Paeds Neuro

Question 1

4 types Cerebral palsy

Answer 1

1) Spastic
2) Athetoid
3) Ataxic
4) mixed

Question 2

3x3 causes of cerebral palsy

Answer 2

Antenatal

• Chorioamnionitis
• Prematurity
• Congenital malformation

Perinatal

• Sepsis
• Chorioamnionitis

Postnatal

• Meningitis
• Trauma
• Kernicterus

Question 3

Management of spasticity in cerebral palsy

Answer 3

Baclofen - Unknown!

Question 4

Criteria for febrile convulsion

Answer 4

• Ax temp >37.8

- Child between 6 months & 5 years

Question 5

Emergency management of febrile seizure

Answer 5

1) A-E
2) Check BM
3) If >5 minutes seizing give rectal diazepam (500mcg/kg)
4) If meningococcal disease suspected benzylpenicillin

Question 6

3 factors indicating complex febrile seizure

Answer 6

1) Focal features at onset or during the seizure.
2) Duration of more than 15 minutes.
3) Recurrence within the same febrile illness.

Question 7

In what proportion of children do febrile seizures recur?

Answer 7

30%

Question 8

What advice to give parents?

Answer 8

• tepid sponging + call if fever at home

- call 999 if >5 mins long

Question 9

Neonatal cause of meningitis

Answer 9

GBS, e.coli

Question 10

1 month to 6 years cause of meningitis

Answer 10

Neisseria meningitides
Strep pneumonia
Haemophilus influenza

Question 11

> 6 years meningitis

Answer 11

Neisseria meningitides

Strep pneumonia

Question 12

> 60 years meningitis

Answer 12

Strep pneumonia

Question 13

Investigations in child with meningitis

Answer 13

B: FBC, Blood cultures, U&Es, ESR, coagulation
O: Urine analysis, Urine microscopy and culture, lumbar puncture
X:

Question 14

Contraindications to LP in children

Answer 14

• Bulging fontanelle
• Papilloedema
• Coagulation disorder (DIC)
• Rapid onset meningococcal disease (rash/fever)
• Focal neurology

Question 15

Management meningitis in children

Answer 15

1. Antibiotics
   < 3 months: IV amoxicillin + IV cefotaxime
   > 3 months: IV cefotaxime
2. Steroids
   if > 1 month and Haemophilus influenzae then give dexamethasone
3. Fluids
   treat any shock, e.g. with colloid
4. Cerebral monitoring
   mechanical ventilation if respiratory impairment
5. Public health notification and antibiotic prophylaxis of contacts
   ciprofloxacin is now preferred over rifampicin

Question 16

ddx for riggers

Answer 16

Biliary sepsis (part of Charcot’s triad)
Pyelonephritis.
Visceral abscess (including lung, liver and paracolic).
Malaria.

Question 17

Inv for DMD

Answer 17

• CK
• Muscle biopsy
• Genetic studies

Question 18

Management for DMD

Answer 18

• Support in walking
• Corticosteroids
• cardiac & respiratory surveillance

Question 19

Temporal lobe epilepsy symptoms

Answer 19

Hallucinations (auditory/gustatory/olfactory), Epigastric rising/Emotional, Automatisms (lip smacking/grabbing), Deja vu/Dysphasia post-ictal)

Question 20

Cardiac complications of Duchenne’s muscular dystrophy

Answer 20

Dilated cardiomyopathy

Question 21

DMD vs BMD

Answer 21

BMD has ABNORMAL dystrophin

DMD has absence of dystrophin

Question 22

Outline the floppy infant

Answer 22

PARALYTIC

• Cerebral palsy
• Down’s syndrome

Non-paralytic
Muscular 
- DMD
NMJ
- Myasthenia Gravis 
Peripheral nerve 
- Guillan Barre
Anterior horn 
- Poliomyelitis

Question 23

What is SMA?

Answer 23

Genetic condition causing death of alpha neutrons from spinal cord to NMJ

Question 24

Symptoms of spinal muscular atrophy

Answer 24

Hyporeflexia
Fasciulation
Muscle weakness

Question 25

Investigation of SMA

Answer 25

CK Genetic testing EMG Muscle biopsy

Question 26

Inheritance of SMA

Answer 26

Autosomal recessive

Question 27

Name two types of ataxia

Answer 27

FRiedRiCHS Ataxia | Ataxia telangiectasia

Question 28

Outline path of Friedrich's Ataxia

Answer 28

``` F- falls R - recessive ie D - Dorsal Column involvement Recessive H - Hypertrophic Cardiomyopathy I C - Cerebellar S - Scoliosis ```

Question 29

Three useful facts about ataxia telangiectasia

Answer 29

1) Presents earlier the friedirch's ataxia 2) telangiectasia 3) associated with lymphoma 4) associated with IgA deficiency

Question 30

What is an ataxia?

Answer 30

Cerebellar hemisphere lesion

Question 31

Causes of hydrocephalus

Answer 31

Non-communicating - congenital - Arnold chiari malformation non-communicating - acquired - Cerebral aqueduct stenosis Communicating - Meningeal thickening (meningitis)

Question 32

Management of hydrocephalus

Answer 32

Pharmacological - acetalazomide Surgical - ventricular-peritoneal shunt

Question 33

Where does IVH arise from in pre-term infants vs term infants?

Answer 33

Pre-term infants - germinal matrix Term infants - Choroid plexus

Question 34

Three types of spina bifida

Answer 34

spina bifida occulta Spina bifida cystic - myelomeningocele - associated with areflexia & flaccid paralysis - Meningocoele

Question 35

How to prevent spina bifida?

Answer 35

Folic acid admin

Question 36

Macroencephaly causes

Answer 36

- normal variation or familial trait - disproportionate growth in chronic conditions, for example achondroplasia, sickle cell anaemia, rickets, failure to thrive - hydrocephalus

Question 37

Microencephaly causes

Answer 37

``` Chromosomal - Patau's syndrome Toxins - FAS Virus - Cytomegalovirus, Zika virus ```

Question 38

Most common cause brain tumour in children

Answer 38

Glioma (astrocytoma)

Question 39

Brain tumour presentation

Answer 39

Headache + red flag

Question 40

Define chronic fatigue syndrome

Answer 40

6 months fatigue + Headache of new type, pattern, or severity. Multi-joint pain without swelling or erythema. Muscle pain. Post-exertional malaise for longer than 24 hours. Significant impairment in short-term memory or concentration. Sore throat. Tender lymph nodes. Unrefreshing sleep.

Question 41

Name four head sutures

Answer 41

Metopic Coronal Saggital Lamboid