Community Paediatrics And Psychiatry

Question 1

What causes speech and language delay?

Answer 1

Hearing loss
Global developmental delay
Anatomical deficit or oromotor incoordination
Environmental deprivation

Question 2

When and how does autism present?

Answer 2

Around 2-4yo
More common in boys
Impaired social functioning, speech and language disorder and imposition of routine with ritualistic and repetitive behaviours
Managed with applied behavioural analysis

Question 3

What is a global developmental delay?

Answer 3

Delay in acquisition of all the skill fields which becomes apparent within first 2 years of life
Likely to be associated with cognitive difficulties

Question 4

When does ADHD present and how is it diagnosed?

Answer 4

Onset before 7yo
Impaired attention - during work or play, not listening and being distracted
Hyperactivity - restlessness, fidgeting, noisiness, interrupt others
Need to be evident in more than one situation

Question 5

How is ADHD treated?

Answer 5

Methylphenidate (Ritalin) and dexamphetamine
Antidepressants and antipsychotics
Behavioural modification and family education

Question 6

What is the definition of anorexia?

Answer 6

BMI

Question 7

How is bulimia diagnosed?

Answer 7

Binge eating
Methods to counteract weight gain
Overvalued idea

Question 8

What causes enuresis?

Answer 8

Lack of bladder control in child old enough to be continent >3-5yo
Lack of attention to bladder sensation
Detrusor instability
Bladder neck weakness
Neuropathic bladder (assc. with spina bifida where bladder is enlarged and fails to empty properly)
Ectopic ureter - constant dribbling

Emotional upset
UTI
Polyuria

Question 9

How is enuresis investigated and treated?

Answer 9

Check perineal sensation and anal tone
Leg reflexes and gait
Sensory loss (S2,3,4)
Urine microscopy

Star charts
Desmopressin (for sleepovers)

Question 10

What are prenatal causes of learning difficulties?

Answer 10

Genetic (Down’s, fragile X, microcephaly, hydrocephalus)
Vascular (occlusion, haemorrhage)
Metabolic (hypothyroidism, phenylketonuria)
Teratogenic (alcohol, drug abuse)
Congenital infection (rubella, cytomegalovirus, HIV, toxoplasmosis)
Neurocutaenous syndromes (tuberous sclerosis, neurofibratosis)

Question 11

What impact does chronic disease have?

Answer 11

Inadequate nutrition - insufficient food, restricted diet or poor diet
Increased nutritional requirement - raised metabolic rate

Over-acceptance - allow illness to take over their life –> more impairment and high levels of anxiety
Denial - signs may be ignored and treated not adhered to

Question 12

What is school refusal?

Answer 12

Inability to attend school due to high anxiety (nausea, headache, hyperventilation) confined to weekdays
Separation anxiety in

Question 13

What are tantrums and conduct disorder and how are they managed?

Answer 13

Refusal to comply with parental demands –> parental exhaustion
Distract the child, leave the room and return a few minutes later
Time out

Conduct disorder - boys 10-12 and girls 14-16
Repetitive and persistent pattern of aggression to people and animals, destruction of property etc.
–> antisocial PD and substance related problems

Question 14

What is chronic fatigue syndrome?

Answer 14

Exhaustion on minimal physical or mental exertion
May be recent coxsackie B, EBV or hep infection

Stomach and eye pain, cervical lymphadenopathy, poor concentration, depressive symptoms

Question 15

How is dyspraxia diagnosed?

Answer 15

Developmental coordination problem - motor planning +/- execution without findings on neuro exam
Disorder of higher cortical processes and may have problems of perception, language and putting thoughts together

Question 16

What are the differences in adult and child depression?

Answer 16

More common: apathy, boredom, separation anxiety, social withdrawal, irritable mood

Less common: loss of appetite, weight, sleep and libido, delusional ideas, thought slowing

Psychotherapy then SSRI

Question 17

How is risk assessed in self harm patients?

Answer 17

have you had Problems for more than a month?
were you Alone in the house at the time?
did you plan the overdose for more than Three hours?
are you feeling Hopeless about the future?
were you feeling Sad for most of the time before the overdose?

Question 18

What are the classes of illicit drugs?

Answer 18

A - ectasy, LSD, heroin, morphine, cocaine and methadone
B - amphetamine, cannabis, dihydrocodeine
C - GHB, temazapam, valium, ketamine

Question 19

What different types of sleep disorder exist?

Answer 19

Difficulty settling - child will not go to sleep unless parent is present

Waking at night

Nightmares

Night/sleep terrors - occur about 1.5hrs after settling, parent finds child sitting up in bed with eyes wide open

Question 20

What is the difference in stammers and speech impediments?

Answer 20

Stammer - presents 2-5yo
Involuntary repetitions of sounds

Speech impediment - stuttering, lisping, muteness, articulation disorders etc.
Caused by physical problem

Question 21

What are perinatal causes of learning difficulties?

Answer 21

Extreme prematurity
Birth asphyxia
Metabolic (hypoglycaemia, hyperbilirubinaemia)

Question 22

What are postnatal causes of learning difficulties?

Answer 22

Infection (meningitis, encephalitis)
Anoxia (near drowning, suffocation, seizures)
Trauma (head injury)
Metabolic (hypoglycaemia)
Vascular (stroke)