Community Flashcards
What are some commoner features of childhood depression (vs adults)? (7)
Apathy / boredom
Irritable mood
Antisocial behaviour
Decline in school performance
Separation anxiety
Social withdrawal
Hypochondriacal ideas
Which features of adult depression are less seen in children? (5)
How is chilldhood depression managed compared to adults?
Slowed movement/thought Delusional ideas Loss of sleep Loss of appetite/weight Loss of libido
Managed similarly to adults
What are the main 3 psychotic disorders seen in paediatrics?
What Ix can be done into them?
Schizophrenia
Bipolar affective disorder
Organic psychosis
Urine dip - drug screen
Exclusion of medication-induced / medical causes / dementia
What questionnaire tool is used regarding self-harm / drug abuse?
PATHOS P - problems > 1month? A - alone at the time? T - overdose planned for >3 hrs HO - feeling hopeless about the future? S - feeling sad for most of time before overdose?
What are the diff kinds of sleep problems seen in paediatrics? (4)
What age group is it mostly seen in?
What is the main feature noted by the parents?
Difficulty settling
Waking in night
Nightmares
Night terrors
Mainly toddlers
Cannot get to sleep unless parent present
List some reasons for difficulty settling to sleep, that must be asked about in the Hx? (9)
Too much afternoon sleep Evening overstimulation Displaced sleep/wake cycle Poor parental practices (e.g. no bedtime routine) Use of bedroom as punishment
Separation anxiety
Fear of darkness/silence
Chronic physical illness
Kept awake by noisy sibling / neighbours
What advice is given to parents for difficulty settling to sleep?
Introduce bedtime routine
OR
Lengthening periods of time b/wn tucking in bed and returning after mins so child learns how to sleep alone
Whats the difference between nightmares and night terrors?
Nightmare - rarely req medical attention unless frequent/stereotyped in content indicating morbid preoccupation or psychiatric symptoms (e.g. PTSD)
Night terrors occurs approx 1.5hrs after settling
Become disorientated/distressed/unresponsive + will have no recollection in morning
Sim origin to sleep walking
Usually due to erratic sleep schedule
What are some diff types of speech impediment? (6)
Stuttering Lisp Muteness Voice disorders Articulation disorders Dysarthria
What are the main causes of speech impediment? (4)
How are most speech impediments managed?
Congenital health conditions e.g.: Cleft palate Poor hearing Defects of facial bones/muscles Defects of digestive system / larynx
Most can be remediated with speech + lang therapy
Define a stammer/stutter
What age usually seen in?
= flow of speech disrupted by involuntary prolongation/repetition of sounds (vowels), syllables, words or phrases and involuntary silent pauses
Ages 2-5 (most resolve after 5)
What are the main contributing factors towards stammer/stutters (4)
Genetics (approx 60% have FH)
Interruption/competition with siblings
Difficulty in brains language processing areas
Other speech/lang probs or developmental delay
What are some factors in physical injury that may indicate it as NAI? (6)
Hx BG of prev abuse Plausability of explanation Delay reportind accident Inappropriate parents reaction Inconsistent stories from parent/child
What factors in the Hx may indicate neglect? (8)
Lacks immunisations/glasses Frequent DNAs Ravenously hungry Dirty/inadequate clothing Parent/child involved in alc/drugs Parent apathetic/depressed Parent indifferent to child Child says no-ones home
When should emotional abuse be considered?
Born when parental separation/violence
‘Wrong’ gender
How may emotional abuse present in babies?
in toddlers?
in school-age?
in teenagers?
Babies: Apathetic, non-demanding, delayed devel, attention seeking, lack of affection
Toddlers: apathetic, fearful, violent
School-aged: wetting/soiling, relationship difficulties, truancy, antisocial behav
Teenagers: self-harm, depression, aggressive/defensive, minor crimes
What does sexual abuse consist of?
Physical contact and/or non-contact (watch/take porn/pictures)
What may be some physical indicators of sexual abuse? (2)
STI / Pregnancy <13 yrs (= always sexual abuse)
Vaginal bleeding/itching/discharge/rectal bleeding
What may be some behavioural indicators of sexual abuse? (6)
Secondary enuresis Soiling Self-harm Aggressive Sexual Poor school performance
What are some causes of induction in Fabrication + Induced Illness?
XS substances e.g. salt
XS meds
Suffocation
Poisoning
What is the main clue that may suggest Fabrication/Induced Illness?
Presentations only occurring in carer’s presence + no clinical evidence
What features are always seen in Chronic Fatigue Syndrome? (6)
What are some other features commonly (but not always) seen? (5)
Always: Myalgia Migratory arthralgia Headache Difficulty getting to sleep Poor concentration Irritability
Often seen: Stomach pains Scalp tenderness Eye pain Photophobia Tender cervical lymphadenopathy
What viruses may contribute towards chronic fatigue syndrome?
Cocksackie B virus
EBV
Hepatitis
How is chronic fatigue syndrome managed?
Graded exercise
and/or
CBT
Recovery can takes months/years
Define dyspraxia
A developmental coordination disorder of motor planning +/or execution, but with normal neuro exam
Affects perception + use of language → education probs
What motor functions may be affected in dyspraxia? (5)
Handwriting / drawing Poor estab laterality (L/R) Dressing self Cutting food Messy eating
How is dyspraxia managed?
Why is Dx usually late?
Assessed/advised with OT/speech and lang therapist
Mild dyspraxia undetected in early life as achieves normal motor milestones
What are the ICD-10 criteria of anorexia nervosa? (3)
Low body weight (BMI < 17.5)
Overvalued idea of being fat
Self-induced wt loss
What are the main endocrine changes that occur in anorexia nervosa? (3)
Amennorhoea / loss of libido
Raised GH/Cortisol
Reduced thyroxine
List some DDx of anorexia/bulimia (5)
Depression Psychosis OCD Dementia Alc/substance abuse
List some causes of daytime enuresis (7)
Lack of attention to bladder sensation Detrusor instability Neuropathic bladder (spina bifida / enlarged+fails empty) Bladder neck weakness Ectopic ureter (constant dribbling) UTI Constipation
What may be seen O/E in daytime enuresis if due to spina bifida? (4)
O/E: distension S2-4 sensory loss Abnorm perineal sensation / anal tone Abnorm leg reflexes + gait
What other Ix can be done in daytime enuresis? (2)
What management strategies (3)
USS w. urodynamic studies
Urine MC+S
Bladder training / pelvic floor exercises
Treat constipation
Poss anticholinergics
List some causes of secondary enuresis (3)
UTI
Emotional upset
Polyuria
What are the main 2 causes of nocturnal enuresis List 3 (uncommon) organic causes
Genetic delay in acquiring sphincter competence
Emotional stress / interference when learning dry nights
UTI
Polyuria
Faecal retention → bladder neck dysfunc
What are the treatment options for nocturnal enuresis (2)
Encouragement/ rewards + no punishment
Desmopression (short term relief e.g. sleepover/holidays)
What are mild/moderate/severe/profound learning difficulties defined as? How does each one initially present
Mild = IQ 70-80 → only apparent when start school Moderate = IQ 50-70 → delay in speech/lang Severe = IQ 35-50 → developmental delay in infancy Profound = IQ <35 → developmental delay in infancy
List some prenatal organic causes for LDs (11)
Genetics: Downs, Fragile X, Microcephaly, Hydrocephalus
Teratogenic: alc/drug abuse
Congenital infection (CMV, HIV, Toxo, Rubella)
Endocrine: hypothyroidism, PKU
Neurocutaneous syndromes
Vascular: occlusion, haemorrhages
List some perinatal causes of LDs (4)
Extreme prematurity
Birth asphyxia
Symptomatic hypoglycaemia
Hyperbilirubinaemia
List some postnatal causes of LDs (9)
Infection: meningitis, encephalitis
Trauma: head injury
Metabolic: hypoglycaemia, inborn metab errors
Vascular: stroke
Hypoxia: seizures, near drowning, suffocation
Define school refusal
What are the 2 main causes
= inability to attend school due to overwhelming anxiety
Separation anxiety (provoked by adverse life events) Anxiety provoked by some aspect of school
What are the child’s complaints in school refusal? (3)
What are the main principles of management of school refusal (4)
Headache
Unwell
Nausea
Treat underlying emotional disorder
Address bullying/educational difficulties
Parental encouragement
Facilitate return
What approach is used to analyse a tantrum
Best management strategies in tantrums (3)
ABC
Antedecent: what happens mins before
Behav: what episode consists of
Consequence: what happened as result
Distract
Leave room / return in mins
Naughty step/ star chart
What is conduct disorder defined as?
What is the main age of incidence in boys/girls
= repetitive/persistent pattern of aggression to ppl/animals, property destruction, theft, truancy
Boys** <18 + Girls 14-16
List some RFs for conduct disorder (4)
What are the main management strategies
Genetic
Parental psychopathology
Abuse/neglect
Education/socioeconomic status
CBT/Family/Group therapy
What is opposition defiant disorder defined as?
defiant/hostile behaviour that does not violate the law
What are the social interaction impairments in ASD? (4)
List the communication impairments (3)
List the abnormal interests/behaviours (4)
Social: Poor eye contact Facial expressions Cannot share Lack friendships
Communication:
Poor spoken language
Lack imaginative play
Difficulty initiating/sustaining convo
Interests/behavs:
Intense preoccupation w. dates/numbers/timetables
Inflexible adherance to routine
Repetitive motor movements (e.g. clapping)
Unusual interest in parts of hard/moving objects
What other features may present with ASD (not seen in all) (3)
Behav probs (aggression, impulsivity, self-injurous) Mental retardation (norm intelligence) (75%) Epilepsy (25%)
What is the prognosis like in ASD?
What factors can improve the prognosis (4)
Prognosis poor: 1-2% achieve full independence + 20-30% achieve partial
Better prognostic factors: IQ > 70 Good language development by 5-7yrs Home/fam support Education support
Whats the difference b/wn ASD + aspergers?
What personality traits may also be seen in aspergers?
Aspergers has social interaction impairment + restricted/stereotypes behaviours
BUT
No abnormality in language / cognitive ability
Schizoid (solitary/no interest in social relationships)
Anakastic (OCD)
What are the main features of ADHD (6)
Onset <6-7yrs Hyperactivity/impulsivity Impaired attention in work/play Not listening when spoken to Often interrupt others V distractible
What are some possible causes of ADHD (4)
Genetic
Dietary
Psychosocial factors
Brain damage
Within the Dx criteria for ADHD, how long must symptoms have been present for?
Symptoms evident in >1 situation (school + home)
Present for at least 6m
Describe the management of ADHD
Pharm:
1st line - works in 3/4 with concentration/academic
Methylphenidate (ritalin)
Dexamphetamine
2nd line - antidepressants/some antipsychotics
Psychotherapy:
Behaviour modification
Family education (permissive parents not helpful)
What is the prognosis for ADHD
What factors are assoc w. worse prognosis? (2)
Improvements in development / remission by 12-20yrs (but persisting symptoms in 15%)
Worse prognosis:
Unstable family dynamics
Conduct disorder
What are the 4 main gross motor milestones in early development (<2y/o) + limit ages for these
Head control - 4m
Sit unsupported - 9m
Standing independently - 12m
Walking independently - 18m
What are the 4 main fine motor/vision milestones in early development + limit ages for these
Fixes and follows objects - 3m
Reaches for objects - 6m
Transfers - 9m
Pincer grip - 12m
When + how (2) does abnormal motor development present?
At 3m-2yrs (when most skill acquisition)
Delayed motor milestones
OR
Abnormal gait / Balance problem / Asymm hand use / Invol movements / Motor skill loss
List some causes of abnormal motor development (4)
Central motor deficit e.g. cerebral palsy
Congenital myopathy
Spinal cord lesions
Global development delay
What are the 5 main speech milestones in early development + limit ages for these
Polysyllabic babble - 7m Consonant babble - 10m 6 words with meaning - 18m Joins words - 2yrs 3-word sentences - 2.5yrs
List some causes for speech + language DELAY (5)
List some causes for speech + language DISORDERS (5)
Hearing loss Speech production difficulty from anatomical deficit (e.g. cleft palate) Global developmental delay Environmental deprivation Normal variant/ familial pattern
Language comprehension Language expression (cannot articulate) Phonation + speech production (stammer/dysarthria/verbal dyspraxia) Pragmatics/semantics/grammar Social/communication skills (ASD)
What are the 5 main social/behavioural milestones + their limit ages
Smile - 8wks Fear of strangers - 10m Feeds self/spoon - 18m Symbolic play - 2/2.5yrs Interactive play - 3/3.5 yrs
