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RC Nuggets > Child > Flashcards

Child Flashcards

1
Q

Percentage of ADHD types in kids

A

Mixed 50-75%
Attentive 20-30%
Hyperactive <15%

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2
Q

Percentage of ADHD types in adults

A

Attentive 50-60%
Mixed 30-40%
Hyperactive 5%

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3
Q

ADHD into adulthood percentage?

A

60%
REGARDLESS OF RESPONSE TO TREATMENT
Increased risk if family history ADHD, conduct/mood/anxiety co-morbidity, psychosocial adversity

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4
Q

ADHD genetics

A

Heritability = 75%
RR 2-3 if 1st degree parent
40-60% parents with ADHD will have a kid with ADHD
25% of kids with ADHD have a parent with ADHD
DAT1, DRD4, DRD5, SNAP25

RISK IF BORN IN SEPTEMBER

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5
Q

ADHD neurobiology

A

Dopamine + norepinephrine
Smaller brain (10%) - especially basal ganglia, frontal lobe, cerebellum
Increased THETA on EEG

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6
Q

Rule-out if suspected ADHD?

A

Epilepsy, thyroid abnormalities, hypoglycaemia

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7
Q

Percentage co-morbidities kids?

A 
31% ONLY ADHD
ODD (40%)
Anxiety (33%)
Conduct (14%)
Tics (11%)
Mood (4%)

50% SUD teens have ADHD

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8
Q

Percentage co-morbidities adults?

A 
14% ONLY ADHD (adults have MORE co-morbidities)
Anxiety (50%) 
Alcohol (34%)
Drugs (30%)
Mood (25%)
Panic (15%)
OCD (13%)

2 TIMES MORE LIKELY to have SUD
(25% SUD adults have ADHD)

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9
Q

Response rate to psychostimulants?

A

80%

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10
Q

Which psychostimulant class causes more increased tics?

A

Amphetamines

Stimulants + Wellbutrin worsen tics in 33%

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11
Q

Atomoxetine is which CYP substrate?

A

2D6

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12
Q

Atomoxetine mechanism?

A

Blocks recapture of NE

Useful if co-morbid epilepsy

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13
Q

Intuniv XR

A

For 6-12 year old
Selective alpha 2 agonist (not as strong as clonidine)
Better tolerated than clonidine
Takes several weeks to work
Watch BP and tachycardia rebound if stopped abruptly

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14
Q

Impact of treating ADHD on future SUD?

A

Treating ADHD in adolescence decreases or delays substance use but NOT TRUE FOR ADULTS

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15
Q

Gilles de la Tourette co-morbidities?

A

ADHD (50%)
OCD (20-40%)
Learning d/o
Mood/anxiety d/o

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16
Q

Most common first tic?

A

Eye blinking

Obscene sx not common <10%

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17
Q

Gilles de la Tourette prognosis?

A

50-60% remission

Peaks later in childhood and decreases in adolescence

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18
Q

Gilles de la Tourette treatment

A

1st line = Intuniv, Clonidine
2nd line = Risperdal, Abilify
3rd line = Haldol, Ziprasidone, Fluphenazine, Zyprexa, Tetrabenazine
CLOZAPINE DOES NOT WORK

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19
Q

Clonidine mechanism?

A 
Presynaptic alpha 2 agonism (decreases NE)
Can give depression
No weight gain, no seizures
Hot flash in menopause
Hypersialorrhea in clozapine
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20
Q

Clonidine doses?

A

0.3mg max in kids in divided doses
0.3-1.2mg max in adults in divided doses
INTOXICATION RESEMBLES THAT OF OPIOIDS
INTERACTS WITH BETA-BLOCKERS (they EXACERBATE withdrawal from Clonidine)

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21
Q

ASD co-morbidity?

A 
70% have one mental disorder
40% have at least 2 mental disorders
ADHD (50%)
ID (30%)
Epilepsy (10-35%)
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22
Q

ASD epidemiology

A

Prevalence 1%
4M : 1F
Girls more likely to have intellectual disability (possibly because those without go unrecognized as ASD)

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23
Q

ASD heritability?

A

90%

If one child has ASD, 5-10% chance sibling will as well

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24
Q

ASD associated genetic conditions?

A 
Fragile X (x-linked)
PKU (recessive)
Tuberous Sclerosis (dominant)
Neurofibromatosis (dominant)
Angelman (dominant)
Cri du chat (dominant)

15% have known genetic mutation (not fully penetrant)

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25
Q

Perinatal factors associated with ASD?

A 
Advanced paternal age
Perinatal complications
Low birth weight
First born
Premature < 24 weeks
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26
Q

IQ tests

A

WPPSI 3-7yo (Weschler preschool and primary)
WISC 6-17yo (Weschler intelligence scale for children)
WAIS 17yo and adults (Weschler adult intelligence scale)

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27
Q

Rx in ASD?

A

NO EVIDENCE FOR SSRI in treating anxiety/rigidity
Risperdal, Haldol, Abilify, Zyprexa
Stimulants not efficacious and poorly tolerated overall (methylphenidate better than amphetamine)

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28
Q

Vineland scale ASD?

A 
Measures adaptive behaviour in 4 areas: 
communication
daily life skills
socialisation
motricity
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29
Q

Language domains? (4)

A

Phonology
Grammar
Semantic
Pragmatic

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30
Q

Expressive language d/o co-morbidities?

A

ADHD (19%)
Anxiety (10%)
ODD/CD (7%)

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31
Q

Childhood onset fluency disorder (stuttering) criteria?

A

NEED ONE out of 7
INTERJECTIONS IS NOT A CRITERIA

RR 3 if first degree relative has it
65-85% recover; severity at 8yo good prognostic factor

NOT ASSOCIATED WITH LANGUAGE DISORDER

32
Q

Social (Pragmatic) Communication disorder

A

Associated with language disorder (unlike stuttering), ADHD, behavioural d/o, learning d/o

33
Q

Learning disorder risk factors?

A

Prematurity
Low birth weight
Prenatal NICOTINE

34
Q

Learning disorder epidemiology?

A

Prevalence 10% in kids, 4% in adults

2-3M : 1F

35
Q

Most common cause of language delay?

A

Intellectual deficit

36
Q

Enuresis

A

Must be at least 5 YEARS OLD
Nocturnal 80%, more boys
Diurnal, more girls
Primary at 5 years old, secondary 5-8 years old
Higher risk if father had history than mother

37
Q

Encopresis

A

Must be at least 4 YEARS OLD

Usually due to constipation (80%)

38
Q

Impact of parental separation?

A

20-25% problems with adaptation in adolescence
33% develop psych problems
More problems than if parent deceased

39
Q

AN severity?

A 
BMI <18.5 needed for diagnosis
Mild >17
Moderate 16-16.99
Severe 15-15.99
Extreme <15
40
Q

AN-Restrictive specifier?

A

No recurrent binge/purge x 3 MONTHS

41
Q

Post-prandial vomiting?

A

Superior mesenteric artery syndrome

42
Q

Bulimia timing?

A

Binge + purge happening on average 1x per week x 3 MONTHS

43
Q

Bulimia severity?

A

Mild 1-3 behaviours/week
Moderate 4-7
Severe 8-13
Extreme 14 and more

44
Q

Binge eating disorder timing?

A

1x / week x 3 MONTHS

45
Q

Rumination disorder

A

Repeated regurgitation x 1 MONTH
Associated with ASD and ID
Treatment with HABIT REVERSAL
(not aversive techniques)

46
Q

PICA

A

Persistent eating non-nutritive non-food substances for at least ONE MONTH

CANNOT DIAGNOSE BEFORE AGE 2
Watch out for iron and zinc deficiencies
Associated with ASD, ID, negligence, pregnancy

47
Q

Other specified eating disorders?

A

Atypical anorexia nervosa (normal BMI)
Bulimia nervosa of low frequency or short duration
Binge eating disorder of low frequency or short duration
Purging disorder (in absence of binges)
Night eating syndrome (have awareness and recall)

48
Q

Risk factors for ED?

A

Female, adolescent, DM1 (RR2), homosexuality (MEN ONLY, protective for women), oriental culture (bulimia ONLY), athletes, family history, dysfunctional family, overprotective family, childhood/parental obesity

49
Q

Indications for hospitalization in ED?

A 
HR < 40 or > 110
BP < 90/60 (80/50 adolescent)
Orthostatic changes
Hypoglycemia < 3.3
Hypokalemia < 3 (2.5 adolescent)
Hyponatremia < 125
Hypothermia < 36
Dehydrated, organ problems, low PO4, low Mg
SI with plan and intetion
Weight < 85% healthy weight
Low tx motivation
NG feeding/supervision (better to give continuous, better tolerated)
Familial conflict
50
Q

AN co-morbidities

A

MDD 65%
OCD 25% (before ED)
Cluster C traits

51
Q

Bulimia co-morbidities

A

MDD 50%
GAD, SAD, OCD, PD
SUD 30%
Cluster B, BPD

52
Q

AN good prognostic factors

A

EARLY START (<15 years old)
< 3 years of symptoms
Normal weight within 2 years
Good relationship with parents

53
Q

AN treatment

A

FBT 1st line (Structural = Minuchin, Strategic = Haley)
CBT not as good as in bulimia but good after normal weight

Zyprexa (level B)
Risperdal, Seroquel (level C)
SSRIs only work once NORMAL weight
CAREFUL QT PROLONGATION

Weight gain 1kg/week inpatient, 0.5kg/week OPD

54
Q

Bulimia treatment

A

CBT first line
IPT, Psychodynamic, Family/Couple, DBT

SSRIs (Prozac 60-80mg, Zoloft, Celexa)
NO WELLBUTRIN (risk of seizures)
55
Q

Refeeding syndrome

A

Day 4-14
Increased glucose, increased insulin
Increased metabolism (requires PO4, Mg, K)
Increased risk if <70% normal weight and enteral feeding
Careful with carbohydrates

ATP NEEDS PO4
Monitor daily x 5 days then q2d x 3 weeks

56
Q

Bulimia abnormalities

A

Metabolic ACIDOSIS with laxatives
Metabolic ALKALOSIS with vomiting (low K, low Cl)
Trousseau + Chvostek sign (hypocalcemia)
Russel (abrasions on back of hand)

57
Q

Osteoporosis

A

Normal 1.5 to -1.5
Osteopenia -1.5 to -2.5
Osteoporosis < -2.5

58
Q

Lab changes in EDs?

A

INCREASED
Urea, amylase, cortisol, cholesterol, AST/ALT, carotene, T3, GH, CRH

DECREASED
FSH/LH, electrolytes, glucose, T4, vit B12, folic acid, Hg, WBC, Plts, thiamine, niacin, albumin, estrogen/testosterone

59
Q

ODD criteria?

A

Lasting 6 months
At least 4 symptoms (out of 8 in categories of angry/irritable mood, argumentative/defiant, vindictiveness), at least one person other than sibling

If < 5yo would expect on most days
If > 5yo would expect at least once per week

Severity depending on number of settings
mild 1 setting
moderate 2 settings
severe 3 or more settings

M>F before adolescence and EQUAL after adolescence

60
Q

ODD co-morbidities?

A

ADHD 30-65%
Anxiety 14%
Mood 15-20% (MDD 9%)
Learning and language disorder

61
Q

ODD prognosis?

A

33% will develop CD
10% will develop ASPD
66% no longer meet criteria at 3yo
Significant predictor of future mental disorders

62
Q

CD criteria?

A

At least 3/15 in past 12 months
At least 1/15 in last 6 months

4 categories
Aggression to people or animals
Destruction of property
Deceitfulness or theft
Serious violation of rules

For stays out past curfew and skips school (if < 13yo)
Runs away overnight x 2 or longer period x 1

63
Q

CD specifiers?

A

Childhood < 10 yo
Adolescent > 10 yo

With limited prosocial emotions AT LEAST 2 in 12 months

  • lack of remorse/guilt
  • lack of empathy
  • unconcerned about performance
  • shallow affect

Severity

64
Q

CD co-morbidities?

A 
ADHD (36%)
Anxiety (22-33%)
Mood (15-31%)
SUD 
Dissociation
Somatoform (MORE FEMALE PRESENTATION)
Learning d/o (30-40%, especially READING and verbal capacity)
ID
TBI
Seizures
65
Q

CD risk factors?

A 
Young mother
Large chaotic family, low supervision
Hostility in divorced parents
Genetic (hx ASPD or CD)
Anxious-avoidant attachment
Chronic illness (RR3), neuro illness (RR5)
Dense population (urban)
66
Q

CD neurobiology

A 
DECREASED SEROTONIN (low 5-HIAA in CSF)
Less conversion of dopamine to NE (low dopamine B-hydroxylase)
Low cortisol in saliva
Increased testosterone
Slow cardiac rhythm

MZ twins = 50%
DZ twins =25%

67
Q

CD prognosis?

A

40% convert to ASPD
(30-50% if childhood onset, 25% if adolescent onset)

GIRLS HAVE WORST PROGNOSIS

68
Q

CD treatment?

A

Tx ADHD also decreases sx of CD
Stimulant > Strattera = Intuniv > Clonidine

If no ADHD, Risperdal or Epival

If also impulsivity and tics, 2nd generation AP

DON’T USE BENZO = disinhibition + paradoxical response
DON’T USE LITHIUM, TEGRETOL, SEROQUEL OR HALDOL

69
Q

IED criteria?

A

Either
- verbal/physical aggression not resulting in harm 2x/week x 3 months
OR
- behavioral outburst resulting in damage (to property or person) x 3 in last 12 months

Not premeditated or for secondary gains
Have to be AT LEAST 6 YEARS OLD

Usually show REMORSE

70
Q

IED tx?

A

Anticonvulsant, Lithium, Antipsychotics, Trazodone, Buspirone

71
Q

Congenital causes of heart anomalies?

A
  1. Trisomy 21

2. Di George

72
Q

Trisomy 21 risk?

A

1/1000 if < 45 yo
1/50 if > 45 yo

Non-dysfunction (95% of cases)
Mosaicism (1-2%)
Translocation (2-3%)

73
Q

Trisomy 21 issues?

A

Intellectual deficiency
Alzheimer’s dementia (4th decade, increased b-amyloid, 21q21.1)
Epilepsy

74
Q

Most frequent preventable cause of ID?

A

Fetal alcohol syndrome

75
Q

Most common cause of malformation and intellectual deficit due to maternal infection?

A

Rubella

RC Nuggets (20 decks)

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