS

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20
Q

What happens to grip in development in first year of life

A

Initially develop full hand grip then move to mature pincer but lose full hand grip a bit

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21
Q

Principles of learning development milestones

A

6wks
6months
12months
18months
24months
36months

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22
Q

When do children normally stand by

A

10 months

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23
Q

Gross motor development milestones

A

6wks- head control
6mths- no head lag, sitting
12mths- pulls to stand, walking, cruising
18mths- walks well, run
24mths- climbs stairs (1 step), kicks ball
36mths- standing on one leg, climbs stairs

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24
Q

Fine motor and vision

A

6wks- fixes and follows
6mths- full hand grip, hand to hand transfer
12 mths- mature pincer, pointing
18mths- build tower of 3 blocks, hand preferance, scribbles
24 mths- build tower of 7 blocks, circular scribbles
36mths- draw circle, imitates bridge

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25
Q

What is cruising

A

When hold on to furniture

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26
Q

Language and hearing development milestones

A

6wks- stills to sound
6mths- turn to sound, babbles
12mths- first word, respond to name
18mths- 6-12 words, follow simple instruction
24 mths- 2 words sentence
36mths- speaks in sentences

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27
Q

Socail skill and self care development milestones

A

6wks- smiles
6 mth- laughs and squeals
12mths- waves and peek-a-boo, drink from cup
18mths- spoon feeding, symbolic play
24mths- start toilet training, remove clothes
36mths- parallel play, interacting play and sharing

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28
Q

When do you get nystagmus

A

If struggling to focus

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29
Q

What does clenched fist suggest with regard to fine motor

A

Unable to form pincer grip

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30
Q

What is criteria for global developmental delay

A

Lack of development in 2 or more fields

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31
Q

Long term management of child with meningitis

A

Review in 4-6 weeks after discharge
- audiological assessment
- neuro/development assessment

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32
Q

Immediate management of meningitis in a child

A

Resus
Abx
- If under 3 months IV amoxicillin/ampicillin and cefotaxime
- Over 3 months IV ceftriaxone/cefotaxime
Steroids (dexamethasone)
- if over 3 months
- prurulent CSF
- WCC over 1000
- raised CSF WCC and protein over 1g/L
- bacteria on gram stain
- over 1 month and Hinfluenzae
- non meningococcal
Fluids

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33
Q

What is used to treat contacts of meningitis

A

Ciprofloxacin

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34
Q

Order of investigations for meningitis

A

LP first unless contraindicated (not meningococcal!)
Blood culture
FBC, U&Es, CRP and glucose
Coagulation profile

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35
Q

Contraindications for initial LP in meningitis

A

Meningococcal
Focal neuro
Papilloedema
Bulging of fontanelle
DIC
Signs of cerebral herniation

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36
Q

Most common viruses causing meningitis

A

Cocksackie B
Echovirus

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37
Q

How to treat viral meningitis

A

Discharge home after tests to rule out bacterial
Supportive therapy- fluids etc

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38
Q

What is purpura fulminans

A

Haemorrhagic skin necrosis from DIC

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39
Q

How does purpura fulminans present

A

Blood spots
Mass discolouration of the skin

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40
Q

Treatment for purprua fulminans

A

FFP and surgical debridement

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41
Q

What are reflex anoxic seizures

A

Seizure in response to pain or emotional stimuli. Caused by neurally mediated transient asystole in those with very sensitive vagal cardiac reflexes

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42
Q

Typical features of reflex anoxic seizures

A

Child goes very pale
Falls to floor- can have seizure
Rapid recovery
Occurs in children aged between 6mths-3 years

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43
Q

DDx for micropcephaly

A

Normal variation
Familial
Congenital infection - CMV etc
Perinatal brain injury liek HIE
Fetal alcohol syndrome
Patau
Craniosynostosis

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44
Q

What is defined as microcephaly

A

An occipital-frontal circumfrence under the 2nd centile

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45
Q

How is retinoblastoma inherited

A

Autosomal dominant

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46
Q

Pathophysiology of retinoblastoma

A

Loss of function in retinoblastoma tumour suppressor gene chr 13
Causes tumour of retinal cells

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47
Q

Most common presenting symptom of retinoblastoma

A

Absence of red reflex giving white pupil

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48
Q

What is leukocoria

A

White pupil

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49
Q

How can retinoblastoma present

A

Leukocoria
Strabismum- eyes dont line up
Visual problems-
Normally around 18months

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50
Q

How can retinoblastoma occur categorically

A

Unilateral
Bilateral- ALL hereditary

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51
Q

Treatment of retinoblastoma

A

Depends on how bad the tumour is, options include;
- enucleation (remove eye but not the muscles)
- other options include external beam, radiation, chemo

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52
Q

Most common type of seizure in febrile convulsion

A

Tonic-clonic

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53
Q

How are febrile convulsions classified

A

Simple
Complex
Febrile status epilipticus

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54
Q

What causes febrile convulsion

A

Temperature rising rapidly early in response to a viral infection

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55
Q

Differences between simple and complex febrile convulsions

A

Simple
- under 15 mins
- generalised seizure
- does not recur

Complex
- 15-30 mins
- focal seizure
- may repeat in 24 hours

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56
Q

What advice should be given about febrile convulsions if happesn again

A

Time it
Protect from head injury
If lasts more than 5 mins call ambulacne or is possibility to use emergency benzos if specialist has advised them.
If given anti-epileptics then wait another 5 mins and see if the seizure has not stopped/unconscious give again and call an ambulance

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57
Q

OPtions for emergency benzos in febrile convulsion

A

Buccal midazolam
Rectal diazepam
Only advised if recurrent seizures

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58
Q

When should febrile seizures be referred for specialist care

A

1st one
Less than 18mths
Diagnostic uncertainty
Focal neuro deficit
Taken recent antibiotics as can mask CNS infection

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59
Q

Most common cause of headache in children

A

Migraine without aura
Then tension

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60
Q

What is criteria for diagnosing migraine

A

At least 5 headaches with 2 of the following

Headache attack lasting 4-72 hours
2 of the following features
- bilateral or unilateral (frontal/temporal) location
- pulsating quality
- moderate to severe intensity
- aggravated by routine physical activity
Is accompanied by 1 of following
- nausea
- photo/phonophobia

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61
Q

What are infatile spasms (WEST syndrome) and how do they present

A

A type of childhood epilepsy with characteristic salaam attacks- head, trunk and arms flex followed by extension of the arms
Typically 4-8 months

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62
Q

What causes west syndrome

A

Typically is an underlying condition
- tuberous sclerosis
- HIE
- downs syndrome
- SOL

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63
Q

Investigations for WEST syndrome

A

EEG- hysparrythmia
CT- underlying condition

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64
Q

Management of WEST syndrome

A

Refer for tertiary centre assessment within 24 hours
Combination therapy with vigabatrin and prednisolone

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65
Q

Presentation of encephalitis

A

LOC
Focal neurology
Ataxia
Fever
Seizure

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66
Q

Investigations for encephalitis

A

CT then LP for viral PCR

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67
Q

Management of encephalitis

A

IV ceftriaxone and aciclovir

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68
Q

What is arm in waiters tip position diagnosis

A

Erb palsy

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69
Q

How does Erb palsy present

A

Reduced tone
Reduced moro reflex
Arm in waitrtd tip position

70
Q

Management of Erb palsy

A

Self-limiting
Physiotherapy

71
Q

Presentation of BPV in a child

A

Episodes of vomiting and transient ataxia
Can note nystagmus

72
Q

How do reflex anoxic episodes occur

A

Precipitated by fear
Stops breathing and LOC
Can be proceeded by bradycardia or a tonic seizure

73
Q

What is talipes equinovarus

A

Clubfoot
Fixed defect with sole of foot facing inwards

74
Q

Causes of talipes equinovarus

A

Idiopathic
Genetic
Spina bifida

75
Q

Treatment for talipes equinovarus

A

Ponseti method
Manipulating the feet into correct position and fixing in cast
Repeated every week for 5-8 weeks and then a minor operation to loosen achilles tendon

76
Q

What is difference between talipes equinovarus and positional talipes

A

Talipes equinovarus is permenant and requires ponseti method
Positional talipes is present in newborns where cramped in utero and requires physiotherapy

77
Q

Why give cefotaxime in under 3months

A

Ceftriaxone contradindicated as causes hyperbilirubinaemia

78
Q

What is cerebral palsy

A

Abnormality in movement and posture which limits activity caused by around birth injury to the brain

79
Q

Risk factors of CP

A

Antenatal- preterm birth, chorioamnionitis, maternal infection
Perinatal- LBW, HIE, neo-natal sepsis
Postnatal- meningitis

80
Q

Causes of CP

A

Antenatal 80%
- genetic syndromes
- structural maldevelopment
- vascular occlusion
During delivery 10%
- HIE
Postnatal 10%
- PVL

81
Q

Where is damage in the types of CP

A

Spastic- UMN
Dyskinetic- basal ganglia
Ataxic- cerebellum

82
Q

What are the 3 types of spastic CP

A

Hemiplegia- one side where arm and leg affected (face unaffected)
Quadriplegia- all 4 limbs affected
Diplegia- 4 affected but mianly legs

83
Q

How does hemiplegic CP present

A

4-12 months
- fisting of affected side
- flexed pronated arm
- tiptoes walk on affected side
- hand preference before 1

84
Q

Common features to all spastic CP

A
  • increased tone and reflexes
  • extensor plantar
  • clasp knife rigidity (velocity dependent)
85
Q

What is clasp knife rigidity

A

Increased tone suddenly releases under pressure

86
Q

How does quadriplegic spastic CP present

A

All limbs affected ie all arms fisted
Involves trunk
Opisthotonos
Low central tone with associated complications

87
Q

Complications of quadriplegic CP

A

Seizures
Microencephaly
Learning disabilities

88
Q

Causes of spastic unilateral CP

A

Largely unknown- typically unremarkable PMH and birth
Most likely an antenatal cause

89
Q

Main associated cause of quadriplegic CP

A

HIE mainly

90
Q

Presentation of diplegic CP

A

Very abnormal gait
Main difficulty in arms comes with fine motor movements

91
Q

Main associations of diplegic CP

A

PVL
Preterm birth damage

92
Q

How does dyskinetic CP present with the different movement types

A

Involuntary uncontrolled movements
Chorea-> sudden brief non-repetitive movements
Athetosis-> slow writhing movements distally like fanning fingers
Dystonia-> simultaneous contractions of agonist/antagonist muscles giving twisted appearance

93
Q

Main associations of dyskinetic CP

A

HIE and kernicterus

94
Q

Presentation of ataxic CP

A

Hypotonia
Ataxia
Malcoordination
Delayed motor development and intention tremor

95
Q

How can unilateral CP present

A

Neonatal hypotonia

96
Q

4 development red flags for CP

A

Cant sit before 8mths
Cant walk before 18mths
Hand preferance before 1 year
Persistent toe walking

97
Q

What could oromotor miscoordination with slow eating and gagging be

A

CP

98
Q

Investigation for CP and when do

A

MRI
Only if diagnosis uncertain from whole clinical history

99
Q

Red flags for other neuro conditions

A

Absence of risk factors
FHx of progressive development issue
Focal neurology developed
MRI findings progressive
Loss of already attained developmental abilities

100
Q

Management of CP MDT

A

Paediatrician- will deal with medical problems
Physio- encourage movement, improve strenthy and stop muscles from losing range of movement
Speech and language
Occupational therapist- identify everyday tasks which may be difficult and help make these more accessible

101
Q

What medication is given in CP if sleep difficulty

A

Melatonin

102
Q

What medication is given in CP if stiffness

A

1st line- diazepam
2nd line- baclofen

103
Q

What medication is given in CP if consitpation

A

Movicol

104
Q

What medication is given in CP if drooling

A

Anticholinergic

105
Q

Pre ictal visual disturbance followed by executive disinhibition and odd motor movements

A

Focal complex seizures

106
Q

Strange sensation around the face typically in the evening
Can be tonic clonic

A

Benign rolandic epilepsy

107
Q

Prognosis of benign rolandic epilepsy

A

Very good- should resolve by adolescence

108
Q

EEG findings of benign rolandic epilepsy

A

Centrotemporal spikes

109
Q

How are seizures classified

A

General
- tonic clonic
- myoclonic
- absence
- atonic
- clonic
Focal
- occipital
- parietal
- frontal
- temporal

110
Q

What happens in tonic clonic seizures

A

Go stiff and fall to floor shaking

111
Q

What happens in tonic seizures

A

Generalised stiffness

112
Q

What happens in atonic seizures

A

Transient loss of muscle tone where head drops or fall to floor

113
Q

What happens in myoclonic seizures

A

Rapid repetitive jerking movements

114
Q

What happens in absence seizures

A

Period where staring into distance and can get flickering of eyelids

115
Q

What happens in parietal seizures

A

Can get dyaesthesia contralterally to where abnormal brain activity is

116
Q

What happens in frontal seizures

A

Motor abnormalities unilaterally

117
Q

What happens in temporal seizures

A

Auditory or olfactory sensations
Automatisms where keep smacking lips etc

118
Q

What happens in occipital seizures

A

Positive or negative visual hallucinations

119
Q

What is dyaesthesia

A

Where get strange sensations like itching burning etc on skin

120
Q

Generalised versus focal seizures

A

Generalised- LOC, both hemispheres affected
Focal- get auras, 1 hemisphere involved but can get LOC and tonic clonic progression

121
Q

What often precipitates absence seizures

A

Hyperventilation or stress

122
Q

EEG finding of absence seizures

A

Symmetrical 3hz wave and spike pattern

123
Q

What happens in juvenile myoclonic seizures

A

Myoclonic seizures in the morning after waking

124
Q

Difference between reflex anoxic seizuers and breath holding attacks

A

Both in toddlers
Reflex anoxic- when in pain stops breathing and goes pale with potential seizure
Breath holding- in response to anger/stress. Holds breath and goes blue then limp

125
Q

Management of meningitis if penicillin allergic

A

If moderate allergy then can still use ceftriaxone however if anaphylaxis history must use chloramphenicol

126
Q

What is risk of a second febrile convulsion

A

1 in 3

127
Q

What age group do febrile convulsions occur

A

6 months-6 years

128
Q

What is common symptom with dyskinetic CP other than movements

A

Oro-motor problems

129
Q

Management of migraine

A

1st line- NSAID/paracetamol
2nd line- nasal sumatriptan

130
Q

What can be used to prevent migraines

A

Propanolol or topiramate under specialist supervision

131
Q

Assessment of headache in a child

A

Obs
Examination- FUNDOSCOPY
Headache diary

132
Q

How does benign rolandic epilepsy present

A

Seizures at time of night or duing sleep
- dyaesthesia in face
- hypersalivation
Can get tonic clonic seizures too

133
Q

What is plagiocephaly

A

When baby sleeps more on back meaning occiput on one side can become flattened

134
Q

Management of plagiocephaly

A

Reassure
- advise about turning cot around so sleeps facing other way
- supervised time during day on front

135
Q

Features of benign intracranial hypertension

A

14
HIgh BMI
Normal MRI and neuro exam
Headache worse on lying down with vomiting
Can be confused/ altered mental state

136
Q

Management of benign intracranial hypertension

A

LPs repeatedly

137
Q

How do MS lesions appear on MRI

A

Inflammation
Demyelinating
In the white matter

138
Q

How do tuberous sclerosis lesions appear on MRI

A

Calcified
Hypointense white matter lesions
Subepednymal lesions

139
Q

What are sun setting eyes and what are they a sign of

A

Where eyes are looking down and upwards gaze impaired
Sign of raised ICP

140
Q

Who is best person to get a written statement about CP for school

A

Consultant paediatrician

141
Q

What are ash leaf macules

A

Where skin in that area hypopigmented

142
Q

How does tuberous sclerosis present

A

Ash leaf macules
Brain ependymomal
Lumps under nails

143
Q

Factors demonstrating will go on to have another febrile seizure

A

Short precipitating fever
Under 18 months
Over 15 mins
Focal sx

144
Q

What are raccoon eyes

A

Under eyes is bruised suggesting raised ICP

145
Q

Tuberous sclerosis inheritance

A

AD

146
Q

Management of juvenile mycoclonic epilepsy

A

Sodium valproate
Lamotrigine second line

147
Q

EEG of lennox gastaut syndrome

A

Slow spike

148
Q

How does lennox gastaut syndrome present

A

Continuation of infantile spasms
Variety of different seizures
Severe learning disability and development delay

149
Q

First line for lennox gastaut syndrome

A

Sodium valproate

150
Q

Management of a first time seizure

A

Refer to paediatric specialist to be seen within 2 weeks

151
Q

Investigating first time seizures

A

Bloods - metabolic causes
12 lead ECG
EEG within 72 hours
MRI if suspecct underlying structural cause

152
Q

First line for tonic clonic seizures

A

Sodium valproate if male and girl under 10
Lamotrigine if over 10 and will have to be on long term therapy

153
Q

First line for focal seizures with or without development to tonic clonic seizures

A

Lamotrigine or levetiracetam

154
Q

First line for absence seizures

A

Ethosuximide

155
Q

First line for myoclonic seizures

A

Sodium vaproate if male and girl under 10
Levetiracetam if girl over 10 who may need to continue long term

156
Q

First line for atonic or tonic seizures

A

Sodium valproate
Lamotrigine if girl over 10 and may need treatment long term

157
Q

What defines status epilepticus

A

Over 5 minutes

158
Q

Management of status epilepticus in community

A

If no IV access- buccal midazolam or rectal diazepam
If IV access and resus facilities available- IV lorazepam

159
Q

Order of how manage status epilepticus

A

Over 5 minutes
Buccal midazolam, rectal diazepam or IV lorazepam
Wait 5 minutes
Give second dose of diazepam
If no response
- phenytoin
- levetiracetam
- sodium valproate
If no response try these again
If no response phenobarbital or general anaesthesia

160
Q

Side effects of sodium valproate

A

Hair loss
Weight
Liver damage

161
Q

What is most common cause of infantile torticollis

A

Sternocleidomastoid tumour

162
Q

How does sternocleidomastoid tumour present

A

Mobile non tender nodule in neck
Reduced movement of neck
Latches only on 1 breast successfully

163
Q

Management of infantile torticollis

A

Physio
Surgery if needed

164
Q

If patient comes in with suspected encephalitis what is first thing do

A

No investigatinos until give IV aciclovir and ceftriaxone

165
Q

Pathophysiology of spinal muscle atrophy

A

Mutations in survival motor neurone 1 causing degeneration of anterior horn cells in spinal chord

166
Q

What on presentation suggests medulloblastoma

A

Cerebellar symptoms

167
Q

Hydrocephalus management

A

Ventriculoperitoneal shunt

168
Q

What is scissor walking seen in

A

Diplegic cerebral palsy

169
Q

Child presents with feeling light headed, seizes for 30 seconds and then returns to normal

A

Vasovagal- hypoperfusion can cause the seizure

170
Q

If febrile seizure repeats within 24 hours what type of febrile seizure is it

A

Complex

Paeds (Owen) (17 decks)

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