Child and Geriatric Disorders

Question 1

6 months of negativistic, hostile and defiant behavior during which at least 4 of the following: Loss of temper, arguments with adults, deying adults’ rules/teachers/parents, delibrately annoying people, easily annoyed and anger and resentment. Dx? Rx?

Answer 1

Oppositional defiant disorder. Psychotherapy and behavior modification and problem solving.

Question 2

A persistent pattern of behavior in which basic rights of others or social norms are violated ( aggression towards others, destruction of property, deceitfulness or theft, serious violation of others) Dx? Rx?

Answer 2

Conduct Disorder. Consistent rules and consequences to reduce problematic behaviors. Antipsychotics/Mood Stabilizers/SSRIs for aggression.

Question 3

At least 6 symptoms of inattentiveness (difficulty listening, following instructions, hyperactivity/impulsivity (restlessness, excessive talking, cant engage in quiet activities or both that persist for 6 months, maladapative and onset prior to age 7. Dx? Rx?

Answer 3

ADHD Attention Deficit/Hyperactivity Disorder. Methylphenidate, Dextroamphetamine and Amphetamine salts. Atomoxetine. Clonidine if all else fails. Psychotherapy, Family, individual and group for behavior modification.

Question 4

6 symptoms present by age 3. Problems with social interaction (lack of interest in sharing enjoyment, lack of social/emotional reciprocity.) Impairments of communication (delayed speech, inability to hold conservations.) Repetitive and sterotyped patterns of behavior and activities (narrowed interest, repetitive motor mannerisms). Dx? Rx?

Answer 4

Autistic Disorder. Supportive: Remedial education, behavioral therapy, antipsychotic medications to help control aggression, hyperactivity and mood lability.

Question 5

Condition has same impairments seen in autism involving social interaction and restricted stereotyped interest and behaviors but there is no clinically significant delay in spoken or receptive language, cognitive development, self-help skills or curiosity about the environment. Dx? Rx?

Answer 5

Asperger Disorder - they have normal language acquisition and cognitive development. Supportive: Remedial education, behavioral therapy, antipsychotic medications to help control aggression, hyperactivity and mood lability.

Question 6

Normal physical and psychomotor development during first 5 months after birth, followed by decreasing rate of head growth and loss of previously learned purposeful hand skills between ages 5 and 30 months. Cognitive development never progresses beyond that of the first year of life. They develop stereotyped hand movements and impaired language. Dx? Rx?

Answer 6

Rett Disorder. Supportive. Supportive: Remedial education, behavioral therapy, antipsychotic medications to help control aggression, hyperactivity and mood lability.

Question 7

Normal development in the first 2 years of life including communication, social relationships, play and adaptive behavior but there is loss of previously acquired skills before age 10 : language, social, adaptive behavior, bowel or bladder control, communication, restricted, repetitive, stereotyped behaviors and interest. Dx? Rx?

Answer 7

Childhood Disintegrative Disorder. Supportive.

Question 8

Multiple daily motor or one or more vocal tics with onset before age 18. Dx? Rx?

Answer 8

Tourette Disorder. Educational and supportive interventions. Supportive and behavioral therapy. Atypical neuroleptics: Risperidone and clonidine. Use typtical neuroleptics for severe cases.

Question 9

1. Involuntary voiding of urine after age 5. 2. Involuntary or intentional passage of feces in inappropriate places by age 4. Dx? Rx?

Answer 9

1. Enuresis - make sure to r/o diabetes. 2. Encoporesis - make sure r/o hypothyroidism, IBD. Psychoeducation, psychotherapy, family therapy and behavioral therapy. Enuresis: bell and pad method, buzzer, imipramine. Encoporesis: bowel catharsis followed by stool stoftners if cause is constipation.

Question 10

First line drug for tic disorder?

Answer 10

Haloperidol. Then clonidine or gaunifacine (alpha agonist)

Question 11

Side effect of Ritalin?

Answer 11

Tics

Question 12

Every morning on school days, 8 year old girl becomes tearful and distressed and claims she feels sick. Once in school, she often goes to the nurse, complaining of headaches and stomach pains. At least once a week, she misses school or is picked up early by her mother due to her complaints. Her pediatrician has ruled out organic causes for the physical symptoms. The child is usually symptom free on weekends, unless her parents go out and leave her with a babysitter. Dx?

Answer 12

Separation Anxiety Disorder.

Question 13

Sleep disturbance, decreased appetite and weight loss, feelings of worthlessness and suicidal ideation, lack of energy and diminished interest in activities. Onset is acute, patient emphasizes failures, sun downing is uncommon, often answers “I don’t know to questions” patient is aware of problems. Dx?

Answer 13

Pseudodementia. Psychotherapy and low dose SSRI,

Question 14

Loss of a loved one or friends: 1. Feelings of guilt and sadness, mild sleep disturbance and weightloss, attempts to resume daily activities/work, symptoms resolve within 1 year. Dx?
2. Feelings of severe guilt and worthlessness, significant sleep disturbance and weight loss, hallucinations and delusions, no attempt to resume activities, suicideal ideation, symptoms persist more than 1 year. Dx?

Answer 14

1. Bereavement - Normal grief 2. Bereavement - Abnormal grief.

Question 15

1 month name the Gross motor, fine motor, language and social milestone.

Answer 15

1. Raises head from prone position 2. Tracks to midline 3. Alerts to sound 4. Regards face

Question 16

3 months name the gross motor, fine motor, language and social milestones.

Answer 16

1. Hold heads up 2. Tracks in circles 3. Coos 4. Anticipates feeling

Question 17

6 months name the gross motor, fine motor, lang and social milestones.

Answer 17

1. Sits up right 2. Transfers objects 3. Babbles 4. Stranger anxiety

Question 18

9 months name the gross, fine, lang and social milestones.

Answer 18

1. Crawls, pulls, stands 2. Immature pincer graps 3. Mama and Dada non specific 3. Plays pat-a-cake

Question 19

12 months name the gross, fine, lang and social milestones.

Answer 19

1. Walks alone 2. Uses mature pincer grip 3. mama and dad specific 4. Imitates actions, comes when called

Question 20

24 months name the gross, fine, lang, and social milestones.

Answer 20

1. Walks up and down steps without help 2. Turn pages 1 at a time 3. Knows 200 words, uses 2 word sentences 4. Engages in parallel play

Question 21

Age 3 name the gross, fine, lang and social milestones.

Answer 21

1. Tricycle 2. copies circle 3. Knows 300 words and 3 word sentences 4.Engages in group play

Question 22

Age 5 name the gross fine, lang and social milestones.

Answer 22

1. Jumps over obstacles 2. Copies triangle, tells stories 3. Prints first name 4. Abides by rules

Question 23

7 yo old boy complains of frequent abdominal pain resulting in many missed school days. He never gets sick over the weekends or during summer. Dx?

Answer 23

Separation Anxiety Disorder.

Question 24

6 yo adopted child is brought in because she has no relationship with her adopted parents. She is inhibited and hypervigilant. Dx?

Answer 24

Reactive Attachment Disorder.

Question 25

7 yo boy brought by his parents. They report he must be told several times to complete his chores, they cannot get him to focus completing his homework. He can sit and watch cartoons for hours. Dx?

Answer 25

Normal behavior. ADHD kids cannot sit and watch cartoons for hours.

Question 26

Name the comorbid conditions for each. 1. ADHD 2. Tics 3. Boderline Personality Disorder.

Answer 26

1. ODD/CD 2. OCD 3. Eating Disorder.