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Paediatrics > Neurology > Flashcards

Neurology Flashcards

1
Q

What is CP?

A

A group of disorders caused by a non progressive disturbance of the developing brain affecting movement and posture as well as activity limitations and associated disturbances.

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2
Q

What is the pathophysiology of organophosphate poisoning?

A

Acetylcholinesterase inhibitor - acetylcholine not broken down = increased parasympathetic sx = hypersalivation, bronchospasm, lacrimation, muscle weakness, headache, slurred speech, ataxia, confusion

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3
Q

How do you treat organophosphate poisoning?

A

Atropine to reverse cholinergic signs
Pralidoxime (cholinesterase reactivator)

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4
Q

What is the definition of microcephaly?

A

Less than two standard deviations below the mean for race, age and sex

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5
Q

What is the definition of microcephaly?

A

More than 2 standard deviations for race, age and sex.

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6
Q

How does cerebral palsy present?

A

> UMN signs = increased tone (spastic/rigid), increased reflexes, pathological reflexes
Developmental delay (motor/global)
+/- microcephaly
abnormal movements (dystonia)

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7
Q

What is the dilemma of imaging in CP patients?

A

The imaging can identify the point in development when the insult occurred, but it cannot indicate the CAUSE

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8
Q

What neurogenetic disorders mimic cerebral palsy?

A

Dyskinetic disorders
>mitochondrial disorders
>neurotransmitters
>glucose transport defects
>brain iron accumulation
>organic acid disorders

Spastic disorders
>hereditary spastic paraplegias
>lysosomal storage disorders
>disorders of forebrain cleavage
>migrational disorders

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9
Q

What are the general principles of the management of CP patients?

A

> Individualise
If a child sits independently before age 2, he will walk
Activity based rehab interventions induce neuroplasticity
Very early intervention, close to the time of incident, optimises neuroplasticity
90% of movement potential is achieved by 5years of age or less if severe
there is no single treatment that will allow a patient to jump from one level up to another

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10
Q

What are complications of cerebral palsy?

A

Pain
Constipation
Behaviour
Reflux
Epilepsy
Spasticity

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11
Q

What are the risk factors for developing CP?

A

Prenatal
>poor maternal health
>epilepsy
>genetic predisposition
>hydrocephalus
>ANC bleeding

Perinatal
>poor maternal health
>small for GA
>Premature
>HIE
>infections

Postnatal
>infections
>trauma
>environmental factors
>vascular (AVMs, strokes, thrombosis)

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12
Q

What are the signs of raised intracranial pressure?

A

> vomiting
headache
Diplopia
bulging fontanelle
papilloedema
diastasis of sutures
worse on lying down
worsened by coughing/sneezing
wakes child from sleep

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13
Q

What are the associated problems with CP?

A

Intellectual impairment
Learning disabilities
Epilepsy
Language disorders
Vision and hearing abnormalities
Behavioural problems
Malnutrition

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14
Q

What are some possible clinical features of cerebral palsy?

A

> hypertonic = fisting, leg scissoring, equines deformity
truncated hypotonia = asked head lag, opisthotonus due to excessive truncated and nuchal tone
brisk deep tendon reflexes = positive babinski reflex,

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15
Q

What is the differential diagnosis of a floppy infant?

A

> sick child
-cardiac
- malnutrition
-any acute illness
syndromic
neurological
-UMN - cerebral/cerebellar,
-LMN - muscular dystrophy, spinal muscular atrophy, NMJ
metabolic/hyperlaxity

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16
Q

What are the signs of UMN lesions?

A

Hyperreflexia
NOT weak
Evidence of CNS involvement (delayed milestones)

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17
Q

What are signs of LMN lesions?

A

Absent/decreased reflexes
Weak/decreased power

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18
Q

What is epilepsy?

A

> /= 2 unprovoked/reflex seizures >24hours apart
OR
One unprovoked seizure and a probability of >60% of further seizures over the next 10 years
OR
Diagnosis of an epilepsy syndrome

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19
Q

What is an epilepsy syndrome?

A

Seizure types + specific EEG patterns + brain imaging + genetic profile = cluster of features with recognisable pattern = determines further investigations + specific treatment

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20
Q

What is a febrile seizure?

A

Seizures in children between 6months and 5 years in association with fever but without evidence of intracranial infection0

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21
Q

How are febrile seizures classified?

A

Simple febrile seizures
Vs
Complex febrile seizures

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22
Q

What’s the difference between simple febrile seizures and complex febrile seizures?

A

Simple
>generalised tonic cloning
>lasts <15mins
>doesn’t recur within 24hrs

Complex
>focal
> usually >15mins
>cluster of 2+ in 24hrs

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23
Q

How do you manage febrile seizures?

A

Identify cause = exclude meningitis with LP
No CT/MRI/EEG warranted

Tx:
>antiepileptic drugs long term is NOT indicated unless complex = phenobarb
>rectal diazepam
>antipyretics

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24
Q

What factors does the drug of choice for epileptic seizures depend on?

A

> age
seizure type/syndrome
dosage according to weight
least side effects
dosage schedule
family and patient
availability
cost

25
Q

What drug is first line tx for absent seizures?

A

Sodium valproate

26
Q

What is the first line drug tx for generalised and focal seizures?

A

Carbamazepine

27
Q

What are the contraindications for a LP?

A

> low platelets/coagulopathy (haematoma risk)
local infection
previous surgery in that area
raised ICP
haemodynamically unstable/resp compromise
decreased LOC <13
focal deficit eg unequal pupils

28
Q

What positioning is needed for an LP?

A

Lateral recumbent position (spine perpendicular to bed)
OR
Fetal position (spine parallel to bed)

29
Q

What layers do you go through when going an LP?

A

1)skin and subcut tissue
2)supraspinous ligament
3)interspinous ligament
4)ligamentum flavour
5)epidural space
6)dura
7)subarachnoid space

30
Q

What tests would you do on the CSF?

A

1)measure opening pressure
2)dipstix
3)cell count
4)gram stain
5)capsular antigen
6)culture
7)biochemistry
8)other CSF specimen for virology

31
Q

What are NORMAL CSF findings?

A

No neutrophils
0-6 lymphocytes
Protein 0,15-0,45
Glucose 3,6-5,6

32
Q

What are the CSF findings in bacterial infections?

A

Predominantly neutrophils
Increased protein
Decreased glucose
Polymorphs

33
Q

What are the CSF findings in viral infection?

A

Predominantly lymphocytes
Increased protein (less than bacterial)
Glucose within normal limits

34
Q

What are the CSF findings of TB meningitis?

A

Predominantly lymphocytes
Grossly increased protein
Grossly decreased glucose (NB check CSF/serum glucose ratio)

35
Q

What are complications of lumbar puncture?

A

Haematoma
Herniation
Pain
Post puncture headache
CSF leakage
Subarachnoid epidermal cysts
Cardioresp arrest
Infection

36
Q

What are the steps to follow when called to casualty for a seizing child?

A

1) stabilise/resus (ABC)
2) quick history
3) examination
4) diagnostic tests
5) treatment

37
Q

What is NB to remember to check when resusing a seizing child?

A

Check glucose!!

38
Q

What do you ask on your quick history when you have a child seizing in casualty?

A

Acute onset?
>infection
>bleed
>stroke
>toxins
>seizures
>metabolic derangement

Subacute onset?
>brain tumor
>hydrocephalus
>inborn errors of metabolism

39
Q

What do you look for in your examination of a child seizing in casualty?

A

Vitals
Intracranial pressure
Meninges irritation
Skull = signs of trauma/non-accidental injury
Seizure activity = tongue laceration/incontinence
Neuro exam = GCS, breathing pattern,eyes, posture, focal signs (tone, reflexes, brain stem reflexes, CN)
Rest of body clues

40
Q

What breathing pattern indicates midbrain lesion?

A

Central neurogenic hyperventilation

41
Q

What pattern of breathing indicates medullary lesion?

A

Ataxic breathing

42
Q

What pupil reaction indicates lesion in midbrain?

A

Midposition, fixed

43
Q

What pupil reaction indicates lesion in pons?

A

Pinpoint

44
Q

How do you treat raised intracranial pressure?

A

Head upright
Restrict fluids
Normocarbia
Mannitol
Specific cause
>meningitis = antibiotics/antivirals
>SOL = neurosurgery
>ingestion = remove toxin
>status = see protocol

45
Q

How do you treat a child <1/neonate who has status epilepticus?

A

1) phenobarbital 20mg/kg
2)phenytoin 20mg/kg if previous step failed (NOT VALPROATE)
3) thiopentone OR midazolam infusion

46
Q

How do you treat a child more than 1y old with status epilepticus?

A

1) lorazepam 0,1mg/kg IVI OR diazepam 0,3-0,5 mg/kg IV or PR
Repeat x1
2) phenytoin 20mg/kg in SALINE 20-30min infusion to avoid cardiac arrest OR valproate 20mg/kg over 5mins (NOT IF CHILD YOUNGER 2y)
3) ICU, EEG, INTUBATE. thiopentone infusion (keep on infusion until 48hrs seizure free) OR midazolam 0,3mg/kg loading dose then 0,1-0,4mg/kg/hr

47
Q

What are red flag signs for autism?

A

12 months = no babbling, no pointing/waving
16 months = no single words
24 months = no spontaneous 2 word phrases
Any stage = loss of language or social skills

48
Q

What developmental milestones should be met at 3 months?

A

GM: lifts head in prone
FM: Hands open, follow 180 degrees
Coms: coo

49
Q

What developmental milestones should be met at 6 months?

A

GM: Roll over both ways, sit with support, braces shoulders when pulls to sit
FM: transfer hand to hand, palmar grasp
Comms: babbles
Social: express emotion, takes everything to mouth

50
Q

What developmental milestones should be met at 12 months?

A

GM: bear walks, stands independently
FM: release objects on request, throws, places cubes in container
Comms: nouns “where’s mommy”, knows name, knows one word phrases
Social: finger eats

51
Q

What developmental milestones should be met at 2 years?

A

GM: jumps, kicks ball, walk upstairs both feet on step, runs
FM: 6 cube tower, circle shapes, hand preference, match puzzle shapes, turn multiple pages
Comms: names one body part, points at 7body parts, knows pronouns, verbs “what do you eat with”
Social: can dress, possessive

52
Q

What developmental milestones should be met at 3 years?

A

GM: walks up stairs individually
FM: 9/bridge, copies circle, draw straight line, can use scissors, turn individual pages
Comms: adjective negative “which one is red” “which one is NOT the animal”, knows name and gender, can count to 10
Social: uses fork, empathy, bowel trained, interactive and cooperative play

53
Q

What developmental milestones should be met at 4 years?

A

GM: jumps on one foot, hopscotch, walk down stairs individually
FM: 12blocks/step, copy a cross, draw person with head, arms and legs
Comms: complex instruction plan, knows age, address, points at colours, knows 4 numbers
Social: handles buttons, bladder trained, washes hands, make believe play

54
Q

What development milestones do you expect in a 5 year old?

A

GM: walk in straight line
FM: draw square, draw triangle, cut along lines
Comms: knows 10 numbers, recites alphabet
Social: uses knife, chooses friends, does laces

55
Q

What are red flag signs in a child with a headache?

A

> signs of raised ICP
signs of meninges irritation
neurological deficits/seizures
described as “worst headache ever” -subarachnoid haemorrhage

56
Q

What are the clinical signs of cerebellar dysfunction?

A

> ataxia
nystagmus
intention tremor
dysarthria
dysdiadocokinesis
past pointing

57
Q

What is friedrichs ataxia?

A

A progressive neurodegenerative disorder (AR) causing progressive damage to your nervous system and movement problems

58
Q

What is ataxic telangiectasia?

A

It is a complex multi system disorder characterised by progressive neurological impairment, cerebellar ataxia, immunodeficiency, impaired organ maturation, ocular and skin telangiectasia and predisposition to malignancy.

Paediatrics (13 decks)

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