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Paediatrics > Neuro and development > Flashcards

Neuro and development Flashcards

1
Q

Paediatric autoimmune neuropsychiatric disorders associated with strep infections (PANDAS)

A

Child with Tourettes, tics, OCD, anorexia plus infection.

ABx plus risperidone.

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2
Q

3 core areas affected in ADHD

A

Inattention
Hyperactivity
Impulsivity

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3
Q

ADHD definition

A

Attention deficit and hyperactivity disorder.
Persistent behaviours (longer than 6months) and inferring with social, academic or occupational performance.
Start before 12yrs.
Occurs in 2 or more environments.

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4
Q

Manifestations of Inattention

A

Disorganised
Difficulty following instructions
Disorganised and loosing items.
Easily distracted

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5
Q

Manifestations of hyperactivity

A

Fidgeting
Tapping
Talkative
Climbs over things

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6
Q

Manifestations of impulsivity

A

Poor road safety
Interrupting speech
Answers before complete questions asked.
Unable to take turns or share.

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7
Q

Some environmental factors in the aetiology of ADHD

A 
Maternal smoking or alcohol consumption during pregnancy.
Parental co-morbidity.
Low birth weight.
Preterm delivery.
Psychosocial adversity.
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8
Q

Common ADHD patient

A

MALE

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9
Q

Differentials for ADHD patients

A

Autism spectrum disorder.
Personality disorder.
Fetal alcohol syndrome.
Auditory or visual impairment.

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10
Q

Investigations and diagnosis of ADHD

A 
Behavioural observation (NB symptoms are not constant)
Discuss with teachers
CLINICAL DIAGNOSIS
Conner's scale
Screen for organic cause.
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11
Q

Treatment of ADHD

A 
Non-pharm =  patient CBT, positive parenting.
Pharm = Ritalin/Methylphenidate 1st line, Atomoxetine 2nd line
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12
Q

Definition of Autism Spectrum Disorder

A

Persistent disorder, present from childhood which causes significant impairments to ADLS of patient. There are significant deficits in social communication, social interaction and restricted repetitive behaviour/interests patterns.

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13
Q

Common autism spectrum disorder patient

A

MALE. Present when patient’s capacity is not enough to manage social demands, despite it being present since childhood.

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14
Q

Risk factors for ASD

A

Preterm (before 35weeks)
Sibling with ASD
FHx of mental health problems e.g. schizophrenia.
Maternal sodium valproate in pregnancy.
Congenital conditions such as cerebral palsy, Downs, neonatal encephalopathy.

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15
Q

Manifestations of impaired social communication in ASD

A 
Lack of close friendships.
Enjoys privacy.
No appreciation for others/lack of empathy.
Lack of acting to social cues
Avoid gaze
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16
Q

Manifestations of restricted, repetitive behaviours

A 
Stereotype movement (spinning).
Narrow fixations.
Insists on following routine.
Distress/tantrum over change.
Echolalia
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17
Q

Other manifestations of ASD

A

Impaired imagination = abnormal communication.

Language delay/regression.

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18
Q

Investigating ASD

A

Specialist team.
Collateral info from school.
Observe behaviour in different settings.
Diagnostic instruments e.g. Autism Diagnostic Observation Schedule or diagnostic interviews.

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19
Q

Management of ASD

A

Early intensive behavioural intervention e.g. applied behavioural analysis.
Speech therapy.
Parental training and education.

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20
Q

Risk factors for cerebral palsy

A 
Preterm
Low birth weight
Neonatal encephalopathy
Neonatal sepsis
Neonatal meningitis
Chorioamnionitis
21
Q

Some causes of cerebral palsy

A 
Antenatal = TORCHS infections = vascular occlusion, structural maldevelopment.
Postnatal = Hypoxic-ischaemia injury, intraventricular haemorrhage, hyperbilirubinaemia. 
Preterm = periventricular leukomalacia.
22
Q

Definition of cerebral palsy

A

Umbrella term used to describe permanent motor dysfunction resulting in postural and movement abnormalities. Caused by non-progressive lesion in developing brain.

23
Q

Symptom progression in cerebral palsy

A

Lesion to brain is non-progressive, however, as brain and cerebrum develops with aging manifestations of the lesion change.

24
Q

Some clinical features of cerebral palsy

A 
Paucity in movements
Hypotonia, spasticity, dyskinesia.
Poor head control, rolling or crawling.
Persistent primitive reflexes.
Feeding difficulties.
Not sitting by 8months
Not walking by 18months.
Asymmetry in hand function before 12months.
25
Q

Subtypes of cerebral palsy

A

Spastic - further divided in hemiplegia, diplegia, quadriplegia.
Dyskinetic - involuntary movements.
Ataxic
Mixed

26
Q

Differences between subtypes of spastic cerebral palsy

A 
Hemiplegia = unilateral arm and leg involvement with arm > leg.
Diplegia = legs > arms.
Quadriplegia = all 4 limbs and trunk with seizures.
27
Q

Management of cerebral palsy

A

MDT = community paediatrician, SALT, nurse, dietician, physio, OT, social worker.
Analgesia if in pain.
Botulinum toxin for excessive, painful spasticity..
Manage co-morbidities.

28
Q

Differentials for delay in walking

A

Duchenne muscular dystrophy.
Birth trauma/DDH.
Spina bifida.
Global developmental delay

29
Q

Causes of global developmental delay

A 
Down syndrome
Fragile X
Duchenne muscular dystrophy
Hydrocephalus
Prenatal alcohol or smoking.
Congenital infections (TORCHS)
Periventricular leukomalacia.
Hyperbilirubinaemia
Hypoglycaemia
Meningitis and head injuries.
30
Q

Primitive reflexes

A 
Palmar reflex
Plantar reflex
Rooting reflex
Moro reflex
Asymmetrical tonic neck reflex.
31
Q

Significance of persistent primitive reflexes

A

Neurodevelopmental pathology eg Cerebral palsy

32
Q

Significance of asymmetrical primitive reflex

A

Peripheral neuropathy or CNS lesion

33
Q

Onset and disappearance of primitive reflex

A

Onset = 28wks gestation.

Go by as postural reflexes appear. 6months?! CHECK

34
Q

Features of a tonic clonic seizure

A

Stiff limbs, jerking, LOC

35
Q

Absence seizure

A

Brief period of unawareness/vacany and staring, eyes may roll back
Rx = valproate

36
Q

West syndrome

A

Infantile spasm - 5months
Head nodding, arm jerks
EEG = hypsarrythmia
Rx = prednisolone then vigabatrin

37
Q

Myoclonic jerks/juvenile myoclonus

A

1-4yrs, mor common in femaless
Most after waking up.
Throwing items which are in patients hand.
Ix = EEG polyspike, photosensitive pattern.
Rx = sodium valproate 1st line, Keppra 2nd line
2/3 at risk fo GTC in later life.

38
Q

Causes of seizures in children

A 
CNS tumour
Idiopathic
Cerebral vascular occlusion
Febrile seizure
Hypoglycaemia
Hypocalcaemia/magnesaemia/natraemia.
Meningitis or encephalitis.
39
Q

Clinical features of a febrile convulsion

A

Generalised tonic clonic, symmetrical seizure.
Fever/pyrexia.
Rx = recovery position, if lasting >5mins buccal midazolam/IV lorazepam.
Parent reassurance and education.
If simple no risk of developing epilepsy, complex do have increased risk.

40
Q

Reflex anoxic seizure

A

Vagal inhibition = cardiac asystole = syncope.
Provoked by pain and discomfort.
Pale, atonic (falls to floor), tonic-clonic movements.
EEG = slow wave discharge.

41
Q

What to monitor with patients on Ritalin

A

weight and height

42
Q

Definition of failure to thrive

A

Failure to gain adequate weight or grow at normal rate for ages. Suboptimal weight gain.
Need 2 measurements 3-6months apart showing child fall across 2 major centiles.

43
Q

Panayiotopoulos syndrome

A

Seizure of autonomic symptoms occurring mainly at night and can last over 30mins. Pale, vomiting, pupil dilation, sweating.

44
Q

Differentials for a seizure

A

Benign myoclonus of infancy
Arrhythmia
Daydreaming - ASD
Syncope

45
Q

Organic causes of a seizure

A 
Infection
Hypoglycaemia
Hyponatraemia
Low calcium or magnesium
Chemotherapy
Lack of sleep
46
Q

Causes of hydrocephalus

A

Infection/meningitis = non obstructive.
Subarachnoid haemorrhage
Aqueduct stenosis
Chiari malformation

47
Q

Features in hydrocephalus

A

Large head
Bulging fontanelle
Downward gaze = sunsetting eyes
Raised ICP = headache, papilledema, n+v

48
Q

Ventricles in hydrocephalus

A

dilate superior to obstruction in CSF flow

49
Q

Treatment for hydrocephalus

A

LP

Ventriculoperitoneal shunt

Paediatrics (16 decks)

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