Neurology

Question 1

What are headache red flags?

Answer 1

wakens child from sleep, sudden increasing severity, change in pattern, gradually increase in severity/frequency (increased ICP)

Question 2

Red flags on physical exam?

Answer 2

growth in head circumference (b/c sutures are open), papilledema, focal neuro deficits

Question 3

Examples of migraine variants

Answer 3

paroxysmal torticollis, cyclic vomiting, abdominal migraine, confusional migraine, benign paroxysmal vertigo

Question 4

Conditions to r/o w/migraine variants

Answer 4

posterior fossa pathology, epilepsy, tumors, GI d/o, urea cycle d/o, drug abuse

Question 5

What is paroxysmal torticollis?

Answer 5

attacks of head tilt from SCM spasm, can cause vertigo and/or vomiting

Question 6

What is benign paroxysmal vertigo?

Answer 6

attacks of vertigo w/nystagmus and vomiting followed by sleep

Question 7

What is abdominal migraine?

Answer 7

acute, severe midline abd pain w/nausea, vomiting, anorexia, pallor lasting 1-72hrs

Question 8

What is cyclic vomiting syndrome?

Answer 8

vomiting attacks, 1-4x’s/hr for up to 5 days not attributable to other causes

Question 9

What is confusional migraine?

Answer 9

episodes of disorientation/combativeness, end in HA

Question 10

What is pseudotumor cerebri (idiopathic intracranial HTN)?

Answer 10

increased ICP w/o a mass or hydrocephalus possibly resulting from impaired CSF reabsorption (similar to communicating hydrocephalus)

Question 11

What are the risk factors for pseudotumor?

Answer 11

girls, overweight, 8-13yo, sinus thrombosis, head injury, SLE, chronic CO2 retention

Question 12

Signs and sx’s of pseudotumor?

Answer 12

HA, papilledema, vision changes, pulsatile tinnitus, CN VI paresis (cannot abduct), vomiting, pain w/eye mov’t, increased ICP w/nml ventricle size

Question 13

What test do you need to do to diagnose pseudotumor?

Answer 13

CT/MRI of head to r/o mass, especially BEFORE doing a LP–otherwise cause hemorrhage w/mass if you do an LP

Question 14

How do you treat pseudotumor?

Answer 14

wt loss, diuretics, LP, glucocorticoids, lumboperitoneal shunt, optic n decompression

Question 15

What is the definition of epilepsy?

Answer 15

Recurrent/repeat seizures w/o an identifiable cause

Question 16

What are examples of symptomatic seizures? i.e. seizure w/a cause

Answer 16

infxn, trauma, hypoxia, malignancy, hypoglycemia, hyponatremia, hydrocephalus

Question 17

What are EEGs used for?

Answer 17

Seizure type classification or subclinical seizure (see it on EEG but not otherwise visible)

Question 18

What are abortive medications and their route of admin?

Answer 18

lorazepam-IV; diazepam-oral, rectal; midazolam-nasal, oral, rectal; phenobarbital, fosphenytoin, levotiracetam if benzos don’t work

Question 19

What are characteristics of febrile seizure?

Answer 19

6mos to 5yo, MC childhood seizure, temp >38, can occur before or after fever, peaks 18-24mos, no other causes, seizure caused by pathogen NOT by the temp (other sources say caused by rapid temp rise), most are simple febrile seizures, often 1st sign of illness

Question 20

Criteria for simple febrile seizure?

Answer 20

< 30min total, generalized, no recurrence in 24 hrs, no focal features

Question 21

Criteria for complex febrile seizures?

Answer 21

> 15min and > 30min total, > 1 seizure in 24hrs, focal features, prolonged

Question 22

What is the DDx for febrile seizures?

Answer 22

chills/rigors, meningitis, encephalitis, tumor, metabolic d/o, neuro d/o (developmental delay)

Question 23

When should you consider an LP for febrile seizure?

Answer 23

less than 18mos old–think meningitis! esp if they have + PE findings.

Question 24

What is the risk of epilepsy in children with febrile seizures?

Answer 24

2% will go on to Dx of epilepsy

Question 25

What is the risk of recurrent febrile seizures?

Answer 25

10% but higher if < 1yo (other sources say 30% recurrence)

Question 26

What are infantile spasms (West syndrome)?

Answer 26

an epilepsy syndrome, need 1 of 3: spasms, mental retardation, abnormal EEG findings. Often 4-8mo, d/t damaged brain

Question 27

What are the tx's for West syndrome?

Answer 27

ACTH, anti epileptics, ketogenic diet

Question 28

What are s/sx's of neurofibromatosus type 1?

Answer 28

cafe au lait spots, Lisch nodules, freckling, neurofibromas, optic glioma, osseous lesion

Question 29

What are s/sx's of neurofibromatosis type 2?

Answer 29

CN VIII tumor (acoustic neuroma), neurofibroma, meningioma, glioma, schwannoma, cataract

Question 30

What is a hamartoma?

Answer 30

benign tumor/normal tissue growing in an abnormal place or abnormally rapidly, e.g. Lisch nodule

Question 31

What are complications of neurofibromatosus?

Answer 31

scoliosis, HTN, learning disabilities, tumors, hypothalamus d/o

Question 32

What are s/sx's of tuberous sclerosis?

Answer 32

seizures/infantile spasms, calcified tumors, mental retardation, hypopigmented skin lesions, shagreen patch (orange peel lesion), sebaceous adenomas, subungual fibroma

Question 33

What are s/sx's of Sturge-Weber dz?

Answer 33

port wine stain, seizures, mental retardation, intracranial calcifications, hemiparesis, cerebral atrophy on CT

Question 34

What is Guillain Barre syndrome?

Answer 34

acquired inflammatory demyelinating polyradiculoneuropathy following an infection

Question 35

What are s/sx's of Guillain Barre syndrome?

Answer 35

ascending paresthesias and weakness/paralysis, decreased DTRs, ileus, bladder dysfxn, autonomic dysregulation

Question 36

What is transverse myelitis?

Answer 36

inflammation of the spinal cord w/perivascular cupping (lymphocytes build up around vasculature) occuring after viral illness

Question 37

What are s/sx's of transverse myelitis?

Answer 37

back pain at lesion, progressive leg weakness, areflexia, spincter dysfxn, sensory loss

Question 38

When do most cases of infanitle botulism occur?

Answer 38

95% between 3wks and 6mos old

Question 39

How do infants get botulism?

Answer 39

unprepared foods! spores can germinate in infants guts < 1yr old but not older than 1yo

Question 40

What are s/sx's of infantile botulism, what is the tx?

Answer 40

symmetric descending paralysis, poor feeding, weak cry, ptosis, apnea--tx is supportive w/botulism IgG

Question 41

How long do tics last in children?

Answer 41

1mo to 1 yr

Question 42

What are some diagnostic criteria for Tourette's Syndrome?

Answer 42

tics nearly qd for > 1yr, no tic free periods > 3mos, motor and vocal tics, onset before age 18

Question 43

What are s/sx's of spinal muscle atrophy type I (Werdnig-Hoffman dz)

Answer 43

hypotonia, weakness, low muscle mass, tongue fasciculations, spared EOM, die by age 2-3yo

Question 44

The DDx for microcephaly includes:

Answer 44

trisomies, TORCH infxn, hypoxia, Tay Sachs, toxins, metabolic d/o

Question 45

DDx for macrocephaly?

Answer 45

pseudomacrocephaly, increased ICP, megalencephaly, familial, thick skull