common issues in older child

Question 1

4 ways to define enuresis

Answer 1

primary - always
secondary - 6 months of no spills
diurnal - when awake
nocturnal - when sleeping

Question 2

2 times enursis is worrying

Answer 2

1. diurnal in school-agers

2. any secondary

Question 3

4 gen. causes of diurnal enureisi

Answer 3

1. fear
2. constipation
3. motivation
4. disease

Question 4

2 causes of secondary

Answer 4

1. if nocturnal, usually a variant of primary

2. if nociturnal only, rarely disease

Question 5

what is primary epi

Answer 5

common

- 1% keep til age 15

Question 6

main cause of promary

Answer 6

sleep too deep

• can’t wake them
• more REM sleep

Question 7

treatment of primary

Answer 7

just accept and don’t make them feel bad

• no behavioral
• no imipramine

Question 8

one drug for primary enur

Answer 8

desmopressin (DDAVP)

• only for short term like before sleep-over
• risk of hyponatremic seizures

Question 9

use for sleep alarms?

Answer 9

bad, wakes everyone else up

- maybe for teens

Question 10

3 times to treat

Answer 10

1. co-bedding
2. sleepovers
3. failure of non-medical mgmt

Question 11

epi of ADHD

Answer 11

~5%

• more boys
• children under 12

Question 12

common ADHD impairments

Answer 12

• school
• social
• family
• driving
• criminal
• job changes

Question 13

common ADHD comorbidities

Answer 13

ODD, CD, mood, anxiety, BN

Question 14

associated factors

Answer 14

• low SES
• low birth weight
• maternal smoking
• dysfunctional families

Question 15

what is heritibility of ADHD

Answer 15

pretty strong - 0.8

- runs in families

Question 16

env effects on ADHD

Answer 16

perinatal
- smoking
- alc
- LBW
port-natal
- head injuries
- infection
- autoimmune

Question 17

2 main cog. deficits

Answer 17

1. exectuve control

2. higher order processing

Question 18

what is effect of methyphenidate

Answer 18

increased DOPA at synapse

Question 19

brain structural diffs (2)

Answer 19

1. reduced size

2. slower growth, esp prefrontal cotrex

Question 20

DSM def. of ADHD

Answer 20

either A or B
A - innattention
B - hyperactivity/impulsivity

Question 21

3 types

Answer 21

1. primarily inattentive
2. hyperactive
3. combined

Question 22

what is hallmark

Answer 22

inattention

Question 23

what is very common issue with ADHD

Answer 23

learning diability

Question 24

10 Ds of ADHD

Answer 24

Distracted
Delayed
Dyslexic
Depressed
Dozy
Defiant
Delinquant
Drugged
Diseased
Disconnected

Question 25

what is best Tx for ADHD with behav. probs

Answer 25

meds and behavior therapy

Question 26

best for core AHDH

Answer 26

meds

Question 27

best for pre-schoolers (4-6yo)

Answer 27

behavior therapy

Question 28

4+1? SEs of ADHD drugs

Answer 28

1. apptetie supression -common
2. insomnia - uncommon
3. emotional after school
4. anxiety
5. growth supression - probably not

Question 29

what is cardiac risk of drugs

Answer 29

no major risk

Question 30

best way to give ADHD drugs

Answer 30

long acting