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2019 RC Specialties > Development > Flashcards

Development Flashcards

1
Q

Passing objects hand to hand and sits with support. Age?

A

6 months

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2
Q

List as many developmental red flags a you know.

A

**Regression of skills
Early primitive reflexes after 6 mo.

GM:

  • rolling < 3 mo.
  • fisting persist at 3 mo.
  • no sitting by 8-9 mo.
  • *- not walking by 18 mo.

FN:
- handedness < 18 mo.

Speech:
- < 3 word at 18 mo.

Social
- no smile at 3 mo.

Cognitive:

  • no alert to environmental stimuli by 3 mo.
  • no peek a boo at 9 mo.
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3
Q

Pincer grasp. Age?

A

9 months.

5 mon: rake small object
6 mon: hand to hand
7 mon: radial palmar grasp

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4
Q

Object permanence major milestone once:

A

9 months

= understanding objects continue to exist even when they can’t be seen

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5
Q

10 month old bites you. True:

  • early sign ASD
  • abusive fam
  • normal and baby excited
A

Developmentally normal and he is excited

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6
Q

What is most characteristic of 9-12 months:

  • object permanence
  • imitate scribbling
  • transfer object hand to hand
  • mama and dada specifically
A

Mama + dada specifically.

  • Transfer object hand to hand by 6 mo.
  • Object permanence by 9 mo.
  • Scribbling imitated at 18 months.
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7
Q

All are true except:

  • walk 3 step by 15 mo
  • copy horizontal line at 15 mo
  • stack 3 block at 18 mo
  • speak 10 word at 18 mo
  • climb stairs holding rail at 18 mo.
A

Copy horizontal line at 15 moon

= imitate vertical stroke at 18 mo and horizontal stroke at 24 month

At 15 mo.

  • walk alone
  • 3 cube tower
  • crayon line
  • name object
  • hug

At 18 mo.

  • walk stair with 1 hand
  • imitate scribbling
  • 10 words, 1 body part
  • feed self
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8
Q

Parachute reflex shown. Which is true:

  • primitive reflex disappear by 4 mo
  • this is voluntary reflex disappear when child walking
  • involuntary reflex; appear at 7-9 mo and never disappear
A

Involuntary
Appear at 7-9 mo.
Does not disappear

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9
Q

Describe a 2 mo, 4 mo, 6 mo, 8 mo, 9 mo old baby:

A

2 mo

  • lift head 45 degree
  • turn to sound + track
  • social smile

4 mo

  • raise head + chest when prone
  • roll over (front to back and then other)
  • reach for object
  • squeal

6 mo.-8 mo.

  • sit
  • hand to hand
  • babble
  • non specific mama/dada
  • stranger anxiety
  • wave near 8.5 mo.

9 mo.

  • crawl/ pull to stand
  • pincer grasp
  • jabber
  • separation anxiety
  • peek a boo
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10
Q

Describe 1-5 y.o. milestones:

A

1 year:

  • walk
  • age x 3 for cubes= 3 cube towers
  • single word
  • drink from cup

18 mo.

  • walk stair with 1 hand
  • imitate scribbling
  • 10 words, 1 body part
  • feed self
  • kick ball

2 y.o.

  • climb two steps
  • 6 cub tower
  • 2 word phrase
  • 25% understandable
  • two step command
  • tell immediate experience

3 y.o.

  • tricycle, jump
  • circle -> start cross
  • 9 cube
  • count 3 objects
  • repeat 3 digits
  • 3 word phrase
  • 3/4 understood
  • pretend group play

4 y.o.

  • alternating stairs
  • balance 1 foot x 4sec
  • square
  • knows name
  • 90% understood
  • interactive role play
  • dress on own

5 y.o.

  • skips
  • triangle
  • name 4 colour
  • fluent speech
  • play competitive game
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11
Q

What is the developmental tip to learn the order of shapes?

A

Alphabetical order

Circle - 3

Cross -3 to 4

Square- 4

Triangle- 5

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12
Q

Which milestone do most children achieve first?

  • Overhand throw ball
  • Kick ball
  • Hopping
  • Riding tricycle
  • Skipping
A

Kick ball= 18 mo.

  • 2= throw overhand
  • 3 = tricycle
  • 4= hopping
  • 5= skip
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13
Q

T or F: bilingualism is an adequate explanation for significant speech delay.

A

False

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14
Q

T or F: tongue tie can affect acquisition of language.

A

False.

  • can affect articulation but not acquisition
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15
Q

T or F: early language disorder strongly associated with reading disorder.

A

True.

Also communication disorders overall higher rate of anxiety (social phobia)

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16
Q

T or F: 10% of those with speech delay catch up by 3 y.o.

A

False.

> 1/2 catch up.

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17
Q

Define global developmental delay:

A

> 1 area of deficit + cognitive impairment in < 5 y.o. child

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18
Q

Define Autism Spectrum Disorder criteria:

A

Social communication + Repetitive restricted (2 of)

  1. Social communication or interaction deficit
    > social-emotional reciprocity
    > non verbal communication
    > developing, maintaining or understanding relationship
  2. Restricted repetitive pattern of behaviour, interest or activity w/ min 2 of:
    > stereotyped or repetitive motor movement, object, speech (echolalia i.e.)
    > insistence of sadness, finlexible
    > highly restricted fixed interest in abN intensity or focus
    > sensory hyper or hyperactivity

Symptom present in early development and cause significant impairment.
Not better explained by intellectual dx or GDD>

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19
Q

List as many indications as you remember for SLP:

A

Any age: no response to sound, environment.

12 month: no mama, dada
15 mo: no 3 word
18 mo: no simple command, no names
24: no point to body parts, not using 25 words
3 y.o.: no 2 step command, vocal < 200 words, echolalia
4 y.o.: stuttering

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20
Q

what is developmental disfluency?

A

2-3 y.o.
fluency or timing inappropriate (reputation, broken word, silent blocking, tension with words)
Last wk-months
Resolve by 4 y.o.
Do not fill in or interrupt or prompt to slow down.

4 y.o.= REFER

Versus stuttering is usually 4-5 y.o. and SLP.

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21
Q

Child with expressive speech delay, parent do all BUT:

  • read at night
  • repeat incorrectly pronounced words over and over
  • make stop activity and look when you talk
  • don’t complete sentences
A

Make him repeat incorrectly pronounced word over and over

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22
Q
  1. 5 y.o. referred for SLP and inferior ectopia lentis. Next?
    - molecular studie for Marfan Syn
    - Echo to R/O aortic root abN
    - fibroblast/skin bx for enzyme assay
    - quantitive serum a.a.
    - plt count and coag for hypercoag
A

Quantitive serum a.a.

R/O homocysteinuria.

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23
Q

All are true re: vision in newborn EXCEPT:

  • newborn sclera thin which cause blue hue
  • able to fix on large since birth
  • 2 mo. follow 180 degree
  • retinal hem rare in newborn and cause permanent deficit
A

Retinal Hemm rare and cause permanent deficit= RARE

  • Superficial retinal hemm observed in MANY and most resolve within 2 wk
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24
Q

T or F: disruption of continuity of care may be potentially detrimental to all children

A

True

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25
Q

T or F: Joint custody is better for child regardless whether conflict btwn parents.

A

False.

Parental depression and conflict more likely determine adjustment than custody issue.

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26
Q

T or F: marital conflict causes child distress and mental health issues often LONG before parents actually separate.

A

True

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27
Q

What are the 3 significant factors impacting child’s well being during a divorce:

A
  1. parenting
  2. parent-child interaction
  3. degree, f, intensity and duration of hostile conflict
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28
Q

What are kids w/ William Syn learning strength and weakness?

A

Strength: verbal short term memory

Weak: visual-spatial skills

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29
Q

List traits of Williams Syn

A
  • elfin facies (stellate iris, fullness with hypertelorism)
  • supravalvular aortic stenosis
  • HTN
  • hypercalcemia
  • connective tissue abN
  • scoliosis
  • extreme friendly
  • talky +++
  • inattention
  • phobia
  • intellectual disability (mild-moderate)
  • Strength: verbal short term memory
  • Weak: visual-spatial skills
  • Anxiety + ADHD
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30
Q

18 mo. Fragile X. which NOT seen in boys with full FMR mutation:

  • delay in fine + motor
  • relatively strong expressive communication
  • cognitive impairment
  • hyperactivity + distractible
  • social avoidance + anxiety
A

Expressive lang usually delayed

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31
Q

How do you define fetal alcohol syndrome:

A

3 facial traits (short palpebral fissures, thin vermillion border, smooth philtrum)
+ growth retardation (<10th % tile)
+ CNS involvement (structural with microcephaly, neuro signs, functional)
+/- confirmed prenatal exposure.

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32
Q

What are functional abnormalities seen in FASD:

A
  • GDD
  • intellectual disability
  • executive f’n deficit
  • motor delay
  • social skill
  • problem with ADHD
  • sensory problem or memory deficit
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33
Q

Which does not have MR as part of ppt?

  • fragile X
  • sotos syn
  • karyotype XXY (Klinefelter)
  • marfan’s
  • homocysteinuria
A

Marfan’s Syn

Tall + DD

  • Klinefelter
  • Triple X syn
  • Fragile X
  • Homocysteinuria
  • Loeyz-Dietz
    • Sotos Syn
  • Weaver Syn
34
Q

Big head, long thin face, receding hairline. DD when older. BIG everything on growth chart. Dx?

A

Sotos Syndrome

35
Q

List 3 things on ddx for macrocephaly:

A
  • hydrocephalus
  • big brain
    > metabolic (MPS)
    > anabolic (Sotos)
    > Autism, Fragile X, achondroplasia
  • thickened skull
    > hemolytic anemia, dysostosis
  • space occupying lesion
    > AVM, tumour, subdural effusion
  • familial/ benign
36
Q

Name 4 biologic determinant of child development:

A
  • genetics
  • teratogen exposure
  • low BW
  • post natal illness (meningitis, TBI, chronic illness)
  • malnutrition
  • inborn errors of metbaolism
37
Q

T or F: Early Childhood Resource Specialist consult on behav concern and parenting strategies for kids with special needs.

A

True

Does not do info on positioning, handling, communication tool or how to practice lang.

38
Q

T or F: microcephaly out of proportion to other growth parameters is MORE of a red flag than all growth parameter down in new adoption kids.

A

True.

if all down- think malnutrition.

39
Q

List 3 aetiologies for microcephaly:

A
  • Familial
  • Syndrome (T21, T18 Edward, Cornelia de Lange)
  • CMV, Rubella, Toxo
  • FAS
  • Meningitis, encephalitis
  • Metabolic (maternal DM)
  • HIE
  • Malnutrition
40
Q

3 y.o. with microcephaly and regression of milestones. abN hand movement. THINK OF:

A

Rett’s

  • normal until 1 y.o. then regression and acquire microcephaly
  • MECP2 mutation
  • lang and motor gone
  • ataxia gait, tremor
  • repetitive wringing movement, loss of purposeful hand movement, autistic mvmt
  • sz, poot wt
  • cardiac arrhythmia possible
41
Q

Most predictive of intellectual disability

  • mom didn’t finish high school
  • maternal alcohol in preg
  • HTN
  • cocaine during preg
  • neonatal hypoxia
A

4X more likely in child in mom who did not finish high school.

42
Q

list 4 RF for intellectual disability:

A

Mild IQ:

  • Williams, Noonans
  • IUGR
  • prem
  • drugs, alcohol
  • fhx low edu

Severe ID if:

  • T21, Fragile X, Rett, Prader willi or angel man
  • lishencephaly
  • IEM (MPS)
43
Q

Mom used IV heroin. 10 mon. now losing acquire milestones and develop b/l spasticity. Likely cause:

  • HIV
  • CMV
  • CP
  • syphilis
A

?HIV

CC: vary from mild DD to progressive encephalopathy, deterioration with acquired microcephaly and symmetric motor dysfunction
- spastic, hyperreflexia

44
Q

Which is more likely to be ID in school aged child rather than young?

  • LD
  • mild cognitive
  • mild ASD
  • LD + ASD
  • all of above
A

All of above.

45
Q

T or F: there is an identifiable cause in most cases of intellectual disability

A

Depends.

  • IQ 50-70
    = Mild: mental age near 9-11 y.o.
  • more environment
  • other cause in < 50%
  • IQ < 50
    = Severe: mental age as adult near 3-5 y.o.
  • cause > 75%
46
Q

Mother pregnant with 2nd. First child has autism. Risk of 2nd having?

  • lower if no MMR vac
  • no difference than population risk
  • slightly increased risk over general popn
A

Slightly increased risk over the general population (3-5%)

RF:

  • extreme prem (< 26 wk)
  • close spacing of preg
  • advanced maternal or paternal age
  • FHX (sibling)
  • FHX of LD, psych, social disability
47
Q

List two neurological disorders associated with Autism:

A
  1. Tuberous Sclerosis
  2. Rett Syndrome
  3. Neurofibromatosis 1
  4. Fragile X
    Other:
  5. Angelman Syndrome
  6. Myotonic Dystrophy
48
Q

Autism. 3 tests you should order:

A
  1. Microarray
  2. Fragile X
  3. Hearing Screen

Other:

  • Lead test
  • FISH for 15q111 in Prader Willi/Angelman
  • genetic MECP2 for Rett
  • metabolic screen
  • EEG if Sz
49
Q

Autism. What 2 consultants would you involve to help with your dx?

A
  1. Developmental Pediatrician
  2. Psychologist
  3. Psychiatrist
  4. Geneticist

Multi-D: SLP, OT, PT

Tx: applied behavioural analysis (ABA) or social skills training if older

50
Q

List 5 things on DDX for Autism Spectrum Disorder:

A

Some…

  1. Communication Disorders
  2. Intellectual Disability
  3. Deaf or Sensory impairment
  4. OCD
  5. Anxiety (selective mutism)
  6. ADHD
  7. Rett Syndrome
  8. TS
  9. Fragile X
  10. Rett Syndrome
  11. PKU
  12. Homocystineuria
  13. Infectious (encephalitis, meningitis)
  14. Endo (hypothyroid)
  15. Toxin (FASD)
51
Q

1 y.o. head banging. P/E normal. Mom worried about brain damage:

  • reassure
  • EEG
  • CT head
  • use helmet
  • family psych
A

Reassure

Usually < 2 y.o., resolve over time.

Head banging in 25% of kids but kids > 5 almost always associated with developmental dx.

Ignore, encourage substitute behaviour.
Do not show worry.
Will not hurt themselves.

52
Q

T or F: head banging over 5 y.o. is normal.

A

False.

> 5 almost always associated with developmental dx.

53
Q

7 y.o. with thumb-sucking. Discuss risk and benefit including:

  • never causes self esteem issue
  • can lead to dental malocclusion and facial growth abN
  • topical deterrent very effective
A

Thumb sucking can lead to dental malocclusion and facial growth abnormalities.

Sucking > 5 associated with paronychia (red, tender, bacterial or fungal infection at base of nail), and anterior open bite (gap between upper and lower front teeth)

54
Q

4 y.o. suck thumb. What to tell mom:

  • put bitter sub on thumb
  • reassure
  • prescribe mouth appliance
  • reward system
A

Reward system

Management:

  • ignore and praise alternate behaviour
  • reminder and reinforcement (reward sys)
  • rarely necessary to use bitter substance
55
Q

30 mon old w/ temper tantrum after starting toilet training. What to d:

  • time out
  • perserve
  • take 1-3 mo. break from toilet training
  • reward each time on potty
A

Take 1-3 month from toilet training

Do not engage in battle as can damage relationship and self-image.

If express refusal- take 1-3 mo. break.

56
Q

How do you tell child ready for toilet training:

A

Gauge signs of readiness:

  • able to walk
  • sit on potty
  • can stay dry x several hour
  • receptive lang to follow simple command
  • can express need to potty
  • want to please and be independent

Goal: gradual use (sit fully dressed, lead to potty and sit without diaper, potty at certain time etc.)

57
Q

T or F: do not initiate toileting during a stressful time.

A

True

58
Q

When should you try training pants or cotton underpants when toilet training?

A

Once successful potty x min. 1 wk

59
Q

Give two pieces of advice re: toddler temper tantrum

A
  • *- Common, express when overwhelmed; emphathsize w/ parent
  • Avert defiance by giving child choice
  • *- Before highly distressed intervene and put in time out (1 min. per age)
  • *- Do not respond w/ anger as can reinforce oppositional; model what you want your child to do
  • *- (+) reinforcement when behave well
60
Q

What should you do if your child has breath holding spells?

A
  • Intercede before distress (time out, consistent discipline)
  • Ignore when start
  • If high levels of aggression refer to mental health
  • Usually self-limited and grow within few years (by 5 y.o. done)
61
Q

8 month old. Not sleeping through night. Wake 1 hr after down in crib. Which is true:

  • falling asleep in crib vs. mom’s arm preventative
  • letting baby cry eliminate problem
  • giving bb pacifier proven technique
  • give bottle of warm milk in bed
A

Falling asleep in crib vs. mom’s arm will be preventive (she helps learn to fall asleep)

62
Q

At what age should child be able to self-soothe when awaken at night?

A

12 months

63
Q

How do you tell the difference of night terrors from frontal lobe epilepsy?

A 
Frontal lobe epilepsy
= older (versus 5-7 y.o. night terrors)
= within 30 min. of sleep (versus few hr after sleep in night terror)
= limb mvmt
= multiple per night
= sleep walking rare
64
Q

Night terrors. Recommend:

A

**Only intervene if will hurt self

**Can wake 30 mn before usual time x 2-4 week until episodes resolve.

+/- Can use benzo or TCA (suppress slow wake sleep) if excessively violent and at risk of injury.

65
Q

8 y.o. primary nocturnal enuresis. Tried alarm x 8 wk w/out success. Wants summer camp. Best:

  • DDAVP
  • amitriptyline
  • imipramine at bed
  • imipramine TID
A

DDAVP

Primary nocturnal enuresis: > 2X/wk beyond 5 y.o.
Reassurance, avoid fluid before bed, empty pre bed, no diaper, include in clean up but not in punitive way.

Therapy if distress:

  • alarm devices
  • pharm (DDAP work best for camp and short term. Avoid fluids 1hr before and 9h after)
  • Other: imipramine (TCA) 1-2h pre bed
66
Q

All are features of sleepwalking EXCEPT:

  • occur in stage 4 non REM
  • (+) fhx
  • can walk around furniture
  • do not walk into dangerous area
  • resolve in later childhood
A

CAN walk into dangerous areas.

Most resolve by puberty.

67
Q

LD with big ears. Mom has LD too. What do you tell her to expect:

  • tics
  • athetosis
  • hyperactivity
  • tremor
  • nystagmus
A

Hyperactivity

80% Fragile X have ADHD

68
Q

List 4 indications for speech therapy in child with speech disfluency.

A

**Avoidance or escapes (pause, head nod, blinking)

**3 or more disfluencies per 100 syllables.

**Discomfort or anxiety while speaking

Suspicion of associated neuro or psychotic dx

69
Q

Biggest predictor of difficulty reading in JK:

A

Early language difficulty. (usually impaired oral development)

70
Q

4 y.o. who can’t use scissors. Can’t copy square. Worry about developmental coordination disorder. 2 Criteria:

A

DSM5 Developmental Coordination Disorder

  • Acquisition or execution of coordinated motor skill below expected
  • Impair daily living
  • Onset in early development
  • Not better explained by ID, Visual impairment, neuro condition
71
Q

Late onset side effect of stimulant:

  • low appetite
  • hard sleep
  • tics
  • depression
A

Depression

72
Q

Which is true of ADHD:

  • teacher and parent checklist often agree
  • check off lead poisoning for all
  • 25% have anxiety dx
  • often thyroid issue
A

25% of kids w/ ADHD have comorbid Anxiety Dx

Comorbidities:

  • lang dx
  • anxiety
  • mood
  • learning dx
73
Q

List ADHD Meds (Stimulant and Non)

A 
Amphetamine:
- dexedrine
- adderall XR
- vyvanse
"Vyvanse= A= Adderall= Amph Class"
Methylphenidate
- ritalin
- biphentin
- concerta
"Concerta= R= Ritalin"

Non stimulant:

  • Atomoxetine= Straterra (good for comorbid anxiety or sub abuse concern)
  • Guanfacine= Intuniv= help everything cool down; good for ODD, CD too
74
Q

ADHD. 14 pound loss. Good control. Best:

  • straterra started
  • consult psych
  • change from 7d to 5d a week
A

Change form 7d to 5d a week dosing

75
Q

How many criteria do you need for mixed subtype ADHD:

A

6 x 6

  • 6 of Inattention
  • 6 of H/I
  • x 6 month each
  • Symp <12 y.o.
  • in 2 settings
76
Q

Severe head injury. No evidence of cerebral oedema or bleeding. Upon d/c from ICU, expect child to develop:

  • fine motor issue
  • sz
  • insomnia
  • behav issue
  • psychiatric dx
A

Behavioural Problems

** cognition most affected area of f’n in traumatic brain injury
= IQ, attn, LD, Behav
- long term issue:
intellectual, learning, memory, social competence, variety of behavioural concerns

77
Q

9 y.o. with depression and SI. Which is RF:

  • bullying
  • recent divorce
  • impulsive behav
  • poverty
A

Bullying?

78
Q

8 y.o. slow to write because writes each letter 3X. No issue with social relationship. Dx?

  • Normal
  • OCD
  • ADHD
  • ASD
A

OCD

79
Q

When can child use regular seat belt:

  • 41 kg
  • child > 6 y.o.
  • while in booster level of ears over head rest of seat
  • child sitting ht at or > 63 cm
A

When eats over headrest while in booster seat.

Outgrown seat IF:

  • Pt reaches top wt or ht allowed for their seat or harness
  • Pt shoulders are above top harness slots
  • Top of pt ears have reached top of seat
80
Q

Name 3 features of Factitious disorder imposed on another (previously Munchausen by proxy)

A

Suspect IF:
- reported symptoms only by 1 parent

  • test fail to confirm dx
  • appropriate tx ineffective
  • evidence of unnecessary or related tests, tx due to parent action

Tx: CAS, choose single medical provider

2019 RC Specialties (31 decks)

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