General Paediatrics

Question 1

Builds tower of 2-3 cubes

Answer 1

18 months

Question 2

Builds tower of 6 cubes

Answer 2

24 months

Question 3

Builds a “bridge” with cubes

Answer 3

3.5 years

Question 4

Drawing a random stroke

Answer 4

18 months

Question 5

Drawing a circle

Answer 5

3 years

Question 6

Weschler Intelligence Scale for Children (WISC)

Answer 6

The test generates an IQ score independent of reading and writing skills

Can diagnose learning disability
Verbal comprehension, visual spacial, fluid reasoning, working memory, processing speed, verbal comprehension, perceptual organisation, freedom from distractibility, processing speed

Used for kids 6-16 years

Average IQ= 100
<70 = intellectual disability (2 SD below the population mean)

*Weschler preschool and primary scale of intelligence (WPPSI) for ages 2.5 years- 7.5 years

Question 7

Bailey scale of infant and toddler development (BSID)

Answer 7

formal development tool
often used to follow up premature babies at risk of developmental delay
Age 1month-42 months

Question 8

Griffith mental development scales

Answer 8

Birth- 6 years

Gross motor skills
Social interaction with others
Hearing and language
Hand eye coordination
Performance (reasoning)
Practical reasoning (2-6 years)

Question 9

McCarthy scales of children’s abilities (MSCA)-

Answer 9

ages 2-8
Measures cognitive ability rather than IQ

Question 10

Peabody Picture Vocabulary test

Answer 10

ages >2.5 years
-tests receptive vocabulary

Question 11

Ages and stages

Answer 11

screening questionare
completed by parents
4 months - 5years

Question 12

intellectual disability

Answer 12

IQ <70 AND low adaptive functioning

Mild - 50-69
Mod- 35-49
severe 20-34
profound <20

Question 13

red flags in child development

Answer 13

poor head control by 4 months
not sitting by 9 months
not walking independently by 18 months
no babbling, pointing or gesturing by 12 months
no single words by 16 months
<10 words by 20 months
no two word combinations by 24 months
<50 words by 30 months
regression in language or social skills at any age (25% of ASD)

Question 14

ADHD assessment tools

Answer 14

Connors
Vanderbilt

Question 15

M-CHAT

Answer 15

modified checklist autism in toddlers
screening tool
between16 and 30 months of age

Question 16

Difference between Autism Diagnostic Interview (ADI) and Autism Diagnostic Observation Schedule (ADOS)

Answer 16

ADI-R explores a child’s early developmental history through semi structured parent interview

the ADOS provides information regarding the child’s current functioning in social, communication and play areas through a structured play session

Question 17

Medications for autism

Answer 17

Usually stimulants for co morbid ADHD
Melatonin + sleep program
Risperidone for agression
Anxiety- SSRI (fluoxetine)
Sertraline - OCD

Question 18

drawing a line

Answer 18

2 years

Question 19

builds bridge

Answer 19

36 months

Question 20

kick a ball

Answer 20

2 years

Question 21

jump in place

Answer 21

2 years

Question 22

throw a ball

Answer 22

12-18 months

Question 23

words by age 2 years

Answer 23

50 -200
50% intelligible

Question 24

runs well

Answer 24

18 - 24 months

Question 25

pretend play by

Answer 25

18 months

Question 26

what age does child turn directly to sound

Answer 26

9-10 months

Question 27

by what age should conversation be clear for others

Answer 27

4 years

Question 28

walks alone

Answer 28

12 months

Question 29

stands alone

Answer 29

11 months

Question 30

crawls

Answer 30

10 months

Question 31

sits independantly

Answer 31

6 months

Question 32

expressive speech milestones

Answer 32

18 months - 25% understood by parents 24 months 50-75% understood by parents 36 months 75-100% understood by parents 4 years- all understood by others

Question 33

echolalia

Answer 33

repetition of words spoken by others

Question 34

pointing at wanted items

Answer 34

12 mo

Question 35

what tests make up newborn hearing screening

Answer 35

otoacoustic emissions (OAE) automated auditory brainstem responses (AABR) - not diagnostic - if test failed, needs audiometry

Question 36

Major gross motor milestones

Answer 36

2 months - lifts head 45 deg 4 months- roll front to back 6 months- roll both ways, sits without support, drinks from a cup, eats with spoon (held by parent) 9 months- crawls, pulls to stand 12 months- cruising, first steps without support 18 months- throws, runs stiffly, kicks ball, uses spoon/cups independently, throw ball 24 months- runs well, up and down stairs 36 months- catch ball, rides tricycle 4 years- hops, up and down stairs with alternate feet, stands one foot 5 years- skips

Question 37

Major fine motor milestones

Answer 37

6 weeks- fixes and follows to midline 8 weeks- fixes and follows past the midline 4 months- reaching for objects 6 months- transfers objects, palmar grasp 8 months- raking 9 months- crude pincer grip 12 months- points with index finger, refined pincer grip 18 months- builds tower of 3 cubes, scribbles, handedness 24 months- builds tower of 6 cubes, draw a line 3 years- tower of 9 cubes, bridge with 3 cubes, draws circle, eats with fork and spoon

Question 38

Major social milestones

Answer 38

6 weeks- smiles 8 weeks- pays attention to faces, cries when bored 4 months- laughs 9 months- stranger and separation anxiety, plays peek a boo, object permanence 12 months- waves, imitates clapping 18 months- points to pictures in book, pretend play 24 months - shares, undresses, parallel play 36 months- dresses self with supervision 4 years- role playing, cooperative play, dresses without supervision

Question 39

Speech and language milestones

Answer 39

6 months - babbles 12 months - first words, can follow 1 command 18 months- names 3 body parts, 5-20 words 2 years- 2 word phrases, names 6 body parts, can follow simple 2 step commands, 50-200 words, language 1/2 clear 3 years- 1000 words, language 3/4 clear 4 years- 1500 words, full name, colours, songs, fully understandable

Question 40

ADHD diagnosis

Answer 40

1. Inattention: 6 or more symptoms present for at least 6 months, inappropriate for developmental level 2. Hyperactivity and impulsivity: 6 or more symptoms, present for at least 6 months 3. Additional criteria: a. Inattentive/ hyperactive symptoms present before age 12 years b. Present in two or more settings (usually home + school) – social, academic, occupational c. Interfere with functioning d. Not explained by something else Check for ODD (60%), and learning disorders (20-60%), anxiety (30%) and autism (10-20%

Question 41

Tests for ADHD

Answer 41

Connors Vanderbilt - both rating scales for parents to fill out

Question 42

MOA stimulants

Answer 42

methylphenidate +dexamphetamine = non-competitively block the reuptake of dopamine and noradrenaline by blocking dopamine transporter (DAT) and noradrenaline transporter (NAT), increasing levels of dopamine and noradrenaline in the synaptic cleft. Dexamphetamine also promotes dopamine (and noradrenaline to a lesser extent) release from synaptic vessels (hence has slightly better effect, but less tolorable)

Question 43

MOA Atomoxetine

Answer 43

selective noradrenaline reuptake inhibitor

Question 44

MOA Guanfecine

Answer 44

alpha 2 adrenergic agonist (same as clonidine)

Question 45

A/E stimulants

Answer 45

1. Anorexia = up to 80% a. Results in poor weight gain 2. Emotional blunting 3. Anxiety 4. Tics 5. Mood lability 6. Initial insomnia 7. Dizziness 8. Rebound effect- can mitigate this by adding a small afternoon dose 9. Psychosis, suicidality ii. Long-term 1. Growth - does have an effect on growth (1-2cm overall) 10. Cardiac - increases HR and BP, may increase arrythmias (long QT) ii. Long-term 1. Growth - does have an effect on growth (1-2cm overall) 2. ? Cardiac strain – no evidence 3. Substance abuse – protects against smoking, neither protects nor increases risk of later substance abuse disorders iii. Risk of cardiovascular events 1. Mild increase in HR, BP – for most children of no consequences 2. Epidemiological – no increase over background rate of SCD 3. FDA recommends a. History i. Child – syncope, palpitations, SOB, chest pain ii. Family – CVS disease, premature SCD b. Examination c. If known cardiac disease or history/examination raise concern  ECG, echo, cardiology consult

Question 46

Comorbidities with Autism

Answer 46

ID up to 70% ADHD 50% Learning difficulties Epilepsy up to 30%

Question 47

Screening tools in autism

Answer 47

1. ADOS (Autism Diagnostic Observation Schedule) – ages 12 mo to adult; formal observation assessment, gold standard 2.M-CHAT (modified checklist for autism in toddlers) ages 16-30 mo; screening test 3. ADI-R – Autism Diagnostic Interview Revised (ages 4+)- structured parent interview 4. CARS – Childhood Autism Rating Scale (ages 2+) – diagnostic test; used to gauge severity 5. ADEC (autism detection in early childhood)- screen for autistic tendencies 12mo-3 years 6. ADIR (Autism diagnosis interview- revised)- formal interview assessment

Question 48

Adverse effects risperidone

Answer 48

mild sedation hypotension akathisia prolactin elevation (which can cause menstrual irregularities) weight gain increased dream activity Risperidone has moderate risk of extrapyramidal symptoms, such as akathisia and dystonia (muscle stiffness).

Question 49

what condition is most commonly associated with ADHD

Answer 49

ODD

Question 50

Otoacoustic emissions

Answer 50

Detection of OAEs during sleep sounds generated from the cochlea transmitted across the middle ear to the external ear canal, where they can be recorded "pass" or "refer" result high likelihood false refer results often due to fluid in the ear Screening tests in infants and young children for hearing at the 30dB level of hearing loss (ie emissions are absent if >30DB hearing loss) More sensitive than behavioral tests in young children If hearing loss is suspected based on the absence of OAEs the ears should be examined for evidence of pathology and then ABR testing should be done for confirmation, identification of type of hearing loss, and lateralise the hearing loss tests to level of brainstem rather than to cochlear (OAE)

Question 51

Auditory brainstem reponse

Answer 51

- Screen newborn hearing, confirm hearing loss in yound children, lateralise hearing loss, and test children who wont cooperate with behavioral test methods - Tests electrical discharges from numerous neurons - Needs to be done during sleep or sedation/GA- to minimise electrical interference caused by muscle activity

Question 52

Behavioral observational audiometry

Answer 52

- Infants <6 months of age - Detects unconditioned, reflexive resonses to complex tests sounds such as noise, speech, music

Question 53

Visual reinforcement audimetry

Answer 53

6 months - 2.5 years Child observes for head turning response on activation of animalted toy reinforcer Not ear specific Designed to rule out hearing loss that would affect speech and language

Question 54

Play audiometry

Answer 54

2.5 years - 5 years

Question 55

primary treatment of manic episode in bipolar

Answer 55

ANTIPSYCHOTIC - usually olanzapine or risperidone better than mood stabiliser