Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

My Phase 3a Revision > PAEDS - NEURO / ENT / OPHTHALMOLOGY > Flashcards

PAEDS - NEURO / ENT / OPHTHALMOLOGY Flashcards

(162 cards)

Start Studying
1
Q

CEREBRAL PALSY
What is cerebral palsy?
How does it progress?

A
  • Permanent disorder of movement + posture due to a non-progressive lesion of motor pathways in the developing brain
  • Sx develop over time as the brain starts to develop
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

CEREBRAL PALSY
What are the causes of cerebral palsy?

A
  • Antenatal (80%) = genetics, congenital malformations or infections
  • Intrapartum (10%) = hypoxic-ischaemic injury
  • Postnatal (10%) = IV haemorrhage (prems), meningitis/encephalitis, trauma (NAI), hydrocephalus, kernicterus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

CEREBRAL PALSY
What are some early features of cerebral palsy?

A
  • Abnormal limb/trunk tone + posture with delayed motor milestones
  • Feeding issues > oromotor incoordination, slow feeding, gagging + vomiting
  • Abnormal gait when walking achieved
  • Hand preference before 12m + primitive reflexes after 6m
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

CEREBRAL PALSY
What are some non-motor presentations of cerebral palsy?

A
  • LDs, epilepsy, squints + hearing impairment
  • Joint contractures, hip subluxation + scoliosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

CEREBRAL PALSY
What are the 4 broad types of cerebral palsy?

A
  • Spastic (pyramidal, 70%)
  • Ataxic (10%)
  • Dyskinetic (athetoid, 10%)
  • Mixed (10%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

CEREBRAL PALSY
What is affected in spastic cerebral palsy?

A
  • UMN pathways damaged (pyramidal or corticospinal) so UMN signs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

CEREBRAL PALSY
What are the main features of spastic cerebral palsy?

A
  • Limb tone persistently increased (spasticity, velocity-dependent)
  • Brisk deep tendon reflexes + extensor plantars (+ve Babinski)
  • Increased limb tone may suddenly yield under pressure (clasp knife)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

CEREBRAL PALSY
What is spastic quadriplegic cerebral palsy?

A
  • All 4 limbs, trunk involved with tendency to opisthotonus (extensor posturing), poor head control + low central tone
  • More severe > associated with seizures, microcephaly, low IQ
  • May have Hx of HIE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

CEREBRAL PALSY
What are the 3 subtypes of spastic cerebral palsy?

A
  • Hemiplegic
  • Quadriplegic
  • Diplegic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

CEREBRAL PALSY
What is spastic hemiplegic cerebral palsy?

A
  • Unilateral involvement of arm + leg (arm worse)
  • Face spared, fisting of affected hand, flexed arm, tip-toe walking
  • Presents 4–12m, normal birth with no HIE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CEREBRAL PALSY
What is spastic diplegic cerebral palsy?

A
  • All 4 limbs (legs worse)
  • Hand function may be relatively normal but walking abnormal
  • Linked with preterm birth (periventricular brain damage)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

CEREBRAL PALSY
What is ataxic cerebral palsy?

A
  • Cerebellum affected > cerebellar signs
  • Early trunk + limb hypotonia (symmetrical)
  • Poor balance + delayed motor development
  • Incoordination, ataxic gait + intention tremor
  • Mostly genetics, can be acquired brain injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

CEREBRAL PALSY
What is dyskinetic cerebral palsy?

A
  • Intellect unimpaired as basal ganglia affected (extra-pyramidal)
  • Associated with kernicterus + HIE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

CEREBRAL PALSY
What are the features of dyskinetic cerebral palsy?

A
  • Intellect unimpaired as basal ganglia affected (extra-pyramidal)
  • Chorea, athetosis, dystonia
  • Muscle tone is variable (floppiness), involuntary movements, poor trunk control
  • Associated with kernicterus + HIE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

CEREBRAL PALSY
What is meant by chorea?

A

Irregular, sudden + brief non-repetitive movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

CEREBRAL PALSY
What is meant by athetosis?

A

Slowly writhing movements distally like fanning fingers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

CEREBRAL PALSY
What is meant by dystonia?

A

Twisting appearance from simultaneous contraction of agonist + antagonist muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CEREBRAL PALSY
What are the investigations of cerebral palsy?

A
  • Clinical Dx (assess posture, pattern of tone, hand function + gait)
  • Functional ability judged by Gross Motor Function Classification System
  • MRI head to identify cause but not necessary for Dx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

CEREBRAL PALSY
What are the stages of the Gross Motor Function Classification System?

A
  • I = walks without limitation
  • II = with limitation
  • III = handheld mobility device
  • IV = III with limitation
  • V = wheelchair
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

CEREBRAL PALSY
What is the MDT approach of cerebral palsy?

A
  • Drs
  • Physio (tone + posture issues)
  • SALT (swallowing issues)
  • OT (home adjustments, help with ADLs)
  • School (special educational needs)
  • Social workers (benefits)
  • Dietitians (?PEG feeding)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

CEREBRAL PALSY
What is the management of spasticity in cerebral palsy?

A
  • PO or IT baclofen
  • PO diazepam
  • Botox injection
  • Orthopaedic surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

VISION
What is vision like in children?

A
  • Visual acuity is poor in the newborn but increases to adult levels by age 4
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

VISION
What are some causes of severe visual impairment?

A

Genetic –

  • Congenital cataracts
  • Albinism
  • Retinal dystrophy
  • Retinoblastoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

VISION
How might visual impairments present in children?

A
  • Loss of red reflex (i.e. cataract)
  • White reflex in pupil (retinoblastoma, cataract, retinopathy of prematurity)
  • Not smiling responsively by 6w
  • Lack of eye contact with parents
  • Random eye movements
  • Failure to fix + follow
  • Nystagmus, squint, photophobia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
VISION When is vision screened in children?
- Pre-school + school entry
26
STRABISMUS What is strabismus? Is it normal?
- Misalignment of visual axis (squint) - - Transient neonatal misalignments common in first few months when looking at near objects, reduce by 2m, gone by 12w
27
STRABISMUS What are the 2 divisions of strabismus?
- Concomitant (non-paralytic, common) = often refractive error, differences in control of extra-ocular muscles - Paralytic (rare) = paralysis in ≥1 of the extra-ocular muscles (if rapid onset may be sinister SOL)
28
STRABISMUS What is the difference between a manifest and latent strabismus?
- Manifest = present when views a target binocularly - Latent = binocular vision interrupted
29
STRABISMUS What are the different types of manifest strabismus? How does this compare to latent strabismus?
- Esotropia = inward moving (cross-eyed) - Exotropia = outward moving - Hypertropia = upward moving - Hypotropia = downward moving - Latent is same but -phoria not -tropia (esophoria etc)
30
STRABISMUS What is the pathophysiology of strabismus?
- When eyes not aligned the images on retina do not match + pt will experience diplopia - When this occurs in paeds, before the eyes have fully established their connections within the brain, the brain will cope by reducing the signal from the less dominant eye
31
STRABISMUS What is a complication of strabismus?
- One eye used to see (dominant) + one eye ignored (lazy) - If untreated lazy eye becomes progressively more disconnected from brain over time + problem worsens (amblyopia)
32
STRABISMUS What causes strabismus?
- Multifactorial (combination of hereditary + refractive errors) - Idiopathic - Secondary to vision loss - Higher incidence in cerebral palsy - SOL (retinoblastoma) rare but suspect if sudden onset + other neurology
33
STRABISMUS What are 3 types of refractive errors?
- Hypermetropia = long-sightedness (common, hard to see nearby objects) - Myopia = short-sightedness (uncommon, less likely to cause permanent visual damage) - Amblyopia = defective visual acuity that persists after correction of refractive error + removal of any pathology (lazy eye)
34
STRABISMUS How does amblyopia present?
- Often unilateral, potentially permanent loss of visual acuity in an eye that has not received a clear image
35
STRABISMUS What are some causes of amblyopia?
Any interference with visual development > squint, refractive error, ptosis, cataracts
36
STRABISMUS What are some investigations for strabismus?
- (Single) cover test for manifest/tropias - Cover-uncover (alternate cover) test for latent/phorias - Corneal light reflex test (Hirschberg's test) - Important to assess visual acuity + ocular movements to exclude paralytic
37
STRABISMUS Explain the cover test
- Cover eye + observe the other eye for a shift in fixation - Direction of shift indicates the type of tropia - Close (33cm) + distant (6m) as some squints only present at one distance
38
STRABISMUS Explain the cover-uncover test
- Helps determine if misalignment is a tropia or phoria - Occlude eye + then quickly uncover, observing the occluded eye for refixation movement - A phoria will shift back to being straight, direction is opposite to the movement (shifts lateral = esophoria)
39
STRABISMUS Explain the corneal light reflex test
- Shine a pen torch in the eyes - Reflection of light should appear in the same position in both eyes
40
STRABISMUS What is the management of amblyopia?
- Early Tx = better to avoid damage, <7y ideal - Refractive adaptation = wear appropriate glasses for 16-18w - Occlusion of 'good' eye (part/full time) to force weaker eye to develop - Atropine drops in better eye causing vision in that eye to be blurred
41
STRABISMUS What are the aims of strabismus management?
- Restore comfortable binocular single vision - Eliminate diplopia - Restore good alignment of the eyes
42
STRABISMUS What are some conservative techniques for strabismus?
- Glasses/contact lenses - Prisms for diplopia - Orthoptic exercises to improve control over eye muscles
43
STRABISMUS What medical treatment can be given in strabismus?
- Botox injections = paralyse the muscle that is pulling the eye in a certain direction - Esotropia = MR, exotropia = LR - May need repeat injections as effects wear off, ketamine anaesthesia
44
STRABISMUS What surgery may be offered in strabismus?
- Strengthening procedure = resection of muscle on side eye does not face - Weakening procedure = recession of muscle on side the eye goes towards - Esotropia = bilateral MR recession or MR recession + LR resection - Exotropia = bilateral LR recession or LR recession + MR resection
45
HEARING What are the 3 types of hearing loss?
- Sensorineural = nerve damage (progressive, never reversible) - Conductive = obstruction in ear canal which prevents sound from getting through, bone conduction can still transmit sound (often reversible) - Mixed
46
HEARING What are some causes of conductive hearing loss?
- #1 = congestion behind eardrums (viral URTI) - Glue ear, ear wax, middle ear infection, perforated ear drum - Structural abnormality of the outer ear (syndromes)
47
HEARING What are some causes of sensorineural hearing loss?
- Genetic or syndromes - Perinatal (trauma, infection, hypoxia) - Congenital infections (rubella, CMV) - Meningitis (pneumococcus can cause ossification of cochlear)
48
HEARING What are some risk factors for conductive hearing loss?
- Down's syndrome, - craniofacial syndromes - cleft palate
49
HEARING What are some risk factors for sensorineural hearing loss?
- Premature, - FHx - consanguinity
50
HEARING How might hearing loss present?
- Parental concern - Incidental finding on screening - Problems with speech, behaviour or education (ignoring calls or sounds)
51
HEARING What are some behavioural changes that might occur in hearing loss?
- Sits near TV + volume loud - Misunderstands/slow in responding or answers incorrectly - Soft/fuzzy speech - Does not turn immediately when named called
52
HEARING What 2 types of hearing tests are part of the newborn hearing screening programme (NHSP)?
- Evoked otoacoustic emission (EOAE) - Auditory brainstem response (ABR) audiometry if EOAE fails
53
HEARING What is evoked otoacoustic emission? What are the pros? What are the cons?
- Earphone produces sound which evokes an echo from ear if cochlear function normal - Simple + quick - Misses auditory neuropathy, cochlear test not hearing, high false +ve in first 24h
54
HEARING What is auditory brainstem response audiometry? What are the pros? What are the cons?
- Computer analysis of EEG waveforms evoked in response to auditory stimuli - Screens hearing pathway ear>brainstem, low false +ve rate - Affected by movement (time consuming), electrodes on infant's head, complex computerised gear
55
HEARING What testing might be done in children 6–9m?
- Distraction testing - Relies on baby locating + turning appropriately to high + low frequency sounds out of field of vision - 2x trained staff
56
HEARING What testing might be done in children 10–18m?
- Visual reinforcement audiometry - Hearing thresholds are established using visual rewards (illumination of toys) to reinforce the child's head turn to stimuli of different frequencies - First test that does single ear measures
57
HEARING What hearing tests are done at... i) >2y? ii) >2.5y? iii) 4y?
i) Performance testing = child performs an action when hear a noise ii) Speech discrimination tests (McCormick toy test) iii) Pure tone audiometry at school entry = child responds to pure tone stimulus with headphones
58
HEARING What are 3 main investigations in hearing?
- Rinne's test (mastoid then external acoustic meatus) - Weber's (forehead in midline) - Audiograms
59
HEARING What does Rinne's test show you?
- Normal = louder at EAM - Conductive = louder on mastoid - Sensorineural = both decreased
60
HEARING What does Weber's test show you?
- Normal = vibrations equal in both ears - Conductive = louder in abnormal ear - Sensorineural = louder in normal ear
61
HEARING What do audiograms show you?
- Frequency (Hz, x) low>high + volume (dB, y) bottom = loud - Anything above 20dB line is normal - Sensorineural = both air + bone conduction impaired (>20dB) - Conductive = only air conduction impaired (>20dB), bone normal - Mixed = both impaired but air worse (>15dB difference)
62
HEARING What are some complications of hearing issues?
- Developmental delay (speech + language) - Social/behavioural problems (too loud or too quiet) - Impact on education, friendships/social life + psychologically
63
HEARING What is the management of conductive hearing loss?
- Most self-limiting so watch + wait - ENT referral for insertion of grommets to help drain excess fluid if necessary - Temporary hearing aids or if permanent cause
64
HEARING What is the management of sensorineural hearing loss?
- Hearing aids > aim to improve hearing so as much speech audible as possible - Cochlear implants reserved for profound hearing loss (>95dB), high frequency, bilateral hearing loss or meningitis related
65
HEARING What is the management of mixed hearing loss?
- Correct conductive problem first + then offer hearing aid
66
DEVELOPMENT MDT What is the child development service?
- MDT + multi-agency (health, social services, education) with aim of providing coordinated service with good inter-agency liaison to meet the functional needs of the child
67
DEVELOPMENT MDT What is the role of child developmental services?
- Liaise between home, school + the child's care needs - Assess child's functional ability + need - Provide therapy + psychosocial support where needed - Ensure health needs of child are met
68
DEVELOPMENT MDT Name some members of the child development services MDT and their role
- Paediatrician = Ax, Ix + Dx, continuing medical Mx, coordination - Physio = balance + mobility, prevent contractures, mobility aids - OT = ADLs, house adaptations - SALT = feeding, speech + language development - Dietician = advice on nutrition - Social worker = benefits - Psychologist = cognitive testing, behaviour management - Specialist health visitor + key workers = coordinate MDT + multi-agency care
69
SEIZURES What is a seizure?
- Sudden disturbance of neurological function due to excessive neuronal discharge
70
SEIZURES What are some causes of seizures?
- Epilepsy - Febrile convulsions - Metabolic (hypoglycaemia, hypocalcaemia) - Head trauma, infection (meningitis, encephalitis) - Toxins, iatrogenic (post-brain surgery)
71
FEBRILE CONVULSIONS What is a febrile convulsion?
- Seizures provoked by a fever in otherwise normal children
72
FEBRILE CONVULSIONS When does it happen?
Usually early in viral infections as temperature rises rapidly
73
FEBRILE CONVULSIONS What is the epidemiology?
- 3% of children, - 6m–6y - often genetic predisposition
74
FEBRILE CONVULSIONS What are the 3 types?
- Simple - complex - febrile status epilepticus
75
FEBRILE CONVULSIONS What is a simple febrile convulsion?
- Generalised (tonic-clonic) seizure - <15m - Typically no recurrence within 24h - Recovery within 1h
76
FEBRILE CONVULSIONS What is a complex febrile convulsion?
- Focal seizure - 15–30m - May recur within 24h
77
FEBRILE CONVULSIONS What is a febrile status epilepticus?
A complex febrile convulsion that lasts for over 30 minutes
78
FEBRILE CONVULSIONS What are some complications of febrile convulsions?
- Usually no lasting damage - 1 in 3 will have another febrile convulsion - 2-7% will develop epilepsy after simple, 10–20% after complex
79
FEBRILE CONVULSIONS What is the management of febrile convulsions?
- Period of observation, paeds referral if first seizure or complex - Antipyretics have NOT shown to reduce risk of recurrence - Education = stay with them, ensure safe, nothing in mouth, call 999 if lasts >5m, teach how to use PR diazepam or buccal midazolam if Hx of prolonged seizures (>5m)
80
EPILEPSY What is epilepsy?
- Recurrent tendency to have unprovoked seizures
81
EPILEPSY What are the 2 phases?
- Ictal = early phase w/ positive Sx such as excessive activity (jerky actions) - Post-ictal = later phase w/ negative Sx such as weakness, drowsiness
82
EPILEPSY What are some causes of epilepsy?
- 2/3rd idiopathic, FHx, alcohol/drugs (+ withdrawal) - Brain injury (hypoxia, trauma, surgery) - SOL (tumour, abscess) - CNS infection (meningitis, encephalitis)
83
EPILEPSY What are the two different types of seizures?
- Focal/partial seizures = arise from one area of cortex or part of one hemisphere - Generalised = discharge arises from both hemispheres
84
EPILEPSY What are the 3 types of partial seizures?
- Simple-partial = consciousness + awareness - Complex-partial = without consciousness + awareness - Secondary generalised = seizures start in one hemisphere but then spread to both (focal>general)
85
EPILEPSY How would a partial seizure present in... i) frontal lobe? ii) temporal lobe? iii) parietal lobe? iv) occipital lobe?
i) Strange smells, motor movements, Jacksonian march ii) Déjà/jamais-vu, automatisms (chewing, lip smacking), hallucinations, aura/sensations, amnesia iii) Contralateral altered sensations (tingling, electric-shock) iv) Flashing lights, eyelid fluttering, eye movements
86
EPILEPSY What is... i) Jacksonian march? ii) Todd's paresis?
i) Motor twitch starts on one side of body then "marches" over a few seconds to affect larger parts of both like entire hand, foot + may generalise ii) Focal weakness in a part or all of the body after a seizure
87
EPILEPSY What are the 4 main types of generalised seizures?
- Absence seizures - Tonic-clonic seizures - Myoclonic seizures - Atonic (akinetic) seizures "drop attacks"
88
EPILEPSY What are absence seizures?
Brief (<30s) pauses where activity stops (still, silent, stares), may have slight eyelid flickering, can be precipitated by hyperventilation
89
EPILEPSY What is the epidemiology of absence seizures?
- Onset 4-8y, - F>M, - may progress tonic-clonic later
90
EPILEPSY What are the investigations for absence seizures?
EEG = 3hz generalised spike, symmetrical
91
EPILEPSY What is the prognosis for absence seizures?
Good, 90% seizure free in adolescence
92
EPILEPSY What is a tonic-clonic seizure?
- Tonic = vague warning, rigidity, falls + may make sound, LOC + can stop breathing - Clonic = convulsions, bilateral rhythmic muscle jerks, irregular breathing, may tongue bite (lateral) or urinary incontinence - Post-ictal = drowsy, confused, irritable or depressed
93
EPILEPSY What is a myoclonic seizure?
- Brief, sudden muscle contractions like jerk of limb, face or trunk - Usually remains awake, can occur in juvenile myoclonic epilepsy - Can be physiological (hiccups, sleep myoclonus)
94
EPILEPSY What is an atonic (akinetic) seizure/drop attack?
- Brief, sudden loss of muscle tone causing a fall but no LOC - Often begin in childhood, ?indicate Lennox-Gastaut syndrome
95
EPILEPSY What are 4 epilepsy syndromes seen in children?
- Infantile spasms (West's syndrome) - Lennox-Gastaut syndrome - Juvenile myoclonic epilepsy - Benign Rolandic epilepsy = M>F, paraesthesia (unilateral face, tongue, twitching) during sleep, EEG shows centrotemporal focal spike waves
96
EPILEPSY Who is affected by infantile spasms?
- Early life (4-6m), M>F, often secondary to serious neuro abnormality (tuberous sclerosis, encephalitis, birth asphyxia)
97
EPILEPSY What is the management of infantile spasms?
Vigabatrin or corticosteroids (poor prognosis)
98
EPILEPSY What are the 3 components to infantile spasms?
- Violent flexor spasms of head, trunk + limbs followed by extension of arms (salaam spasms) for 1-2s, can repeat up to 50 times - Progressive mental handicap - EEG shows hypsarrhythmia
99
EPILEPSY What is Lennox-Gastaut syndrome? How does it present? Management?
- Can be extension of infantile spasms, 1-5y - Atypical absences, falls, jerks + 90% have mod-severe mental handicap - EEG shows slow spike, ketogenic diet may help
100
EPILEPSY Who is juvenile myoclonic epilepsy more common in? How does it present? Management?
- Teens, F>M - Infrequent generalised seizures (often morning), daytime absences, sudden shock-like myoclonic seizures (can happen before seizures) - Good response to valproate
101
EPILEPSY What are some investigations for epilepsy?
- Mostly clinical Dx + witness Hx crucial - Exclude organic causes with FBC, U+E, LFTs, glucose, ECG - EEG, often sleep deprived or hyperventilate to provoke - ?Neuroimaging (CT/MRI head) if focal neurology + concerns of SOL
102
EPILEPSY What is the general management of epilepsy? What are the treatment principles?
- Ensure little harm, maintain airway, do not restrain - Aim for monotherapy, maximum tolerated dose before changing or adding drugs, avoid abrupt withdrawal
103
EPILEPSY What is the management of generalised seizures?
- 1st line = sodium valproate - 2nd line = lamotrigine, carbamazepine (TC), clonazepam (myoclonic)
104
EPILEPSY What is the management of myoclonic seizures?
- 1st line = sodium valproate - 2nd line = clonazepam
105
EPILEPSY What is the management of focal seizures?
- 1st line = carbamazepine or lamotrigine - 2nd line = levetiracetam or sodium valproate
106
EPILEPSY What is the management of absence seizures?
- Ethosuximide or sodium valproate
107
EPILEPSY What is a note about treatment with carbamazepine?
- Can exacerbate absent + myoclonic seizures
108
EPILEPSY What last line treatments may be used in epilepsy?
- Vagal stimulation, - surgery (hemispherectomy, non-dominant lobectomy)
109
'FUNNY TURNS' What are the triggers for reflex anoxic seizures?
- Pain or discomfort, - cold food, - fright (emotions)
110
'FUNNY TURNS' What are the causes of reflex anoxic seizures?
Cardiac asystole from vagal inhibition to heart (syncopal episode)
111
'FUNNY TURNS' What is the clinical presentation of reflex anoxic seizures?
- Child becomes pale + falls to floor, - hypoxia may induce generalised tonic-clonic seizure which is brief + child RAPIDLY recovers
112
'FUNNY TURNS' What are the investigations for reflex anoxic seizures?
- Ocular compression under controlled conditions often lead to asystole - paroxysmal slow-wave discharge on EEG
113
'FUNNY TURNS' What are the triggers for breath holding attacks?
Upset, worked up or angry
114
'FUNNY TURNS' What is the clinical presentation of breath holding attacks?
- Child cries, holds their breath + goes cyanotic, - sometimes brief LOC but RAPID recovery
115
'FUNNY TURNS' What are breath holding attacks associated with?
Linked with Fe anaemia so treating as such may minimise further ones
116
'FUNNY TURNS' What are some other causes of 'funny turns'?
- Syncope - Migraine - Benign paroxysmal vertigo - Cardiac arrhythmias - NEAD - Fabricated by parent or child
117
'FUNNY TURNS' What is the presentation of syncope?
- Clonic movements may occur, - triggers like hot/stuffy, - standing long
118
'FUNNY TURNS' What is the presentation of migraine?
- Can happen ± headache, - unsteadiness/light headedness with other classic migraine Sx
119
'FUNNY TURNS' What is the presentation of benign paroxysmal vertigo?
- Nystagmus, - unsteady, - headache
120
DISORDERS Name 2 neurocutaneous disorders What is the mode of inheritance for these conditions?
- Neurofibromatosis (type 1 + 2) + tuberous sclerosis - AD
121
NEUROFIBROMATOSIS What is the clinical presentation of neurofibromatosis 1?
- No intellectual problems but lots of skin involvement - >5 café-au-lait spots - Axillary freckling in skin folds - Iris hamartomas, scoliosis + pheochromocytomas - Peripheral neurofibromas
122
NEUROFIBROMATOSIS What is the clinical presentation of neurofibromatosis 2?
- Hearing problems with no skin involvement - Bilateral vestibular schwannomas > sensorineural hearing loss then tinnitus + vertigo
123
TUBEROUS SCLEROSIS What are the cutaneous features of tuberous sclerosis?
- Hypopigmented 'ash-leaf' spots which fluoresce under UV light - Roughened (Shagreen) patches of skin over lumbar spine - Angiofibromas (butterfly distribution over nose) - Subungual fibromata
124
TUBEROUS SCLEROSIS What are some other features of tuberous sclerosis?
- Neuro = epilepsy (infantile spasms or partial), developmental delay + intellectual impairment - Retinal hamartomas, - polycystic kidneys, - rhabdomyomata of heart
125
TUBEROUS SCLEROSIS What are the investigations?
CT/MRI will detect calcified subependymal nodules + tubers from 2nd year of life
126
NEURAL TUBE DEFECTS What are neural tube defects?
- Failure of normal fusion of the neural plate to form neural tube during first 28d pregnancy
127
NEURAL TUBE DEFECTS What are the risk factors?
If you have a child with neural tube defect there is 10x increased risk of second foetus having similar problems
128
NEURAL TUBE DEFECTS What are neural tube defects associated with?
- Insufficient folic acid - anti epileptic drugs
129
NEURAL TUBE DEFECTS What are 5 different types of neural tube defects?
- Spina bifida occulta (#1) - Meningocele - Myelomeningocele (most severe) - Anencephaly - Encephalocele
130
NEURAL TUBE DEFECTS What is spina bifida occulta?
- Failure of fusion of the vertebral arch, often incidental XR finding
131
NEURAL TUBE DEFECTS What is the presentation of spina bifida occulta?
Site may have identifiable birthmark, lipoma or hair patch (lumbar)
132
NEURAL TUBE DEFECTS What is the management of spina bifida occulta?
Neurosurgery
133
NEURAL TUBE DEFECTS What is meningocele?
- Sac of fluid protruding spinal canal (without neural tissue), not exposed
134
NEURAL TUBE DEFECTS What is a myelomeningocele?
- Sac of fluid protruding spinal canal (with neural tissue), open lesion
135
NEURAL TUBE DEFECTS How may a myelomeningocele present?
- Paralysis of legs, - dislocation of hip + talipes, - sensory loss, - neuropathic bladder + bowel, - scoliosis - hydrocephalus from Chiari malformation
136
NEURAL TUBE DEFECTS How does Chiari malformation lead to hydrocephalus?
- Herniation of cerebellar tonsils + brainstem > foramen magnum = disrupt CSF flow
137
NEURAL TUBE DEFECTS What is the management of myelomeningocele?
- Close back lesion, - physio for paralysis, - ?indwelling catheter, - shunt
138
NEURAL TUBE DEFECTS What is anencephaly?
- Failure to develop cranium + brain, - stillborn or die rapidly
139
NEURAL TUBE DEFECTS What is the management of anencephaly?
Antenatal USS Dx with TOP usually performed
140
NEURAL TUBE DEFECTS What is encephalocele?
- Brain + meninges extrude through midline skull defect
141
NEURAL TUBE DEFECTS What is the management of encephalocele?
- Surgical correction but often underlying cerebral malformations
142
NEURAL TUBE DEFECTS What can be used as prophylaxis for neural tube defects?
- Folic acid (0.4mg for normal pregnancies, 5mg if high risk
143
OTITIS MEDIA What is otitis media?
- Acute infection of middle ear, affects most children, common 6–12m
144
OTITIS MEDIA What are some causes of otitis media?
- Viral (RSV, rhinovirus) - Bacterial - pneumococcus, Group A strep, H.Influenzae
145
OTITIS MEDIA What are some complications of otitis media?
- Extracranial = mastoiditis, tympanic membrane perforation, glue ear - Intracranial = meningitis, abscess, venous sinus thrombosis
146
OTITIS MEDIA What is the management of otitis media?
- Regular pain relief (paracetamol, ibuprofen) - Most resolve spontaneously, may need amoxicillin/co-amoxiclav
147
OTITIS MEDIA Who is most at risk?
Younger children as Eustachian tubes short, horizontal + function poorly
148
OTITIS MEDIA What is the clinical presentation of otitis media?
Ear pain, fever, reduced hearing ± coryza
149
GLUE EAR What is glue ear/otitis media with effusion (OME)?
- Most common cause of conductive hearing loss in children
150
GLUE EAR What is the management?
- Insertion of ventilation tubes (grommets) to drain excess fluid - Adenoidectomy as adenoids can harbour organisms + obstruct Eustachian tube so poor ventilation + drainage
151
GLUE EAR What investigations would you do?
- Otoscopy (TM appears dull + retracted, often with visible fluid level) - Flat trace on tympanometry + evidence of conductive loss on pure tone audiometry (or reduced hearing on distraction test if younger)
152
GROMMETS what are grommets?
tiny tubes inserted into the tympanic membrane they allow fluid to drain from the middle ear into the ear canal
153
DEAFNESS what are the different types of deafness?
sensorineural conductive
154
DEAFNESS At what volume does deafness begin to cause problems with development?
hearing loss up to 20dB does not affect development loss over 40dB affects speech and language development
155
DEAFNESS what are the causes of sensorineural hearing loss?
Inherited/genetic - ushers syndrome, Waardenburg syndrome Acquired - perinatal - birth asphyxia, hyperbilirubinemia, congenital infection (rubella, CMV, syphilis) - postnatal - drugs, meningitis, head injury, labyrinthitis, acoustic neuroma
156
DEAFNESS what are the causes of conductive hearing loss?
External - ear canal atresia/stenosis Middle ear - acute/chronic otitis media, glue ear
157
PERIORBITAL CELLULITIS what is it?
an infection of the eyelid or skin around the eye
158
PERIORBITAL CELLULITIS what is the clinical presentation?
Unilateral eyelid swelling and erythema Unilateral eye pain/tenderness Fever/malaise/irritability Ptosis Consider history of foreign body or traumatic eye injury
159
PERIORBITAL CELLULITIS what are the causes?
- following minor injury to the eye - following another infection such as cough or cold
160
PERIORBITAL CELLULITIS what are the investigations?
- assessment of eye movements - visual acuity - assessment of cranial nerves + pupillary responses - CT sinus and orbits with contrast medium - bloods - WBC, blood cultures
161
PERIORBITAL CELLULITIS what is the management?
Mild = oral co-amoxiclav/cefuroxime + metronidazole for 7-10 days Moderate-severe = immediate referral to hospital + IV cefotaxime/clindamycin can also consider incision, drainage and culture of any abscesses
162
PERIORBITAL CELLULITIS what are the complications?
can progress to orbital cellulitis - infection involves the deeper tissues around the eye and the eyeball itself

My Phase 3a Revision (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions