Behavioral and Learning Problems Flashcards
1
Q
DSM Diagnostic Criteria of Intellectual Disability
A
- IQ < 70 AND impairment in 2+ areas of functioning (communication, self care, home living, social skills, use of community resources, health, safety, academic skills, work skills)
- Mild IQ 50-70 - more likely environmental
- Severe IQ < 35 - more likely genetic (Fragile X, trisomy 21, Prader-Willi, Angelman syndrome, Rett)
2
Q
How do you calculate mid-parental target height for boys and girls?
A
- Boys: (dad + mom + 13) / 2
- Girls: (dad + mom -13) / 2
in CM
3
Q
Differential for Short Stature
A
- Constitutional Delay
- Familial short stature
- Chromosomal abnormality - Turner or trisomy
- Achondoplasia or hypochondroplasia
- Noonan, Prader-Willi, Russel-Silver syndromes
- Systemic diseases - celiac, Chron’s, CF, severe cardio defects, lung disease needing chronic steroids, renal problems / Fanconi
- Nutritional def
- Psychosocial growth retardation - abuse or neglect
- Endocrine
- Hypothyroid
- Cushing
- GH def or insensitivity
- Poorly controlled type 1 DM
- Pseudo-hypoparathyroidism (Albright hereditary osteodystrophy)
- Drugs - steroids
4
Q
What are the 2 most common causes of short stature? How do they differ?
A
- Constitutional Delay - delay in bone age; eventually catch up; later puberty as well
- Familial short stature - no or little delay in bone age; parents also short
**Bone Age - get Xray of L hand, fingers and wrist and compare epiphyseal plates to age-appropriate standards
5
Q
Short Stature Work-Up Labs
A
- CBC w/ diff
- ESR
- TSH and free T4
- Electrolytes
- Tissue transglutaminase IgA and total IgA (celiac)
- Serum IGF1 and IGFBP3 for GH deficiency
- Consider karyotype if dysmorphic
6
Q
Definition of Colic
A
- crying in otherwise healthy infant for > 3 hours a day (usually evening) > 3 X per week for 3+ wks
- Not consoled by diaper change, feeding, rocking, burping, feeding
- Often occurs same time every day
- Not attributed to medical causes
- Often starts in first 2-6 weeks of life
7
Q
Differential for Crying Baby
A
(IT CRIESS)
- I - infection (UTI, meningitis, osteomyelitis)
- T - trauma / testicular torsion
- C- cardiac problems or colic
- R - reflux or reaction (to formula or meds)
- GER - arching back during or after feeding, frequent spit up or vomiting, poor wt gain
- Milk protein allergy - blood streaks and mucous in loose stool or severe constipation - I - immunizations, insect bites
- E - eye (Corneal abrasion - do fluorescein exam)
- S - surgical issue (volvulus, intussusception, inguinal hernia)
- S - strangulation from hair tourniquet - hair accidentally wrapped around extremity or digit
- ** may also be normal
8
Q
ADHD Dx
A
- inattention (category A) and hyperactivity/impulsivity (category B) present b/f age 7 for > 6 mo and in multiple settings (school and home) and cause significant functional impairment; need 6+ sx from A, B or both
- A - Inattention
- Easily distractible
- Do not pay attention to details
- Diff organizing and completing tasks
- Forgetful in daily activities
- Diff following directions - B - Hyperactivity
- Inc energy for age
- Fidget and restless
- Cannot remain seated
- Cannot play by self and entertain self
- Talks excessively - B - Impulsivity
- Cannot wait turn
- Interrupts others
***Use scale for both parent and teacher (ex - Vanderbilt)
9
Q
Meds for ADHD (include side effects)
A
- Stimulants - methylphenidate, dextroamphetamine (inc BP, insomnia, dec appetite, headache, nausea, moody)
- Non-stimulants - atomoxetine (NE reuptake inhibitor) may be good option if stimulants in tics and anxiety; main side effect is fatigue
10
Q
Normal Continence
A
- Newborns should urinate 3-4X/day
- Ready to start potty training at 2 yo
- Usually achieve continence by 3-4 yo (girls > boys)
- Nighttime continence a little later 4-5 yo
11
Q
Enuresis (definition, causes, tx)
A
- (pee pants 2X / wk for 3 months in a row)
- Primary - never continent
- Secondary - had 6+ mo dryness beforehand
- Causes - nocturnal (immature cortical control, family hx, alteration in circadian vasopressin) v. daytime (waiting too long to void)
- R/o UTI, DM, spinal cord lesion or compression, overactive bladder, chemical urethritis from bubble bath/soap, physical trauma or sexual abuse
- Tx - waking child thru night to void, episodic use anti-diuretic hormone, reassurance
12
Q
Encopresis (definition, causes, PE, tx)
A
(any soiling beyond 4 yo)
- Causes
- Chronic constipation - rectum becomes distended so need larger volume to produce sensation
- Emotional stressors leading to regression in control of bowels - May present as abdominal pain / lack of appetite, large stools when they do occur, may mistake for diarrhea but actually leakage around bulky stool
- Digital rectal exam, assess anal tone, may do Xray to look for impaction
- Tx - polyethylene glycol (Miralax), inc fiber, dec milk and juice, inc water, encourage frequent bathroom trips, psycho counseling if not due to constipation
13
Q
Normal Sleep by Age
A
- Newborns - 20 hrs / day
- Normal circadian rhythm w/ REM and NREM established by about 3 mo; when baby should sleep thru night
- By 1 yo should be sleeping 12 hr / night + 1-2 naps
- Adolescents need 9 hr sleep / night
14
Q
Nightmares v. Night Terrors
A
BOTH BENIGN
- Terrors - NREM in first 1/3 sleep, child appears awake, is not consolable and does not remember, usually 3-8 yo boys
- **Can be associated w/ stress, illness, over tiredness so suggest calm bedtime routine w/o scary TV
- Nightmares - REM in last 1/3 sleep, child awakens, can be consoled and remembers, in any age
15
Q
Presentation of Breath-holding Spells (2 diff types)
A
- Presentation - apnea, color change, change in muscle tone, brief LOC ( < 1 min) often n 6-18 mo old
***Not a seizure but may lead to anoxia –> seizure (often mistaken by parents for seizure)
1 - Cyanotic (more common) - forced expiration/Valsalva –> inc intrathoracic pressure –> dec CO –> dec flow to brain –> LOC
- Triggered by tantrums, anger, crying
- Blue, limp or stiff
2- Pallid - vagal cardiac inhibition –> bradycardia / asystole –> dec flow to brain –> LOC
- Triggered by sudden pain or scare NOT crying
- Pale, apneic
