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Paeds > Community Paeds & Psychiatry > Flashcards

Community Paeds & Psychiatry Flashcards

1
Q

How does ASD present?

A

Usually 2-4y when language/social skills rapidly expand
- Where only some behaviours present → autistic features but not full spectrum

Triad of difficulties:

  1. Impaired social interaction
  2. Speech and language disorder
  3. Imposition of routines with ritualistic & repetitive behaviour
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2
Q

Examples of impaired social interaction in ASD?

A
  • Does not seek comfort, share pleasure, form close friendships
  • Prefers own company
  • Gaze avoidance
  • Lack of joint attention
  • Socially and emotionally inappropriate behavior
  • Does not appreciate others have thoughts/ feelings
  • Lack of appreciation of social cues 

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3
Q

Examples of speech and language disorder in ASD?

A
  • Delayed development, may be severe
  • Limited use of gestures and facial expression
  • Formal pedantic language, monotonous voice
  • Impaired comprehension with over­literal
interpretation of speech
  • Echoes questions, repeats instructions, refers to 
self as ‘you’
  • Can have superficially good expressive speech 

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4
Q

Examples of routines/repetitive behaviour in ASD?

A
  • Violent temper tantrums if disrupted
  • Unusual stereotypical movements such as hand flapping and tiptoe gait
  • Concrete play
  • Poverty of imagination in play and general 
activities
  • Peculiar interests and repetitive adherence
  • Restriction in behaviour repertoire
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5
Q

Co-morbidities with ASD? (2)

A

LD (2/3)

Seizures (1/3) - often not until adolescence

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6
Q

What treatment has been shown to be effective in ASD?

A

Applied behavioural analysis

→ Helps reduce ritualistic behaviour, develop language, social skills and play and to generalise use of all these skills

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7
Q

What % of children with autism are able to function independently as adults?

A

<10%

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8
Q

4 areas of development?

A
  1. Gross motor
  2. Vision & fine motor
  3. Hearing, speech and language
  4. Social, emotional & behavioural
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9
Q

When assessing development, what age do you adjust for gestational age up until?

A

2y

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10
Q

Developmental milestones for vision/ fine motor with median and limit ages?

A 
Fixes and follows - 6w, 3m
Reaches for objects - 4m, 6m
Transfers - 7m, 9m
Pincer grip - 10m, 12m
Makes marks with crayon - median = 16-18m
Tower of 3 - median = 18m
Tower of 6 - median = 2y
Draws a line - median = 2y (drawing can copy 6m earlier)
Circle - median = 3y
Square - median = 4y
Triangle - median = 5y
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11
Q

Developmental milestones for hearing, speech & language with limit ages?

A 
Polysyllabic babble - 7m
Consonant babble - 10m
Saying 6 words with meaning - 18m
Joins words - 2y
3 word sentences - 2.5y
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12
Q

Milestones for social, emotional &behavioural development with limit ages?

A 
Smiles - 6w, 8w
Fear of strangers - 10m
Feeds self/spoon - 18m
Symbolic play - 18-24m, 2-2.5y
Interactive play - 2.5-3y, 3-3.5y
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13
Q

How may abnormal motor development present?

A
  • Delay in motor skills
  • Problems with balance
  • Abnormal gait
  • Asymmetry of hand use
  • Involuntary movements
  • Loss of motor skills (rare)

Usually presents b/w 3m -2y

  • No hand dominance until 1–2y → asymmetry of motor skills during 1st y always abnormal and may suggest underlying hemiplegia
  • Late walking (>18m) needs to be differentiated from children who display normal locomotor variants of bottom­shuffling or commando crawling (walk later)
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14
Q

Causes of motor delay? (4)

A
  • Central motor deficit e.g. CP
  • Congenital myopathy/primary muscle disease
  • Spinal cord lesions, e.g. spina bifida
  • Global developmental delay, as in many syndromes or of unidentified cause
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15
Q

3 screening questions asked prior to pGALS assessment?

A
  1. Do you have any pain in your joints?
  2. Do you have any pain or trouble walking?
  3. Do you have any pain or problems dressing yourself?
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16
Q

Causes of speech/language delay? (5)

A
  • Hearing loss
  • Global developmental delay
  • Difficulty in speech production from anatomical deficit, e.g. cleft palate, or oromotor incoordination, e.g. CP
  • Environmental deprivation/lack of opportunity for social interaction
  • Normal variant/familial pattern
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17
Q

Prenatal causes of developmental delay/LD? (6 categories)

A

Genetic - chromosomal, cerebral dysgenesis
Vascular - occlusions, haemorrhages
Metabolic - hypothyroid, PKU
Teratogenic - alcohol/ drug abuse
Congenital infection - rubella, CMV, toxoplasmosis, HIV
Neurocutaneous syndromes - tuberous sclerosis, NFM

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18
Q

Perinatal causes of developmental delay/LD? (3 categories)

A

Extreme prematurity - IVH, periventricular leucomalacia
Birth asphyxia - HIE
Metabolic - hypoglycaemia, hyperbilirubinaemia

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19
Q

Postnatal causes of developmental delay/LD? (5 categories)

A

Infection - meningitis, encephalitis
Anoxia - suffocation, near drowning, seizures
Trauma - head injury
Metabolic - hypoglycaemia, inborn errors of metabolism
Vascular - stroke

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20
Q

Ix for global delay?

A
  • Cytogenetic
  • Metabolic → TFTs, LFTs, U&Es etc etc
  • Infection
  • Imaging → Cranial USS, CT, MRI,
  • Neurophysiology → EEG
  • Histopathology → muscle biopsy
  • Other → hearing, vision, clinical genetics, cognitive assessment, therapy assessment etc
21
Q

Classification of learning difficulties?

A
  • Mild (IQ 70-80)
  • Moderate (IQ 50-70)
  • Severe (IQ 35-50)
  • Profound (IQ <35)
22
Q

Presentation of learning difficulties?

A
  • Severe and profound learning difficulties usually apparent from infancy as marked developmental delay
  • Moderate LDs emerge only as delay in speech and language
  • Mild LDs may only become apparent when child starts school or even later
23
Q

Diagnostic criteria for ADHD? (4)

A
  • Combination of overactive, poorly modulated behaviour with marked inattention and lack of persistent task involvement
  • Sx prior 6yo and of long duration
  • Impairment present in 2 or more settings
  • Exclude diagnosis of anxiety disorders, mood affective disorders, pervasive developmental disorders and schizophrenia
24
Q

Behavioural management of ADHD?

A
  • 1st line if mild/mod
  • Advice to parents + teachers to build concentration skills, encourage quiet self-occupation, increase self-esteem and moderate extreme behavior
  • Have clear rules and expectations
  • Consistent use of rewards and consequences where appropriate
25
Q

Pharmacological management of ADHD?

A
  • If unresponsive to behavioural
  • Normally only >6yo
  • Stimulants → methylphenidate (Ritalin) or dexamphetamine
  • Non-stimulants → atomoxetine
  • → Both reduce XS motor activity and impove attention
  • May continue for several years
  • Yearly trial off medication recommended
26
Q

What mayday daytime enuresis be caused by? (7)

A
  • Lack of attention to bladder sensation
  • Detrusor instability
  • Bladder neck weakness
  • Neuropathic bladder (associated with spinal bifida –> bladder enlarged and fails to properly empty)
  • UTI
  • Constipation
  • Ectopic ureter (constant dribbling)
27
Q

Treatment of daytime enuresis?

A
  • No neurological cause –> star charts, bladder training and pelvic floor exercises
  • Constipation treated
  • Anticholinergic drugs may be helpful
28
Q

What is secondary enuresis?

A

Loss of previous urinary continence

29
Q

Causes of secondary enuresis? (3)

A
  • Emotional upset
  • UTI
  • Polyuria (eg DM)
30
Q

Ix for secondary enuresis? (3)

A
  • Test urine for infection, glucose and protein
  • Assessment of urinary concentrating ability
  • USS of renal tract
31
Q

What percent of 5 and 10 year olds have nocturnal enuresis?

A

6% 5yo

3% 10yo

32
Q

Causes of nocturnal enuresis? (6)

A
  • Genetic - 2/3 have 1st degree relative affected
  • Emotional stress

Organic causes (uncommon):

  • UTI
  • Fecal retention
  • Polyuria due to DM
  • Renal concentrating disorders
33
Q

Management of nocturnal enuresis?

A
  • > 4yo, enuresis resolves spontaneously in 5%
  • Explain that problem is common and beyond conscious control
  • Parents should stop punishing child
  • Star charts can help by encouraging child for not wetting bed
  • Enuresis alarm may be used to wake child and prompt them to empty their bladder
  • Desmopressin can provide short-term relief for holidays or sleepovers as it is an analogue of ADH
34
Q

ICD-10 criteria for anorexia nervosa? (4)

A

All of following:

  • BMI <17.5
  • Self-induced weight loss
  • Overvalued idea
  • Endocrine disturbances (failure to make expected development if prepubertal)
35
Q

What endocrine disturbances may occur in anorexia nervosa? (5)

A
  • Amenorrhoea in post-menarchal women
  • Loss of sexual interest
  • Raised GH and cortisol
  • Reduced T3
  • Pubertal events may be delayed or arrested in certain age groups
36
Q

ICD-10 criteria for bulimia? (3)

A

All of following:

  • Binge eating
  • Methods to counteract weight gain (vom, lax, diuretic, fasting, XS exercise)
  • Overvalued idea 

37
Q

% of population that have

a) bulimia
b) anorexia nervosa?

A

a) 3-5%

b) 1%

38
Q

Management of anorexia? (4)

A

1st must reefed - sometimes NG
Family therapy = mainstay of treatment
Also individual therapy
Hospitalisation if BMI <13.5, syncope, electrolyte abnormalities, rapid wt loss

39
Q

What % of people with anorexia and bulimia recover?

A

50% anorexia recover
- further 25% go on to have bulimia

50-70% bulimia recover

40
Q

3 chronic illnesses that may present with short stature?

A

Coeliac
Crohn’s
Chronic renal failure

41
Q

RFs of conduct disorder? (5)

A
  • Genetics
  • Parental psychopathology
  • Abuse, neglect
  • Education
  • Socioeconomic status
42
Q

RFs for depression in children? (2)

A

FH

Bullying

43
Q

Key features of chronic fatigue syndrome? (4)

A
  • Post-exertional fatigue or malaise
  • Cognitive difficulties
  • Sleep disturbance
  • Chronic pain
44
Q

Developmental milestones at 6m in each domain?

A
  • Sit with no support
  • Pass blocks b/w hands
  • Single syllable
  • Feed self
45
Q

Developmental milestones at 1y in each domain?

A
  • Stand independently
  • Pincer grip
  • Responds to name, mama/dada
  • Drinks from cup with 2 hands
46
Q

Developmental milestones at 2y in each domain?

A
  • Runs
  • Scribbles
  • 2 word sentences
  • Takes off garment
47
Q

Developmental milestones at 3y in each domain?

A
  • Jumps up
  • Copies vertical line
  • 3-4 word sentences
  • Puts on garment
48
Q

Developmental milestones at 4y in each domain?

A
  • Stands on each foot for 3s
  • Copies a cross
  • Name 4 colours
  • Dresses independently
49
Q

Developmental milestones at 5y in each domain?

A
  • Heel-toe walking
  • Draw person with 6 parts
  • Counts to 5
  • Board game/ brushes teeth

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