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PEDS > Developmental Notes > Flashcards

Developmental Notes Flashcards

1
Q

What are the characterizations of cerebral palsy? Diagnostic test?

A

motor dysfunction w/ variable impact on other domains

MRI is diagnostic test-shows periventricular leukomalacia.

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2
Q

Spastic diplegia is a form of what?

A

cerebral palsy

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3
Q

What are the 3 domains where you might see delay in autism?

A

social: best indicator: no pointing, looking back
language: echolalia, delays, scripting
behavioral: specific routines, rituals, hand flapping

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4
Q

When do you do MCHAT screening?

A

18-24 mo

failure means that you need some further screening.

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5
Q

Red flags for autism?

A

no babbling by 1 year
no 1word by 15 months
no 2 word sentences by 2 years
or loss of language/social skills

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6
Q

What is the adjunct workup for autism?

A

hearing test
lead level
genetic testing (fragile x)
EEG/MRI

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7
Q

Treatment for sleep issues or anxiety?

A

hydroxyzine H1 antagonist

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8
Q

What is Asperger’s?

A

autism spectrum disorder w/o language impairment
social interaction is professorial or pedantic.
social difficulties

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9
Q

Rett disorder?

A

normal development until 5 months
then decreased head growth and loss of previous learned motor skills 5mo-30mo
then hand wringing or washing will begin

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10
Q

What is the abnormal workup for Rett disorder?

A

EEG abnormal
MECP gene
only seen in females
monozygotic twins 100% concordance.

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11
Q

what are the 3 domains to consider in ADHD? what are the requirements for diagnosis?

A

domains: inattention, hyperactivity, impulsivity
>6 symptoms in 2 or more settings for at least 6 mo
before age 12

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12
Q

What is one thing that has to be ruled out in ADHD diagnosis?

A

lead poisoning

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13
Q

What is the definition of intellectual disability?

A

IQ

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14
Q

What is the number genetic cause of ID?

A

Trisomy 21

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15
Q

What are the features of Down’s syndrome?

A 
heart defects: AV defect, VSD, ASD
GI: duodenal atresia, constipation, Hirsphrung's
cryptochordisim
hypothyroidism
neonatal hypotonia
visual hearing issues
atlanto-axial instability
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16
Q

what is cryptochordism?

A

no testes in the scrotum

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17
Q

What are the features of hypothyroidism in down’s syndrome?

A

prolonged jaundice
hypotonia
constipation
macroglossia

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18
Q

What are some of the physical features of down’s syndrome?

A 
brushfield spots (grey spots on iris)
microcephaly
epicanthal folds
upward slanting palpebral fissures
wide spaced toes
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19
Q

What are some of the consequences of atlanto-axial instability in down’s syndrome?

A

compression of spinal cord
torticollis (head persistently turned to one side)
urinary incontinence
vertebrobasilar symptoms (spasticity, hyperreflexia, + babinski sign)

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20
Q

What is the 2nd most common genetic cause of intellectual disability? Most common inherited form of ID?

A

Fragile X

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21
Q

What are the features of Fragile X?

A 
large jaw
long face
large testicles
big ears
big hands
FMR1 trinucleotide expansion
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22
Q

In female carriers of Fragile X… higher rates of what?

A

psychiatric disorders

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23
Q

What’s the deal with Prader-Willi?

A 
Mom takes over. Dad deletion of chromosome 15
overweight pt, hyperphagia
almond-shaped eyes
hypogonadism
hypotonia
argumentative, aggressive
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24
Q

What’s the deal with Angelman syndrome?

A

Dad takes over, Mom deletion of chromsome 15
Happy puppet
inappropriate laughter, jerky movements, seizures, ataxia

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25
Q

What’s the deal with Williams syndrome?

A 
elfin facies
well developed verbal skills
hypercalcemia (too much santa milk)
extreme friendliness with strangers
like will ferrell
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26
Q

What’s the deal with tuberous sclerosis?

A

seizures

angiofibromas

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27
Q

What are the features of FAS?

A

microcephaly
smooth philtrum
thin upper lip
ID

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28
Q

What is oppositional defiant disorder?

A

less bad than conduct disorder
frequent loss of temper
arguments with adults
annoying people, anger, resentment

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29
Q

What is conduct disorder?

A

antisocial personality disorder for children

persistent violation of the rights of others

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30
Q

What is disruptive mood dysregulation disorder?

A

severe pervasive irritability and poor frustration tolerance
temper outbursts
unlike ADHD, no hyperactivity, inattention, disorganization

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31
Q

What are the requirements for tourette’s?

A

multiple motor tics and at least one vocal tic
onset before age 18
tic free period

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32
Q

What brain changes do you see in Tourette’s?

A

impaired regulation of dopamine in the caudate nucleus

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33
Q

What is the treatment for tourette’s?

A

atypical antipsychotics
clonidine is first line alpha 2 agonists or guanfacine
pimozide

34
Q

How do you make the diagnosis of enuresis?

A

must be older than age 5
at least 2 episodes/wk, 3+ months
have to workup with UA-r/o DM, infections. Need to make sure no clinical suspicion for seizures.

35
Q

What is the treatment for enuresis?

A

enuresis alarm
desmopressin
TCAs
oxybutynin (muscarinic receptor antagonist-for daytime incontinence)

36
Q

What are breath-holding spells?

A

can be associated with iron deficiency anemia
(think of iron man competitor swimmer holding breath)

sometimes after crying.

workup includes CBC, ferritin.

37
Q

Freud’s 0-18 mo?

A

oral stage
sense of security and basic trust of others
failure of this stage: urgent demands, extreme dependence, lack of consideration for others, very low tolerance for frustration

38
Q

Freud’s 1.5-2.5 yr?

A

anal stage
control over bodily needs
success: control, independence, pride
failure: problems with self control and rigid behavior patterns. likes ordliness.

39
Q

Freud’s 2.5-4yr?

A

phallic stage
explore world autonomously
success: stable sense of self-worth

40
Q

Freud’s 4-6 yr?

A

oedipal
develops special relationship with same sex parent
failure: guilt anxiety, depression, phobias, anxieties
perfectionism, hysteria

41
Q

Freud’s 6-12 yr?

A

Latency
kids learn to interact with ppers
identify with same sex
failure: poor social skills, ostracism

42
Q

Freud’s teen years?

A

adolescence

personal identity

43
Q

Erikson’s 0-18 mo?

A

Infancy Trust v. Mistrust

44
Q

Erikson’s 2-3 yr?

A

Early Childhood
autonomy v. shame
personal skills and self control

45
Q

Erikson’s 3-5 yr?

A

Preschool
initiative v. guilt
children assert control over their environment
success: sense of purpose

46
Q

Erikson’s 6-11 yr?

A

School age
industry v. inferiority
success: competence

47
Q

Erikson’s 12-18 yr?

A

identity v. role confusion

48
Q

Erikson’s 19-40 yr?

A

intimacy v. isolation

49
Q

Erikson’s 40-65 yr?

A

generativity v. stagnation

50
Q

Erikson’s >65 yr?

A

ego integrity v. despair

51
Q

Children should triple their weight by which year?

A

year 1

52
Q

What is constitutional growth delay?

A

bone age

53
Q

What is familial short stature?

A

bone age=real age

both parents are short

54
Q

What are some developmental questionnaires?

A

Ages and stages
PEDS
Denver II

55
Q

When should you do a screening H&H?

A

12 months

iron intake may be deficient

56
Q

Vision screen and hearing screen when?

A

vision-3

hearing-4

57
Q

See dentist when?

A

first tooth eruption or by age 1

58
Q

Lead screening when? BP screening when?

A

lead-6 months

bp age 3

59
Q

Milestones for 2 mo?

A
  • smiles
    • looks @ parent
    • visual tracking across midline
    • holding head up steadily
    • coos, gurgles
    • pushes up on tummy
60
Q

Milestones for 4 mo?

A
  • sits with support
    • reaches for objects, pushing up on arms
    • plays
    • copies facial expressions
    • babbles
    • pushes down on legs
    • rolls tummy-back
    • check lower milestones too.
61
Q

Milestones for 6mo?

A
  • ah eh oh
    • knows name
    • “m”, “b” babbles
    • passes object from one hand to the other
    • curiosity
    • rolls both ways
    • stranger anxiety
    • sits on its own
    • crawls a little
    • pincer grasp
62
Q

Milestones for 9 mo?

A
  • mama, dada
    • stranger anxiety
    • finger points
    • knows a few words
    • object permanence: peek a boo
    • stands holding things
    • crawls
63
Q

Milestones for 12 mo?

A
  • stacks 3 cubes
    • separation anxiety
    • walking
    • parallel play
    • drinks from cup
    • waves bye, shakes head
    • copies words
    • brushes hair
64
Q

Milestones for 18 mo?

A
  • remove some clothing
    • speak six words
    • copies others
    • able to name common objects 1 word at a time
    • 2-4 block towers
65
Q

Milestones for 2 yrs?

A
  • 2 word phrases, 200 words, 50% understandable
    • throw a ball, kick a ball
    • jumping
    • stairs
    • follows 2 step commands
    • hops
    • imitates
    • brushes teeth
66
Q

Milestones for 3 yrs?

A
  • 3 word sentences
    • rides a tricycle
    • draws a circle
    • 1000 words
    • friend affection
    • dresses and undresses
    • first name, age, sex
    • 6 block tower
    • make believe
    • uses utensils
67
Q

Milestones for 4 yrs?

A
  • draw a square
    • hop
    • colors, numbers
    • cooperative play, board games
    • stories
    • scissors
68
Q

What are the guidelines for eating for infants?

A

breast feeding: 8-12X/d for 10-20 min
formula: 4-6 oz q3h by 2mo, 6-8 oz q6-8 h by 6 mo + table foods
9mo-75% of calories from breast milk/formula
use cup by 1 year, cow’s milk can start then

69
Q

T/F it is okay to use a feeding bottle at 2 yo?

A

False. increased risk for dental carries

70
Q

Vit D supplement started when?

A

week 1 of life in infants who are exclusively breastfed.

71
Q

Meconium should be seen by what age?

A

24-48 hours

72
Q

How does the frequency of meconium vary when pt is formula fed v. breastfed?

A

formula fed: 4-5 stools/d

breastfed: 1 stool/d

73
Q

How many wet diapers of urination should be produced per day?

A

first week of life-# of days alive=# of diapers/d

~6/d for infants

74
Q

What are the expectations for sleeping for infants?

A

after 4-6 mo: sleep thru the night

by 9 mo->sleep 11 hrs with 1-2 naps/d

75
Q

Weight gain expectations?

A

15-30 g/d for 2mo
then 15-20 g/d for 3 mo
then 10-15 g/d for 6-12 mo
double body weight by 5 mo, triple by 12 mo

76
Q

When should the primary series of vaccines be completed by? Influenza started?

A

Primary series completed by no later than 24 mo

influenza started at 6 mo

77
Q

When should you use a rear facing car seat?

A

until 2yo or until they reach max height and weight
40-50 lb-booster seat with belts. until about 4’9” or 12 yo
teenager to ride in the front seat

78
Q

What is considered pubertal delay in girls?

A

lack of breast development by 14
lack of period by 16
>5 years from initial breast tissue to menarche

79
Q

What is considered pubertal delay in boys?

A

no testicular enlargement by 14

>5 yrs from initation to completion of genital development

80
Q

What are the stages for boys puberty development?

A 
growth of testicles
pubic hair
growth of penis and scrotum
first ejaculations
growth spurt
attainment of adult height (17)

PEDS (14 decks)

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