Neuro

Question 1

def. of epilepsy

Answer 1

chronic, recurrent, unprovoked seizures

- 2 or more afebrile seizures

Question 2

main types of seizures

Answer 2

1. partial - discrete areas of brain
   - simple - focal neuro signs with no impaired consciousness
   - complex - focal neuro with impaired cons
2. generalized - whole brain
   - absence - staring spells, consc impaired
   - myoclonic - rapid jerks
   - tonic - rigid and stiff
   - clonic - rhythmic jerks
   - tonic-clonic - jerk and stiff
   - atonic - loss of tone

Question 3

DDx for seizure

Answer 3

• syncope
• breath holding spells
• GERD
• self stim behaviour - ASD
• chorea

Question 4

Phx for seizures

Answer 4

• ABC
• general for Infeciton
• neuro exam - LOC, meningitis, focal neuro

Question 5

imaging for seizure

Answer 5

• labs based on Hx
• CT or MRI
• LP to examine CSF
• ECG, EEG

Question 6

mgmt of seizure

Answer 6

- rule out provoked causes
meds after 2 unprovoked or 1 unprovoked with abnoral EEG
- valproic acid for general
- carbamazepine for partial
surgical

Question 7

def. status epilepticus

Answer 7

def is 30 minutes, but should treat if longer than 5

Question 8

mgmt of stat epi

Answer 8

p 208

Question 9

2 main types of febrile seizures

Answer 9

1. simple febrile - brief, generalized and once in 24 hrs

2. complex - >15 mintues with or without focal features or recurs in 24 hours

Question 10

tests for febrile seizures

Answer 10

• labs as indicated
  LP
• for those under 12 months
• or meningeal signs

Question 11

mgmt of feb. seizure

Answer 11

safety - none in mouth, roll on side

• treat infection
• Tx of fever not effective

Question 12

prog. of febrile seizures

Answer 12

simple
- increased risk of another
complex
- increased risk of epi, not another febrile

Question 13

most common headache in children

Answer 13

migraine

Question 14

5 main classes of HA and some types

Answer 14

1. acute general
   - infections
   - CSF leak
   - post-ictal
   - HTN
2. acute local
   - sinusitis
   - AOM
   - TMJ
   - eye strain
3. acute recurrent
   - migraine
   - cluster
   - tension
   - exertional
4. chronic progessive
   - ICP
   - CNS tumor
   - pseudotumor cerebri
   - venous thrombus
5. chronic non-prgressive
   - depression
   - chronic tension
   - post-concussion
   - caffeine or analgesic induced

Question 15

when to image HA (red flags)

Answer 15

• neuro Sx
• progressive pattern
• new or severe
• increased with strain,cough sneeze
• explosive or suddne
• systemic Sx
• sleep related - in AM or wakes up
• clinical suspicion

Question 16

mgmt for all HA

Answer 16

• education
• sleep hygene
• diary
• exercise, regualr meals

Question 17

mgmt of migraines

Answer 17

• tylenol
• advil
• 5-HT1 agon
• triptans

Question 18

mgmt of tension

Answer 18

advil/tylenol

Question 19

def. of cerebral palsy

Answer 19

non-progressive motor impairments caused by lesions or injuries to dev. brain
- hypertonia is primary abnormality

Question 20

risk factors for CP

Answer 20

• premature
• LBW
• breech birth
• multiples
• toxins
• maternal seizures
• asphyxia
• hemmorage
• post-natal meningitis

Question 21

4 main types of CP

Answer 21

1. spastic - stiffness
   - hemi, di or quadraplegic
2. ataxic
3. dyskinetic - invol, uncontrolled movements
4. mixed

Question 22

Phx for CP

Answer 22

• complete PE
• screen for accompanying impariments
• neuro exam

Question 23

invest for CP

Answer 23

MRI - for etiology and timing

EEG - only in children with CP and suspected sizures

Question 24

mgmt of CP

Answer 24

• physio
• OT
• speech therapy
• assistive devices
• medical therapy

Question 25

def. of hypotonia

Answer 25

reduced restistance to passive ROM in joints

Question 26

DDx for hypotonia

Answer 26

1. cerebral - congenital - chromosomes - metabolic 2. spinal cord disorders - hypoxic ischemic myelopathy 3. polyneuropathies 4. disorders of neuromusc. transmission - MG or botulism 5. muscular dystrophies

Question 27

important part of HPI

Answer 27

onset - floppy at birth or progressive

Question 28

maternal Hx questions for hypotonia

Answer 28

- toxins - decreased fetal movelment in utero - APGAR

Question 29

Phx for hypotonia

Answer 29

1. tone - lying - horizontal suspension - vertical suspension - in traction 2. strength/power 3. muscle bulk 4. deep tendons 5. plantar response 6. laxity

Question 30

labs for hypotonia

Answer 30

- CBC - ext. lytes - LFTs - renals - Ammonia - glucose - karyotype/FISH

Question 31

imaging for dystonia

Answer 31

MRI for central

Question 32

neuromusc. tests for hypotonia

Answer 32

CK EMG muscle Bx

Question 33

table for hypotonia

Answer 33

p216

Question 34

most common causes of head trauma

Answer 34

1. falls 2. sports related 3. hit with object 4. bike or MV

Question 35

classification of severity by GCS

Answer 35

mild - 14-15 mod - 9-13 severe

Question 36

when to xray head

Question 37

when to CT (CATCH rule) 7

Answer 37

any of | 1. GCS

Question 38

mgmt of mild, mod and severe head

Answer 38

``` mild - DC to respnosible parents - observe if LOC mod - CT severe - stabilize and intubate, then CT - then trauma center ```

Question 39

def. concussion

Answer 39

mild TBI caused by mech forces

Question 40

main Sx of concussion

Answer 40

``` usual Sx - HA, NV, dizzy, photo/phonophobia behav. changes cog impairments sleep disturbances ```

Question 41

red flags for concussion

Answer 41

- worsening HA - seizures - increased confusion - cannot recognize ppl and places - strange behav. changes - repeated vomiting

Question 42

Phx for concussion

Answer 42

``` HEENT exam CNs motor - pronator drift sensation reflexes balance coordination cognition ```

Question 43

mgmt of concussion

Answer 43

graded return to work/play | see table p221