ABP Content Specs #5 General health problems Flashcards
Major Depressive Disorder criteria?
depressed or irritable mood, loss of interests, or pleasure most of hte day nearly every day of past 2 weeks.
sxs cause significant distress or impairment in social, academic, or other areas of functioning
Needs at least 4 of hte following:
- poor appetite/weight gain
- change in sleep patterns
- change in activity level (psychomotor agitation or retardation)
- fatigue/loss of energy
- feelings of worthlessness or excessive/inappropriate guilt (can’t do anything right, failure, shame of family)
- change in concentration
- suicidal ideation
Understanding of death
infants: no understanding of death; just like significant separation
0-2 years: respond to changes in routines, caregivers, emotional stress in family; experience separation anxiety, irritable, regression
preschool 3-5 years: death is temporary/reversible; literal thinking about causes; will link unrelated things to death (transductive reasoning); use magical thinking to explain death (e.g. got sick b/c didn’t eat soup that mom told me to eat)
school age 6- 8 year: death is final/irreversible but not universal; death ‘catches’ elderly/disabled; may be contagious; concerned with safety and predictability
pre-adolescent 9-12 year: adult understanding- death is final/irreversible/universal; understands biological aspects of death; interested in rituals/roles/ceremonies; understand causality - feel guilty about contributing to it; will intellectualize death
adolescent 13-18 year: adult understanding that death is final/irreversible; engages in high-risk activities to challenge own mortality; reject adult rituals and support
What is patient adherence/compliance?
degree to which patient correctly follows medical advice
Vulnerable child syndrome?
-children who have an increased, atypical, or exaggerated susceptibility to disease or disorder due to medical, socio-economic, psychological, genetic, biological, and environmental risk factors
-a child with a real or imagined illness in early life is the target of altered attachment by her parents
-parents start thinking that child is susceptible to illness, injury or loss
-child viewed as fragile, incapable of age-approp behavioral expectations
-leads to ongoing intra-familial stress, altered interaction btwn child and parent, inability to allow age-appro autonomy or set limits
Side effects of atomoxetine?
increased suicidal thinking
rare psych side effects: hallucinations, delusional thinking, mania
new onset motor tics
Side effects of tricyclic antidepressants (imipramine, desipramine, nortriptyline)?
it inhibits reuptake of serotonin and norepinephrine
-s/e: anticholinergic effects (dry mouth, constipation, urinary retention), fatigue, cardiac arrhythmias
Side effects dopamine reuptake inhibitors (buproprion)
-blocks reuptake of NE and DA
-s/e: irritability, insomnia, motor tics, decreased seizure threshold at high doses
S/E of systemic glucocorticoids?
-most sxs are mild and reversible for short duration tx; worse with chronic use
-emotional lability, hypo-mania, mania, depression, psychosis, delirium, confusion, sleep issues (roid rage?)
S/e of beta-agonists (albuterol for asthma)?
-excitement/hyperactive, nervousness, tremor, HA, insomnia, anxiety
S/e of alpha-agonists (guanfacine, clonidine)?
sedation, depression, bradycardia, HA, fatigue
S/e of stimulants?
-psychosis - rare develop symptoms (hallucinations, delusional thinking, mania)
-tics: new onset or worsening of tics in children with existing tic d/o
-tics are c/i for some formulations of methylphenidate
-sleep disturbance, jitteriness, emotional lability, including social withdrawal
premature infants
IVH grades 1?
IVH grade 1: uni/bilateral hemorrhage in germinal matrix (<10%); ventricular area
premature infants
IVH grades 2?
10-50% hemorrhage of ventricular area (w/o ventricular dilation)
premature infants
IVH grades 3?
ventricular dilation, with at least 50% occupied by hemorrhage; might see periventricular echo-densities
premature infants
IVH grades 4?
hemorrhage going into parenchyma; likely cystic PVL
what is PVL (periventricular leukomalacia)?
-if extensive damage in fronto-pareital and frontal-parietal-occipital regions worse the developmental outcomes
-if PVL at 40 weeks then leads to poor developmental outcomes
-cerebral palsy increases with decrease in birth weight
Increased risk of which developmental/behavioral outcomes due to prematurity?
- IVH
- hydrocephalus
- cerebral palsy
- bronchopulmonary dysplasia
causes of cerebral palsy?
- unknown etiology
- congenital brain malformations
- neuronal migration disorders
- vascular disturbances
- genetic conditoins
- maternal infections
- other mom factors: perinatal trauma, asphyxia, infection, hemorrhage
sequelae for CP?
-50% have ID
-30% have epilepsy
-12% hearing issue
-36% visual deficit
-24% nonverbal
-26% behavioral problems
-23% sleep disorders
Baby effects due to carbamazepine (tegretol)?
-increase risk of spina bifida, head/face deformations, heart defects
Baby effects due to phenytoin (dilantin)?
fetal hydentoh syndrome (abnormal fingers/toes, developmental delay, cleft palate), microcephaly, brain malformations
Baby effects due to valproate (depakote)?
-increased spina bifida, neural tube defects, hypospadias, heart defects, limb and genetic defects
Baby effects due to warfarin/coumadin?
-low BW, ID, microcephaly, deafness, malformed bones
Baby effects due to cyclophosphamide (cytoxan)?
-IUGR, cranial/eye malformation, hydrocephalus, microtia, hearing defects, craniosynastosis, some limb effects