Neurological

Question 1

What is a seizure

Answer 1

Sudden disturbance of neurological function caused by an abnormal or excessive neuronal discharge

Question 2

What is a febrile seizure

Answer 2

type of seizure accompanied by a fever which is not caused by epilepsy or other neurological pathology such as meningitis or tumour

Question 3

What is only age range that can get febrile convulsions

Answer 3

6 months-5years

Question 4

What is a simple febrile convulsion

Answer 4

generalised, tonic clonic seizure. Last less than 15 minutes and only occur during a single febrile illness

Question 5

What is a complex febrile convulsion

Answer 5

partial or focal seizures, last more than 15 minutes or occur multiple times during same febrile illness.

Question 6

How is a diagnosis of febrile convulsion made

Answer 6

Exclude all differentials such as epilepsy, meningitis, brain tumour, intracranial hemmorhage, syncope, trauma.

Question 7

Typical presentation of febrile convulsion

Answer 7

around 18month child, 2-5 tonic clonic seizure during a high fever. Fever caused by underlying viral/bacterial illness such as tonsillitis.

Question 8

Tx of Febrile seizure

Answer 8

Manage underlying source of infection

Question 9

When is lumbar puncture contraindicated

Answer 9

If child is unconscious or has cardiovascular/resp instability, raised ICP.

Question 10

What is a paroxysmal disorder and different types

Answer 10

Broad diagnosis of ‘funny turns.’ Include epilepsy, breath-holding attacks, reflex anoxic seizures, syncope, migraine.

Question 11

What is syncope/vasovagal

Answer 11

temporarily losing consciousness due to disruption of blood flow to brain, often leading to a fall. Caused by emotional event, change in temperature, painful sensation, extended standing.

Question 12

Why is reflex anoxic seizure common pitfall for epilepsy diagnosis

Answer 12

Syncope or triggering event causes faint to floor. Hypoxia induces a generalised tonic-clonic seizure.

Question 13

What is epilepsy

Answer 13

a tendency to have seizures.

Question 14

What is a seizure

Answer 14

transient episode of abnormal electrical activity in the brain

Question 15

Generalised tonic clonic seizure signs

Answer 15

loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) movements. May be associated tongue biting, incontinence, irregular breathing.

Question 16

What is post-ictal period

Answer 16

person is confused, drowsy, feels irritable

Question 17

Tx of general tonic-clonic

Answer 17

1st line: sodium valproate

2nd line: lamotrigine or carbamazepine

Question 18

What is a focal seizure

Answer 18

seizures arise from one lobe - e.g. temporal lobe -> Affect hearing, speech, memory and emotions

Question 19

How can a focal seizure present

Answer 19

temporal - hallucination, dejavu, memory flashbacks, lip smacking, picking at ones clothing.
Frontal - involves motor cortex. May lead to clonic movements (Jacksonian March).

Question 20

Tx of focal seizure

Answer 20

Opposite of tonic-clonic:
1st line: carbamazepine or lamotrigine
2nd: Sodium Valproate

Question 21

What is a absence, atonic and myoclonic seizure

Answer 21

Absence: blank, stares into space and then abruptly returns to normal.
Atonic: drop attacks, brief lapses in muscle tone
Myoclonic: Sudden brief muscle contractions, like a sudden jump.

Question 22

What is a squint? Whats its medical name? Types of squint?

Answer 22

• misalignment of the eyes
• Strabismus
• 1. Esotropia = affected eye positioned towards nose
     
     2. Exotropia = affected eye positioned outward and towards ear
     3. Hypertropia = upward moving affected eye
     4. Hypotropia = downward moving affected eye
     5. Amblyopia = affected eye has reduced function compared to dominant eye

Question 23

Causes of squint

Answer 23

• usually idiopathic
• retinoblastoma (space occupying lesion)
• cataracts
• cerebral palsy
• trauma

Question 24

How to diagnose squint

Answer 24

cover test: occlude one eye and observe other for a shift in fixation.  Direction of shift in fixation determines type of tropia: medial shift (when opposite eye is occluded) = exotropia
lateral shift (when opposite eye is occluded) = esotropia

Question 25

How to treat squint and what could happen if dont treat

Answer 25

- Eye patch over unaffected eye to train affected eye. | - squint may become permanent, can lead to ambylopia = defective visual acuity

Question 26

What is Cerebral palsy

Answer 26

permanent neurological problems resulting from damage to the brain around the time of birth. - not progressive however symptoms may change over time during growth or development

Question 27

Causes of cerebral palsy

Answer 27

- majority antenatal -> maternal infections or trauma during pregnancy - perinatal -> birth asphyxia, pre-term birth - post natal -> meningitis, head injury

Question 28

Types of Cerebral palsy

Answer 28

- Spastic (pyramidal CP): From damage to upper motor neurones = Hypertonia (stiff) and reduced function. MOST COMMON (80%) - Dyskinetic (extrapyramidal): Damage to basal ganglia = hypertonia + hypotonia, athethoid movements (slow, involuntary movements of fingers, hands, toes) - Ataxic: Damage to cerebellum. Problems with coordinated movement. - Mixture of all.

Question 29

Patterns of spastic cerebral palsy

Answer 29

Monoplegia: one limb affected Hemiplegia: one side of the body affected Diplegia: four limbs are affects, but mostly the legs Quadriplegia: four limbs are affected more severely, often with seizures, speech disturbance and other impairments

Question 30

Px of cerebral palsy

Answer 30

- spastic: flexion of arms, extension of legs + plantar flexion of feet. Normal muscle bulk, increased tone. - Athetoid movements = indicate basal ganglia involvement/dyskinetic CP - Cerebellar involvement = loss of coordination and balance (walk different, trouble writing, depth perception). - developmental problems: failure to meet milestones, hand preference below 18 months, coordination/speech/walking problems, learning difficulties - strabismus

Question 31

What investigation confirms cerebral palsy diagnosis

Answer 31

- MRI

Question 32

Mx of cerebral palsy

Answer 32

- multi disciplinary - physio - occupational therapy - speech and language - dietician - orthopaedic - paediatricians

Question 33

Differentials for a upper motor neuron lesion | + presentation

Answer 33

- acquired brain injury - tumour - cerebral palsy - increased tone, fast reflexes, increased muscle bulk/preservance

Question 34

5 Types of gait and what indicate

Answer 34

Hemi/diplegic: UMN lesion Ataxic: Cerebellar lesion - wide based (clumsy, staggering) High stepping gait: Foot drop or LMN lesion Waddling gait: myopathy/ pelvic muscle weakness Antalgic gait: limp/localised pain