Paediatrics Flashcards by Will Muirhead

What are causes of macrocephaly?

hydrocephalus SOL - e.g. tumour, arachnoid cyst, CSDH Venous hypertension due to AVM Metabolic causes Syndromic overgorwth syndromes (Soto’s syndrome) Cranial hyperostosis

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Describe the ETV success score?

Age (0-50) Aetiology (post infectious 0, myelomeningocoele 20, aquaductal stenosis/tectal tumour 30) No previous shunt 10

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What is natural history of MM without treatment?

Without treatment 25% survive infancy of these 50% ambulatory and 70% normal IQ With treatment 80% ambulatory 70% normal IQ 85% ‘social continence’ 5% normal urinary function

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What is shunt rate after myelomeningocoele?

80% post natal closure Goes down to 40% prenatal closure (Improvement of 1 level or more is 40% in prenatal and 20% post natal)

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What are the radiological findings of Chiari II?

Small post fossa with low torcula Elongated and low lying fourth ventricle Beaking of tectal plate (elongated inferior colliculus) Large massa intermedia Thin corpus callosum Medullary, tonsillar and vermian herniation through FM

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Risk of open neural tube defects

1:1000 - up to 2% if 1 previous birth with MM

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Name three disorders of gastrulation relevant to neurosurgeons?

e.g. these three disorders (all disorders of notochord integration) - neurenteric cysts - dorsal enteric fistula - split cord malformation

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What are the two types of split cord malformation?

Type 1 - two hemicords within separate dural tubes Type 2 - single dural tube

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Name a disorder of secondary neurulation

Tight filum terminale

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What types of disorders of primary neurulation are there? And what’s the mechanism

Closed dysraphism - Premature dysjunction - lipomyelomeningocoele - lipmyeloceole - intradural lipoma Open dysraphism - Nondysjunction - dorsal dermal sinus - myelomeningocoele (open or closed) -

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What are features of Dandy-Walker malformation?

Vermian agenesis Cystic dilatation of 4th ventricle High-lying torcula with inverted tentorial angle

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What are considerations in paediatric pineal?

Neuraxis MRI Steroids Treat hydrocephalus Eyes

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What are layers of myelomengicoele?

Neural placode, zona epitheliosa, abnromal skin, normal skin

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What are principles of myelomeningocoele surgery?

Incise to normal skin, identify dural sac, reduce placode into dural sac, oversow sac +/- fascia

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What are most common conditions producing focal CNS lesions in AIDS?

Toxoplasmosis Primary CNS lymphoma (can look atypical) PML (progressive mulifocal leukencephalopathy - JC virus) Cryptococcal abscess TB (tuberculoma)

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How do you work up an AIDS patient with cerebral lesion?

Toxoplasmosis IgG serology Consider lumbar puncture - cytology for primary CNSlymphoma LP - PCR for JCvirus and EBV

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What staging of medulloblastoma is there?

Chang’s staging - based on tumour size and extent of metastases

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What are the groups of medulloblastoma and prognosis:

WNT - good prognosis SHH - intermediate prognosis Group 3 - poor prognosis Group 4 - intermediate prognosis

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What is total volume of CSF in adult vs Newborn?

150ml vs 5mls

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What is circulating blood volume?

75ml/kg (up to 85mls/kg term 100mls/kg in premature)

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What is paediatric fluid requirement?

Over 24 hours 100ml/kg first 10kg 50ml/kg next 10kg 20ml/kg thereafter Bolus is 1/6th bodyweight

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What are the attachments of lillequest’s membrane?

Y shaped Dorum sellae to mamillary bodies Inferiorly there is a mesencephalic leaf

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Draw floor of third ventricle

To place mamillary bodies Intermammillary space Tuber cinereum Infundibulum Chiasm

What is the velum interpositum?

It’s the double layer of tela choroidea which contains a potential space above the internal cerebral veins

How do you disconnect a fatty filum?

At L5/S1

Distinguish positional plagiocephaly from lamboid synostosis

in lamdoid synostosis ear is posterior and down In positional plagiocephaly there is ipsilateral frontal prominence

What's the cause of vein of galen malformation?

Persistant median prosencephalic vessel of Markowski

Dive DVLA return to drive advice for Meningioma TBI GBM Seizure CSDH Elective Clipping SAH and treated aneurysm

Meningioma - 6/12 TBI - case dependent, 6-12/12 depending (If minimal post traumatic amnesia, normal scan, no impairment can drive on clinical recovery) GBM - 2 years after completion of primary treatment Seizure - typically 1 year (not drive whilst meds being withdrawn + 6 months after last dose)\_ Chronic subdural - clinical recovery Elective clipping - clinical recovery Treated anuerysm and SAH - clinical recovery

What's the difference between cut and coag?

Cut is continuous Coag is pulsed and higher voltage

What is root level of shoulder muscles?

All C5/6 apart from shrugging (accessory)

What are carried by Aalpha Abeta Agamma Adelta B C fibres?

Aalpha - motor Abeta - touch and pressure Agamma - proprioception Adelta - fast pain and temperature B - autonomic C - slow pain and temperature

What are three nerves that can cause winging of the scapula?

Dorsal scapula nerve Accessory Long thoracic

Describe nurick scale

0-5 from no myelopathy through to bedridden (on mobility)

What are the four kinds of OPLL in Japanese Ministry of Health and Welfare classification?

Continuous Segmental Mixed Localised

Mechanisms of anticoagulants Warfarin Heparin Dabigatran Apixaban

Warfarin - II, VII, IX, X Heparin - inactivates II and X (via antithrombin 3), LMWH same Dabigatran - direct anti thrombin (factor II) Apixaban - Xa inhibitors

How does Aspirin Clopidogrel/ticagrelor/prasugrel dypyridamole Tirofiban Work?

Aspirin - COX1 Clopidogrel/ticagrelor/prasugrel - ADP receptor antagonists (later blocking G2b3a pathway) Dipyridamole - prevents adenosine updake Tirofiban - direct G2b3a inhibotor (IV only)

Explain clotting cascade?

Extrinsic and intrinsic pathway Both lead to activation of factor X Which activates factor II (thrombin) Which cleaves fibrinogen to fibrin

Draw the hippocampus

Subiculum Dentate gyrus CA1-CA4 Dentate gyrus

Whaat sensory latency do you expect in CTS?

\>3.5ms

What are sites of median nerve entrapment?

CTS Anterior interosseous enuorpathy Heads of pronator teres Above elbow - struthers ligament

X and O on audiogram?

X is left, O is right

What are medical treatments for prolactinoma?

cabergoline bromocriptine

What are the medical treatments for acromegaly?

Octreotide Pegvisamant Cabergoline

Klippel feil - triad

Congenital fusion of 2 or more vertebrae Triad Low posterior hairline Short neck Limited neck movement

Organisms in brain abscess?

Streptococcus (e.g. strep milleri, strep anginosus) Otitis media can have bacteroides Enterobacter

Describe briefly functional arrangement of basal ganglia?

Input = Striatum (caudate and putamen) Outputs = GPi and Substantia nigra pars reticularis which project to ventrolateral thalamus

What's pallister hall syndrome?

hypothalamic hamartoma pituitary hypoplasia polydactyly

Name three multiple tumour syndromes?

Turcot syndrome - GBM + bowel cancer Li-Fraumeni - P53 includes astrocytomas and PNET Cowden - multiple hamartoma syndrome associated with dysplastic gangliocytoma of cerebellum (lhermitte duclos)

What's tolosa hunt?

Inflammation of cavernous sinus/superior orbital fissure non-specific granulomatous Rx is steroids

What's the grade of haemangiopericytoma?

II or III if anaplastic Arises from pericytes Treatment is surgery + RTX Can metastasize - chemo

Where's MacCarty Keyhole?

7mm superior + 5mm posterior to frontozygomatic suture Or at anterior termination of superior temporal line

When do you get the spasms of hemifacial spasm?

During sleep (unusually for movement disorder)

How do carbamazepine and gabapentin?

Carbamazepine is sodium channel blcoker Gabapentin is gaba analogue

What are the neurosurgical associations in downs?

Basilar invagination secondary to atlantoaxial instability

What is embryological basis of Rathke's cleft cyst?

Single layer of cuboidal epithelium Rathke's pouch has infolded from the pharynx to form anterior pituitary

Where are most common aneurysm locations?

Acomm 30% PcommaA 25% MCA 25% Vertebrobasilar 5-15%

What are the features of lateral medullary syndrome of Wallenberg?

Ipsilateral facial pain and temperature loss Ipsilateral horners Contralateral body pain and temperature loss Vertigo, nystagmus, ipsilateral ataxia, IXth, 10th nerve