Behavior

Question 1

What are the criteria for ADHD?

Answer 1

> 6 months period
Inconsistent with child’s developmental level
Involve more than one setting
Significant functional impairment at home, school, or social
Some symptoms must have begun <13 yo

Can be evaluated as young as 4 yo

Question 2

What are the 3 most common primitive reflexes?

Answer 2

Asymmetric tonic neck reflex (ATNR) - turning head laterally results in extension of arm and leg on that side and flexion on other side (“fencer” sign)

Moro reflex - pulling arms up during supine position, baby will have abduction of upper extremities and extension of arms, then adduction of arms and hands come to front of body (like falling)

Tonic labyrinthine reflex - infant suspended in prone position: neck flexion results in shoulder protraction and hip flexion, while neck extension results in shoulder retraction and hip extension

Question 3

What age do children develop handedness?

Answer 3

By 18-24 mo old, with preference fixed by 5 yo

Handedness before 1 year could be problem with affected side (e.g. hemiparesis, brachial plexus injury)

Question 4

How may gross motor milestones be used to infer about intellectual disability?

Answer 4

Delayed gross motor infers delayed intellectual delay

But, normal gross motor says nothing about cognitive function

Question 5

What is the Goodenough-Harris drawing test?

Answer 5

Draw a person test - 3 parts at 4 yr 9 mo old, 6 parts at 5 yr 3 mo old

Question 6

Red flags: Unable to:
Sit unsupported
Walk
Run

Reach
Point to demonstrate

No speech

Answer 6

Sit unsupported - by 12 months
Walk - by 18 mo (boys)/2 years (girls)
Run - by 2.5 years

Reach - by 6 months (corrected by prematurity)
Point to demonstrate - by 2 years

No speech - by 18 months

Question 7

Describe the appearance of a superficial infantile hemangioma

Answer 7

Strawberry, bright red, sharply demarcated, blanching nodule/plaque
Will regress after 6 mo

Question 8

When is action necessary for superficial infantile hemangioma?

Answer 8

> 5 lesions –> liver ultrasound
Facial/segmental –> echo and MRI of head (ie PHACE)
Cervicofacial (beard) –> laryngoscopy
Lumbosacral –> spinal ultrasound

Beta-blocker (propranolol –> vasoconstriction and inhibits growth factors) for high-risk:
Large, facial, segmental, rapid growing (ulceration/scarring)
Periorbital (visual impairment)
Hepatic (high-output HF)
Subglottic (airway obstruction)

Question 9

What does a pyogenic granuloma look like?

Answer 9

Small, bright red, dome-shaped papule that bleeds - grows initially and does not involute