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Pediatric Questions > MENTAL AND BEHAVIORAL HEALTH > Flashcards

MENTAL AND BEHAVIORAL HEALTH Flashcards

1
Q

A 3-year-old boy is frequently reaching for his genitalia; his face becomes flushed; he is sweating and starts to breathe irregularly, stops when parents
distract him

A

Masturbation (distract the child to stop)

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2
Q

A 2-year-old girl frequently postures her lower extremities and keeps crossing her legs in a repetitive movement; she stops when her mother is distracting her; the mother is concerned about her
having a seizure

A

Masturbation (seizure will not stop with
distraction)

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3
Q

What is the best management of masturbation in children?

A

Guide the child to limit the behavior. Otherwise, it is a normal behavior

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4
Q

A 2-year-old boy is sucking his thumb mostly when he is tired, hungry, or sad. What is the best recommendation?

A

Reassurance (most children will outgrow the habit by 4 years of age)

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5
Q

A 6-year-old boy with thumb sucking behavior. He is bullied and teased in school. He has dental malocclusion. What is the best recommendation?

A

Positive reinforcement, aversive techniques, competitive responses, and orthodontic devices (intervention if > 4 years of age)

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6
Q

A 6-year-old boy wakes up in the middle of the night scared; he remembers a giant dinosaur was trying to eat him

A

Nightmares—reassurance (television viewing should be avoided for about 2 h prior to bedtime)

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7
Q

The parents of a 4-year-old girl have noted episodes of screaming, intense fear, with difficulty of arousal that occur several times per week; she does not remember the episodes

A

Night terrors—reassurance (preemptive
awakening before the episodes and safety precautions)

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8
Q

Adolescent female presents with numbness and difficulty moving her legs. All lab results and imaging studies are normal. The patient has been
feeling stressed as a result of school

A

Conversion disorder

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9
Q

A 7-year-old boy exposed to a horrific car accident; father died in the accident. Boy has difficulty sleeping, a flashback of the event, recurrent distressing dreams for 3 weeks after the accident

A

Acute stress disorder 3 days to 1 month after exposure

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10
Q

A 7-year-old boy exposed to a horrific car accident; father died in the accident. Boy has difficulty sleeping, a flashback of the event, recurrent distressing dreams for 6 months after the accident

A

Post-traumatic stress disorder (6 months after exposure)

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11
Q

Two siblings are jealous of each other and are always fighting each other in front of their parents. “Sibling rivalry.” What is the best approach?

A

Focus on individual needs of each child, giving each the time and attention needed, to feel loved and secured

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12
Q

Exposure to which substances during the prenatal period is associated with aggressive behaviors in children?

A

Cocaine, alcohol, and tobacco

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13
Q

Two siblings are fighting and hurting each other physically

A

They should be separated, and told violence is not allowed

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14
Q

What is the best way to discipline a 3-year-old boy who is misbehaving?

A

Time out—1 min for each year of age
Ensuring that the reward is developmentally appropriate
Corporal punishment is NOT recommended as a method of discipline

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15
Q

What is the best method of discipline
recommended for an adolescent?

A

Limit privileges and establish boundaries

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16
Q

A 2-year-old boy is crying hysterically and banging his head while the mother and father are in a restaurant

A

Acknowledge his frustration, take him in safe place letting him ride out the tantrum

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17
Q

Mother is worried about autism in the above instance because of headbanging and frequent outbursts

A

Headbanging in isolation with a tantrum is not a red flag of autism

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18
Q

A 4-year-old boy is frightened of dogs

A

Show him pictures of dogs, then videos, then toy dog, then finally a real dog

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19
Q

Child is adaptable to new situations, regular sleeping, and eating patterns, less demanding, and cheerful

A

Easy temperament

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20
Q

Child with intense emotional reactions adapts poorly to new situations, unpredictable, lower sensory threshold, moody and negative

A

Difficult temperament

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21
Q

Child initially withdraws from new situations, observes hesitantly before entering a new activity, moderate negative response, and gradually warms up to the new situations

A

Slow to warm temperament
What

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22
Q

What is the best management of temperaments?

A

Reassurance (will learn to moderate their own temperamental reactions as they grow older)

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23
Q

Adolescent with 2 weeks of depressed or irritable mood, decreased pleasure, still going to school and doing homework, no suicidal thoughts. What is the best initial treatment?

A

Cognitive behavioral therapy (CBT)

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24
Q

Adolescent with 2 weeks of depressed, irritable mood, decreased pleasure, lack of interest in activities, and suicidal thoughts. What is the best initial treatment?

A

Cognitive behavioral therapy (CBT) and
medication

25
Q

What are the SSRI medications approved by the US Food and Drug Administration (FDA) for the treatment of depression in adolescents?

A

Fluoxetine and escitalopram

26
Q

What does CBT aim to achieve?

A

To reframe present negative thoughts into healthier thoughts, resulting in more positive feelings and behaviors

27
Q

A 6-year-old boy with significant receptive and expressive language problems; he is in special education classes, has difficulty with changes and
sensory sensitivity. He bites his hands frequently and avoids eye contact. What is the most likely underlying condition?

A

Fragile X syndrome

28
Q

At what age are the dysmorphic features of fragile X syndrome, such as a long face, prominent jaw, and macroorchidism, usually seen?

A

Around the time of puberty

29
Q

What is the most common cause of inherited intellectual disability?

A

Fragile X syndrome

30
Q

What is the most likely cognitive deficit in boys with a full mutation (> 200 CGG repeats) in cases of fragile X syndrome?

A

Moderate ID (average IQ ~41), girls are more mildly affected

31
Q

What is the best test to confirm the diagnosis of fragile X syndrome

A

Fragile X DNA analysis

32
Q

Mother is concerned about possible speech delay in her 2-year-old, who is currently exposed to 2 languages at home

A

No significant difference between 1 and 2 languages exposure in speech development

33
Q

Mother is concerned because her 6-year-old has a problem with certain speech sounds, but the child’s speech is 100% intelligible to strangers

A

Reassurance (certain speech sounds may not be well articulated until 8 years of age)

34
Q

Child with speech and language delay. What is the next best step?

A

Formal audiology evaluation

35
Q

A 2-year-old boy presents with speech delay, no eye contact, does not share any activities with other children. Physical examination is normal. What is the next best step?

A

Refer the child to early intervention (EI) for evaluation of autism spectrum

36
Q

A 3-year-old boy presents with speech delay, no eye contact, does not share any activities with other children. Physical examination is normal. What is the next best step?

A

Refer to the school district for evaluation of autism spectrum

37
Q

What is the mainstay of autism spectrum disorder treatment?

A

Applied behavioral analysis (ABA), speech and occupational therapies

38
Q

What is the etiologic workup in classic cases of autism spectrum disorders?

A

None; it is a clinical diagnosis

39
Q

What is the etiologic workup in cases of autism spectrum disorders associated with intellectual disability or global developmental delay?

A

DNA analysis for fragile X syndrome and a chromosome microarray analysis

40
Q

Adolescent with several antisocial behaviors, defiance, rule-breaking, vandalism, and aggression. What is the best management?

A

Cognitive behavioral therapy, family therapy, and behavior management training

41
Q

An 8-year-old boy is struggling academically, no specific learning disability has been identified by the school. What is the next best step?

A

Summer school, after school programs, tutoring, and early reading programs

42
Q

What is the disadvantage of grade retention in students who are struggling academically?

A

High risk of dropping out of high school, and ultimately employment problems

43
Q

A 10-year-old girl is struggling in school; parents are concerned because of her poor grades. What is the next best step?

A

Psychoeducational evaluation request in writing from parents to her school

44
Q

What is the role of pediatricians in children with learning disabilities upon diagnosis?

A

Review the initial psychoeducational evaluation and child’s report card with the family.
Make sure that the child is receiving
remediation, accommodations, modifications, and therapies.
Investigate for related disorders, such as attention deficit hyperactivity disorder (ADHD), adjustment disorder, or anxiety disorder

45
Q

An example of a child who may benefit from the 504 plans

A

Child with ADHD. Section 504 (Accommodation) of the US Rehabilitation Act of 1973 covers kids with disabilities who do not require specialized instruction (504 school accommodations for peanut allergy is another example)

46
Q

Examples of accommodations in school under 504 for children with ADHD

A

Preferential seating, extended time for testing, modifications in classroom assignments

47
Q

Which child may benefit from the US Individuals with Disabilities Education Act (IDEA), providing qualified children with an Individualized Education Program (IEP)?

A

Specific learning disability, e.g., dyslexia,
dysgraphia, dyscalculia
Others, e.g., autism, deafness, vision
impairment, intellectual disability

48
Q

Can a child with ADHD qualify for IEP?

A

Yes, if he or she requires specialized instructions

49
Q

The first-line treatment of ADHD

A

Stimulant medications, e.g., methylphenidate

50
Q

Indications of non-stimulant medications (e.g., atomoxetine, guanfacine, clonidine) in the treatment of ADHD

A

Preference of parents
Poor response or significant side effects with stimulant medications
Concerns about substance/stimulant abuse or significant tics

51
Q

What is the significance of IQ test scores greater than 2 SD below the mean (< 70) in both cognitive and adaptive measures?

A

Intellectually disabled range

52
Q

An 8-year-old girl underwent psychoeducational testing, and her aptitude test score in IQ was within
normal range, her academic achievement scores were within normal in reading, and writing, but in math her score was < 70

A

Specific learning disability in math

53
Q

The girl in the previous example qualifies for which of the following: 504 plan or IEP?

A

IEP special education program

54
Q

Participation of children with and without disabilities in the same educational settings

A

Educational inclusion

55
Q

What are the benefits of educational inclusion?

A

Promotes tolerance, empathy, and collaboration among students

56
Q

What are the benefits of educational inclusion?

A

Promotes tolerance, empathy, and collaboration among students

57
Q

Independent in personal care and activities of daily living with minimal support, education level up to sixth grade, independent employment with a
possible need for minimal support or supervision

A

Mild intellectual disability (ID)

58
Q

Can care for personal needs and activities with limited support, education level up to third grade;
difficulty understanding time and money, supportive living such as in a group home, supported, or supervised job, unskilled or semiskilled work

A

Moderate ID

Pediatric Questions (31 decks)

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