Neuro
A key piece of CNS exam
Fundoscopic exam
Nocturnal seizures, focal/face, activated by drowsiness
What are Benign Rolandic Seizures -
AKA: childhood epilepsy with centrotemporal spikes
typically in ages 3-13 year olds
This is also the "common cold"
What is Rhinovirus
This is the most common cause of the common cold - however many other viruses can cause URI symptoms
AIR
What is the recommended management for GINA TRACK 1 (adolescents)?
AIR - The Global Initiative for Asthma (GINA) Track 1 recommendation for adolescents (aged 12 and older) uses an anti-inflammatory reliever (AIR) strategy.
It specifies as-needed low-dose inhaled corticosteroid-formoterol as the preferred reliever across all treatment steps—used as-needed for mild asthma (Steps 1–2) and combined with daily maintenance therapy (MART) in Steps 3–5
REMEMBER -
What is Acute Bacterial Rhinosinusitis.
Remember -
Pain, pressure localized to affected sinus à URI +
Fever, cough > 10days, + nasal discharge > 10 days or longer without improvement --> think Acute Bacterial Rhinosinusitis
Need antibiotics and possible ENT referral for drainage
REMEMBER - AYA patients may present with occipital headaches specifically (don't forget about tumors but get a good history of symptoms and timeline and think ABRS)
At least 2 unprovoked (or reflex) seizures occurring > 24 hours apart
One unprovoked seizure and the probability of further seizures
What is the definition of Epilepsy
4-8 month old with cluster of flexor/extensor spasms, common upon waking
What are Infantile spasms (West Syndrome)
Triad of West Syndrome: Infantile spasms, hypsarrhythmia, MR
ID's and treated early - better outcomes
6-8 a year
This is how many colds children tend to have a year.
This number increases to 10-12 if in day care - and decreases as we age.
This is a source of carer anxiety and often needs much education as to symptom management and importantly when to return to the office or go to the ED.
Viral infection, Exercise. Allergens and Smoke?
What are Asthma triggers -
SO - ask the questions and make sure to address environment, activity and exposures (including location of housing and occupation) in your HEADSSS.
And - once answered guidance on cleaning, hygiene and how to mitigate exposures is key - otherwise they may continue to have symptoms regardless of medications and TRACK steps used.
This is key as the PNP-PC!
Sweet remedy that may help relieve nighttime coughing and therefore improve sleep
What is Honey?
Ideally local honey - can be expensive so be mindful but a nice option for those not wanting to take meds or who do not need meds at this time -
From slide -
Honey - WHO
◦Antioxidant and antimicrobial effects (Gram +/-) Staph aureus, Strep faecalis, pseudomonas
◦Mani et al (2019) - study showed honey to be effective in symptomatic relief of child nocturnal cough and sleep difficulties related to URTI.
◦In the absence of safe and effective anti-tussive drugs, honey should be considered as an effective and safe treatment of cough
Biofeedback, Adequate sleep, Healthy diet, Exercise
What are nonpharmacological therapies for headache management
EEG with no activity but patient having active movement on clinical exam
What is the description of Psychogenic Non-Epileptic Seizures
Paroxysmal non-epileptic events that are not associated with EEG changes
A real condition that is thought to be a response to stress, non-intentional, less likely to have incontinence with event
Measures expiratory flow?
What is Peak Flow Meter
Remember -
Daily symptoms and night waking
What are - questions we should ask about at each visit as they suggest level of asthma.
Ex - night waking 2-3 times a week and using inhaler weekly = persistent asthma
Within 48hrs of symptoms
What is starting antivirals for Influenza specifically.
REMEMBER - Antiviral not recommended for mild URI - no matter how many times they ask!!!
ANTIVIRALS - recommended for Influenza virus –may decrease severity if started early for those at high risk for serious complications (48hrs)
◦Tamiflu (oseltamivir) (po, 2weeks and older), Xofluza (baloxavir –marboxil) (po, 12 and older), Relenza (zanamivir) (inhaled, 7 and older),
Rapivab (IV, 6 months and older)
carbamazepine, gabapentin, oxcarbazepine, phenobarbital, phenytoin, and Ethosuximide
What are narrow spectrum medications for seizures
Focal seizures - carbamazepine, gabapentin, oxcarbazepine, phenobarbital and phenytoin
CAE (Absence) seizures - Ethosuximide
Documented headache over 3 or more consecutive cycles, occur exclusively on day 1+/-2days
In at least 1 out of 3 menstrual cycles and no other time of the cycle
What is a Menstrual Migraine
Different from a menstrually related migraine that occurs additionally at other times of the cycle
In pure menstrual migraine without aura hormone therapy is more likely to be effective
Most are viral in origin?
What are URIs...most are viral in origin.
50% resulting from infection by rhinovirus
Parainfluenza viruses, Respiratory Syncytial Virus (RSV), Coronavirus, and Human Metapneumovirus – Common
Adenovirus, Enterovirus (EV D68- 2014), Influenza virus can cause occasionally (still circulating)
Spread by inoculation of the nose and possibly conjunctiva
◦Direct inhalation of the virus by droplet from sneezing, coughing, nose blowing
◦Can spread from touching nasal secretions or contaminated object or surface and touching eyes, nose or mouth- the virus gains entry and produces a new infection!
Drooling, tripod positioning and severe sore throat suggests this
What is Epiglottis
This has been eliminated by the HIB vaccine for most but...
We are seeing it in our older patients - so be aware in your AYA patients.
Life-threatening and tripoding is a main clinical presentation along with drooling
Single dose of ceftriaxone 500mg, IM
What is the dose of antibiotics to treat oral gonorrhea - remember the sore throat slide - YOU NEED TO ASK THE QUESTIONS especially if rapid strep is negative-
oAsk history of sexual activity
oThese questions need to be specific
oNot all consider oral-genital contact “sexual activity”
oBacterial infection so need to treat with antibiotics
oMay also need to treat for Chlamydia trachomatis – not automatic 2021
oSingle dose of ceftriaxone 500mg, IM (weigh less than 150kg) & 1g Ceftriaxone for those weighing >/= 150kg
oAND…
oDoxycycline 100 mg po twice a day for 7 days (Chlamydia)
oTest of Cure 7-14 days after treatment (throat infection)
o Keep this in mind when you have a sexually active AYA presenting with mild URI symptoms!
Headache diary and lifestyle modifications
Individualized approaches to headache management
Naproxen, Ibuprofen, Acetaminophen, Excedrine migraine
What are first-line abortive medications for headaches/migraine after nonpharmacological
Leads to nasal congestion, runny nose, scratchy throat, cough?
What is a URI - remember the patho-
Viruses invade the cells of the respiratory tract
Trigger inflammation and production of mucous
Leads to nasal congestion, runny nose, scratchy throat, cough- common symptoms of a URI
Can develop feeding problems and dehydration - at all ages so we need to educate about this!
*****Direct invasion of the mucosa lining the upper airway -->Inoculation of the V/B -->Hand touches pathogen à hand touches nose/mouth-->Direct inhalation of respiratory droplets from infected cough/sneeze -->V/B hit barriers -->Cilia lining nose filters/traps some pathogens – but not all à infection --> Mucous coating URT traps pathogens – but not all stop infection
Pathogens Get Past The Barriers!
This leads to --> Local swelling, erythema, edema, secretions, fever à result from inflammatory response of the immune system to the invading pathogens (and toxins produced by the pathogens)
*****Patients with suboptimal humoral and phagocytic immune function are at increased risk of URI. So if you are seeing a patient with a history in the past 6 months to 1 year with frequent infections - THINK Immune deficiency!
Conjunctivitis with URI symptoms
What is Adenovirus.
If you see this presentation or have report of crusty, sticky eyes along with URI symptoms think Adenovirus.
This does not change management - outside of education on viral conjunctivitis and care as this can move to a bacterial infection needing abx drops - so EDUCATE!
Can be diagnosed on an RVP
Most common chronic childhood illness
What is ASTHMA -
Know GINA for Adolescent tracks!
Remember - NO MONOTHERAPY!