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139 Cards in this Set
- Front
- Back
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A child has altered mentation, fever and headache. If you are given the following information, what is the most likely etiology of her encephalitis?
Warm climate Mosquito |
West Nile or St. Louis. These are arboviruses
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A child has altered mentation, fever and headache. If you are given the following information, what is the most likely etiology of her encephalitis?
Preceding irritability and confusion. Generalized neurologic findings Transmitted human to human |
Enterovirus
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A child has altered mentation, fever and headache. If you are given the following information, what is the most likely etiology of her encephalitis?
Non-specific findings. |
HSV. Diagnose with HSV PCR
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A child has altered mentation, fever and headache. If you are given the following information, what is the most likely etiology of her encephalitis?
Parotitis Orchitis Teenager from another country Late winter Early Spring |
Mumps
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A 2yo presents with fever and seizure. She is lethargic for about one hour after the seizure. The CBC is is normal, and the LP is consistent with viral meningitis. What is the treatment?
A) Reassurance B) Phenobarbital C) Dilantin D) Acyclovir E) Steroids |
D. This is likely HSV encephalitis.
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A 15yo comes in with a headache that she describes as a band-like pressure across her forehead. What is the treatment?
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Remove the stressor. This is a tension headache.
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A 16yo comes in for headache that she has been experiencing every day for several weeks, malaise, excessive sleeping and declining performance in school. What is the underlying etiology and diagnosis?
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Tension Headaches from Depression
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A 14yo boy comes in with headache and photophobia. Which of the following would NOT be an appropriate treatment?
A) Sumitriptan SQ B) Ibuprofen C) Tylenol D) Fluids and Rest E) Ergotamines |
A. Subcutaneous sumitriptan is not a treatment option for kids with migraines.
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A 9yo has had recurrent headaches for several months. She had a minor CHI after a fall from the monkey bars several months ago, but had no LOC at that time. The headaches are frontotemporal and are not relieved with tylenol or naproxen or ibuprofen. What is your next step in management now?
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Stop all medications. She probably has headache from chronic use of the OTC meds.
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An 8yo is brought in by his grandmother because she has noted that the boy has not been walking straight and has been doing progressively worse in school. The child complains of headache that is worst when he wakes up in the morning. His grandmother became especially concerned when she found him inducing vomiting. What is your suspicion and your next step?
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He likely has a space-occupying posterior fossa tumor and needs a head CT.
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A 13yo is brought to the hospital becomes his mother found him to be confused and disoriented. His past medical history is significant for chronic liver failure. What is his likely diagnosis?
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Encephalopathy. This can be seen in older kids with liver failure, kidney failure, pulmonary disease, and cardiac pathology.
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A 3yo boy is brought in because his mom found him in the bathroom confused and lethargic. His LP is normal as is his CT head. What is the most likely diagnosis?
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Encephalopathy due to toxic ingestion.
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A 3yo is brought in lethargic. His blood glucose was 27. D50 has been given twice and his sugar is still only 42. What is the likely cause?
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Ingestion of oral hypoglycemic agents.
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An afebrile 2 day old is non-responsive. What is you next diagnostic test(s)?
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Organic acidemia and ammonia
Neo Coma Order Organic Ammonia |
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What is the genetic inheritence pattern and pathology in Wilson's disease?
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It is an autosomal recessive disease in which the liver cannot get rid of copper, so it accumulates in the liver, kidney, eye and brain.
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A 2yo is found to be lethargic and non-responsive. She has elevated liver enzymes and mild ascites, but a normal ammonia level. What is her diagnosis?
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Wilson's disease.
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A 15yo is brought in because he has been acting strange lately. He has had tremors, difficulty with handwriting, depression and abnormal eye movements. What do you imagine on slit lamp exam?
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Kaiser-Fleischer rings.
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Which of the following lab values is NOT consistent with Wilson's disease?
A) Low Ceruloplasmin B) High Serum copper C) Hemolytic Anemia D) High urine copper E) Calcium abnormalities |
B. Serum copper is low because most of it is deposited into soft tissue. Urine copper is high because whatever is there is being excreted.
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How do you treat Wilson's disease? What are complications of untreated Wilson's disease?
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Chelation with penicillamine and a low copper diet. Untreated, it can cause liver failure or death
Remember a copper penny for penicillamine. |
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A neonate has congestive heart failure with hydrocephalus and a cranial bruit. What do you suspect?
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Vein of Galen malformation
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A 7yo otherwise healthy girl is brought to the ED because she was noted to have an unsteady gate. She is afebrile now, but recently recovered from chicken pox. What is the most likely cause of her ataxia?
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Post viral ataxia.
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A 2yo who has lymphoma comes in with an abnormal gait. She is also noted to have the a spider like rash on her face, and pigmentation of the eye. Her vision is normal, but her cognitive development is delayed. What is her most likely diagnosisis?
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Ataxia Telangiectasia
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A 3yo is brought in because she has never been able to attain a steady gait. She is now also developing a rash on her cheeks and nose. She has frequent URI and pneumonia spells which has prompted you to do an immune workup which reveals decreased immunoglobulin and decreased T-cells. What is you diagnosis?
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Ataxia Telangiectasia.
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What is the genetic inheritence of ataxia telangiectasia?
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Autosomal recessive
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A 12yo presents with a slow and clumsy gait. She has diagnosis of friedrich's ataxia. Which of the following is not associated with this disorder?
A) Elevated plantar arch B) Absence of lower extremity DTR C) DM D) Renal Disease E) Cardiac Disease |
D.
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What is the most common cause of inherited ataxia?
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Friedrich's Ataxia
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A 6yo is fidgety in class, has poor tone, and has quick random, jerky movements. She has difficulty paying attention in class because she becomes emotional. What is your next step?
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Obtain antistreptolysin O levels. This is Sydenham Chorea
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True or False.
Sydenham is one of the major Jones criteria for rheumatic fever. |
True
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A child had a strep pneumonia about 4 months ago and is suspected to have Sydenham's Chorea but the antistreptolysin titers are normal. What do you suspect?
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Sydenham's is not ruled out.
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A 7yo has been having jerky movements in class and is especially emotionally labile. She is excessive rigidity on exam. What is her diagnosis?
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Huntington's Chorea
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What is the genetic inheritence pattern of Huntington's chorea?
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autosomal dominant
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A 2yo has a fixed upward gaze. He is alert and vitals are stable. There is some suspicion for a toxic ingestion. What is your treatment of choice?
A) Rectal diazepam B) NG tube C) Diphenhydramine (benadryl) D) Syrup of ipecac E) Activated charcoal |
C.
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A 10yo with ADHD has been on methylphenidate for 3 years. He briefly experienced repetitive eye blinking which has since resolved spontaneously. He has no other problems. What is the most likely explanation of the eye blinking? What is the most appropriate intervention?
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This is likely a simple motor tic and does not need any treatment.
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True or False.
Tics are often caused by anxiety disorders. |
False. They may be associated with them, but not caused by them.
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A 7yo has been having jerky movements in class and is especially emotionally labile. She is excessive rigidity on exam. What is her diagnosis?
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Huntington's Chorea
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What is the genetic inheritence pattern of Huntington's chorea?
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autosomal dominant
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A 2yo has a fixed upward gaze. He is alert and vitals are stable. There is some suspicion for a toxic ingestion. What is your treatment of choice?
A) Rectal diazepam B) NG tube C) Diphenhydramine (benadryl) D) Syrup of ipecac E) Activated charcoal |
C.
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A 10yo with ADHD has been on methylphenidate for 3 years. He briefly experienced repetitive eye blinking which has since resolved spontaneously. He has no other problems. What is the most likely explanation of the eye blinking? What is the most appropriate intervention?
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This is likely a simple motor tic and does not need any treatment.
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True or False.
Tics are often caused by anxiety disorders. |
False. They may be associated with them, but not caused by them.
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True or False.
Choreiform movements are repetitive jerking movements which can not be voluntarily suppressed. |
True
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How do you distinguish Tourette's syndrome from a simple tic?
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Tourette's tics are present for at least 1 year persistently and do not start until 2-3 years after starting stimulant medications.
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A 12yo boy has been on Ritalin for ADHD since he was 8yo. He is doing well in school and has no behavioural problems at home either. He has developed a tic of his left arm that has been persistent for about a year now. His parents are concerned about the tic, and wonder if the Ritalin should be stopped. How do you reply?
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No. Do not stop the ritalin.
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What is the most common supratentorial tumor in kids?
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Craniopharyngioma
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An afebrile 9yo boy comes in with recurrent headache and neckpain. He complains that he is not able to see the board well at school. He is afebrile and on exam you not bilateral visual deficits. What is your next step? What is your diagnosis and treatment?
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Next step is CT or MRI brain. Diagnosis is Craniopharyngioma and treatment is surgery or radiation.
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A 15yo has fallen off her growth curve. She has also developed headaches and vision problems. She also has developed hypothyroidism and is amenorrheic. Her skull film has a calcification in the sella turcica. What is the most likely diagnosis and treatment?
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Craniopharyngioma
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True or false.
Optic nerve gliomas are malignant tumors often associated with neurofibromatosis? |
False. They are benign but do affect vision in which case they need to be radiated.
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A 1 month old infant presents with irritability, decreased PO intake, macrocephaly, wide sutures and bulging fontanelle. She has downward deviation of her eyes. She is afebrile and hemodynamically stable. What is your next step?
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CT Head or MRI brain
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A 7yo comes in with headache, ataxic gait, and vision problems. On exam she is afebrile, but is bradycardic and has a BP of 190/100. What is your next step?
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Steroids, then imaging.
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A 15yo comes in complaining of double vision, papilledema, headache and tinitis. She has no prior medical problems and does yoga daily and eats plenty of vitamins and minerals, A-Zinc. What is the study of choice? What is the diagnosis and treatment?
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This is most likely pseudotumor cerebri. It will typically have increased ICP, but test of choice is MRI. Treat with carbonic anhydrase inhibitors (acetazolamide).
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Which of the following medications or class of meds is not associated with pseudotumor cerebri?
A) Steroids B) Thyroxine C) Antidepressants D) Antibiotics E) Lithium |
C.
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What is the suspected type of disorder and differential diagnosis for a patient who presents with the following presentation?
Acute Proximal weakness affecting hips and shoulders |
Acute muscular disorder.
Polymositis Dermatomyositis Electrolyte imbalance |
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What is the suspected type of disorder and differential diagnosis for a patient who presents with the following presentation?
Chronic Proximal weakness |
Muscular disorder (chronic)
Muscular dystrophy Mitochondrial myopathies Congenital myopathies |
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What is the suspected type of disorder and differential diagnosis for a patient who presents with the following presentation?
Progressive onset |
Neuromuscular junction
Myasthenia Gravis |
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What is the suspected type of disorder and differential diagnosis for a patient who presents with the following presentation?
Progressive onset with rapid descending weakness. |
Neuromuscular junction
Botulism |
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What is the suspected type of disorder and differential diagnosis for a patient who presents with the following presentation?
Acute Loss of DTR (5 differentials) |
Acute peripheral nerve process.
Guillan Barre Polio Diptheria Tick Paralysis Lead Poisoning |
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What is the suspected type of disorder and differential diagnosis for a patient who presents with the following presentation?
Chronic loss of DTR (3 differentials) |
Chronic demyelinating polyneuropathy
Hereditary neuropathies Leukodystrophy |
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What is the suspected type of disorder and differential diagnosis for a patient who presents with the following presentation?
Loss of motor and sensory function with loss of bladder or bowel function and increased reflexes. |
Spinal cord weakness
Transverse myelitis Anterior spinal artery infarction Spinal Cord compression (tumor) Epidural abscess Tethered cord Trauma |
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A 7yo girl is carried into the ER by her father in the middle of the night because she woke up crying that she couldn't move.
By the time she arrived to the ED, she had dizziness, was orthostatic and on exam, had areflexia. Her temp was 36.8, respiratory rate was 12 and HR was 140 in sinus rhythm. You have done an LP. What do you expect? How should you monitor this child? How should you treat her? |
LP should show increased protein in CSF. You must monitor her breathing with PFTs, peak flow, or ABG. Treatment for Guillian Barre is with airway support, plasmapheresis and IVIG.
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True or False.
First line treatment for suspected Guillane Barre is steroids. |
False. Steroids have no role in Guilliane Barre
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Do Tick bites cause ascending or descending paralysis?
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Ascending.
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A 12yo girl present to your office complaining of excessive fatigue especially by the end of the day. Here is her picture. How do you confirm your suspicion of myesthenia gravis?
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Give them a short acting ACH-ase inhibitor...this leaves ACH in the field and gives temporary relief of symptoms. This is the Tensilon test (edrophonium)
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True or False.
Babies born to mothers who have myasthenia gravis are predisposed to transient myasthenia gravis. |
False.
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A patient presents with an acute dystonic reaction with neck hyperextension and decreased extra-ocular movements. His vitals are stable. He was recently put on reglan for constipation. What is your immediate step?
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Give benadryl.
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A patient has a positive Tensilon test. What other tests can support your suspicion of Myasthenia Gravis?
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Anti-smith antibodies and an EMG
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What is the chronic treatment of Myasthenia Gravis?
A) Pyrodostigmaine B) Plasmapheresis C) Thymectomy D) Edrophonium E) Steroids |
D. Edrophonium is for testng only. It is too short acting for treatment. Pyrodostigmaine which inhibits acetylcholinesterase is the mainstay, but the rest are good second line and third line agents.
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How long does it take for transient myasthenia gravis to resolve in infancy?
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6 weeks. It takes that long for the mother's antibodies to disappear.
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For the following issues regarding myasthenia gravis in infancy, A= congenital, B=transient, C= both, D = neither.
1. It is lifelong. 2. It will resolve within 6 weeks 3. Babies will have ptosis 4. Will respond to Tensilon test |
1. A: It is due to a genetic defect in the neuromuscular junction, so it is lifelong.
2. B. This is when mom's antibodies will go away. 3. A. Only in congenital 4. C. Both will respond to tensilon test. |
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A 2 month old is brought in floppy and not eating well. She is constipated and has a weak cry, but is afebrile. On exam, she is listless, and she is having trouble breathing. Mom was not present when this happened, the child was with a new nanny when it occurred. What is your first step in management?
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This is botulism. Airway protection likely with intubation.
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How do you distinguish the following?
Guillane Barre Botulism Myasthenia Gravis |
Guillane Barre is ascending paralysis and is has DTR loss.
Botulism is descending paralysis and rapid onset. Myasthenia is also descending paralysis but takes weeks to occur. |
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What is the difference in terms of mechanism between Botulism and Myasthenia gravis?
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Myasthenia has antibodies against the acetylcholine receptor. Botulinum toxin inhibits the release of ACH.
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A 12yo girl has a proximal muscle weakness and a butterfly malar rash. What is your next test?
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Check CPK. If high, this is dermatomyositis.
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What is the genetic inheritence and pathology of Duchenne's muscular dystrophy? Which is the chromosomal anomaly? How do you diagnose it?
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X-linked and absence of dystrophin can be seen on muscle biopsy.
Xp21 genetic testing can also be done. |
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True or False.
Boys with Duchenne's MD typically do not attain or are delayed in achieving first year developmental milestones. |
False. They do achieve early milestones.
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What are the first signs of Duchenne's MD?
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Poor head control in infants and lordotic posture in toddlers.
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What are typical physical and lab findings of Duchenne's MD?
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Hypertrophic calves
Gower's sign Elevated CPK |
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What is the most frequent cause of death in boys with Duchenne's MD?
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Cardiomyopathy leading to CHF or Respiratory failure
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True or False
Boys with Duchenne's MD do not have tongue or eye involvement. |
True. They don't wiggle their tongue and roll their eyes at you!
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True or False
You can safely assume that mom is a carrier if she has a son with Duchenne's MD. |
False. She can have elevated CPK, but 1/3 of them are not carriers.
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True or False
Myotonic muscular dystrophy affects striated and smooth muscle. |
True
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A 5 year old has difficulty in relaxing his fingers after letting go of a crayon. He also has diastolic cardiac dysfunction. What is his diagnosis? How do you confirm it?
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Myotonic muscular dystrophy. Confirm with muscle biopsy
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For the following issues regarding muscular dystrophy, A= Duchenne's, B= Myotonic, C= both, D = neither.
1. Autosomal recessive 2. Autosomal dominant 3. X-linked recessive 4. X-linked dominant 5. Elevated CPK 6. Smooth and Striated 7. Striated only 8. Distal muscle involvement 9. Proximal muscle involvement 1. It is lifelong. 2. It will resolve within 6 weeks 3. Babies will have ptosis 4. Will respond to Tensilon test |
A= Duchenne's, B= Myotonic, C= both, D = neither.
1. Autosomal recessive = D 2. Autosomal dominant = B 3. X-linked recessive = A 4. X-linked dominant = D 5. Elevated CPK = C 6. Smooth and Striated = B 7. Striated only = A 8. Distal muscle involvement = B 9. Proximal muscle involvement = A |
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A 17yo IV drug user comes in with fever and lower back pain. On hospital day 2 the nurse tells you the girl has had bladder incontinence and on exam you also note bilateral paresthesia, Increased reflexes, and decrease rectal tone. What is your next step?
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Stat MRI spine and consult Neurosurgery. Treatment is with Vanc and ceftriaxone and surgery.
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A 9yo boy has chronic sinusitis and as such you get a head and face CT. You note a space occupying lesion. What is this?
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Brain Abscess most likely.
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True or False.
Cyanotic heart disease, pulmonary disease and chronic sinusitis are associated with brain abscess. |
True
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A 10yo boy had the flu last weak but now has sudden onset of weakness, hypotonia and decreased reflexes. This is followed by increased tone and hyperreflexia. The CSF has increased PMN and a negative gram stain. There is pain on palpation of his spinal canal so you do an MRI which reveals cord swelling. What is your major concern? What is your diagnosis? And what is the prognosis?
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This is acute transverse myelitis or Post-infectious myelitis. The major concern is airway. Most cases resolve spontaneously over a few months.
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A patient has extrinsic spinal cord mass lesion. What should you do while waiting for neurosurgery to show up?
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Give steroids.
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For the following issues, A= Werdig-Hoffman Disease, B = Botulism, C= both, D = neither.
1. Motor and Sensory involvement 2. Motor involvement only 3. Problem at neuron-muscle synapse 4. Problem at anterior horn 5. Hypotonia 6. Poor suck 7. Tongue fasciculations 8. Full recovery 9. Death by age 2yo |
A= Werdig-Hoffman Disease, B = Botulism, C= both, D = neither.
1. Motor and Sensory involvement = B 2. Motor involvement only = A 3. Problem at neuron-muscle synapse = B 4. Problem at anterior horn = A 5. Hypotonia = C 6. Poor suck = C 7. Tongue fasciculations = A 8. Full recovery = B 9. Death by age 2yo = A |
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An infant is noted to have a patch of hair on the base of his spine. He also has a sacra dimple. When you see him, you note a discrepancy in leg strength, elevated arches and gait abnormalities. What is the test that would idenitfy the diagnosis?
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MRI of the spine
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What is a myelomeningocele?
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It is a protrusion of the spinal cord and surrounding membranes through a defect in the vertebral column.
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Who needs to be consulted in the early ocurrence of a myelomeningocele?
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Othro, Urology and neurosurgery.
Ortho Neurosurgery Urology |
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If you suspect myelomeningocele, who should you consult after obtaining the MRI?
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Orthopedics and Urology
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True or False.
Kids with spina bifida are cognitively delayed from infancy and progressively worsen. |
False. They are normal or well through preschool, then they begin to decline. IQ is typically low-average.
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If there is high suspicion for spinal trauma what should be your first step?
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methylprednisolone 30mg/kg
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When do you use each of the following medications as related to spinal/CNS problems?
Methylprednisolone Dexamethasone Mannitol |
You use methylprednisolone for spinal trauma and dexamethasone for spinal cord compression and mannitol for increased ICP.
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This type of seizure occurs within the first month of life. What is it?
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Neonatal seizure
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This type of seizure affects only one part of the body. The child remains awake during this type of seizure. What is it?
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Simple Partial Seizure
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This type of seizure affects only one part of the body. The child is unaware of what is happening during this type of seizure. What is it?
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Complicated Partial Seizure
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A child sits in class and stares into space without any awareness of her environment. She does this multiple times throughout the day. What do you expect on EEG?
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This is an absence seizure. 3 per second spike and wave on eeg.
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For each of the following indicate which is it describing: A= abscence
B = Complex partial seizure 1. Less than 30 seconds 2. Abrupt in onset 3. Abrupt in ending 4. Gradual in onset 5. Gradual in ending 6. Post-ictal phase 7. Child may initially be aware of seizure. |
A= abscence
B = Complex partial seizure 1. Less than 30 seconds = A 2. Abrupt in onset = A 3. Abrupt in ending = A 4. Gradual in onset = B 5. Gradual in ending = B 6. Post-ictal phase = B 7. Child may initially be aware of seizure. = B |
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What is an easy and free test you can use to diagnose abscence seizures?
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Have the child hypervenitlate
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What is the treatment and prognostic factor of abscence seizures?
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Ethosuximide. Age is the best prognostic factor. The earlier that they are treated, the more likely they will respond to therapy.
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This type of seizure occurs in the first year of life and is associated with mental retardation and a poor prognosis. What is it?
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Infantile spasm
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What is the definition of status epilepticus?
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Seizure activity greater than 30 minutes or repeated seizures with no return to normal in between.
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What are the two most common causes for a child who has a treated seizure disorder to have a breakthrough seizure?
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Non-compliance or Patient has outgrown the dose.
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A child has a sudden onset of motor weakness of only his left arm. His head CT is negative and he is afebrile with a normal CBC. What is your diagnosis?
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Todd's paralysis. This is post-ictal motor weakness.
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A child is brought to the trauma bay in status epilepticus. What is your series of course of actions?
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1. ABC and check Dextrose
2. Ativan 3. IV fosphenytoin or Rectal valium |
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Why do we give fosphenytoin vs. phenytoin?
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Fosphenytoin does not cause skin necrosis like phenytoin does.
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What are the three criteria for a complex febrile seizure? What is the implication?
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> 15 minutes
recurrs < 24h Focal Risk of epilepsy |
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Which of the following kids is not likely to have a second febrile seizure?
A) A 2yo. B) A child with fever of 40 at onset of first seizure C) A child with family history of febrile seizures. D) A child in whom there was minimal time between fever and seizure. |
B. Kids with low fever at time of seizure are more likely to have recurrent febrile seizure.
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What is the "real" risk of epilepsy in a child who has febrile seizures?
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1% vs. 0.5%. But just reassure the parents
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When would you do an LP in a child with a febrile seizure? (2 situations)
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It is a focal seizure or the child is less than 18 mos old.
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During which phase of tonic clonic seizure do the following occur? A=tonic, B=clonic, C=post-ictal
1. Sleeping and confused 2. bladder incontinence 3. Apnea 4. 30 seconds long 5. 1-2 minutes long 6. Flexion of the trunk and extension of the back, arms and legs. |
A=tonic, B=clonic, C=post-ictal
1. Sleeping and confused = C 2. bladder incontinence = B 3. Apnea = B 4. 30 seconds long = A 5. 1-2 minutes long = B 6. Flexion of the trunk and extension of the back, arms and legs. = A |
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What is the drug of choice to treat kids with grand mal seizures?
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Valproic acid
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What is a major side effect of lamictal?
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Stevens Johnson Syndrome
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These are single or repetitive contractions of an isolated group of muscles. The child falls forward. What is this?
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Myoclonic seizure
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True or False.
Children are unaware of having a myoclonic seizure? |
False. There is no impairment of consciousness or memory.
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A 4 month old is noted to have repetitive flexing of her head, trunk and extremities...like she is bowing and saying Salaam. She has about 20-30 of them in a row. Her EEG shows hypsarrhythmias, and she seems to be cognitively delayed. What is your diagnosis and treatment?
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This is infantile spasm. Give her ACTH (or steroids or benzos)
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A 5 month old boy has Wilm's tumor, ash leaf spots and is developmentally delayed. His father has the same disease. What type of seizure is he predisposed to?
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Infantile spasm, as he has the Autosomal dominant tuberous sclerosis.
Remember kids love sweet "potatoes" as in "tuberous" sclerosis. |
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A 4yo child has twicthing movements and lip smacking. His mother says, the child tends to moan when this occurs and he seems to be moaning when the events occur. She has tried to snap him out of it, but that doesn't work, instead the child falls asleep. What is your diagnosis and treatment?
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These are complex partial seizures and treatment is with anti-epileptic drugs.
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What is the main distinguishing factor between simple and complex partial seizures?
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Simple partial seizure has no LOC.
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A 12yo presents with recurrent arm tremor especially when she wakes up in the morning. She is not bothered by it, and it resolves spontaneously. She really does not want any medication for it. Her mother wants to treat her. What do you say?
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The patient does not need treatment as this is a simple partial seizure, which she may grow out of.
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For the following items, indicate whether they are associated with A=Rolandic Seizures, B=complex partial seizures, C = both, D = neither
1. Child is awake and arousable 2. Autosomal dominant 3. Child is conscious 4. Occurs during the day 5. Occurs at night 6. Facial movement 7. Sensory involvement 8. Vocalization |
A=Rolandic Seizures, B=complex partial seizures, C = both, D = neither
1. Child is awake and arousable = D 2. Autosomal dominant = A 3. Child is conscious = A 4. Occurs during the day = B 5. Occurs at night = A 6. Facial movement = C 7. Sensory involvement = A 8. Vocalization = B |
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A 5yo has just been diagnosed with epilepsy. His family just bought a house with a swimming pool and would like to know if the child can swim. What is your reply?
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Yes he can swim, but only with supervision.
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A 16yo has diagnosed epilepsy. His grandfather just bought him a car. His mother wants to know if it okay for her son to drive. What is your reply?
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Yes as long as he has been seizure free for 12 months.
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How long must a child be seizure free before discontinuing medications?
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2 years.
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What are the 4 caveats before withdrawing seizure medication?
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Onset after age 12yo
Neonatal seizures Multiple medications before control of seizures was obtained Diagnosis of juvenile myoclonic epilepsy. |
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What is the most common risk factor for preemies to develop CP?
A) birth asphyxia B) Preeclampsia C) gestational age D) Maternal DM E) Perinatal infection. |
E.
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True or False
Maternal preeclampsia decreases the risk of CP. |
True
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A child has bilateral spasticity of the legs. He was born premature and his walking was delayed. When he does walk, he walks on tiptoe. What is the diagnosis? What do you expect his cognitive function to be?
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This is a spastic diplegic. His cognitive function is excellent
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A child has spasticity of his upper extremities and walking was delayed until age 2yo. What is the diagnosis? What do you expect his cognitive function to be?
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This is spastic hemiplegia. 1/4 have cognitive impairment
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A child has increased tone in all extremities, seizures, feeding problems, vision problems. What is the diagnosis? What do you expect his cognitive function to be?
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He will likely be mentally retarded
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A child has increased tone in all extremities Lower < Upper an also has dystonia and stange movement. What is this?
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Athetoid CP
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An afebrile child with sickle cell disease had a headache and neck pain earlier in the day. She now has focal parlysis. The CT head confirms a CVA. What is the next step?
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Cerebral angiography
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A child presents with acute unilateral hemiparesis; other than blunt trauma to the chest yesterday during football practice, his history is benign. Which diagnostic study would be most helpful?
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Carotid angiography. This is due to the blunt trauma which led to an embolic stroke.
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A child presents with acute hemiparesis and sensorineural deafness. She has an elevated lactate level. What test will establish the underlying diagnosis?
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Molecular analysis of mitochondrial DNA
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For the following indications, indicate whether Head CT or Brain MRI is best. Also pick urgent or non urgent.
1. Hemorrhage 2. Partial seizures 3. HSV 4. Tumors 5. Abscesses |
1. Hemorrhage = CT urgent
2. Partial seizures = Brain MRI, non-urgent 3. HSV = Brain MRI, non-urgent 4. Tumors = CT urgent 5. Abscesses = CT urgent |
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A 4yo girl comes in with saying she feels dizzy. She denies vomiting or LOC and has not been in any recent ships. On exam you note nystagmus and pallor. What is your diagnosis?
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Benign positional vertigo
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True or False
Benign positional vertigo can last several hours or days. |
False.
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True or False
Benign positional vertigo can also have hearing loss. |
False. This would be labyrinthitis.
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