Development

Question 1

18 month old who wakes up screaming, inconsolable, parents at loss of what to do. Does not recall events.

A. Reassure
B. EEG
C. MRI
D. Refer to psych

Answer 1

A. Reassure

Question 2

The mother of a 3.5 y.o girl is concerned about her speech. She said her first words at 11 months and is speaking in 3 word sentences. There are no concerns with her development. She has begun to have difficulty with speaking. She will repeat the same word (mommy, mommy, mommy) and repeat sounds at the start of words (m-m-m-mommy), pause during speak and insert “uh” in the middle of a sentence. She has associated facial twitches and blinking. What do you recommend ?

A. Reassure
B. Follow up in 6 months
C. Refer to SLP
D. Development assessment
E. Audiology

Answer 2

C. Refer to SLP

Question 3

3 year old male is brought to you because the mother has concerns about his language. He guides mom’s hand to things that he wants , has 18 single words, and can follow 2 step commands. His fine motor and gross motor development is normal. What is this most consistent with ?

A. Expressive language delay
B. Receptive language delay
C. Normal variant
D. Autism spectrum disorder

Answer 3

D. Autism spectrum disorder

Question 4

A 4 month old presents with a narrow elongated head and frontal bossing. What suture is most likely fused ?

A. Metopic
B. Sagittal
C. Lambdoid
D. Coronal

Answer 4

B. Sagittal

-scaphocephaly (dolichocephaly)

Question 5

Father worried about size of penis of otherwise healthy 4kg newborn. Penis measure stretched out 3cm. What do you do ?

A. Dose of 17-OH progesterone
B. CGH
C. Reassure
D. DSD

Answer 5

C. Reassure

Question 6

Female with autism. Best test to detect underlying diagnosis?

A. Microarray
B. Fragile X testing

Answer 6

A. Microarray

Question 7

Toddler with episodes where she doesn’t get her way, cries/throws tantrum, then loses consciousness and sometimes turns blue. These episodes are increasing in frequency. What do you recommend ?

A. Ignore the behaviour and put her in timeout after the episode
B. Refer for behavioural therapy
C. Put her in a time-put before behaviour has a chance to escalate
D. Give in to what she wants

Answer 7

C. Put her in time-our before behaviour has a chance to escalate

Question 8

9 year old girl, parents divorced. How does she handle it ?

A. Blames herself
B. ?
C. ?
D. Chooses one parent and takes their side

Answer 8

D. Chooses one parent and takes their side

Question 9

About a 9 year old whose parents are getting a divorce and they ask what type of behaviour she will exhibit:

A. Developmental regression
B. Pick sides (mother vs father) and blame the other parent
C. Try to make everyone happy
D. Blame herself for the divorce

Answer 9

B. Pick sides (mother vs father) and blame the other parent

Question 10

13 y.o boy breaking things at home, not listening to instructions, and skipping school. He seems angry. What is the next BEST step ?

A. Parent training
B. Start an atypical antipsychotic
C. Start an SSRI

Answer 10

A. Parent training

Management of ODD
Treatment often combo of:
- Parent- Management Training Programs and Family Therapy
- Cognitive Problem- Solving skills training
- social- Skills programs and school- based programs
- medication

Question 11

Two year old child is brought in by her parents for concerning behaviour. Cries and screams when she is not able to get what she wants and sometimes these episodes are associated with her turning blue and having jerking movements (breath holding spell). Parents what to know what to do about these episodes ?

A. Ignore the behaviour, then put the child in a time out afterwards
B. Interrupt the behaviour with a time out before it escalates
C. Give the child what they want to avoid the behaviour

Answer 11

B. Interrupt the behaviour with a time out before it escalates.

Marked as controversial likely with
A. Ignore the behaviour, then put the child in a time out

Question 12

11 y.o boy who has never been dry at night. Father had nocturnal enuresis until age 10. Having difficulty and not able to spend time at his friends’ houses for sleepovers. What is the best advice regarding management ?

A. Alarm
B. Imipramine
C. DDAVP
D. Oxybutynin

Answer 12

A. Alarm

Question 13

Boy with stable ADHD has been on a stable dose of stimulant for the last two years. Had started to become very aggressive when spoken to and gets easily frustrated when he doesn’t get what he wants. You’ve already ruled out psychosocial stressors. What do you want to do as your next step ?

A. Benzo PRN
B. Increase psychostimulatn
C. Add SSRI
D. Add atypical antipsychotic

Answer 13

B. Increase psychostimulant

Why ? Need to find source

Question 14

16 y.o boy with history of ADHD on Vyvanse. His mother notes him becoming more withdrawn and secretive over the past year, wanting to spend all of his time in his room and away from friends and family, on his computer. She has also noted money missing from her purse and strange charges on her credit card from an unknown source. What should you do ?

A. Increase his medication dosage
B. Assess him for gambling problems
C. Add a mood stabilizer
D. Reassure

Answer 14

B. Assess him for a gambling problem

Question 15

A mother brings in her baby with concerns about his head shape. This is what the head looks like. Photo. What is the most likely diagnosis ?

Description of photo, flattened posterior head on right with right ear forward and flattening of forehead on other side

A. Positional plagiocephaly
B. Lambdoid craniosynostosis
C. Dolicocephaly
D. Scaphocephaly

Answer 15

A. Positional plagiocephaly

Question 16

What is the minimum requirement to sit in a car with a seatbelt and no car seat ?

A. 135cm
B. 145 cm
C. 150cm
D. 155cm

Answer 16

B. 145 cm

Needs to be 8y.o and 36kg

Question 17

15 month old is seen in your office. What would make you the most concerned ?

A. Not pointing to show interest
B. No words and part of bilingual family
C. Cannot scribble with a crayon

Answer 17

Answer A: not pointing to show interest - concern for ASD/no reciprocity

Question 18

A 3 year old boy is in your office. He is very energetic, aggressive and destructive. His height is on the 50th percentile and his weight on the 95th percentile. He is described as having a voracious appetite. He comes to see you and hugs you. He speaks in 1 word sentences. What is the diagnosis ?

A. Emotional deprivation
B. Diencephalic syndrome
C. Prader Willi syndrome
D. ADHD

Answer 18

A. Emotional deprivation

For emotional deprivation they can be fat if the parents are over feeding them.

B. Diencephalic syndrome also causes FTT but emaciation

C- prader willi would not be hugging

D- ADHD does not make you fat/voracious appetite

Question 19

A 10 year old boy with previously repaired TAPVD comes to your office with symptoms of ADHD. He is on no medications currently and has been well. Your next best step is:

A. Start stimulants
B. ECG
C. Refer to psychiatry
D. Continue to monitor

Answer 19

A. Start stimulants

Question 20

Which of the following would be the most helpful in confirming the diagnosis of ADHD in a 12 y.o male.

A. Symptoms are only at school
B. Difficulty making friends
C. Forgets his homework at school
D. Spends a lot of time playing video games

Answer 20

C. Forgets his homework at school

Question 21

Child with I towing and difficulty walking. What would make you suspicious that this is spastic dialectic CP ?

A. Prematurity, global development delay, normal reflexes
B. Prematurity, delayed motor milestones, increased reflexes
C. Birth asphyxia, global development delay, normal reflexes
D. Birth asphyxia, delayed motor milestones, increased reflexes

Answer 21

B. Prematurity, delayed motor milestones, increased reflexes

Question 22

A 10 month old baby wakes up every 2 hours and needs to be rocked back to seep by his mom. What is the most likely cause ?

A. Benign Rolandic epilepsy
B. Sleep onset association disorder
C. Night terrors

Answer 22

B. Sleep onset association disorder

Question 23

36 month baby what is best predictor of cognition ?

A. Gross motor
B. Fine motor
C. Social
D. Language

Answer 23

Answer: D language

Language is linked to both cognition and emotional development. Language delays may be the first indication that a child has mental retardation, has an ASD, or has been maltreated

Question 24

You suspect a 3 y.o female of having autism spectrum disorder. What diagnostic test would MOST likely reveal an abnormality ?

A. Karyotype
B. Very long chain fatty acids
C. Fragile x testing
D. Chromosomal microarray

Answer 24

D. Chromosomal microarray

They suggest that all children with ASD receive chromosomal microarray and fragile X testing

Question 25

What is the best way for a 7 year old to ride in the back of a car, in the middle seat with no head rest? (Pictures shown taken from CPS statement)

A. Forward facing car seat
B. Booster seat with no back
C. Booster seat with a full back
D. Seat belt

Answer 25

C. Booster seat with a full back

Stage 1 (rear facing) - until at least 1 year and 10kg (22lbs)
Stage 2 (forward facing) - until at least 18kg (40lbs)
Stage 3 (booster) - until at least 8 years old, 36kg (80lbs) and 145cm (4ft 9 inches)
Stage 4 (seatbelt)

Weight order is 10kg/20lbs - 20kg/40lbs - 40kg/80lbs

Full/high back booster - provide neck support and should be used for seats without a head restraint.

Question 26

A mom brings in her son for concerns around his school performance, but feels he is cognitively normal. He has trouble with reading, and has trouble understanding when he reads to himself. His teacher has been spending more resource time with him, and when she reads aloud to him, he understands well. What is the most likely diagnosis ?

A. Myopia
B. Dyslexia
C. General learning disorder
D. Speech apraxia

Answer 26

B. Dyslexia - most common LD - causes bu deficits in phonological processing (inability to segment words into smaller units). Deficits are unexpected in relation to the students overall intelligence

A. Myopia - unlikely as they aren’t mentioning visual deficits in any other area
C. General learning disorder -
Unlikely as they aren’t mentioning any other deficits
D. Speech apraxia - impairment in the ability to organize and initiate a motor pattern of speech (ie; problems making sounds, syllables and words - not because of muscle weakness but because the brain has trouble moving the body parts necessary for speech.)

Question 27

8 y.o boy is brought to you because of “difficulties learning “. He has difficulties finding words and with some pronounounciation. He does not comprehend what he reads. However he understands when his parents read to him. What is the most likely diagnosis ?

A. Aspergers
B. Specific language impairment
C. Verbal apraxia
D. Dyslexia

Answer 27

D. Dyslexia

Question 28

Boy with new diagnosis of ADHD and uses drugs. What ADHD meds to prescribe ?

A. Vyvanse
B. Amphetamine slow release (Ritalin)
C. Dextroamphetamine

Or

Kid with Hx of substance abuse. Needs medication for ADHD. Which is BEST option ?

A. Vyvanse
B. Methylphenidate IR
C. Guanfacine
D. Ritalin SR

Answer 28

A. Vyvanse

Question 29

In a 15 month old infant, which of the following is the most indicative of an autism spectrum disorder ?

A. Not babbling frequently
B. Not pointing to indicate interest

Answer 29

B. Not pointing to indicate interest

Question 30

What is the first line intervention for sleep onset association type sleep disorder ?

A. Melatonin
B. Stable bedtime routine
C. Clonidine

Answer 30

B. Stable bedtime routine

Question 31

Parents are concerned about a child’s performance at school. He has normal intellect. He is very clumsy and teachers mention that he has poor handwriting. He has difficulty hopping on one foot and seems to tire easily. He has normal strength on exam but low tone. Diagnosis is most likely ?

A. Duchenne’s muscular dystrophy
B. Cerebral palsy
C. Developmental coordination disorder

Answer 31

C. Developmental coordination disorder - aka clumsy child

Question 32

A 4 year old girl is referred to you for dysfluency. She grimaces when she stutters. What do you do ?

A. Refer to SLP
B. Reassure
C. MRI head

Answer 32

A. Refer to SLP

If the child is grimacing they are upset about it - probably not just developmental dysfluency of preschool children

Question 33

A child is referred to you for assessment of a learning disability. What did you do ?

A. Refer for psychoeducation testing

Answer 33

A refer for psychoeducation testing

Question 34

A teenage boy with addiction issues is diagnosed with ADHD. His mother is concerned about the potential for abuse with some ADHD medications. Which stimulant do you start him on ?

A. Concerta XR
B. Ritalin
C. Vyvanse

Answer 34

C. Vyvanse - because of its pro- drug design, it’s delivery curve is not changed by mode of administration (oral, inhalation or injection), reducing its possible abuse potential, linger effect

A. Concerta - the abuse potential is significantly reduced in comparison to short- acting medication due to the product formulation according to anecdotal reports from Canadian regional addiction Centers.

Question 35

3 year old female, picky eater. Since 8 months of age, weight 15th percentile. Physical exam normal. Difficulties at mealtime specifically. Best option ?

A. Allow kid to choose food
B. Introduce child’s choice plus what family eats at mealtimes
C. Cyproheptadine
D. Offer several small snacks throughout the day plus mealtimes

Answer 35

B. Introduce child’s choice plus whatever family eats at mealtimes

Question 36

In a 5 month old boy, which would be the most concerning ?

A. Doesn’t turn to the sound of his own name
B. Doesn’t sit upright without support
C. Fisting of one of his hands
D. Doesn’t smile all the time at his caregiver

Answer 36

Answer C. Fisting - Extreme handedness at an early age and perisistence of fisting after 4 months is another indicator of potential neuronal migration disorders requiring imaging ie; CP

Sound of name - 10 months
Sits upright - 6 months
Smiling - 6 weeks, but doesn’t have to smile all the time !!

Question 37

The mother of a 2.5 y.o girl is concerned about her speech. She said her frost words at the age of 11 months and is speaking in 3 word sentences. There are no concerns with her development. She has begun to have difficulty with speaking. She will repeat the same word (mommy, mommy,mommy), repeat sounds at the start of words (m-m-m-mommy), pause during speech, and insert ‘uh’ in the middle of a sentence. What do you recommend ?

A. Audiology
B. Full developmental assessment
C. Reassure
D. Refer to speech language pathologist

Answer 37

D. Refer to SLP

- not this version had no grimacing but you still refer because of parental concern

Question 38

3 year old girl with developmental regression and small head. What is diagnosis ?

Answer 38

Rett syndrome

Question 39

Boy with enuresis, what is a good non pharm way to treat it ?

A. Positive reinforcement
B. Bed alarm
C. DDAVP
D. Bladder training

Answer 39

B. Bed alarm

Question 40

18 month old won’t go to sleep, used to be breastfed at 12 months. What does he have ?

A. Sleep onset association disorder
B. Nightmare
C. Night terror
D. Delayed sleep phase

Answer 40

A. Sleep onset association disorder

Question 41

Child with expressive language delay and otherwise makes 12 point piece puzzle, social. Most likely associated with ?

A. Reading difficulty
B. Autism

Answer 41

Answer: A reading difficulty

Question 42

2.5 y.o girl who stutters. What would make you most concerned ?

A. Repeats whole word
B. Repeats part of word
C. Facial grimacing
D. Pauses between words

Answer 42

C. Facial grimacing

This makes us more concerned that the child is anxious or upset but the stuttering, prompting quick referral to SLP

Question 43

12 y.o boy with school difficulties. Teacher thinks he has a learning disability. Your history and physical exam are negative. What would you do ?

A. CBC, lead levels, TSH
B. Start stimulant
C. Send to psychology
D. Assess short term memory and fine motor skills

Answer 43

C. Send to psychology - the child with a suspected LD needs a psychoeducational assessment

Question 44

18 month old wakes up throughout the night, needs parents to console. Ends up sleeping in parents bed.

A. Sleep wake transition disorder
B. Sleep onset association disorder
C. Night terror
D. Nightmares

Answer 44

Answer B: sleep onset association disorder

Question 45

9 month old with asymmetric tonic neck reflex. Cause ?

A. CP
B. Normal

Answer 45

A. CP

ATNR appears at 35 weeks and is gone by 4 months

Question 46

4y.o girl with night terrors every night at midnight. What do you advise the parents ?

A. Reassure the parents
B. Wake up kid 15min before for half hour

Answer 46

B. Wake up kid 15 min before for half hour - since this is every night at same time

Question 47

What do you tell mom of an ADHD kid on stimulant medication ?

A. It will decrease the risk of drugs dependency

Answer 47

A. No other choice :)

Compared to those without ADHD, children with ADHD have a higher risk of substance abuse. However, children with ADHD who are treated with medication have a lower risk of substance abuse that children with ADHD who are not treated.

Question 48

A mother brings her 6 y.o son to your office with concerns that he has always been ‘awkward’. His teacher has commented on poor writing. On exam, he has normal power, low muscle tone and is unable to hop. Most likely diagnosis ?

A. Developmental coordination disorder
B. Cerebral palsy
C. Muscular dystrophy
D. Tourette syndrome

Answer 48

A. Developmental coordination disorder

Question 49

18 month old child falls asleep with his dad rocking him to sleep. However, he wakes up screaming multiple times per night. He will go back to sleep of calmed down, but often in his parents bed. He was breastfed to sleep for the first 12months. What is the issue?

A. Sleep- wake- transition disorder
B. Sleep association disorder
C. Night terrors

Answer 49

B. Sleep association disorder

Question 50

3.5 year old girl was referred to you for assessment. She speaks 50 words and 50% of her words are intelligible to others. She points to things she wants. She can run well, can kick a ball. She can can walk up and down stairs. She cannot throw a ball overhead. She can use a spoon. What is the MOST likely explanation of her symptoms ?

A. Hearing deficit
B. Developmental delay
C. Language delay

Answer 50

Answer:

I think this answer is C. Language delay

Question 51

Af what weight and age can a child start to use a front facing car seat ?

A. 9kg, 9 mo
B. 10kg, 12 mo
C. 18kg, 20mo

Answer 51

B. 10kg,12 mo

Question 52

A 14 y.o boy with ADHD is taking 36mg of concerta. His symptoms and school performance have improved and his mother is happy with his improvements. For the past two weeks, however, he has been sad, often crying unpredictably. He also is having difficulty falling asleep at night. What is the next best step in his management ?

A. Decrease the dose of concerta
B. Change from concerta to adderrall
C. Add fluoxetine
D. Add melatonin

OR
Child who you are following for ADHD, and started treatment 2 weeks ago. Mom tells you he has done really well at school, and his grades started to improve. Side effects of difficulty sleeping, sad, moments, moody, poor appetite. His current dose of medication is Concerta 36mg x 7 days. What did you do?

A. Decrease concerta dose to 27mg
B. Add fluoxetine
C. Add melatonin
D. Change to Adderall

Answer 52

Answer: A/A - reduce dose

• concerta is 8- 12h and used in older kids and Adderall XR is shorter acting at 6-8h so It’s not longer acting !! Would worsen symptoms
• mood lability is one of the side effects of stimulants
• if mood lability occurs at the time of peak concentration, can start by reducing the dose or switching to a longer acting preperation.
• irritability, sadness and increased activity as the medication wears off is common when using short acting medication on a morning/noon (twice a day schedule) and in this case adding an afternoon dose or switching to a long-acting form can be tried.
• should also screen for coexisting mood disorder/anxiety disorder
• insomnia - establish a bedtime routine and good sleep hygiene habits; omit or reduce the last dose of the day.
• fluoxetine

Side effects of stimulants: decreased appetite, poor growth, dizziness, mood lability, insomnia, rebound when med wears off, tics , psychosis, diversion/misuse

Question 53

4 year old with various developmental descriptions (stacks 7 cubes, 1 step at a time, 3word sentences). What is their developmental age?

A. 24months
B. 30months
C.33 months
D. 35 months

Answer 53

Answer A. 24 months

Stacks: 6-7 cubes = 2 years
1step at a time = 2years
2-3 word sentences = 2 years

Question 54

A mom comes to see you about her 2 year old, previously well child. The child is having daily episodes where her trunk is writhing, and she becomes flushed and diaphoretic. She also grunts, and breathes rapidly during these episodes. Mom is sure she does not lose consciousness and if she talks to her daughter, she can shorten the duration of the worrisome. They happen when the child is in her car seat or watching tv. What is your next step ?

A. Refer to neurology for an EEG
B. Upper GI to rule out reflux
C. Reassure mom
D. Refer to a psychologist

Answer 54

C. Reassure mom

Masturbation

Question 55

18 month old wakes up 1-2h after going to bed, screaming, difficult to arouse, is confused and diaphoretic. Likely cause ?

A. Nightmares
B. Night terrors
C. Seizures

OR
Child has recurrent episodes of sudden crying, frightening episodes, unaware. Diagnosis?

A. Night terrors
B. Nightmares

Answer 55

Answer B/A

Question 56

Question about child with isolated language delay- what are they at risk for in the future ?

Answer 56

A. Reading disability/dyslexia

Question 57

At what age should a child be able to self- soothe when he awakens at night ?

A. 5-7months
B. 8-10months
C. 11-13 months
D. 14-17 months

Answer 57

A. 5-7months

• sleep regulation or self- soothing involves the infants ability to negotiate the sleep-wake transition, both at sleep onset and following norms awakenings throughout the night.
• the capacity to self soothe begins to develop in the first 12 weeks of life and is a reflection of both Neuro developmental maturation and learning.
• it is important to recommend that parents put their 2-4month old infants to bed “drowsy but awake” to avoid dependence on parental presence at sleep onset and to foster the infants ability to self- soothe.

Question 58

5 year old with 21 y.o old single mom. Teacher says she is hyperactive, hoarding food and not remorseful for inappropriate behaviour. No eye contact with mom, but runs up and hugs you. Most likely diagnosis?

A. ADHD
B. Autism
C. Attachment disorder
D. Oppositional defiant disorder

Answer 58

C. Attachment disorder

Question 59

30 month old child has been introduced to potty training. She has been encouraged to sit on potty after meals whether she can void or not. She has been doing it for one week. Now she is having temper tantrums every time you get her near the toilet. What is your advice on management ?

A. Continue with current toilet training
B. Stop for 1-3months and try again later
C. Punish her
D. Give treat every time she can sit on toilet quietly

Answer 59

B. Stop for 1-3 months and try again later

Question 60

How to diagnose expressive language delay in a 2.5 y.o ?

A less than 100 words
B. No 2 word combinations

Answer 60

B. No 2word combinations

• receptive language refers to ability to understand and expressive language to produce symbolic communication

Question 61

14 month old says specifically “dada” only. What other features makes you worried about language delay ?

A. Not responding to own name
B. Not babbling

Answer 61

A. Not responding to own name

• start to respond to name at 5months and orients well to name by 9 months
• babbling should have already stopped by 14 months so this wouldn’t be concerning

Nelson’s- at 9-10months - babbling becomes truncated into specific words (ie: mama or dada for their parents

Question 62

Whom you would refer to speech and language therapy?

A. 18 month old with no single word
B. 6y.o with phoneme problem
C. 3year old with 3 word sentences
D. 4 y.o with dysfluency

Or
Who to refer to SLP?
A. 6 year old with trouble with phonemes
B. No words by 18 months, in a bilingual household
C. 2 year old, people only understand 50%

Answer 62

Answer A/B - 18 month old with no words

• refer for 15 month old without 3 words, so 18 month old with no words should be referred
• 3 year old should speak in 3 word sentences
• 2 y.o should only be 50% intelligible
• 4 y.o dysfluency - depends on if stuttering present and in what capacity
• 6y.o with phoneme problems - should also probably have assistance but it wouldn’t necessarily be through an SLP

Question 63

3.5 year old, follows 2-step commands, interested in communication, developmentally appropriate girl with 50% intelligible speech and repeats syllables and whole words. Most likely diagnosis ?

A. Developmental dysfluency
B. Normal development
C. Delayed expressive language skills
D. Delayed receptive language skills

Answer 63

Answer C. Delayed Expressive language skills - yes as should have 75% intelligible speech - answer given
Or why not ? (Me)
A- developmental dysfluency -yes repeats words and syllables

Other
B- no not normal development
D- delayed receptive language skills - at 3 should follow 3-step commands but red flags only note to refer if not following 2-step commands by this time

Question 64

Mom comes in wondering if her 2 year old is ready for toilet training. Of the following, which is most likely to show readiness ?
A. Child motivated to please parents
B. Child able to follow two-step commands
C. Child has at least a 100 word vocabulary

OR
Signs of toilet readiness?
A. Able to dress and undress himself ?
B. Desire to please based on positive relationship with parents
C. Can stay dry overnight
D. Can communicate need for toilet use using full sentences

Answer 64

Answer. A/B - desire to please

Just need to be able to follow one step command.

Question 65

Teenage girl with severe ADHD. Started in Concerta 36mg. Medicine is working great for her ADHD, but on follow-up notes to have lost 10 pounds. What would you do ?

A. Switch to straterra
B. Decrease concerta to 5days/week from 7 days/week

Or
Teen with ADHD, 14 pound weight loss. Currently ADHD is better controlled on his long-acting ADHD med. what is best thing to do ?
A. Start Strattera
B. Consult a psychiatrist
C. Change from 7 days a week dosing to 5 days a week

Or
10 y.o girl with ADHD on Concerta 35mg comes after 3 months with 4kg weight loss. What do you do ?
A. Decrease concerta to 5 times a week
B. Change to straterra

Answer 65

Answer: B,C,A - decrease to 5x week

-concerta - extended release methylphenidate- s/e are moderate appetite suppression, mild sleep disturbances, transient weight loss, irritability, emergence of tics

Lowest dose: 18mg, 27mg, 36mg, and 54mg

Strattera - extended release atomoxetine “An atom in the stratosphere” - s/e nervousness, sleep problems, fatigue, stomach upset. Dizziness, dry moth. Can lead in rare cases to severe liver injury or to suicidal ideation

Question 66

5 y.o boy is having difficulties with bad behaviour at school, including stealing objects. His parents have recently divorced and are having difficulties in their relationship. His mother would like advice on how to help with his behaviour. Best advice ?

A. Take parenting classes and learn way to manage his behaviour
B. You need to meet with both parents together to better assess the situation
C. She needs to start discipline her child ASAP

Or
Marital troubles at home, child is acting out at school and daycare. Mom has come in for advice.
A. Give the mom parenting classes
B. Request a meeting with both parents to assess the home situation
C. Give him Ritalin

Answer 66

Answer: B - meet both parents

Question 67

Divorcing parents. What’s best for the kid ?
A. Best if joint custody could be given ASAP
B. Best of child gets to see both parents (ie; joint custody ) even if the parents are fighting all the time
C. Best if parents can settle their differences and not fight in front of kids

Answer 67

C. Not fight in front of kids

Question 68

2.5 year old who is not combining 2-words, has about a 50 word vocabulary and other people understand about 25%. Otherwise, climbs stairs, runs around, throws underhand. Interested in other people. What is this most consistent with ?

A. Isolated language delay
B. Global developmental delay
C. Autism

Answer 68

A. Isolated language delay

Question 69

57 pound (26kg) child. What car seat should you use ?

A. Lap and shoulder belt with seat
B. Seat with built in restraint
C. Lap and shoulder belt, no airbag
D. Lap and shoulder belt, with airbag

Answer 69

A. Lap and shoulder belt with seat

Question 70

An 18kg child is being transported in a car. Which of the following is the best restraint?

A. Car’s lap and shoulder belt
B. Car seat with its own restraining device
C. Car seat with the car’s restraining device

Answer 70

C. Car seat with the car’s restraining device

Question 71

18 month old girl with delayed language. Points to things that she wants. Has two dolls that she loves to cuddle. What is the likely diagnosis ?

A. Isolated language delay
B. Autism
C. Asperger syndrome

Answer 71

A. Isolated language delay

Because she points and shows affection not ASD

Question 72

Child who doesn’t talk at school or make good eye contact with people. Including recess. Doesn’t have any friends. At home speaks normally. Diagnosis?

A. Selective mutism
B. Language delay
C. ASD

Answer 72

A. Selective mutism

Tx: refer to psychologist/psychiatrist for behavioural therapy. Sometimes medications after attempting behaviour therapy (SSRI)

Question 73

Which of the following has the lowest rate of relapse rate when used for primary enuresis in a 7y.o boy?

A. Imipramine
B. DDAVP
C. Alarm system
D. Nighttime fluid restriction

Answer 73

C. Alarm - cure rate just under 50%

Imipramine/DDAVP - used for short term (such as sleep overs)

Fluid restriction - not in CPS statement but true that we ask not to give a lot of fluid right before bed

Question 74

10 month old child has just started to bite his parents. What statement is true?

A. This is an early sign of possible autism spectrum disorder
B. There may be an abusive situation in the family.
C. Baby is developmentally normal and is excited
D. The baby may be emotionally disturbed

Answer 74

C. Baby is developmentally normal and he is excited

• children still learning to talk can bite to express excitement or frustration
• self-biting is an example of a self-injurious behaviour common among ASD patients

Question 75

Mother has questions about her 5 year old sons’ performance at school. She is concerned that he will have reading problems because his father had significant problems with reading. Of the following which predicts a future difficulty with reading ?

A. Delayed walking
B. Delayed language milestones

Answer 75

B. Delayed language milestones

Question 76

30 month old with 50 words, otherwise normal. No history suggestive of autism. What would you tell mom that he is at risk for:

A. Reading problems
B. Autism
C. ADHD

Answer 76

A. Reading problems

Question 77

Which patient requires immediate referral ?

A. Baby doesn’t turn head to voice at 4 months
B. No babbling by 6 months
C. Not following commands at 15 months
D. No two word sentences at 26months

Or
Which is the indication for urgent evaluation ?
A. Baby does not turn to sound at 4 months
B. Baby not babbling at 6 month
C. 15 month old does not follow simple command with gesture
D. 24month without 2 word phrases

Answer 77

Controversial

A- some people say this one as should startle to sound at 1 month but other sources say turn to voice/sound at 4-6months

Vs
D - no two word sentences in a 2 year old

From table red flags

• neonate - infant does not startle to loud sounds
• 2months - does not alert to voice
• 6 months -lack of turning to voice
• 24 months - lack of words and two-word meaningful sentences

Since it’s turning to voice red flag only at 6 months I am going for D !!!

Question 78

20 month old with 3 words, point to pictures in book when asked to, mimics mother at work, stacks 2 blocks. What is diagnosis ?

A. Global developmental delay
B. Speech delay
C. Hearing loss
D. Pervasive development disorder

Answer 78

Controversial
Answer A - global
Developmental delay but other group said B but seems all areas delayed

Verbal- should have 2 word phrases and by 18 months should have 10-25word
Fine motor - should be able to stack 5-6 cube tower
Social- 15 months imitating

Question 79

Autism. Risk for recurrence ?

A. Slightly higher than general population
B. Equal to general population
C. 50% chance because AD
D. Non if avoids MMR

Answer 79

A. Slightly higher risk - actually quite a bit higher

Nelson’s- there is a high recurrence risk (2-19%) for ASD among siblings as well as higher Concordance rate (37-90%) in twin studies

• normal prevalence is 1%
• risk factors: closer spacing of pregnancies, advanced maternal or paternal age, extremely premature birth <26 weeks gestational age) as well as family members with learning problems, psych disorders, and social disability

Question 80

3 year old boy brought for assessment of developmental delay; features of autism: 3 words, no response to name, not interested in play, no identification of body parts, not pointing, wants to play with blocks only. Initial test ?

A. Hearing screen
B. MR of head
C. Psychometric testiing

Or
3 year old kid with very delayed language, no imaginative play, no reciprocal social interaction and some other developmental abnormalities. How to investigate first ?

A. Audiology
B. Psych testing
C. Karyotype

Answer 80

A. Hearing screen

ASD a need

1. Hearing screen
2. Ophthalmology
3. Woods lamp exam for TS
4. Microarray (CMA)

Question 81

A couple wants to adopt a child from overseas, and brings a file for you to review. Which of the following would MOST likely be associated with other problems?

A. Microcephaly in context of normal growth and weight
B. Delayed speech with low weight
C. Microcephaly in proportion to low height

OR
A couple comes in to your office asking advice regarding the adoption of a child. Which scenario gives the worst prognosis ?
A. Significant height and weight restriction
B. Microcephaly proportionate to height reduction
C. Significant microcephaly with normal height and decreased weight

Answer 81

Answer: A,C - microcephaly with normal growth and weight would be indicative of pathology and warrant immediate evaluation

• if it was microcephaly in proportion to low height - may be an endo cause, so not as bad as the causes listed below…
• significant height and weight restriction - could just be FTT

Question 82

7 year old boy still thumb sucking. What to tell mother ?

A. Can lead to malocclusion and facial deformation
B. Topical aversion therapy works well
C. Reassure
D. Is never associated with decreased self esteem

Answer 82

A. Can lead to malocclusion and facial deformity

Question 83

Mother brings 4 year old child in to you worrying that they are delayed. Gross motor: stands on 1foot momentarily, rides tricycle. Fine motor: draws circle, copies cross, speech: counts to 3, remembers 3 numbers, social: washes hands, parallel playZ what is developmental age ?

A. 24mo
B. 30mo
C. 36mo
D. 48mo

Or 
Mom worried about her 4year old son being developmental delayed. He can say his name and age. Stack 10 blocks. Draw a circle and copy a cross. Stand on 1 foot briefly. Parallel play.
What is developmental age ?
A. 24 mo
B. 36 mo
C. 48 mo

Answer 83

C, B - 36 months /3years

Gross motor delayed
Fine motor delayed
Speech delayed should be able to count to 4
Social: parallel play is 24 months, washes hands is 30months

Question 84

Which child would you send for further speech and language evaluation ?

A. 3 year old with dysfluency with repetitions of words and syllables
B. 2y.o with 75 words and understood by 50% of strangers
C. 6 year old with rouble with phonemes
D. 18 month old from bilingual household with no words

Or
Who should you get referred to SLP ?
A. 3 year old with occasional dysfluency
B. 6 year old with trouble with certain phonemes
C. 18 month old from bilingual home with no single words

Answer 84

D, C - 18 month old with no words

Notice how second question is clearer

Should have 10-25 words and bilingualism is not a reason for speech delay.
But 6 year old with rouble with phonemes would also make me consider for dyslexia….

Question 85

Giving advice to parents about a 4 month old with positional plagiocephaly. You would
A. Suggest they do neck exercises to prevent torticollis
B. Suggest a child stay in car seat at home
C. Babe to sleep on their side
D. Encourage tummy time

Answer 85

D. Encourage tummy time

Need to teach parents about positional changes and tummy time and refer to PT in cases of congenital torticollis

Question 86

Etiology of primary enuresis as opposed to secondary:

A. Holding urine during the day
B. Family history
C. Abuse

Answer 86

B. Family history

Primary = bladder control has never been obtained

Secondary = if incontinence recurs after > 6 months of continence

CPS on primary enuresis - family history is often present

Secondary enuresis: often due to a stressful event( ie; parent divorce, birth of sibling); could be due to constipation, sleep apnea, DM, DI, UTI, neurologic/spinal cord abnormalities, sickle cell, chronic kidney disease, psychogenic polydipsia

Question 87

Question on car seat indications. When can the child use regular seat belt ?
A. When child weighs 41lbs
B. If child is > 6years old
C.When child, while in booster seat, has level of ears over headrest of the seat
D. When child has a sitting height at or greater than 63 cm

Answer 87

Answer C.

Ruled out A, B, D so must be C

Question 88

8 month old baby is not sleeping through the night. She is waking up one hour after being put down in her crib. Which of the following is true:

A. This should improve if she learns to fall asleep in her crib vs being rocked to sleep
B. She should be allowed to cry to seep to solve this problem
C. Giving the baby a pacifier is a proven technique
D. She should be given a bottle of war milk to help her fall asleep in her crib

Answer 88

A. Should improve if lears to fall asleep on own

Question 89

A 2y.o child cries when mother is leaving for work everyday. She is also attached to a “special” teddy bear. What should be done?

A. Remove child’s teddy bear since this is abnormal attachment to an object
B. Reassure parents that this is normal separation anxiety appropriate for child’s developmental level

Answer 89

B reassurance

Separation anxiety normal 18-24months

Question 90

An infant can sit with a round back using his hands for support, can roll from prone to supine, stands with support, has a player grasp, laughs, and babbles. What is his most likely age ?

A. 3 months
B. 6 months
C. 8 months
D.12 months

Answer 90

Answer C. 8 months vs 6 months (me) likely going with 6 months

Sits using hands for support - 6 months
Rolling prone to supine - 4 months
Palmer grasp - 5 months
Laughs out loud - 4 months
Babbling - 5-6 months
Stand with support - unable to find age ?
- standing with one hand held - 10 months
- at 7 months - sits with pelvis supported, leaning forward on hand with back rounded, babies, grasps using racial palm, May support most of weight, bouncing actively, rolls over when prone

According to Denver II developmental assessment milestones chart, infants can usually stand holding on to things btw 6.5 -8.5 months. Pull to standing btw 8-10 month

Question 91

A 12 month old child has psychosocial deprivation. What is the most likely finding ?
A. Poor appetite
B. Microcephaly
C. Normal
Development
D. Absence of cuddling response

Answer 91

D. Absence of cuddling response

Question 92

4 year old boy has trouble with expressive language (at approx) 1.5 y.o level, no echolalia. Currently speaks only 50 words and is using 2 word phrases. His receptive language is good. Development otherwise normal. Builds 12 piece puzzle and house with LEGO. What is she most likely at risk for ?

A. Developmental disability/disorder
B. Difficulty with reading/reading disorder
C. ASD
D. ADHD
E. Pervasive developmental disorder

Answer 92

B. Difficulty with reading/ reading disorder

Question 93

Child with expressive sleep delay. Parents should be encouraged to do all the following EXCEPT:

A. Read to him at night
B. Make him repeat incorrectly pronounced words over and over again
C. Make him stop his activity and look at you when you talk
D. Don’t complete his sentences

Answer 93

Answer B make him repeat

Question 94

3 year old girl was normal developmentally for a while but has shown regression in the past year. Now she has microcephaly, and abnormal hand movement s.

A. Rett
B. Fragile x
C. Autism

Answer 94

A. Rett

Question 95

What places infant are risk for SIDS ?

A. Exposure to environmental cigarette smoke
B .exposure to cold

Answer 95

A. Cigarette smoke

Question 96

Which is true of ADHD?

A. Teacher and parent reporting of symptoms on a checklist frequently agree
B. Check for lead poisening in each kid with ADHD
C. 25% of kids with ADHD have comorbid anxiety disorder
D. Kids with ADHD often have thyroid hormone abnormalities

Answer 96

C. 25% anxiety disorders

Comorbid disorders

• LD: 15-25%
• language disorders: 30-35%
• anxiety disorders: 20-25%
• May also have sleep disorders, memory impairment, decreased motor skills

Question 97

Which of these patients can give a valid consent:

A. Teenager who is currently drunk who was sexually assaulted 36h ago
B. Down’s syndrome with femur fracture
C. 14 y.o who wants an abortion
D. A patient who is hallucinating
E. Person who is unconscious who needs surgery

Answer 97

C. 14y.o wants an abortion

We have talked about consent in other subjects. Basically there is no age of consent, based on your assessment of whether or not they are mature enough to make that decision.

Question 98

A baby can transfer a rattle hand to hand, sit with a rounded back using hands for support. What is his age ?

A. 3 months
B. 4 months
C. 6 months
D. 9 months
E. 12 months

Answer 98

C. 6 months

Nelson’s
- at 7 months sits with pelvis supported, leaning forward on hands with back rounded, babbles, transfers objects from hand to hand

Question 99

Child who is 2 years old. Speaks 8 words. Points and gestures. Socially appropriate. What is the most likely diagnosis ?

A. Global developmental delay
B. Developmental language disorder
C. PDD

Answer 99

B. Developmental language disorder

• PDD no longer exists
• assuming that he has no motor delays because then it could also be GDD

Question 100

Which is true regarding children in foster care:

A. In older kids, occasional visits with parents is warranted if child previously had developed a strong attachment to parents
B. Disruption of continuity of care may be potentially detrimental to all children (this was the exact wording)
C. If they are in a loving foster home for their first year of life, they will do well long term
D. Child should be placed with grandparents for best long-term outcome

Answer 100

B. Disruption in continuity of care

CPS - physicians should advocate for Perlman year planning including placement stability and personal intervention plans which establish a child or youth’s long- term life goals.

Question 101

4 y.o sucks thumb while watching tv. What do you tell mom?

A. Put a bitter tasting substance on her thumbs
B. Reassure
C. Prescribe a mouth appliance
D. Implement behaviour modification with timeouts

Answer 101

B. Reassure

Normal in infancy and toddlerhood

Question 102

What is true of a normal 9 month old child ?
A. Just acquired Palmer grasp
B. Says mama/dada and one other word
C. Has object permanence 
D. Has name for objects

Answer 102

C. Has object permanence

A- palmar grasp starts at 4 months
B. Extra word at 12 months
D. Not till > 12 mo

Question 103

What kind of car seat does a 10kg, 13mo baby need ? Where, what direction ?

A. Infant, back seat, facing back
B. Infant, back seat, facing front
C. Infant, front seat, facing front
D. Infant, front seat, facing back

Answer 103

B. Infant, back seat, facing front

Question 104

Parents bring their son into the ER in the middle of the night. He had awoken screaming, was awake but non-responsive, then went back to sleep. You:
A. Reassure them and send them home
B. Order CT, EEG
C. Admit for observation

Answer 104

A. Reassure them and send them home

Night terrors

Question 105

The most plausible theory of ADHD is that it occurs due to a dysfunction of which of the following neurotransmitters ?

A. Adrenaline
B. Dopamine
C. Glutamate
D. Serotonin

Answer 105

B. Dopamine

Question 106

Among the following, the factor that would have the most adverse effect on the long-term prognosis of an 8 y.o boy who has a specific learning disability:

A. Adjustment reaction to parents divorce
B. Associated ADHD
C. IQ of 85
D. myelomeningocele at L5-S1

Answer 106

D. Myelomeningocele at L5-S1

• vast majority -95% have Chianti II malformation - abnormal spine and a small posterior fossa with descent of the brainstem and cerebellar tonsils.

Question 107

An infant is speaking 6 words including mama and dada. He is also able to follow one-step commands without a gesture and can walk alone. He age is closest to:

A. 12mo
B. 15mo
C. 18mo
D. 21mo

Answer 107

B. 15mo

15months - 3-5 words, walks holding toy
12 months - points to desired object, follows 1 step commands with gesture

18 months - 10-25 words

Question 108

A child brought to the clinic for a routine exam. She can dress with help, ride a tricycle, knows her own age, and can speak in short sentences. She had difficulties in copying a square.

A. 30mo
B. 36mo
C. 48mo
D. 60 mo

Answer 108

B. 36 mo (3y.o)

Question 109

An infant moves his head from side to side while following a moving object, can lift his head from a prone position to 45 degrees, smiles when encouraged and makes coping sounds, cannot maintain a seated position.

A. 3mo
B. 5mo
C. 7 mo
D. Not enough information to conclude

Answer 109

A. 3 mo

Question 110

Which of the following treatment to help reduce symptoms of colic?

A. Behavioural support to parents
B. Elimination of cow’s milk from the diet of the breastfeeding mother
C. Use of low lactose formulas in the bottle fed infants
D. Use of soy milk formula in bottle fed infants

Answer 110

A. Behavioural support to parents

Question 111

7 y.o boy with last history of speech delay. His reading is now below a grade 1 level. Teacher thinks that he has ADD. What would be the most appropriate next step ?

A. Investigate for learning disorder
B. Psychotherapy
C. Behavioural therapy
D. Ritalin 5mg BID
E. Ritalin 20mg BID

Answer 111

A. Investigate for a learning disorder but also work up for ADHD questionnaire

Question 112

A 10 y.o boy has headaches, abdominal pain, lethargy anytime of the day. He has missed 30 days of school in 4 months. He has:

A. Migraines
B. School phobia
C. Brain tumor

Answer 112

B. School phobia

Question 113

6 y.o boy in grade 1 is not paying attention, disruptive, in danger of failing. He does not read or write as well as his classmates. Appropriate action:

A. Fail him
B. Full psychoeducational assessment
C. Ritalin
D. Classic slow learner

Answer 113

B. Full psychoeducational assessment

Question 114

A mother brings her 1 y.o child for concern of head banging. Physical exam is normal. The parents are worried about brain damage. What should you do?

A. Reassure
B. EEG
C. CT head
D. Use a helmet to prevent head injury
E. Family psychological assessment

Answer 114

A. Reassure

Head banging beyond 3 years is unusual. You want to screen for autism.

Question 115

A mother is concerned that her 3y.o child was able to speak 3-4 words sentences at 22 months of age but now she seems to be stammering a lot. What next:

A. Reassure
B. Audiology testing
C. Refer to SLP
D. Complete Neuro developmental assessment
E. Emotional disturbance can be the cause of stammering

Answer 115

Answer C. Refer to speech pathologist

Mom is concerned. Stuttering typically starts 2-5y.o, more in boys, don’t know why it happens

Don’t need psychoeducation or hearing testing but stuttering that isn’t resolved can have long-term effects on learning/academic performance and social situation.

Question 116

You are asked to assess a child for autism. Which of the following statements would best support the diagnosis ?

A. Child takes toys from other children in the examining room
B. Child consistently displays a startle response to a ringing telephone
C. Child spends much of the examination spinning a wheel on a toy truck
D. Child brings each of the toys I got the exam room to show his mother
E. He looks at you during the interview

Answer 116

C. Child spends much of the examination spinning a wheel on a toy truck

Question 117

All of the following are features of sleepwalking EXCEPT:

A. Occurs during stage 4 non-REM sleep
B. Positive family history 
C. Can walk around furniture
D. Do not walk into dangerous areas
E. Resolve spontaneously in later childhood

Answer 117

D. Do not walk into dangerous areas

A- true - stage 4 non- REM
B- true - family history
C. True - can be found at parents bedside
D. false - go outside on winter nights
E. True most resolve by early adolescence

Question 118

Which of the following is characteristic of RETT syndrome

A. Ataxia
B. Seizures
C. Head bobbing
D. Hand wringing

Answer 118

D. Hand wringing

Question 119

Mother used IV heroin before and during her pregnancy. Her 10 month old child is now losing acquired milestones and developing bilateral spasticity. The most likely cause is:

A. HIV
B. CMV
C. Cerebral palsy
D. Syphillis

Answer 119

A. HIV

IV drug user - so think of something transmitted in that way

B- CMV - congenital infection - most are asymptomatic but end up with CP
C- cerebral palsy - not CP because not progressive and don’t loose milestones, just don’t gain them
D. Syphillis - onset <2years: hepatomegaly, jaundice, nasal discharge “snuffles”, rash, generalized lymphadenopathy, skeletal abnormalities

HIV encephalitis is a well known complication defined by one or more of the following:
A. Failure to attain dvlp milestones, loss of milestones, or loss of cognitive ability
B. Impaired brain growth or acquired microcephaly as determined by head circumference measurements, or brain atrophy demonstrated by CT or MRI
C. Acquired symmetric motor deficits manifested by two or more of the following: paresis, pathologic reflexes, ataxia, or gait disturbances

Question 120

6 y.o with night terrors disturbing the whole family.

A. List 2 features that differentiate between night terrors and nightmares

B. List 2 differential diagnosis

C. List 2 non-pharmacological approaches for night terrors.

Answer 120

A. List 2 features that distinguish

1. Night terrors during stage 4 non-REM sleep and nightmares occur during REM sleep
2. Child does not remember night terrors but does remember nightmares

B. 2 ddx

1. Sleep association disorder
2. Sleep-wake transition disorder

C. 2 non-pharmaceutical tx

1. Good sleep hygiene
2. Waking 15 min before night terrors x 7 days

Question 121

Girl who refuses to talk at school but talks at home perfectly well.

A. What is the diagnosis ?
B. What are 2 management options for her ?

Answer 121

A. Dx - selective mutism
B. 2 management options
1. Behavioural therapy
2. SSRI

Question 122

Baby with flattening of right side of head.

A. Most important sign to distinguish btw positional and craniosynostosis

B. 3 things you can do

C. 3 limitations to using the helmet And

Answer 122

A. Most important differentiating factor
- Ear position

B. 3 things you can do

1. Tummy time
2. Physiotherapy to prevent torticollis
3. Re-positioning crib

C. 3 limitations to using helmet

1. Expensive/coverage
2. Time - needs to be on for significant amount of time to be effective
3. Side effects ie; skin irritation/pressure sores, infection

Question 123

Mom of 3 year old boy telling him to swallow his toothpaste because she thinks it prevents caries.

A. Name 1 physical exam finding consistent with severe fluorosis

B. Name 1 indication for fluoride supplementation in a child over 6 months

Answer 123

A. Physical finding
- mottled enamel
B. Indication for fluoride supplementation
- living in area where water supply has no or little fluoride

Question 124

14 y.o girl with CP has trouble with drooling. It is beginning to bother her at school.

A. What are 3 pharmacological treatments
B. What are three known side effects you should warn her about for these medications ?

Answer 124

A. 3 meds

1. Anticholinergics
   - Glycopyrrolate
   - Scopolamine patch
   - Benztropine
2. Salivary glands botulinum neurtoxicin
3. Not a med but Surgery excision of sublingual
   Gland
   * not sure if naming 3 anticholinergics is acceptable as I couldn’t find any other meds

B. 3 side effects of these meds

• Antocholinergics = swallowing difficulties (xerostomia) + blurred vision + hyperactivity + constipation + urinary retention
• botulinum = fever, transient pain, local irritation/bruising
• surgery = Ranu Ka, dry mouth, difficulty swallowing, changes consistency of saliva

Question 125

A 1 month old baby has been having poor weight gain, only about 5g per day. On exam, he has ankyloglossia but otherwise a normal physical exam. His mother reports that she is breastfeeding but having difficulties because he has a poor latch, slips off the breast, and also it is very painful for the mom. They have already seen a lactation consultant. What 2 things do you recommend for management ?

Answer 125

2 things for management

1. Express breast milk and offer by bottle till the issue is resolved, nipple shield
2. Referral for tongue toe release (frenotomy)
3. Oral examination of neonate and address underlying issue

CPS - benefits of frenotomy

• reduce nipple pain
• better latching
• Improve breastfeeding

Management

• usually conservative, requiring not intervention
• provide parents education and reassurance
• if complete tongue tie - and surgical procedure required - medical expert and proper analgesia
• frenotomy complications = bleeding, pain, infection or injury to Wharton’s duct, scarring and further limitation of tongue movement

Question 126

Childhood toxic stress can lead to problems with mental health in adulthood.

A. Name 3 examples of toxic stress that a child may be exposed to

B. What is the relationship between toxic stress exposure and poor outcomes in adulthood ?

Answer 126

A. 3 examples

1. Exposure to domestic violence
2. Physical hostility, especially when it is directed toward children
3. Abusive bahviour (emotional and physical) towards the child
4. Caregiver mental heath problem
5. Caregiver substance use disorder
6. Chronic neglect
7. Burdens of family economic hardship

B. Rlt

• the more toxic stress the more it has a cumulative effect with increased risk of mental heath concerns ie; depression etc and decreased resilience
• decrease self esteem
• poor neurocognitive dvlp
• constant exposure to adrenaline rush and stress at home affect growth and dvlp.

Question 127

List 6 things beside putting the baby to sleep on their back that decrease the risk of SIDS ?

Answer 127

1. Preventing exposure to tobacco smoke, before and after birth
2. Put infant to seep in a crib, cradle or bassinet that meets current Canadian regulations
3. Infants who share a room with parent/caregiver, sleeping in their own crib/bassinet
4. Breastfeeding provides a protective effect on SIDS
5. Pacifiers appear to provide protective effect for SIDS
6. Avoid overheating the infant
7. Avoid bumpers on crib, blankets or loose toys
8. Avoid sleeping on same bed with infant

Question 128

You see an 18 month old boy with young parents. They are coming to you because he wakes up throughout the night, crying and screaming, and will only go to sleep with a bottle, in his mother’s arms, with soothing.

A. What are 5 recommendations you would make

Answer 128

5 recommendations for sleep onset association disorder

1. Put the child in bed to sleep while drowsy but awake
2. Avoid associations of sleeping for example bottle to bed or contact with caregivers
3. Set regular bedtime routine, avoid bedtime routine longer than 30 min
4. Encourage soothing activities prior to bedtime for example having a bath or reading a book
5. Reassure parents that majority of babies have periods of waking between sleep cycles and encourage them to teach the child to self- soothe back to sleep when it happens.
6. Avoid feedings overnight when age allows

Question 129

A 14 month old boy is brought by his mother to your clinic for sleep problems. He wakes up several times during the night and needs to be fed a bottle each time. He only ever falls asleep in his mother’s arms.
A. What are 3 things you would do to improve this child’s sleep ?

Answer 129

1. Routine and sleep hygiene is very important
2. Allow babies to learn how to fall asleep on their own
3. Allow children to learn to sleep in their own crib
4. Recognition of REM sleep and “false awakening” explain parents about this
5. Avoid feeding sober night when age allows
6. Parents should put child awake
7. Travel or sickness may disrupt routine (especially in toddlers
8. 9-18 month separation anxiety can make things difficult
9. Use a transition object “blanket”, stuffed toy
10. Parents should leave the room - so child can fall asleep on own
11. Structure is best - always encourage a good bedtime routine

Question 130

What are 4 strategies recommended by the CPS to prevent early childhood caries in First Nations/Inuit communities ?

Answer 130

4 strategies

1. Utilize motivational interviewing and anticipatory guidance for the parents and caregivers of infants and children on oral hygiene and diet
2. Promote the supervised use of fluoridated toothpaste in all Indigenous and other high- risk children after the first tooth has erupted (‘smear’ of toothpaste for infants and ‘green pea size’ for children )
3. Ensure that all Indigenous children have access to a) the series of fluoride varnish and b) an assessment to determine the need for sealant placement on deep grooves and fissures
4. Community heath nurses, family physicians, or paediatricians should perform oral heath screening during child heath assessments and provide referrals as needed to dents health providers
5. Provide women with preconception and prenatal screening for oral health, anticipatory guidance for oral health and hygiene, and referral for dental care if required.

Question 131

Four features of dyslexia

Answer 131

1. Difficulty reading due to poor word recognition
2. Poor spelling and decoding abilities
3. Normal cognition and comprehension when read to aloud
4. Can be associated with secondary consequences such as reduced reading comprehension and reduced reading experience

Other

• difficulty understanding combination of phonemes
• have word finding difficulties, spoken word lacks fluency, mispronunciations

Question 132

Child with ODD (they give you this)

A. What management would you suggest (2)

B. What 3 comorbidities are associated (3)

Answer 132

A. 2 management

• parent management training
• cognitive problem skills training
• social emotional skills training

B 3 comorbidities
- ADHD
- anxiety
Depression
Bipolar
PTSD
Substance abuse
Impulse control
Learning
Communication disorders

Question 133

6 or 7 month old boy that his mother is concerned about his development. He rolls both sides, is unable to sit without support, he babbles and his mother thinks he is right handed because he crosses the midline to grab with his right hand when objects are on the left.

A. Of those findings what one thing is the MOST worrisome oh history ?
B. Explain why?

Answer 133

Handedness as can be a sign of CP

Rolls front to back - 4 months
Rolls back to front - 5 months
Inability to sit without support red flag at 9 months

Handedness - usually establishes by 3rd year. Early hand preference can be a sign of CP - hemiplegic CP

Question 134

A 6 y.o old boy in grade ? Is brought to your office because the school says he is at risk for academic failure and wants him assessed for ADHD. In class, he is inattentive, occasionally defiant. What are 5 other things that would be on you differential for his presentation ?

Answer 134

1. Specific learning disability
2. Language disorder
3. Autism spectrum disorder
4. Hearing and visual impairment
5. Obstructive sleep apnea
6. Others: intellectual disability, emotional and behaviour disorders like oppositional defiant disorder, anxiety disorder

Question 135

Name 5 characteristics of Rett syndrome

Answer 135

1. Normal development in the first year of life
2. Loss of speech
3. Loss of purposeful hand use and onset of stereotypical hand movements
4. Gait abnormalities
5. Deceleration of head growth (acquired microcephaly)
6. Seizures
7. Intermittent breathing abnormalities - sighing with intermittent periods of apnea/cyanosis
8. ANS dysfunction
9. Cardiac abnormalities- cardiac arrhythmias
10. Sleep disturbances
11. Autism
12. Feeding difficulties, poor weight gain

Question 136

A 9 y.o boy with autism is on risperidone.

A. What are 5 possible side effects of risperidone?
B. What are 4 clinical or laboratory things you should monitor ?

Answer 136

A. 5 s/e of risperidone

1. Increased weight gain/overweight/obesity
2. Insulin resistance and hyperglycaemia
3. Hyperlipidemia
4. Hypertension
5. Galactorrhea
6. Others: sedation, EPS

B. 4 clinical or lab things to monitor
Clinical
- abdominal girth
- BMI

Lab

• Fasting blood sugar
• lipid profile - total cholesterol, fasting TG

Other

• height, weight
• BP
• EPS
• prolactin

Question 137

3 year old single mom brings her 4y.o girl in because of concerns regarding her sleep. She says that she sleeps only 9-10h per night and does not nap anymore. The mom is upset because this used to be her quiet time. Also she sleepwalks sometimes.

A. What are 2 questions that you would ask to get a better sense of the sleeping pattern

B. What is your impression of this sleeping pattern

C. What is the most important thing to do regarding the sleep walking ?

Answer 137

A. 2 questions about sleeping pattern
1. What is her bedtime and quality of sleep - what is her sleep latency (troubles falling asleep), sleep interruptions or awakenings at night/difficulty getting back to sleep, and early terminations ? When did she stop napping?

2. What is her sleep environment (own room, co-sleeping or shared bed with parents, transition item, any fears) ?

B. Impression
- normal sleep pattern - only 26% of 4 y.o take a nap

C. Sleep walking

• safety of the child
• ensure gates are at top of stairs
• doors and windows are locked and secured
• install bedroom door alarms

Question 138

A 7 y.o old boy fights when going to bed and takes an hour to fall asleep. What are five pieces of advice you would give the parents for improving sleep hygiene ?

Answer 138

5 sleep hygiene

1. Establish a regular bedtime routine
2. Consistent bedtime and wake up times both weekdays and weekends
3. Identify and eliminate any maladaptive associations
4. Eliminate screens (tv, phone, tablets, video games) from bedroom
5. Don’t send child to bed hungry - have a night time snack
6. Avoid products containing caffeine for at least several hours before bedtime
7. Make sure the child spends time outside everyday
8. Make the hour before bed shared quiet time. Avoid any high energy activities
9. Keep the bedroom quiet and dark
10. Make sure temperature is good
11. Don’t use bedroom for time out or punishment

Question 139

A 9 y.o girl has a short temper, is argumentative, and disrespects her parents. What are 5 key features of a parenting plan for this child ?

Answer 139

1. Establish consistent rules that all caregivers follow
2. Identify negative behaviours that parents want to target interventions at instead of addressing all annoying behaviours: prioritize negative behaviours that harm self or harm others or property
3. Set reasonable and consistent limits
4. Parents should implement consequences immediately after a negative behaviour
5. Praise the child and catch them being good. Reinforce positive behaviour
6. Developing a warm supportive relationship with the child

Question 140

A 6y.o is referred to you for school difficulties. He is previously healthy and was born at term. What information on history would help confirm your suspicion of reading disability (dyslexia)? They had 5 lines but did not specify how many points they wanted

Answer 140

1. Normal development in other domains
2. History of mistakes in spoken language (ie; mispronunciations, dysfluency)
3. History of avoiding reading and disliking reading
4. History of word finding difficulty or delay/inability to come up with and Ora response quickly when asked a question
5. Family history of dyslexia
6. Other: understands what others read to him
   - reads slow

Or

1. Difficulty reading aloud
2. Difficulty with reading comprehension
3. Understanding when someone reads to him
4. Normal intelligence/cognition in other spheres of learning
5. Word finding difficulties, spoken word lacks fluency, mispronunciations (phonological processing)

Question 141

Name 5 sleeping advice

Answer 141

Safe sleeping advice

1. Sleep in supine position (never prone)
2. Baby should sleep clothed in a light sleeper or blanket - avoid overheating
3. No crib runners, bumpers, soft objects, toys in crib
4. For the first 6 months, babies should co-sleep in the same room as their caregivers in a bassinet or crib that meets Canadian regulations
5. Do not share the same sleeping surface with an adult (ie; bed, couch)
6. Others: firm surface with tight fitting mattress, no waterbed, no tobacco smoking

Question 142

You noticed that the community has a high rate of dental caries, what 5 things can you do at the community level to decrease dental caries ?

Answer 142

5 things
1. Fluoride in public water
2. Advocate for public dental screening programs for children (ie; in schools) so that early childhood caries can be identified earlier
3. Create public health campaign that educate parents about dental hygiene (ie; proper tooth brushing 2x daily with fluoridated toothpaste, avoiding sugary snacks)
4. Advocate for recruitment of more dental health professionals
5. Advocate to government for universal dental care coverage or programs that help lower income families seek dental care
6. Other: advocate for oral health for pregnant women
Or
1. Ensure that all children in their respective jurisdictions be afforded equal access to basic treatment and preventive oral care, regardless of where they live or their family’s socioeconomic status
2. Ensure that every child has a dental home by one year of age
3. Support the CPS and the Canadian dental association recommendations on fluoride supplementation
4. Create leadership positions to represent the specific interests of children and youth on oral health issues
5. Develop an ongoing surveillance system to capture key data and to reflect the state of pediatric oral health.

Question 143

A 28 week prem is now 10 months old (chronologically). He is able to sit alone for 5min, is commando crawling,, can transfer objects hand to hand and can stand if supported. He does not have a pincer grasp.

A. What is his developmental level
B. How should you advise parents

Answer 143

A. 7-8 months
B. Appropriate for corrected gestational age

10 months old, 28weeks = 7 months cGA

Sitting without support - 6 months
Transferring objects hand to hand - 6 months
Stand if supported - 7-9 months 
Pincer grasp - 9 months 
Crawling - 6-9 months

Question 144

Name 4 biological factors that influence a child’s development

Answer 144

1. Prenatal exposures (teratogens, drugs, alcohol)
2. Intrauterine infections (TORCH)
3. Prematurity
4. Genetic conditions ie: T21
5. Hearing/visual impairment
6. Illness/disease states (metabolic, neurologic)
7. Genetic potential
8. Congenital CNS malformations
9. Presence of seizure disorder
10. Postnatal illnesses ie; meningitis, traumatic brain injury

Question 145

Teacher concerned about 4y.o child who can’t use scissors, can’t copy a square. She wonders about developmental coordination disorder. List 2 diagnostic criteria for developmental coordination disorder

Answer 145

1. Performance of coordinated motor skills is substantially below that expected given the child’s chronological age and opportunity for skill learning and use
2. The poor performance significantly and persistently interferes with activities of daily living appropriate to chronological age and impacts academic/school productivity, provocation and vocational activities, leisure and play
3. The symptoms began in early developmental period
4. The impairment in motor skills deficits are not better explained by intellectual disability or visual impairment and cannot be attributed to another neurological or neuromuscular condition affecting movement (ie; CP, muscular dystrophy, degenerative disorder)

Short version

1. Motor skills below that expected for age
2. Interferes with ADLs/play/school
3. Began early
4. Not better explained by another condition

Question 146

5 things you would tell a boy to improve his sleep hygiene

Answer 146

1. Establish a regular bedtime routine (30-60min of winding down time before bed )
2. Regular bedtime and regular wake -up time - do not sleep in by more than 1 hour on weekends
3. Avoid caffeinated drinks after dinner time
4. Eliminate screens (tv, tablets, phones, computers) from the bedroom
5. Avoid high energy or vigorous activity before bedtime
6. Age appropriate number of hours in bed

Question 147

School refusal: what three recommendations would you make ?

Answer 147

3 recommendations
1. Identify underlying etiology: bullying, separation anxiety, school work too difficult (ie learning disability)
2. Work with work with school personnel
To come up with a plan
3. Calmly send child to school and reward child for each completed day of school
4. If child calls to come home in the middle of the day, encourage child to stay at school (identify a safe quiet space where they can spend time)
5. CBT

Question 148

Table of 5 different developmental milestones for an 18 month old. Mark as normal or abnormal:

A. Walked at 14 months, not yet doing stairs
B. Speaks a 2 word vocabulary
C. Follows 1 step command
D. Cries for wants but does not point to needs
E. Points to face but does not know any other body parts

Answer 148

A. Walked at 14 months, not yet doing stairs
- normal, red flag if not walking by 24 months, and stairs later
B. Speaks a 2 word vocabulary
- abnormal, by 18 months should have 6 words
C. Follows one step command
- normal, 12 months one step command with gesture and without gesture at 14-15 months
D. Cries for wants but does not point to needs
- abnormal, at 12 months should be pointing to get desired object
E. Points to face but does not know any other body parts
- Abnormal, should point to 3 body parts

Question 149

Mom brings in her 6 month old child. Noted to not be using the left hand, and left arm and leg appear stiff., but unable to sit even with support. Otherwise looks well. What is your first management step ?

Answer 149

1st management step

- MRI brain

Question 150

List 3 criteria for autism that you would be able to identify in your office.

Answer 150

3 criteria for autism
1. Abnormal non-verbal communication (ie; poor eye contact)
2. Deficits in social-emotional
Reciprocity (ie; not back and forth conversation, reduced pointing/sharing of interest
3. Stereotyped/repetitive movements, use of objects or speech (ie; hand flapping, ordering toys, echolalia, opening/closing doors)
4. Highly restricted/fixated interests (ie; preoccupied with certain objects/parts of objects)
5. Increased/decreased response to sensory inputs (adverse response to certain sounds, excessive touching/spelling objects).

Question 151

A kid brought into your office. Teachers feel he is inattentive at school, and has poor school performance. List 4 DDX:

Answer 151

4 DDX

1. ADHD
2. Hearing impairment
3. Learning disability
4. Intellectual disability
5. Psychosocial stressors at home
6. Depression
7. Substance abuse

Question 152

A mother is concerned that her 7 month old baby is not sitting independently. She thinks that the baby is right handed and is able to transfer objects across the midline using her right hand. Do you have any concerns about this child’s development ?

Answer 152

Concerns

- yes as already showing handedness and should not have preference until 2-3years of age

Question 153

The parents of a 3 y.o girl what advice about toilet training. What are four signs of toilet readiness ?

Answer 153

4 songs of toilet readiness

1. Able to walk to potty chair
2. Stable while sitting on the potty
3. Able to remain dry for several hours
4. Receptive language skills allow the child to follow simple (one and two step) commands
5. Expressive language skills permit the child to communicate the need to use the potty with words or reproducible gestures
6. Desire to please based on positive relationship with caregivers
7. Desire for independence, and control of bladder and bowel function

Question 154

What are four features of infantile colic ?

Answer 154

4 features infantile colic
The Rome III criteria for functional
gI disorders defines infantile colic as including all of the following in infants you get than 4 months of age
-paroxysm of irritability, fussiness or crying that start and stop without obvious cause;
- episodes lasting 3h or more per day and occurring at 3 days per week for at least one week; and
- no FTT

• must be in infants younger than 4 months

Question 155

Description of a child with autism. His physical

Exam is normal and he has no history of developmental regression. What are 3 tests you wild order ?

Answer 155

3 tests autism

1. Hearing screen
2. Microarray
3. Wood’s lamp exam
4. Fragile X

Question 156

List 4 diagnostic features of Autism

Answer 156

DSMV autism

A. Persistent deficits in social
Communication and social interaction across multiple contexts, as manifested by the following, currently or by history:
1. Deficits in social- emotional reciprocity
2. Deficits in non-verbal communication behaviours used for social interaction
3. Deficits in developing, maintaining, and understanding relationships

B. Restricted, repetitive patterns of behaviour, interests, or activities, as manifested by at least 2 of the following, currently or by history :

1. Sterotyped or repetitive motor movements, use of objects, or speech.
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or non- verbal behaviour
3. Highly restricted, fixates interests that are abnormal in intensity or focus
4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment

C. Symptoms must be present in the early developmental period ( may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life)

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or GDD

Question 157

A mom has brought her 2y.o son in for a regular visit. She has the following concern and asks for your advice: when she says “no” for whatever reason, he screams and hits her. There are other otherwise no concerns in behaviour or development. What are 3 recommendations you can give her ?

Answer 157

CPS statement: Effective discipline for children

1. Reinforce desirable behaviour
2. Apply rules consistently
3. Set reasonable and consistent limits
4. State acceptable and appropriate behaviour that is attainable
5. Time outs or withdrawal of privileges

Question 158

A mom wonders if her autistic 2 year old daughter could have Retts. Name 3 characteristics of Retts (besides autism)

Answer 158

Main criteria
1. Partial or complete loss of acquired purposeful hand skills
2. Partial or complete loss of acquired spoken language
3. Gait abnormalities: impaired (dyspraxia) or absence of ability
4. Stereotypic hand movements such as hand wringing, clapping,
Mouthing/rubbing automatisms

Question 159

Devlopmentally delayed child. Brother I special class. Maternal cousin has autism. Diagnosis and test ?

Answer 159

Fragile X ? Very hard to tell with this stem.

Investigations with the highest diagnostic yield in GDD

1. Microarray
2. Fragile X testing in boys with family history
3. MECP2 testing in girls
4. Metabolic - only if other symptoms or consanguinity

Question 160

Picture of child (large ears, macrocephaly). He is hyperactive. 50th percentile for height and weight + 95th percentile for HC. Identify diagnosis ?

Answer 160

Fragile X

Question 161

Description of child with florid autism
A. Name three tests you would order
B. Which two consultants or services would you involve to help you with your diagnosis ?

Answer 161

A. Three tests

1. Hearing and visual screen
2. Microarray
3. Fragile X
4. Wood’s lamp

Other: ADOS

B. 2 consultants

1. Developmental pediatrician
2. Psychologist or psychiatrist

Question 162

Child comes to office because his teacher wants him investigated for disruptive behaviour and is concerned for ADHD. Parents may have some concerns about his attention but none about his behaviour

A. What do you think is the diagnosis ?
B. What are 4 things to request to investigate for this diagnosis ?

Answer 162

A. ADHD - concerned about his attention and disruptive behaviour - which could be from inattention or hyperactivity/impulsivity

B 4 things to investigate for diagnosis
1. History and developmental assessmen with physical exam: want to rule out - emotional or behavioural disorders (anxiety, depression, ODD, and conduct disorders)
-
Developmental disorder (LDs, language or other Neuro dvlp)

2. Questionnaires for parents and teachers
   - Connors 3 questionnaire - gold standard
   - SNAP IV and SWAN (free on internet)
3. Hearing and vision testing
   4 Psychoeducation assessment

Question 163

Description of night terrors. List two things to do for management.

Answer 163

2 things for
Management 
1. Reassure 
2. Anticipatory awakening 
3. Rarely would need Benzo

Question 164

10 month old with cerebral palsy. What are 3 signs/symptoms clinically that might confirm CP

Answer 164

3 signs/symptoms in CP at 10 months

1. Spasticity
2. Hyperreflexia
3. Delayed gross motor development
4. Handedness

Question 165

Name 3 diagnostic criteria for ADHD -inattentive subtype and 3 for hyperactive/impulse subtype

Answer 165

A persistent pattern of inattention and/or hyperactivity- impulsivity that interferes with Functioning or development:

1. For children 6 or more symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level, and that negatively impacts directly on social and academic activities. Symptoms must not be solely a manifestation of ODD, defiance, hostility, failure to understand tasks or instructions. If over 17 needs 5
2. Present before age 12
3. 2 or more settings
4. Interferes with social/acedemic
5. Not attributed to other medical condition

Inattentive 6/9

1. Fails to pay close attention to details/careless errors
2. Lacks sustained attention
3. Does not seem to listen
4. Fails to follow through or does not finish
5. Disorganized
6. Avoids /dislikes homework
7. Loses things
8. Distractable
9. Forgetful

Hyperactive/ impulsive 6/9

1. Often fidgets of squirms in seat
2. Leaves seat what remaining seated is expected
3. Inappropriately runs around about/climbs
4. Difficulty with quiet leisure activities
5. “On the go”, driven by a motor
6. Talks excessively
7. Blurts out answers before questions are completed
8. Difficulty waiting turn
9. Interrupts or intrudes on others

Question 166

Name 2 milestone in each of the following criteria for a 36 month old: 1 line each

Gross motor
Fine motor
Speech
Social
Self care

Answer 166

3 y.o

Gross motor- rides tricycle, balance on one foot
Fine motor - copies circle
Speech - 3-4 word phrases. 75% intelligible, 200+ words, knows name
Social - role playing, cooperative play
Self care - undresses, puts on shoes (without laces)

Question 167

4 y.o child with symptoms of autism.

A. What is dx
B. What 2 neurological disorders are a/w this

Answer 167

A. Autism

B. Fragile x, rett, tuberous sclerosis

Question 168

Toddler with description of breath-holding spells. Your presumptive diagnosis is breath holding spells. What treatment if any would you recommend for mom

Answer 168

1. Reassurance - ignore breathholding and usually without reinforcement will
   Disappear
2. Do not respond with punitive anger as can reinforce behaviour
3. Parents best advised to avert defiance by giving the child choices; once child has begun a tantrum, the child can be given a timeout. After it’s over tell
   Child while frustration is understandable defiance isn’t

Question 169

Parents bring 18 month old so. To see you because of concern for head banging. What treatment of any do you offer ?

Answer 169

Reassure, ignore behaviour, positive reinforcement for good behaviour

Question 170

2019 Q: At what age are most children sure of their gender identity

A. 4
B. 6
C. 8
D. 10

Answer 170

A. Age 3-4

Question 171

2019 question: 8y.o boy with 1 year history of worsening tics including blinking, lip smacking, tugging at his ears, clearing throat, other vocal tics. Very distressed by this and teased by kids at school. What do you do ?

A. Reassure
B. Refer for psychological assessment
C. Start alpha 2 agonist
D. Start a benzodiazepine

Answer 171

B. Refer for psychological assessment
- psychoeducation- habit reversal therapy

A reassure - not its bothering hiM
c. Alpha 2 agonist - only if severe
D. Benzo - no

Question 172

2019 Q: school aged child, difficulty making friends, doesn’t get invited to birthday parties. Doing well academically. Has a very organized desk and gets upset with people when they touch it. Does not make eye contact with classmates

A. OCD
B. ASD
C. Social anxiety
D. ?

Answer 172

Not sure not enough info.
Going with B ASD - poor eye contact, difficulty making friends, gets upset when people touch desk

A. OCD - no mention of obsessions caisson compulsions
C. Social anxiety - could be this one but not sure why needs desk organized

Question 173

2019 Q: 2 year old with stuttering. Speaks in 3-4 word sentences. What would make you most concerned ?

A. Pauses between words
B. Repeats full words
C. Repeats parts of words
D. Tension in face

Answer 173

D. Tension in face - indicates they are worried about it

Question 174

2019 Q: 4 months old with eruption of 2 new teeth, what do you do ?

A. Brush with water only
B. Brush with fluoride toothpaste
C .send to dentist now and every 6 months
D. Discontinue night time feed

Answer 174

B. Brush with fluoride toothpaste

A. Brush with water only- some sources say this is ok too
C. Send to dentist now and every 6 months - no it’s around 12 months
D. Discontinue night time feeding - your for that

Question 175

2019 Q: A 10 year old boy with ADHD and is stable on stimulants for 2 years. He presents with increased aggressive behaviour and difficulty following limits. His seep and appetite are otherwise normal. After ruling out psychological stressors. Which of the following is the most appropriate action ?

A. Increase his stimulant dose
B. Use Benzo PRN
C. Add atypical antipsychotic
D. Add an SSRI

Answer 175

A. Increase his stimulant dose- can’t find the source for this

Why can’t it be C. Atypical antipsychotic ?

Question 176

2019Q: 10 year old boy with poor school performance, behaviour issues and decreased attention who was diagnosed with ADHD by his family doctor and not responding to stimulants. What are 4 other possible causes of his symptoms ?

Answer 176

4 ddx

1. Learning disorder
2. Intellectual disability
3. ODD
4. Anxiety
5. ASD
6. Genetic disorder

Question 177

2019Q: name 3 differences between regular childhood tantrums and tantrums experienced by children with autism spectrum disorder.

Answer 177

1. Goal Oriented vs overload/lol overwhelmed by sensory input/information or change in routine
2. willfull behaviour showed by rewarding desired behaviours and decreases with age vs meltdown can occur across lifespan and don’t go away
3. Tantrums need an audience and stops when ignored vs tantrums occur in autism when alone - response to external stimulus