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Pediatrics > BRS2 > Flashcards

BRS2 Flashcards

1
Q

developmental quotient

A

developmental age/chronologic age x 100

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2
Q

Developmental quotient > 85%

A

normal

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3
Q

Developmental quotient < 70%

A

abnormal

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4
Q

Developmental quotient 70-85%

A

close follow-up warranted

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5
Q

developmental domains (4)

A

motor, language, social and cognitive

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6
Q

gross motor milestone at birth

A

turns head to side

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7
Q

gross motor milestone at 2 months

A

lifts head when lying prone, head lag when pulled from supine position

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8
Q

gross motor milestone at 4 months

A

rolls over, no head lag when pulled from supine position, pushes chest up with arms
gross motor milestone at birth

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9
Q

gross motor milestone at 6 months

A

sits alone, leads with head when pulled from supine position

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10
Q

gross motor milestone at 9 months

A

pulls to stand, cruises

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11
Q

gross motor milestone at 12 months

A

walks

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12
Q

infants with CNS damage have ___ primitive reflexes and ____ postural reactions

A

stronger and more sustained primitive reflexes

delayed development of postural reflexes

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13
Q

primitive reflex

A

these develop during gestation and are present at birth. usually disappear between 3-6 months of age.

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14
Q

postural reactions

A

not present at birth- they are acquired.

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15
Q

4 primitive reflexes

A

moro, hand grasp, atonic neck reflex, rooting

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16
Q

moro reflex

A

abduction and extension of arms with trunk extension. then adduction of upper extremities. present at birth, gone by 4 months

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17
Q

hand grasp reflex

A

grasp anything placed in palm. present at birth, gone by 1-3 months

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18
Q

atonic neck reflex

A

head turned to Left- arms extend on left (E for same) and flex on the right (opposite side). present at 2-4 weeks and gone by 6 months

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19
Q

rooting reflex

A

turn head toward same side as stimulus when corner of mouth is stimulated. present at birth and gone by 6 months.

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20
Q

2 postural reactions

A

head righting and parachute

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21
Q

head righting

A

ability to keep head vertical despite body being tilted. appears at 4-6 months and persists

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22
Q

parachute

A

outstretched arms and legs when body is moved head first in down direction. seen at 8-9 months and persists

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23
Q

fine motor milestone at birth

A

hands kept tightly fisted

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24
Q

fine motor milestone at 3-4 months

A

brings hands together at midline and then to mouth

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25
Q

fine motor milestone at 4-5 months

A

reaches for objects

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26
Q

fine motor milestone at 6-7 months

A

rakes objects with whole hand, transfers objects from hand to hand

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27
Q

fine motor milestone at 9 months

A

uses immature pincer

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28
Q

fine motor milestone at 12 months

A

uses mature pincer (using tip of index finger)

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29
Q

earliest sign of neuromotor delay

A

persistent fisting beyond 3 months of age

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30
Q

early hand dominance (before 18 months)

A

sign of weakness of opposite extremity

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31
Q

which is better- receptive or expressive language

A

receptive is always more advanced than expressive

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32
Q

language vs. speech

A

language is ability to communicate with symptoms (writing, signing, speaking etc.)

speech is the vocal expression of language.

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33
Q

when is optimal language acquisition

A

first 2 yrs of life

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34
Q

language milestone at birth

A

attunes to human voice, developes recognition of parents voice

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35
Q

language milestone at 2-3 months

A

cooing, musical sounds (ooh, agh)

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36
Q

language milestone at 6 months

A

babbling like da da da ba ba ba

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37
Q

language milestone at 9-12 months

A

jargoning. mixed consonants, inflection. uses terms like mama, dada (non specific)

38
Q

language milestone at 12 months

A

1-3 words. mama and dada specific

39
Q

language milestone at 18 months

A

20-50 words. beginning to use 2 word phrases

40
Q

language milestone at 2 yrs

A

2 word sentences like “mommy come” 25-50 % speech should be intelligible

41
Q

language milestone at 3 yrs

A

three word sentences. more than 75% of speech should make sense

42
Q

pre-speech period

A

0-10 months. cooing and babbling

43
Q

naming period

A

10-18 months. infant understanding people have names and objects have labels

44
Q

word combination period

A

18-24 months. early word combinations. telegraphic- no prepositions, pronouns. combine words 6-8 months after first word

45
Q

differential for language impairment

A

hearing loss, global delay, environmental deprivation, pervasive developmental disorder like autism

46
Q

how to determine cognitive or intelligence in an infant

A

language is the single best indicator of intellectual potential. gross motor skills correlate poorly with cognitive potential

47
Q

when does functional play begin

A

at about 1 yr of age. child puts a toy telephone to their ear

48
Q

when does imaginative play begin

A

24-30 months. use blocks to build a castle or a stick as a fork

49
Q

when does concrete thinking develop

A

interpret things literally. preschool and early elementary years

50
Q

abstract thinking develops

A

in adolescent years

51
Q

when and what is object permanence

A

develops about 9 months. concept that mom still exists even if she isn’t in the room. can lead to separation anxiety- common between 6-18 months.

52
Q

cause and effect behavior

A

at 9-15 months. dropping something makes it fall to the floor. actions cause things to happen

53
Q

magical thinking

A

normal state of mind during preschool toddler years. child assumes inanimate objects are alive and have feelings

54
Q

predictor of verbal intelligence

A

language development

55
Q

predictor of non verbal intelligence

A

problem solving skills

56
Q

3 social milestones

A

attachment, sense of self, social play

57
Q

attachment

A

bonding with a primary caregiver. begins at birth. need empathy within first 3 yrs of life

58
Q

a sense of self and independence

A

separation and individualization begins about 15 months

59
Q

social play

A

toddlers exhibit parallel play during the first 2 yrs of life. learn to play together and share by about 3.

60
Q

definition cerebral palsy

A

static and non progressive encephalopathies caused by injury to the developing brain. motor function is primarily effected. injury can be prenatal or perinatal. patients have increasing tone or spasticity, hypotonia, asymetric reflexes, abnormal issues with disappearing innate reflexes and appearing of postural responses

61
Q

2 types of cerebral palsy

A

spastic and non spastic

62
Q

spastic diplegia

A

weakness usually in the lower extremities more. early rolling over, increased muscle tone. scissoring is common. common in prematurity

63
Q

spastic hemiplegia

A

unilateral spastic motor weakness, usually upper extremity is involved. early hand preference, attempts at grasping always on same side and fisting. absent pincer on one side. seen with perinatal vascular insults, post natal trauma

64
Q

spastic quadriplegia

A

motor involvement of head, neck and all 4 limbs involved. seizures, scoliosis, facial weakness, Gi reflux etc. CNS infections, trauma, malformations, hypoxic ischemic encephalopoathy

65
Q

non spastic cerebral palsy= athetoid CP

A

extrapyramidal. athetoid movements. hypotonia. arms more than legs. oral involvement may be prominent drooling, problems with speech. often in full term infant with hypoxia ischemic encephalopathy, kernicturus leading to basal ganglia damage

66
Q

mental retardation definition

A

significantly subaverage general intellectual functioning with deficits in adative behavior like self care, social skills, work and leisure. manifested before 18 yrs of age.

67
Q

learning disabilities definition

A

significant discrepency between a child’s academic achievement and the level expected on the basis of age and intelligence. most commonly idiopathic. can be caused by CNS damage.

68
Q

pervasive developmental disorder (PDD)

A

spectrum of developmental disabilities affects multiple developmental areas, especially behavior and learning with a wide range of severity.

69
Q

prototypical PDD

A

autism. more common in boys

70
Q

difference between autism and aspergers

A

asperger has a qualitative impairment in peer relationships and social interactions but no clinically significant language delay. language in aspergers may actually be advanced.

71
Q

ADHD

A

poor selective attention, difficulty focusing or distractibility. hyperactivity may or may not be part of this.

72
Q

what medications can be used for ADHD

A

stimulants are first line treatments- improve attention, impulsivity and hyperactivity. examples are methylphenidate (ritalin) and amphetamines like adderall.

73
Q

neurotransmitter issue with ADHD

A

lower levels of dopamine and norepi. stimulants increase these and improve symptoms

74
Q

non stimulant drugs for ADHD

A

second line therapy. tricyclics, and adrenergic agents like clonidine. clonidine is especially helpful at bedtime and can be used with a stimulant

75
Q

when do you need to identify a hearing problem by

A

hopefully before 6 months to prevent delayed langugae skills and academic and behavior problems

76
Q

most common cause of hearing issues in kids

A

genetics. autosomal recessive.

77
Q

labs to check in hearing loss child

A

genetic evaluation, creatinine level (because of associated kidney disease in things like Alport syndrome), viral serologies for infections, CT of inner ear if still unclear.

78
Q

primary cause of blindness in children worldwide

A

trachoma infection. other causes include retinopathy of prematurity and congenital cataracts

79
Q

colic definition

A

crying that lasts more than 3 hours per day and occurs more than 3 days per week. normal crying should be about 2 hours per day at 2 weeks and increases to 3 hours per day at 3 months. begins at 2-4 weeks of age and resolves by 3-4 months. typically more irritable in the afternoon early evening.

80
Q

enuresis

A

urinary incontinence beyond the age at which kids are capable of continence. can be primary (never continent) or secondary (following a period of continence)

81
Q

causes of enuresis (genetic)

A

strong familial tendency for nocturnal primary enuresis. gene on chromosome 13

82
Q

sleeping through the night

A

this is sleeping more than 5 hours straight after midnight for a 4 week period. this is seen in 50% of infants at 3 months

83
Q

trained night waking

A

this is abnormal. occurs between 4-8 months. infant does not resettle without parental intervention during normal night stirrings and awakenings. treatment is establishing a routine and placing infant in bed while drowsy but awake.

84
Q

nightmares

A

common after 3 yrs. can occur as early as 6 months. occur during REM sleep and are normal

85
Q

night terrors

A

seen at 3-5 yrs of age. ocur 90-120 minutes into sleep and NON REM stage 4 sleep.

86
Q

appetite after 1 yr of age

A

it actually may decrease and this is normal

87
Q

temper tantrums

A

expressions of emotions like anger that are beyond the child’s ability to control. common between 1-3 yrs. usually from frustration or fatigue. more if there is poor motor skills or expressive language.

88
Q

breath holding spells

A

benign episodes in which children hold their breath long enough to cause parental concern. spells are involuntary in nature, harmless, and always stop by themselves. can start at 6-18 months and disappear by 5 yrs. iron has been shown to help.

89
Q

cause of a cyanotic breath holding spell

A

usually from frustration and anger. child cries and becomes cyanotic. can become unconscious and have a seizure

90
Q

cause of a pallid breath holding spell

A

unexpected event that is frightening. hyper vasovagal response. child becomes pale or limp

91
Q

normal age of bowel and bladder control

A

bowel control by 29 months of age. range is 16-48 months. average bladder control by 32 months with a range of 18-60 months.

92
Q

how long should a time out be?

A

1 minute per year of age (max of 5 minutes).

Pediatrics (3 decks)

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