Lectures

Question 1

Hi Dr you know the diagnosis of ADHD requires hyperactivity inattention and there was one more but I can’t remember what it was can you tell me

Answer 1

Impulsivity

Question 2

Hi Dr I’ve just finished your consultation with a mum and her seven year old son. The mum is convinced that her son has ADHD because he has been misbehaving at school and has poor concentration the thing is this is anything going on for 3 months is this long enough to give a diagnosis of ADHD

Answer 2

No a diagnosis of ADHD requires 6 months symptoms that are inconsistent with the developmental level of that child

Question 3

Hi Dr I have just finished the consultation with a 8 year-old boy and his mum his mum has been saying that Charlie the 8 year old does not seem to listen when spoken to directly he doesn’t follow through on instructions he has difficulty organising tasks and activities and fails to give Close attention to details. This is been going on for 5 months in total is this long enough for a diagnosis of ADHD

Answer 3

No unfortunately you need 6 months

Question 4

Hi Dr I was just finished the consultation with Jon 9-year-old boy it’s Dad has said that Jon fidgets and squirms a lot he has difficulty playing quietly he has difficulty in waiting his turn and interrupts others often. These are all clearly signs of hyperactivity but I am not sure whether I can give a diagnosis of ADHD at how long do the symptoms need to have been going on for before I can give the diagnosis

Answer 4

6 months

Question 5

Hi Dr I have just seen Jonah a 7 year old boy and he has had symptoms of hyperactivity in attention and impulsivity for the last year now we finally been able to pick him up and I was wondering what we need to do now from a school perspective

Answer 5

So he needs to be observed in school

Question 6

Hi Dr I have just diagnosed Luke with ADHD after he presented with six months worth of hyperactivity inattention and impulsivity behaviour inconsistent with his developmental level for the last six months are there any psychological tests that we need to carry out or any questionnaires

Answer 6

Yep there’s the Connor screening questionnaire and w i s c psychological tests Teach

Question 7

Hi Dr one of the medical students was asking me about the physiology behind attention deficit hyperactivity disorder I remember that involved two three key areas of the brain but I can’t remember which can you tell me

Answer 7

The three key areas of the brain involved in ADHD are the cortical regions the subcortical regions and the cerebellum

The cortical regions involved the prefrontal cortex and the anterior cingulate cortex does subcortical regions include the limbic system including the amygdala and the basal ganglia

Question 8

Hi Dr Sally one of the medical students was asking me to she knows that there are three key areas of the brain implicated in ADHD the cortical subcortical and cerebellum but she was wondering which neurotransmitter specifically is involved in ADHD

Answer 8

Yes that’s correct the three key areas are the cortical subcortical and cerebellum and the specific neurotransmitter is dopamine

Question 9

Hi Dr Sophie one of the fourth year medical students was wondering how best to phrase the management for ADHD I opted for conservative medical and surgical that is this the best way

Answer 9

That’s an ok with doing it but it would be better to say non pharmacological interventions such as psychoeducation parenting intervention and school intervention or pharmacological approach such as central nervous system stimulants

Question 10

Hi Dr I am with the parents of Jon and 9 year old diagnosed with ADHD after a years worth of symptoms they have asked me for advice on how they should manage him at home what kind of things can I advise them to do. They’ve asked specifically is it right that we tell him off

Answer 10

Ok so tell them to try and avoid harsh discipline and to recognise the good behaviour and try and build on that good behaviour with rewards

Question 11

Hi Dr I have just spoken to the school about Luke the seven-year-old who is diagnosed with ADHD they were wondering how they can Taylor the school learning environments to better meet his Educational Needs and have asked me for advice what should I tell them

Answer 11

The key thing with children suffering from ADHD is provided structured environment with a clear routine

Question 12

Hi Dr one of the medical students asked when you say pharmacological interventions specifically CNS stimulants which drugs are you referring to for ADHD

Answer 12

So the main one is methylphenidate but there’s also amphetamines such as dexamphetamine Lisdexamphetamine

Question 13

You are the GP who has initiated treatment for a child with ADHD the treatment you have opted for addae pharmacological central nervous system stimulants you have chosen methyl Fender date the parents ask you are there any side effects that we should know about with using this medication what do you tell them

Answer 13

Methylphenidate and the amphetamines used to treat ADHD may decrease appetite and thus impact growth
Also poor sleep which contributes to a low mood and may raise blood pressure

Question 14

Hi Dr how did General history question one of the medical students asked who came up with this whole concept of milestones to assess development in children between 0 and 5

Answer 14

Arnold Gesell1920

Question 15

Hi Dr I have just finished a developmental assessment of a child aged 4 I believe his development is delayed but I can’t remember how far away from normal it had to be

Answer 15

So to diagnose delayed development the performance must be greater than 2 standard deviations below the mean on a standardized test

Question 16

Hi Dr I have just seen a 3 year old child who has delayed social milestones are you there are more than two standard deviations away from normal. In his past medical history I specifically asked his mum about down syndrome and another chromosomal disorder called fragile x but there was no issue there. I asked about the history of the pregnancy and her son was born to town with no complications due vaginal delivery however she reports that she suffered postnatal depression after giving birth to him do you think that could be the cause for the delay

Answer 16

Yes neglect is one of the causes of delayed development so always ask during the pregnancy history about any depression

Question 17

Hi Dr I have just finished a consultation with a 3 year old boy who his Mum describes as quite a shy and anxious child who unfortunately is not doing as well as his peers in school. She said that in the family history on his dad’s side of the family there’s a history of developmental delay. What chromosomal condition is a very common cause of intellectual delay in boys

Answer 17

Fragile X

Question 18

Hi Dr I have just congratulated Mrs Jones on her newborn son. Her son was born weighing 3.8 kg and she was wondering when he would be weighed again so she can jot it down in her calendar. what should you tell her

Answer 18

Babies weighed at birth at 5 days at 10 days

Then at 2 3 4 8 and 13 months

Question 19

You are the GP Mrs Smith comes in with her 6 week daughter and asks is this appropriate time to get her head circumference measured what do you say

Answer 19

Yes head circumference is typically measured between 6 to 8 weeks after the child is born

Question 20

The tonic neck reflex the grasp reflex bar crawl reflux the step reflex the Moro reflex and the rooting reflex are all primitive reflexes which should disappear after how long

Answer 20

A couple of months

Question 21

Hi Dr I have just done an examination of a 2 year old child. I noticed that when I touched her hand she automatically grasped my finger. Is this normal

Answer 21

No primitive reflexes such as the grasp reflex should disappear after the first few months of life

Question 22

Hi Dr I was doing the developmental assessment of a one-year-old and I was specifically looking at his gross motor skills what should he be able to do by 12 months so 1 year old just in terms of his gross motor skills

Answer 22

By six months you should be able to sit independently and hold his head up supported

Question 23

Hi Dr I’ve just seen a two year old boy and clinic and his mum is specifically worried about whether he should be walking by now what is the normal range for when children start walking

Answer 23

Ok doctor so he’s two years old this means that he should be able to walk independently. In fact he should now be able to walked up and down stairs holding onto som 2 feet to every step

Question 24

Hi Dr I have just examined a three year old and I can’t remember if by 3 they are supposed to be able to walk up each step two feet to a step or 1 foot to a step

Answer 24

One foot per step by age 3

Question 25

Hi Dr I’m doing a developmental assessment of a three year old and I have started assessing his gross motor skills I asked him to walk up the stairs nearby and I noticed that he was walking two feet per step is this correct for his age

Answer 25

Ideally by 3 years he should be walking one foot per each step

however less than 2 standard deviations from the mean of a standardised test can still be considered normal

Question 26

Hi Dr I have just done a developmental assessment of a 2 year old. His mum has told me that he runs up and down the stairs at home and thinks that he is really advanced for his age is she correct

Answer 26

She is correct because it’s 4 year olds we would expect to run up and down the stairs

By 2 we would hope that he is walking up and down the stairs with support 2 feet per step

Question 27

Hi Dr I I’m about to do a developmental assessment of an 18 month year old child and I just wanted to check in terms of gross motor development what am I expecting him to be able to do. Should he be walking by now

Answer 27

Yes by 18 months we would expect that they would be walking independently

Question 28

To medical student I have just done a developmental assessment on a child. His Mum tells me that he is able to pedal a tricycle. At what age do we typically expect children to be able to ride a tricycle

Answer 28

The hint is in tricycle 3

Question 29

Hi Dr I have just done a developmental assessment of a young girl. To assess her gross development I simply watched her play for a few kim with the other kids I noticed she was able to throw the ball overhand. At what age do we hope that kids will be able to throw a ball overhand

Answer 29

By 2 years old

Question 30

Hi Dr I have just taken history from John’s Mum. John is a two year old child and Mum reports that he is quite advanced for his age. mum says that already he is hopping and standing on one foot be it only for two seconds. Is John’s man correct is hopping on one foot for a maximum of two seconds advanced for a 2 year old

Answer 30

Yes we will accept child to be hopping on one foot for max 2 secs by Age 4

Each to we would hope that a child is able to kick a ball

Question 31

Hi Dr I am assessing the language development skills of a 4 year old and I just wanted to check beforehand what I’m expecting him to be able to do by 4

Answer 31

By 2 months
you would expect them to make gurgling sounds

By 4 months
you’d expect them to babble

By 6 months you would expect them to respond to their own name and say Mama and Baba

By 9 months you would expect that they would understand no

By 1 year old they should be responding to Simple spoken requests by

18 months they should be saying several single words or be not connected

by 2 years old they should be able to point to things or pictures when they are named

by three years old they should be able to follow Instructions with two or three steps and therefore before we expect them to be doing all of the things I’ve just mentioned and

being able to tell a story

Question 32

Hi Dr memorising the developmental milestones is good in all but if I want a more formal way of assessing a child’s development are there any tools/questionnaire that I can use

Answer 32

Yes so there are three main developmental assessment questionnaires these are the Denver SOGS and Bailey scales

Question 33

Hi Dr I am a GP in primary care and I need to carry out an appropriate developmental assessment I know that you can use a Denver dogs or a Bayley scales of infant and toddler development but which one is most appropriate for primary care

Answer 33

The Denver developmental screening test to assess a child’s development in fine motor gross motor personal social and language

Question 34

I am a medical student revising for exams I know that there are three commonly used developmental assessments than the schedule of growing skills and Bailey scales I was wondering what is the maximum age you can use a Bayley scales of infant and toddler development questionnaire

Answer 34

3.5 years old

Question 35

Hi Dr one of the medical students I was asking me about the difference between anxiety and fear how would you explain the difference

Answer 35

I would define anxiety in my own words to be the feelings of dread you get when you think of a future event

Feeling scared in response to an immediate stimulus

Question 36

You are the psychiatrist and have been asked to see child age 5 to 7 the child is deathly afraid of spiders what is the most common psychiatric disorder in children

Answer 36

Anxiety

Question 37

Name as many anxiety disorders as you can apart from the ones that you have memorized

Answer 37

Acute stress disorder obsessive compulsive disorder and social phobias

Question 38

Hi Dr one of the medical students was telling me that he remembers a specific type of therapy that can be effective for post-traumatic stress disorder which involves the eyes can you tell me what it was called

Answer 38

EMDR which stands for eye movement desensitization and reprocessing

Question 39

Hi Dr I have just finished my follow-up of Charlie nine year old boy who was diagnosed with OCD a year ago he has been tried on a specific type of CBT but I can’t remember which specific type of CBT is used in treatment for OCD can you tell me

Answer 39

ERP which sand for exposure response prevention therapy which essentially forces of person’s with an obsessive compulsive disorder to face their fears without ritualising

Question 40

Hi Dr I have just seen a 7 year old child who I believe has a fear of Wide Open Spaces can you tell me what the medical term for this type of fear is

Answer 40

Agoraphobia

Question 41

Hi Dr I have finished taking a history from the mum of john a 9 year old boy who his Mum describes as being very shy and anxious whenever he’s out in public with her oftentimes he will hide behind her. Besides the antidepressants which other drug class is commonly used to treat anxiety

Answer 41

Benzodiazepines such as diazepam and clonazepam