Neurology

Question 1

what type of headache is most concerning?

Answer 1

chronic progressive

Question 2

what is chronic non-progressive headache most likely related to?

Answer 2

primary headache disorder

Question 3

what are the signs/sx of tension headache?

Answer 3

• non-pulsating pressure/tightness
• pain mild to moderate
• NOT associated with n/v, photophobia
• 1 hr to several days

Question 4

what is a key difference between migraine in pediatrics vs. adults?

Answer 4

children can have bilateral headaches and can be frontal or temporal

Question 5

what are pediatric headache “red flags”

Answer 5

waking up from sleep with headache

associated with cough/defecation

explosive or sudden onset headache

progressive pattern (increased severity or frequency)

altered mental status

systemic symptoms

Question 6

What does the SMART acronym stand for in pediatric headache management?

Answer 6

Sleep modification

Meals

Activity - regular exercise

Relaxation - stress reduction

Trigger avoidance

Question 7

when would you consider triptans in a pediatric patient >6 years?

Answer 7

NSAID use >2 or 3 days/week

Question 8

what is the prevalence of epilepsy in the US population?

Answer 8

1%

Question 9

what seizure type is more common in children v. adults?

Answer 9

generalized seizures

Question 10

Does a normal EEG exclude epilepsy?

Answer 10

No

(it does make absence seizures less likely)

Question 11

what are the criteria for febrile seizure?

Answer 11

convulsion associated with temperature greater than 38 degrees C in a child older than three months and younger than six years

without CNS infection, inflammation or acute systemic metabolic abnormality

Question 12

what is the epidemiology of febrile seizures?

Answer 12

male>female

mc neuro disorder of young children

3% of children < 5 years

peak 12-18 months

1/3 recurrent

Question 13

what are the risk factors for febrile seizure?

Answer 13

peak temperature during illness

1st degree relative with f.s.

neurodevelopmental delays

HSV6 exposure

vaccinations for DTaP, Influenza may be assoicated

50% no identifiable risk factor

Question 14

what is the treatment for febrile seizures?

Answer 14

antipyretics DON’T help

rectal diazepam

daily antieptileptics not routinely recommended

Question 15

how is status epilepticus defined in peds?

Answer 15

at least 5 minutes of continuous seizure activity or intermittent convulsive activity without regaining consciousness

long-term damage concerns at 30 minutes or greater

Question 16

what’s the epi of status epilepticus?

Answer 16

1/3 initial event

1/3 patient with established epilepsy

1/3 other (trauma, infection, toxic ingestion, etc.)

Question 17

what’s a tool for figure out height and weight in a child who is not conscious for medication dosing?

Answer 17

Brazelow tape

Question 18

Status Epliepticus management in the pediatric patient:

Answer 18

A,B,Cs - 100% 02

IV access

blood glucose

meds (see subsequent card)

Question 19

What’s the pharmacologic management of seizures?

Answer 19

benzos every 5 minutes for a max of 3 doses

phenytoin (dilantin)

phenobarbitol (respiratory depression)

Question 20

what percentage of children have one unprovoked afebrile seizure and never have one again?

Answer 20

most (50-60%)

Question 21

who is epilepsy defined in childhood?

Answer 21

2 or more unprovoked afebrile seizures

Question 22

What is the PECARN rule for concussion?

Answer 22

A way to avoid imaging:

severe MOI: airbag deployment, rollover, death of another passenger, fall over certain height

Question 23

what are the Zurich Guidelines for Return to Play?

Answer 23

Question 24

what’s the epi of migraine?

Answer 24

Prevalence 1-3% in children age 3 – 7 years

Prevalence 8-23% in adolescents