Behavior and Development

Question 1

development quotient

Answer 1

dev age/chronologic age *100. 70-85- close f/u. 85= normal

Question 2

primitive reflex

Answer 2

present at birth. gone in 3-6mo. if have CNS injury, become stronger and more sustained.
Moro: birth-4mo
hand grasp- birth-1 to 3mo
rooting: turn head to same side of stimulus when corner of mouth stimulated: birth-6mo
atonic neck reflex- head to one side, arm and leg extend on same side and flex on pop: 2-4wk to 6mo

Question 3

postural reflex

Answer 3

not present at birth= acquired. facilitate oritentation of body. CNS damage cause delay dev
head rigging: keep head vertical despite tilted body.
parachute: outstretch arm and legs when body moved head first in downward direction

Question 4

gross motor milestone

Answer 4

birth- head side to side
2mo- lift head when prone. lag when lift from supine position
4mo: roless over, no head lag from supine, rushes chest up with arms
6mo: sits alone, lead with head when pull from supine
9mo: pulls to stand, cruises
12mo- walk

Question 5

fine motor milestone

Answer 5

birth: fisted hands
3-4mo: hands to midline together then to mouth
4-5mo: reach for obj
6-7mo: rakes. transfer obj from hand to hand
9mo: use immature pincer
12mo: mature pincer (tip of index finger

Question 6

motor dev red flags

Answer 6

1. persistent fisting after 3mo- earliest sign of NM prob
2. early rolling over, pulling to stand instead of sitting, persistent toe walking- spasticity
   3) spontaneous postures ~ scissoring in spastic kid, frog leg position with hypotonic infant
   4) : early hand dominance (bf 18mo) - hemiparesis

Question 7

language milestone

Answer 7

Prespeech: : 0-10mo
1) brith- attune to human voice, dd parents
2) 2-3: coo (voos), musical sounds
3) 6mo: blabbing (mix vowel + consonants
naming period: 10-18mo
1) 9-12: jargon- parsody
2) 12mo: 1-3 words
3) 18: 20-50 words
word combination period 18-24mo- telegraphic
2y: 25-50% speech intelligible
3y: 3 word sentence. 75% speech intelligible

Question 8

DD speech or language delay

Answer 8

1) global dev delay or MR
2) hearing impairment
3) enviro deprivation
4) pervasive dev D, like autism

Question 9

intellectual dev

Answer 9

dep on attention, information processing, memory. language in infants is best indicator of intellectual potential. motor correlates poorly

Question 10

stages in cog dev

Answer 10

1) sensorimotor: birth -2yo: explore through physical manipulation of obj
2) functional play: >1yo: rec obj and their function
3) imaginative play: 24-30mo: use symbols- blocks to build forts
4) concrete thinking: preschool- elementary- interpret literally
5) abstract thinking: adolescent

Question 11

obj permanence

Answer 11

9m = why separation anxiety start 6-18mo

Question 12

cause and effect

Answer 12

9-15mo

Question 13

magical thinking

Answer 13

noral in preschool toddler years. inanimate obj are alive and have feelings

Question 14

red flags in cog dev

Answer 14

language estimate verbal IQ, problem solving measure nonverbal so delay in both = think MR
if only language delay ck hearing prob or communication D
only problem solving delay then visual or fine motor prob
discrepancy btw language and problem solve - learning disability

Question 15

social skills

Answer 15

self and indeed at 15mo. parallel play at 2y. together play at 3

Question 16

motor deficits

Answer 16

cerebral palsy, metabolic abn, chromosomal abn, MN disease, degen diseasl, SC injury, myopathies, CNS strucural defects

Question 17

cerebral palsy define and RF

Answer 17

static encephalopathies caused by injury to developing brain in which motor func is primary affected. IQ could be normal.
P: neuro damage- motor prob, seizure, cog defict, MR, learning disability, sensory loss visual and auditory deficits
RF: mom (multiple gestation, premie), prenatal (IUGR, congeital, TORCH), perinatal (traumatic delivery, low apgar, premature or postdate), postnatal hypoxic encephalopathy, intraventricular hemorrhage, trauam, kernicterus)

Question 18

cerebral palsy epi, dx, classification

Answer 18

epi- .2-.5%
dx- repeated neurodev examinations with incr tone, opacity, hypotonia, asylum reflexes, mV D, abn pattern in disappearance of primitive reflexes.
classification: spastic cerebral palsy- incr tone, scisorring = sign of spasticity, early hand pref, seizure, scoliosis; extrapyramidal cerebral palsy= athetoid CP, writhing, oral motor mvt= prob speech/drooling, hypotonia of neck and trunk limiting exploration

Question 19

pervasive dev disorder (PDD)

Answer 19

affect multiple dev areas, especially behavior and learning

autism

Question 20

ADHD

Answer 20

30-50% have 1st degree relative with it
dop and NE prob
dx bf 7
comorbidity: anxiety, conduct D, ODD, OCD

Question 21

hearing impairment- etio, prognosis

Answer 21

screen bc outcome better if intervene bc 6mo- less delayed speech and language defect, behavioral prob
80% auto recessive. 20% pre/peri/postnatal factors( congenital infection, prematurity, bacterial meningitis, middle ear anomalies)
prog: degree of loss, etiology( inherited is better. acquired associated with more other neural def), family support, after age two>bf, timing of amplification- early=better, cochlear implants- improve hearing

Question 22

hearing medical eval

Answer 22

genetic eval. Cr lvl bc kidney disease + hearing = aport, viral serologies, CT head

Question 23

blindness

Answer 23

leading cause: trachoma infection. especially developing countries
retinopathy of prematurity
congenital cataracts
haptic perfection- tactile sensation to dev mental image

Question 24

colic: define, sig, epi,

Answer 24

crying>3hr
sig: disrupt attachment, cause family stress.
10% newborn- healthy, well fed. being 2-4wk and end 3-4mo
periods of irrtability

Question 25

enuresis

Answer 25

etio- genetics - chromsome 13; infection, DM, child abuse; constipation is comorbid

Question 26

sleep

Answer 26

0-4wks: day light reversal. >4wks: start clustering sleep time 3mo: 50% sleep through the night= 5hr after 12am for 4 wks abn- trained night waking and feeding= parent need to stop intervening when baby fusses. 4-8mo

Question 27

nightmare

Answer 27

>3yo. but can start at 6mo. REM

Question 28

night terror

Answer 28

common 3-5yo. non REM stage 4 sleep. autonomic arousal

Question 29

feeding

Answer 29

appetite decr after 1yo. autonomy more important so avoid power struggles

Question 30

breath -hold spells

Answer 30

5%. start btw 6-18mo. disappear by 5yo involuntary and harmless cyanotic speels- most common- frustration/anger - cries- becomes cyanotic- apnea and loc or seizure pallid spells: unexpected event- fright- hypervasogvagl repsonse- become pale and limp if induced by excitement or excursus need to ECG to r/o dysrrhythmia

Question 31

bowel control

Answer 31

avg 29mo. range 16-48mo

Question 32

bladder control

Answer 32

32 mo. range 16-60

Question 33

discipline

Question 34

pubertal growth spurt

Answer 34

50% of wt and 25% ht. happens 18-24hr earlier in female than males

Question 35

male puberty

Answer 35

6-12mo after female 1) testical enlargement 11-12 2) facial and axillary hair- 2y after pubic hair

Question 36

female puberty

Answer 36

1) breast buds - thelarche at 9.5yo 2) public hair 3) menarch avg 12.5

Question 37

tanner male

Answer 37

1: preadolescent. no PH, prepubertal testes 2: testes larger, PH 3: tests larger, penis length incr, darker coarse, curlier hair 4L darkening of scrotal skin, penis length/width incr, PH extending over symphysis pubis 5: adult size genitals, adult PH spread to medial surface of thighs

Question 38

tanner female

Answer 38

1: pre adolescent breast, no PH 2. elevation of breast and nipple, space downy hair 3: enlargement of breast do sep of areola and breast. darker coarser curlier hair 4: areola and nipple project to form secondary mound. adult type hair cover symphysis pubis 5: nipple project, areola recede. adult PH spread to medial surface of thigh.

Question 39

sexually active female screen for

Answer 39

culture of gonorrheaew. immunofluorescent ab for chlamydia. syphilis serologic test, POP for HPV, wet mount of trichinous vaginalis

Question 40

sexually active male screen for

Answer 40

annual syphilis, urinalysis of pyruria, urine ligase for chlamydia

Question 41

problem drinking

Answer 41

intoxicated 6+ in 1y or having problems in areas attributable to drinking

Question 42

binge drinking

Answer 42

5+ consecutive drinks at one sitting.

Question 43

smoking complications

Answer 43

CAD. peptic ulcer disease, preg complications- stillbirth, low birth wt,

Question 44

obesity

Answer 44

wt >20% ideal body wt= >95% for age and sex.

Question 45

obesity heath effects

Answer 45

earlier pubertal dev, HTN and CVD, hyperchol, elevated triglycerides, DM2, gallbladder disease, orthopedic prob, poor body image - depression

Question 46

OCP distadvantages

Answer 46

CI: breast or endometrial ca, stroke, CAD, liver disease | relative CI: HTN, migrane HA, dibetes, sicke cell anemia, elevated lipids, smoking

Question 47

most common std

Answer 47

herpes simplex, HPV, C trachomatis

Question 48

T vaginalis

Answer 48

yellow green discharge. strawberry cervix. pH>4.5. tx- oral metronidazole (if alc= antabuse) tx partner. protozoa

Question 49

bacteria vaginosis

Answer 49

decr in lactobacilli cause inr in gardenella vaginalsi, mycoplasma hominis, gram neg gray white vaginal disrachge. fishy, little info pos whiff test. - enhance on KOH. clue cells pH>4.5. tx- oral metronidazole or topical clindamycin. partners don't need tx

Question 50

candidal vulvovaginitis

Answer 50

candida albicans. ithcing, white curdle dc. inflm. fungal hyphae on wet mount. oral fluconazole. partners don't need tx

Question 51

cervicitis

Answer 51

inflm of mucous men of endocerviz. chlamydia or gonorrhea. purulent endocervical dx, fribale edematous erythmaouts, dyruria, urinary freq, most asx culture endocervix is gold standard. tx: clamydia- doxy, erythromycine or azithromycine gonorrhea- I'm ceftriazone or oral ciprofloacin. tx partner

Question 52

PID

Answer 52

lower abd tenderness, cervical motion tenderness, uni/bl adnexal tenderness. and 1 of: fever, wbc>10.5K, infm pelvic mass, incr ERS or CRP, lab evidence of gonorrhea or clamydia inpt tx- iv cefoxitin + oral doxy or IV clindamycine + gentamicin

Question 53

urethritis

Answer 53

M>F. info of urethra. but if in F, ck for cervicitis. most common is gonorrhea or chlamydia. clinical: dysuria, inc urinary freq, mucopurulent dx, asx infection dx: pos leukocyte esterase on first void urine specimen, greater than 10bc on gram stain. definitive dx- culture

Question 54

newborn growth

Answer 54

``` 1-2mo old term: 100cal/kg/d= 20-30g wt gain preterm- 115-130kcal VLBW: 150kcal double wt by 5mo triple by 12 ```

Question 55

sleep through the night

Answer 55

by age 4-6mo

Question 56

car seat

Answer 56

under 13yo = back seat. until 2yo, face rear

Question 57

acetaminophen v vaccine

Answer 57

may lower ab response for some immunizations

Question 58

RUQ mass + pallor on 9mo old DD

Answer 58

hepatic neoplasm, hydronephrosis, neuroblastoma, teratoma, wilm's tumor

Question 59

hepatic neoplasm

Answer 59

can cause asx abd tumor. may have jaundice

Question 60

hydronephrosis

Answer 60

multicystic kidney could cause this. ck for UTI

Question 61

neuroblastoma

Answer 61

most common neoplasm in infants. 50% present

Question 62

wilm's

Answer 62

likely in 9mo with asx RUQ mass and no jaundice, lymphadenopathy, norm dev. smooth mass and rarely cross midline. 50% have ab pain, V, HTN mean age of dx-3yo