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Flashcards in Neurology Deck (51):
1

What is the most common cause of headache in children?

Migraine without aura

2

What is the best acute management of a migraine in children?

Ibuprofen

3

Can you use triptans in young people with migraines?

Sumitriptan nasal spra can be used in children over 12.
Oral triptans can only be used in those over 18.

4

What are the first line treatments for preventing migraines in children>

Pizotifen (Seratonin antagonist)
Propanolol

5

What is the definition of a febrile convulsion?

1. A seizure occuring after one month of age
2. Associated with a febrile illness (not causes by an infection of the CNS)
3. No previous neonatal seizures or previous unprovoked seizures
4. Nor meeting criteria for other symptomatic seizures.

6

In most situations, what type of seizure is a febrile convulsion?

Usually a tonic clonic seizure

7

What is the difference between a simple and a complex febrile convulsion?

Simple
- Age between 3 months and 6 years
- Tonic Clonic
- Less than 5 minutes
- Isolated event with the febrile illness
Complex
- Focal onset
- More than 10 minutes
- Recurrent events suring the same febrile illness

8

What is the definition of febrile status epilepticus?

Lasts more that 30 minutes

9

If you have a simple febrile seizure what is the risk that you will go on to develop epilepsy?

2.4%

10

If you have a simple febrile seizure what is the risk that you will go on to develop epilepsy?

6 - 8%

11

What first aid measures should be performed if a child has a febrile seizure?

- Protect from injury
- Check airway and clear
- Place in recovery position
- If it lasts over 5 minutes rescue medication should be given

12

What medication should be given for a febrile seizure that has gone on for longer than 5 minutes?

Buccal midazalam
Rectal diazepam

13

Do antipyretics reduce the incidence of febrile seizures?

No

14

If a child has a febrile seizure what is their temperature usually above?

38 degrees

15

A child has a febrile convulsion. Which red flags would make you think that this was more likely to be meningitis?

- History of irritability, poor feeding or lethargy
- Complex febrile seizure
- Bulging fontaneel, neck stiffness, photophobia, focal neurological signs
- Prolonged postictal altered consciousness or neurological defecit
- Drowsinness
- Previous or current antibiotic treatment
- Incomplete immunisations

16

Below what level of consciousness (GCS and AVPU) would you want to intubate immediately?

GCS less than 9
Unresponsive

17

If a child presents with a depressed level of consciousness, low BP and high HR what fluids do you need?

20ml/kg fluid bolus isotonic saline

18

If a diabetic child presents with a depressed level of consciousness and blood sugar level of 1.2 what fluids do you give?

2ml/kg or 10% dextrose

19

What signs indicate raised ICP in a child?

Bradycardia with hypertension
Abnormal pupils
Abnormal breathing pattern
Abnormal posture (decerebrate/decorticate)
Bulging fontanelle in infants

20

What are contraindications to doing a lumbar puncture?

- Signs of raised ICP
- GCS below 8 or deteriorating
- Post ictal period following a seizure
- Focal neurological signs
- Signs of circulatory or septic shock
- CT/MRI suggests CSF pathway obstruction, brain swelling or focal mass lesions.

21

What drug can be given to help reduce ICP?

Mannitol

22

What is the triad of symptoms in guillain barre syndrome?

Progressive ascending motor weakness
Areflexia
Elevated CSF protein

23

What are the symptoms of guillan barre syndrome?

Lower back pain
Progressive weakness going from distal to proximal
This progresses rapidly over 4 weeks then there is a plateau phase followed by recovery

24

What investigations can you do if you suspect guillan barre?

MRI spine with contrast (excludes other spinal pathologies)
LP: Raised CSF protein
Nerve conduction studies - segmental demyelination

25

What is the treatment of guillan barre in children?

Supportive care in acute phase
Immunoglobulins
Prevention of contractures during acute paralytic phase
Rehabilitation

26

A 9 year old child presents to the GP with neck stiffness a headache and a temperature of 39 degrees,

Bacterial meningitis

27

What investigation do you need if you suspect bacterial meningitis?

Lumbar puncture

28

What is the CSF like in bacterial meningitis?

Positive gram stain
High neutrophil count
High protein
Low glucose

29

You see a patient in the GP and the have a rash and symptoms that are suggestive of mennigococcal septicaemia. What should you do in the GP?

Transfer as an emergency to hospital (Call 999)
Give IM or IV Benzylpenicillin

30

What is the managements of children in hospital with a petichial rash, fever and raised CRP?

IV ceftriaxone
This indicates an increased risk of having bacterial meningitis

31

What blood results do you want in a child who you suspect has bacterial meningitis?

CRP
WCC

32

When you take the CSF to look for bacterial meningitis in a child what bacteria do you look for and how do you look for it?

PCR for N meninngitidis

33

What all are you looking at in the CSF of a child with suspected meningitis?

WCC
Protein
Glucose
Gram stain
Culture

34

What is the empirical antibiotic treatment for children under 3 months with suspected bacterial meningitis?

IV cefotaxime and amoxicillin

35

What is the empirical antibiotic treatment for children over 3 months with suspected bacterial meningitis?

1st dose of Cefotaxime followed by OD daily ceftriaxone
+/- dexamethasone IV starting before or with first dose of antibiotic

36

What is the treatment for herpes simplex encephalitis

IV Acyclovir

37

What antibiotic do you also give if a child with suspected bacterial meningitis has had recent travel outside the UK

Vancomycin (in addition to cefotaxime and ceftriaxone)

38

What is the empirical antibiotic treatment for children over 3 months with H influenzae bacterial meningitis?

IV ceftriaxone for 10 days

39

What is the empirical antibiotic treatment for children over 3 months with strep pneumoniae meningitis?

IV ceftriaxone

40

What is the empirical antibiotic treatment for children under 3 months with haemophilus influenzae bacterial meningitis ?

IV cefotaxime for 14 days

41

What is the empirical antibiotic treatment for children under 3 months with L monocytogenes bacterial meningitis?

IV amoxicillin + Gentamicin for the first 7 days

42

What is the treatment for suspected bacterial meningitis in a child who in penicllin allergic?

Chloramphenical (must measure plasma concentration)

43

What is the potential adverse effect of chloramphenicol?

Aplastic anaemia

44

What viruses commonly cause viral meningitis?

Enteroviruses
Echoviruses
Coxsackie virus

45

What does the lumbar puncture look like in viral meningitis?

WCC raised (mostly lymphocytes)
CSF protein normal (maybe slightly high)
CSF glucose normal)

46

What are the common causes of neonatal meningitis?

Group B strep
E Coli
Listeria monocytogenes

47

How do neonates get Group B strep meningitis?

Acquired from vaginal colonisation of the mother

48

What is the treatment for neonatal meningitis caused by group B strep?

Benzylpenicillin
Gentamicin

49

Who gets intrapartum Benzylypenicillin?

Pre term labour
Prolonged rupture of membranes
GBS on vaginal swab/urine
Fever in labour
GBS in previous baby

50

What is the treatment for neonatal meningitis caused by E Coli?

Cefotaxime and Gentamicin

51

What is the treatment for neonatal meningitis caused by listeria monocytogenes?

Amoxicillin and Gentamicin