Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Specialties > Paeds Written - NEURO > Flashcards

Paeds Written - NEURO Flashcards

1
Q

Plagiocephaly signs O/E

A

Unilateral flat occiput

Ipsilateral ear pushed forward

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

Plagiocephaly management

A

REASURRANCE

Conservative:

  • turning cot
  • tummy time during day
  • supervised supported sitting
  • moving toys/mobiles in cot to change baby focus & head position
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Salaam attacks - definition & what condition are they seen in?

A

Repeated flexion of heads/arms/trunk –> extension of arms
Lasts 1-2 seconds
Repeated up to 50X

Seen in West’s syndrome (Infantile Spasms)

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

Key IX findings in West’s syndrome (infantile spasms)

A

EEG –> dramatic hypsarrhythmia

CT –> diffuse or localised brain disease e.g. tuberous sclerosis

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

Most common cause of cerebral palsy?

A

Antenatal (80%) - cerebral malformation, congenital infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Most common form of Cerebral palsy? Key clinical signs/sx?

A

Spastic (70%)

3 forms:

  • Hemiplegia
  • Diplegia
  • Quadriplegia

Increased muscle tone
Abnormal gait

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Area of damage in Spastic cerebral palsy?

A

Upper motor neurons in periventricular white matter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Area of damage in dyskinetic cerebral palsy?

A

Basal ganglia & substantia nigra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Key Signs & Sx of dyskinetic cerebral palsy?

A

Athetoid movements - slow, writhing motions of hands/feet
Oro-motor issues
Difficulty holding objects (fluctuating muscle tone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Key Signs & Sx of ataxic cerebral palsy?

A

Cerebellar signs

  • Nystagmus
  • Ataxia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Medications for spasticity in cerebral palsy

A

Oral diazepam
Oral & intrathecal baclofen
Botulinum toxin Type A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What monitoring is required whilst taking Ritalin (Methylphenidate)?

A

Height & weight every 6 months

ECG before starting tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Management of ADHD

A

10 week watch + wait period
If Sx persist –> referral to specialist Paediatrician or CAMHS

1st line = behavioural therapy + educational intervention at school
- E.g. parent training programmes

2nd line = methylphenidate (Ritalin)

  • only if 5 yrs +
  • trial for 6 weeks
  • other options if poor response OR good response but cannot tolerate SE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SE of Ritalin (methylphenidate)

A

Abdo pain
Nausea
Dyspepsia

Effect on growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

IHS Criteria for Paediatric migraine without aura

A

At least 5 episodes lasting 4-72 hours

with 2 of the following:

  • affects frontal or temporal region
  • triggered by strenuous activity
  • pulsating
  • moderate/severe intensity

and 1 of the following:

  • photophobia/phonophobia
  • associated nausea or vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Medication options for Paediatric migraine

A

Ibuprofen > Paracetamol

Triptans

  • over 12 yrs
  • sumatriptan nasal spray licensed (taste = poor tolerance)
  • NOT oral

Prophylaxis

  • unclear evidence
  • GOSH 1st line = pizotifen + propranolol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

IHS criteria for Paediatric tension headache

A

At least 10 episodes lasting 30 minutes –> 7 days

with at least 2 of:

  • pressing/tightening (non pulsating)
  • mild/moderate intensity
  • bilateral location
  • no aggravation by routine physical activity

AND both of following:

  • no nausea, vomiting
  • no photophobia and phonophobia (or only 1)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Abx for Paediatric meningitis

A

<3 months = Cefotaxime + amoxicillin/ampicillin

> 3 months = Cefotaxime/Ceftriaxone
+/- IM benzylpenicillin ASAP (in community?)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Criteria for giving Dexamethasone in meningitis

A

Over 3 months (or > 1 month and H. influenzae)

Frankly purulent CSF
Bacteria on gram stain
WBC >1000/uL
Raised WCC + protein >1g/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Purpura fulminans - what is it? complication of what?

A

Seen in meningitis

Haemorrhagic skin necrosis from DIC
Acute
Blood spots/bruising of skin
Can be fatal

Tx = FFP, debridement, amputation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Contraindications to an LP

A 
Cardio-resp instability
Focal neuro signs
Signs of raised ICP - papilloedema, high BP with low HR
Coagulopathy
Local infection at LP site
Meningococcal septicaemia

Causes undue delay in starting Abx Tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Benign rolandic epilepsy key signs/Sx

A

Night time seizures

Focal/partial motor seizures, Paraesthesia
Usually 1 side of face and/or muscles of speech & swallow
Can develop into generalised tonic-clonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Juvenile myoclonic epilepsy key Signs/Sx

A

12-19 year olds
affect neck, shoulders, upper arms
Most occur after waking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What anti-seizure medication should be avoided in myoclonic seizures

A

Lamotrigine - makes seizures worse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What anti-seizure medication should be avoided in absence seizures

A

Carbamazepine - makes seizures worse

26
Q

Tonic-clonic seizure meds

A

Sodium valproate

Lamotrigine, Carbamazepine, Oxcarbazepine

27
Q

Absence seizure meds

A

Sodium valproate, Ethosuximide

Lamotrigine

28
Q

Myoclonic seizure meds

A

Sodium valproate

Levetiracetam, topiramate

29
Q

Focal seizure meds

A

Carbamazepine, lamotrigine

Leviteracetam, oxcarbazepine, sodium valproate

30
Q

Sodium valproate key side effects

A

Hair loss (transient)
Weight gain
Liver failure - rare

31
Q

Carbamazepine key side effects

A 
Rash
Neutropenia
Hyponatraemia (SIADH)
Enzyme inducer - careful with COCP!
Ataxia
32
Q

Lamotrigine key side effects

A

Stevens-Johnson syndrome

33
Q

Status Epilepticus Tx pathway

A
  1. Airway + high flow O2 + check BM
  2. 5 mins convulsing:
    - if existing vascular access (or can be established quickly) = IV or IO Lorazepam 0.1mg/kg
    - if not = buccal midazolam 0.5mg/kg OR rectal diazepam 0.5mgkg
  3. Call for senior help + Lorazepam 0.1mg/kg IV or IO
    - prepare phenytoin
    - re-confirm epileptic seizure
  4. Senior help should be present
    - ICU / anaesthetist advice
    - consider retcal paraldehyde
    - give phenytoin 20mg/kg IV or IO over 20 mins

NOTE: if already on phenytoin, give phenobarbitone (same dose) at 5 mins

  1. still seizing –> rapid sequence induction, intubation + ventilation
    - done by anaesthetist
34
Q

Myelomeningocele clinical features

A

Variable neuro deficit

Small defect:

  • mobility issues
  • intellectual impairment
  • bladder dysfunction

Large defect:

  • loss of lower lim function
  • anaesthesia
  • urinary / faecal incontinence
35
Q

Key Examination finding in Spina Bifida Occulta

A

Cutaneous markers over side of failed vertebral fusion

  • hair tuft
  • port wine stain
  • sinus
36
Q

Indications for CT scan of head (within 1 hour)

A

Head injury

+ two or more of:

  • LOC > 5mins
  • Abnormal drowsiness
  • 3+ discrete episodes of vomiting
  • dangerous mechanism/high impact
  • amnesia >5 mins (anterograde or retrograde)

OR one or more of:

  • non accidental injury
  • post-traumatic seizure
  • GCS <14 or 2 hours after injury GCS < 15
  • suspected open/depressed skull fracture
  • tense fontanelle
  • basal skull fracture signs
  • focal neuro deficit
  • child <1 year and bruise, swelling or laceration >5cm on head
37
Q

Basal skull fracture signs

A

Raccoon eyes
Battle sign - bruising over mastoid
Rhinorrhoea, otorrhoea

38
Q

Extradural haemorrhage clinical features

A

Lucid interval
THEN deteriorating concsiousness
+/- seizures
+/- focal neuro signs - dilatation of ipsilateral pupil, contralateral limb paresis

39
Q

Subdural haemorrhage clinical features

A

Gradually decreasing GCS
No lucid interval

Forms part of ‘shaken baby’ tirad with

  • retinal haemorrhages
  • encephalopathy
40
Q

Subarachnoid haemorrhage clinical features

A

Acute onset head pain
neck stiffness
fever
+/- seizures or coma

(May have Hx of known aneurysm or AVM)

41
Q

Grading of intraventricular haemorrhage

A

Grade I = germinal matrix only

Grade II = intraventricular but no enlargement

Grade III = intraventricular + enlargement

Grade IV = into surrounding brain tissue

42
Q

Complications of intraventricular haemorrhage

A

Grade 3/4 –> long term brain injury

Blood clots within ventricles –> hydrocephalus

Periventricular white matter damage (periventricular leukomalacia) –> spastic cerebral palsy

43
Q

Causes of communicating hydrocephalus

A

Meningitis - pneumococcal, TB

Subarachnoid haemorrhage

44
Q

Signs & Sx of hydrocephalus

A 
Increased head circumference
Tense fontanelle
Papilloedema
Ataxic gait
6th CN palsy
Sunset sign - eyes driven down bilaterally
45
Q

Medical & surgical options for hydrocephalus

A

Surgical:
Ventriculo-peritoneal shunt
- may need replacing if becomes blocked/infection
Endoscopic tx - creates ventriculostomy

Medical: Furosemide - inhibit CSF production

46
Q

Types of Tic

A

Motor
Vocal
Phonic

47
Q

Prognosis of Tic disorder

A

1 in 3 rule:

1 in 3 have no tic as adult
1 in 3 - mild
1 in 3 - severe

48
Q

Non-medical strategies for treating Tic disorder

A

Self help

  • sleep & stress management
  • encourage parents NOT to draw attention or punish tic

Habit reversal therapy - teach another movement to ‘compete’ with tic

Exposure & response prevention - help child adjust to unpleasant sensation experienced before a tic

49
Q

Medical Tx of Tic disorder

A

1st line = antipsychotic e.g. risperidone

2nd line

  • clonidine - treat ADHD at same time
  • Clonazepam
  • tetrabenazine - only for tics with underlying condition e.g. Huntington’s
  • Botilunum toxin - lasts <3 months
50
Q

Criteria to diagnose Neurofibromatosis Type 1

A

Need 2+ of the following:

6+ cafe au last spots (>5mm pre-puberty, >15mm post-puberty)
>1 neurofibroma
Axillary freckling
Optic glioma +/- visual impairment
1 Lisch nodules (haemartoma on iris) - seen on slit lamp examination
Bony lesions from spheroid dysplasia +/- eye protrusion
Affected 1st degree relative

51
Q

Inheritance of Neurofibromatosis Type 1

A

Autosomal dominant
High penetrance
variable expression

52
Q

Cutaneous features of Tuberous Sclerosis

A

Woods Lamp (medical LED) –> ‘Ash leaf’ /Fitzpatrick patch / amelanocytic naevi

Shagreen patches - rough skin on lumbar spine

Angiofibromata - butterfly facial distribution

53
Q

Neuro features of Tuberous sclerosis

A

Infantile spasms / West’s syndrome

  • seizures
  • progressive developmental delay

Focal epilepsy

Intellectual disability (often with ASD)

Non-communicating hydrocephalus (from subependymal giant cell astrocytoma)

54
Q

Ix & results in Tuberous sclerosis

A

CT –> calcified subependymal nodules, tubers
- seen from 2 years +

NOTE: MRI is more sensitive

55
Q

Key clinical features of Sturge-Weber syndrome

A

Port wine stain in region of trigeminal nerve

Epilepsy
Intellectual disability
Contralateral hemiplegia
Glaucoma
Phaeochromocytoma
56
Q

Most common forms of somatisation in children

A

Recurrent abdo pain - peaks 9yo, sharp, colicky

Recurrent headaches - peak 12yo

Limb pain, aching muscles, fatigue, other neuro Sx - peaks >12 yo

57
Q

Most common Paediatric CNS tumour

A

Pilocytic astrocytoma (WHO grade I)

58
Q

Subtentorial tumour signs/sx

A

Cerebellar ataxia
Long tract signs - increased tone, brisk reflexes, clonus
CN palsies

59
Q

Supratentorial CNS tumour signs/sx

A

Focal neuro deficit
Seizures
Personality change

60
Q

Best imaging for CNS tumours

A

MRI > CT / PET

61
Q

CNS tumour management - general principles

A

Surgery = 1st line

  • resect as much as possible
  • minimise damage to normal tissue

Radiotherapy - for low & high grade gliomas, mets

Chemotherapy (incl biological agents) - for high grade gliomas

Specialties (35 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions