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z Pediatrics - Final > 4 - Special Needs Pop > Flashcards

4 - Special Needs Pop Flashcards

1
Q

Neurodevelopmental disorder

-4 categories

A

Socializing
Language and communication
Problem solving
Physical

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2
Q

Autism spectrum disorder

-defined by…

A

A common set of behaviors and should be characterized by a single name according to severity

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3
Q

Autism spectrum disorder

-prevalence

A

Greatly incr over last 20 years
-may be due to changes in the definition, incr awareness

Est. 1/59 children have

4-5x’s more likely in males

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4
Q

Autism spectrum disorder
-etiology
—pathogenesis
—factors - genetic and environmental

A

Pathogenesis not completely understood

Genetics

  • may alter brain development
  • multiple genes responsible
  • MRI indicates ASD indiv use different patterns of connectivity, cognitive strategy, and brain areas to process info

Environmental
-little evidence

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5
Q

Autism spectrum disorder

-comorbidites (main point)

A

1/5 with ASD are dx with a psychiatric disorder by adulthood (anxiety, depression, ADHD, OCD, etc.)

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6
Q

Autism spectrum disorder

-deficits in social communication and interaction (4)

A

Social reciprocity - how actions of one affect others

Joint attention - wanting to share an interest

Nonverbal - using or interpreting

Social relationships - developing/maintaining friendships

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7
Q

Autism spectrum disorder

-examples of restricted repetitive patterns of behavior, interests, and activities

A

Lining up toys

Flapping hands

Fixed on routine

Restrictive thinking

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8
Q

Autism spectrum disorder characteristics

-sensory issues (examples)

A

Over/under-reacting to stimuli

Stereotyped body movements (hand flapping, rocking, bouncing)

Unusual behaviors (looks from angles, sniffs/licks objects, toe walks)

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9
Q

Autism spectrum disorder characteristics

-social difficulties (examples)

A

Relating to/expressing emotions

Limited eye contact, use/understanding of non-verbal gestures

Flat/limited facial expressions

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10
Q

Autism spectrum disorder characteristics

-communication

A

Very limited verbal comm

Primarily to have needs met, not socially

Late development of language

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11
Q

Autism spectrum disorder

-diagnosis (3)

A

Observe behaviors

Listen to caregivers’ observations

Given a severity score (1/mild - 3/severe)

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12
Q

Autism spectrum disorder

-examining children with ASD

A

Ask about triggers, what will keep them motivated during exam

Limit wait time

Offer quiet alternative if needed

Consider shortened exam or breaks

End on a positive note

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13
Q

Autism spectrum disorder
-pre-exam questions
—what is echololia

A

Repeat whatever you say

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14
Q

Autism spectrum disorder

-what to say during pt education

A

“Everything is normal for your child”

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15
Q

Intellectual disability

-describe

A

Previously “mental retardation”

Limitations in intellectual functioning, adaptive behavior

Onset before age 18

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16
Q

Intellectual disability

-epidemiology

A

~1% of population, 85% of those are mild

Males more likely

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17
Q

Intellectual disability

-IQ test basics

A

Major tool in measuring intellectual functioning

Below/around 70 indicates limited functioning

18
Q

Intellectual disability: Down syndrome

-epidemiology

A

Most common chromosomal condn diagnosed in the USA

~6000 babies born annually (1/700)

19
Q 
Intellectual disability: Down syndrome
-genetics
—trisomy 21
—translocation
—mosaic
A

T21: ~95%, not hereditary, but spontaneous

Tr: ~3%, of these cases 1/3 have a hereditary component

M: ~2%, some cells have three copies of 21, others only two copies
-may have fewer features of the condn due to some cells having normal number of copies

20
Q

Intellectual disability: Down syndrome

-only association that has been verified to be linked with DS

A

Mother’s age

21
Q

Intellectual disability: Down syndrome
-prenatal dx
—screening
—diagnostic

A

S: estimates the chance, bloodwork and ultrasound

D: chronic villus sample (CVS) and amniocentesis, 1% risk of miscarriage but nearly 100% accurate

22
Q

Intellectual disability: Down syndrome

-dx at birth

A

Prescence of certain physical traits

  • low muscle tone
  • single, deep palm crease
  • slightly flattened facial profile
  • upward slanted eyes

Karyotype to confirm

23
Q

Intellectual disability: Down syndrome

  • cognitive impairment
  • developmental delays
  • social skills
A 
Mild = IQ 50-70
Severe = IQ 20-35

Static development

Impaired

24
Q

Intellectual disability: Down syndrome

-associations (5)

A 
Hearing loss
Otitis media
Obstructive sleep apnea
Congenital heart defects
Delayed dental eruption, hypodontia
25
Q

Intellectual disability: Down syndrome
-vision problems
—frequency
—common findings (6)

A

60%

Significant RE/need glasses (50%)
Strab, pseudo strab/prominent epicanthal folds (47%)
Nystagmus (33%)
Brushfield spots (35-78%)
Amblyopia
Keratoconus
26
Q

Intellectual disability: Down syndrome

-refractive error

A

Usually high astigmatism and hyperopia

Rx to prevent amblyopia

27
Q

Intellectual disability: Down syndrome

-glasses

A

Need to fit flat nasal bridge

Brand Specs 4 Us

28
Q

Intellectual disability: Down syndrome

-accommodation

A

Insufficiency

May benefit from bifocal, reading glasses

29
Q

Intellectual disability: Down syndrome

-brushfield spots

A

Multiple, round, focal areas on anterior surface of iris

Appear beige or light brown/grey

Areas of stromal HYPERplasia surr by relative HYPOplasia

More common with lightly pigmented irises (Europeans)

Not pathognomonic

30
Q

Intellectual disability: Down syndrome

-reduced VA

A

May be normal to have between 20/30 and 20/60 BCVA

Studies show reduced low contrast and Vernier acuity

31
Q

Intellectual disability: Down syndrome

-cataracts

A

Congenital

Cerulean

  • blue dot opacities in anterior and posterior capsule
  • bilateral
  • do not affect VA
  • stable, non-progressive
32
Q

Intellectual disability: Down syndrome

-nystamus

A

Rapid, horizontal most common

Latent next most common

Can be assoc with decr acuity

33
Q

Intellectual disability: Down syndrome

-strabismus

A

ET most common

  • congenital or infantile
  • accommodative
  • do not confuse with spasm of accomm
34
Q

Intellectual disability: Down syndrome

-amblyopia

A

Iso or anisometropic

Strabismic

Important - avoid atropine penalization due to cardiac abnormalities (patching works)

35
Q

Intellectual disability: Down syndrome

-keratoconus

A

Onset early adulthood

Possible etiologies

  • incr eye rubbing
  • steeper K with higher astigmatism rate
  • genetic link to chromosome 21
36
Q

Intellectual disability: cerebral palsy

-describe

A

Disorder of movement, muscle tone, or posture that’s caused by damage that occurs to the immature (often developing) brain, usually before birth

Every case is unique to individual

37
Q

Intellectual disability: cerebral palsy

-etiology

A

Caused by abnormality/disruption in brain development, usually before born

Factors include

  • mutations
  • maternal infection
  • fetal stroke
  • infant infection
  • traumatic head injury
  • lack of oxygen (asphyxia)
38
Q

Intellectual disability: cerebral palsy

-signs

A

Doesn’t usually present until infancy/childhood due to use of muscles

Impaired movement, abnormal reflexes
Rigidity of limbs, trunk
Abnormal posture
Involuntary movements
Unsteady walking
39
Q

Intellectual disability: cerebral palsy

  • effect on functional abilities
  • may also occur (3)
  • commonly have eye…
A

Greatly varies

Epilepsy, blindness, deafness

Eye muscle imbalance

40
Q 
Intellectual disability: cerebral palsy
-severity
—mild
—mod
—severe
A

Mi: can move w/o assitance, daily activities not limited

Mo: needs braces, meds, and adaptive technology for daily activities

Se: requires wheelchair, significant challenges in daily acitivities

41
Q

Intellectual disability: cerebral palsy

-locations (4)

A

Monoplegia (one limb, usually arm)
Hemiplegia (R or L side)
Diplegia (legs or arms)
Quadriplegia

42
Q

Intellectual disability: cerebral palsy
-motor function
—spastic
—non-spastic

A

S: increased muscle tone (e.g. clenched wrist/hand)

NS: decr or fluctuating muscle tone

z Pediatrics - Final (17 decks)

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