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OPIC > Learning Disability > Flashcards

Learning Disability Flashcards

1
Q

What is the definition of a Learning Disability?

A
  • A learning disability is a state of arrested or incomplete development of the mind
  • It is characterised by impairment of skills manifested during the developmental period and skills that contribute to the overall level of intelligence
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2
Q

What is the triad that must exist to constitute a learning disability?

A
  1. Low intellectual performance below 70
  2. Onset at birth or during early childhood
  3. Wide range of functional impairment
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3
Q

What is the ICD-10 Criteria for the diagnosis of LD for Mild?

A
  • Mild = IQ = 50-70
  • Moderate = IQ = 35-49
  • Severe = IQ = 20-34
  • Profound = IQ <20
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4
Q

What is the ICD-10 Criteria for the diagnosis of LD for Mild?

A
  • Mild = IQ = 50-70
  • Moderate = IQ = 35-49
  • Severe = IQ = 20-34
  • Profound = IQ <20
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5
Q

What is the Pathophysiology of Learning Disability?

A
  • Genetic: Down’s Syndrome, Fragile X syndrome, Tuberous sclerosis, Homocystinuria, Phenylketonuria
  • Antenatal: Rubella, CMV, Intoxication (alcohol, cocaine, lead), endocrine disorders (hypothyroidism, hypoparathyroidism), physical damage (injury, radiation, hypoxia)
  • Perinatal: Birth asphyxia, Intraventricular haemorrhage and neonatal sepsis
  • Neonatal: Hypoglycaemia, meningitis, neonatal infections, kernicterus
  • Postnatal: Meningitis, encephalitis, anoxia, metabolic (hypothyroidism, hypernatraemia) and cerebral palsy
  • Environmental: Neglect/ Non-accidental injury, malnutrition and socioeconomically deprived
  • Psychiatric: Autism, Rett’s Syndrome
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6
Q

What is the prevalence of Learning Disability?

A
  • Mild = 85%
  • Moderate = 10%
  • Severe = 5%
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7
Q

What are the Clinical Features of Learning Disability?

A
  • Motor Disabilities (Ataxia, Spasticity)
  • Epilepsy
  • Impaired hearing and vision
  • Incontinence (faecal and urinary)
  • Language is limited
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8
Q

What is the definition of Down’s Syndrome?

A
  • A genetic disorder (trisomy 21) characterised by LD, dysmorphic facial features and multiple structural abnormalities
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9
Q

What are the physical features of Down’s Syndrome?

A

PROBLEMS:
Palpebral fissure (up slanting)
Round Face
Occipital + Nasal flattening
Brushfield spots (pigmented spots on iris)/Brachycephaly
Low-set small ears
Epicanthic folds
Mouth open + protruding tongues
Strabismus/ Sandal gap deformity/ single palmar crease

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10
Q

What are some of the medical problems for Down’s Syndrome?

A
  • Heart defects (ventricular and septal defects, TOF)
  • Hearing loss
  • Visual disturbance (cataracts, strabismus, keratoconus)
  • GI problems (oesophageal/ duodenal atresia, Hirschsprung’s, coeliac)
  • Hypothyroidism
  • Haematological malignancies (AML & ALL)
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11
Q

What is Fragile X syndrome?

A
  • The second most common cause of LD
  • A sex-linked disorder with developmental, physical and behavioural problems
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12
Q

What are the Physical Features associated with Fragile X syndrome?

A
  • Large, Protruding ears, long face, high arched palate, flat feet, soft skin and lax joints
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13
Q

What are the Medical Problems associated with Fragile X syndrome?

A
  • Mitral Valve Prolapse
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14
Q

What is Prader- Willi Syndrome?

A
  • A deletion of part of chromosome 15
  • Characterised by hypotonia, developmental delay as an infant, obesity, hypogonadism and behavioural problems (compulsive eating and disruptive behaviour)
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15
Q

What is Cri du chat?

A
  • Caused by partial deletion of chromosome 5.
  • Those affected have a high- pitched cry like a cat
  • Low birth weight and feeding difficulties are also characterised
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16
Q

What investigations would you do before birth?

A

Before Birth:
- Amniocentesis, Chorionic villus sampling, genetic testing and karyotyping
- Down’s Syndrome:
1. Serum Screening B-hcg and pregnancy- associated plasma protein A + nuchal translucency (the sonographic appearance of a collection of fluid under the skin behind the fetal neck in the first trimester of pregnancy)
2. Quad test (B-hcg, a-fetoprotein, inhibin A, estriol)

After Birth:
- Bloods: FBC (infection), TFTs (hypothyroidism), Glucose (hypoglycaemia), serology( ToRCH infections)
- Brain Imaging: CT head and/ or MRI
- IQ test

17
Q

What is the managment for Learning Disabilities?

A
  • A MDT approach (psychiatrist, SALT, specialist nurses, psychologist, OP, social worker and even teacher)
  • Behavioural techniques = applied behavioural analysis, positive behaviour support, CBT, psychiatrists, mental health nurses and psychologists
  • Family Education = educational programmes and voluntary organisations
  • Prevention = genetic counselling and antenatal diagnosis
18
Q

What are the clinical features of a patient with a mild LD?

A
  • Adequate language abilities
  • Adequate Social skills
  • Adequate self-care
  • Most live independently - may need some support in housing and employment
  • Have difficulties in academic work
19
Q

What are the clinical features of a patient with a moderate LD?

A
  • Able to communicate but language is limited
  • May need supervision for self-care but can do simple work
20
Q

What are the clinical features of a patient with severe LD?

A
  • Marked degree of motor impairment
  • Little to no speech
  • can perform simple tasks under supervision
  • Associated physical disorders
21
Q

What are the clinical features of a patient with Profound LD?

A
  • Severe motor impairment
  • Severe difficulties in communication
  • Little or no self-care
  • Frequently have physical disorders and require residential care
22
Q

What are common psychiatric co-morbidities in LD?

A
  • Early- Onset Alzheimer’s disease
  • Schizophrenia
  • Anxiety
  • Depressive disorders
  • Autism
  • Hyperkinetic Disorder
  • Eating Disorders
  • Personality Disorders
23
Q

Why do people with learning disabilities have worse health than people without learning disabilities?

A
  • Less likely to be able to verbalise concerns
  • May not understand that there has been a change to their health
  • May be unable to access healthcare correctly
  • May not be brought to appointments

OPIC (18 decks)

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