MRCPsych Paper B - Child Flashcards

1
Q

Heritability of ADHD (%)

A

70-80%
*risk of ADHD in siblings is 2-3x increased

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2
Q

At what age are 99% of children dry by day

A

5yo

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3
Q

Blockade of this receptor leads to reduction of vocal and motor tics in Tourette’s

A

D2

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4
Q

Pediatric manic episodes typically presents as…

A

mixed or atypical features - irritability, labile mood, and behavioral problems

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5
Q

drug treatment of choice for uncomplicated Tourette syndrome in the pediatric age group

A

clonidine

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6
Q

most common psychiatric emergency seen in child and adolescent population

A

suicidal behavior

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7
Q

NICE recommendations for stepped care treatment to pediatric depression

A

First line: fluoxetine, only when psychological therapy is ineffective
Second line: sertraline and citalopram.
AVOID: paroxetine, venlafaxine, TCA

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8
Q

Rett Syndrome inheritance

A

x-linked dominant
almost exclusively female
initially normal development

progressive loss of acquired skills starting 1-4yo
> purposeful hand movements, spoken language, gait disturbance

stereotypical hand movements, autism, ataxia, facial grimacing, teeth-grinding, irregular respiration (apnea, breath holding, hyperventilation), scoliosis, seizures, initial/ intermediate insomnia, excessive daytime sleep

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9
Q

most common psychiatric comorbidity associated with Asperger’s syndrome

A

depression

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10
Q

Pica typically occurs at what age group

A

2-3yo

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11
Q

Pedia patient + uncoordinated movement of limbs + history of fever and sore throat

A

Sydenham chorea
*rheumatic fever, group A strep

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12
Q

most common cause of comorbidity in pediatric bipolar disorder

A

53% ADHD
*
42% ODD
27% conduct disorder
23% anxiety disorder
09% substance use disorder

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13
Q

most common comorbidity in Tourette syndrome

A

ADHD 55% and OCD 50%
*ASD 20%

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14
Q

First line treatment for adolescent inhalant abuse

A

multimodal - psychotherapy and programs. No known pharmacotherapy

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15
Q

First line treatment for OCD in children

A

CBT

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16
Q

First line medication in pediatric ADHD

A

methylphenidate

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17
Q

most common age for school refusal

A

11yo

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18
Q

percentage of school-aged children affected by developmental dyslexia

A

4%

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19
Q

most important predictors of delinquency (Cambridge study)

A

antisocial child behavior
ADHD
low IQ and poor school attainment
family criminality
family poverty
poor parental child rearing behaviour

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20
Q

Pediatric age group where prevalence of depression in males and females are euqivalent

A

prepubertal

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21
Q

genetic aetiology most increases risk of parents having a second child with Down syndrome

A

translocation

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22
Q

rate of self-harm in teenagers who identify as Goth

A

50%

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23
Q

child with developmental disturbance + MRI hypoplasia of cerebellar vermis

A

autism spectrum disorder

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24
Q

most common inherited cause of ID

A

fragile X syndrome

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25
Q

most common positive symptoms found in childhood onset schizophrenia

A

auditory hallucination 95%
*visual hallucinations 80%, delusions 60%

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26
Q

most common comorbidities with ASD

A

80% ID
40-84% anxiety disorders
30-50% ADHD
OCD
tics

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27
Q

most common comorbidities in pediatric ADHD

A

70% learning disorders
59% ASD
55% tics/ Tourette
50% ODD
50% depression
47% bipolar
35% anxiety disorders
10% conduct disorders

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28
Q

very early onset schizophrenia or childhood onset schizophrenia occurs before what age

A

13yo

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29
Q

Heller syndrome - how many years of normal development before marked regression in several areas of functioning

A

2y
*aka Childhood disintegrative

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30
Q

scale for epidemiological study as a screening tool of caseness among school children before further diagnostic procedure

A

Strengths and difficulties questionnaire

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31
Q

what part of the sleep cycle does sleep-related bruxism commonly occur

A

transition to sleep
stage 2 sleep
during REM sleep

32
Q

most common blood abnormality in adolescents with anorexia nervosa

A

normocytic normochromic anaemia

33
Q

ASD symptom that tend not to improve over time

A

ritualistic and repetitive behaviours

34
Q

medication of choice for pediatric ADHD with tics

A

NE reuptake inhibitor/ atomoxetine

35
Q

best treatment option for pediatric ADHD with substance abuse

A

NE reuptake inhibitor/ atomoxetine
*less abuse potential

36
Q

Medications licensed in the UK for OCD treatment in pediatric population

A

sertraline (starting age 6y)
fluvoxamine (starting age 8y)

37
Q

chief differential medical problem to be excluded in children with encopresis

A

Hirschsprung disease, aka aganglionic megacolon

38
Q

pediatric ADHD with frequent aggressive outbursts + unresponsive to methylphenidate or gaunfacine

A

risperidone
*
psychosocial interventions →
add stimulant methylphenidate →
atomoxetine/ guanfacine/ clonidine →
risperidone (no other antipsychotics are indicated)

39
Q

in children, ADHD medication SE of mild slowing of weight, height, and growth

A

methylphenidate

40
Q

in children, ADHD medication SE of liver dysfunction

A

atomoxetine, rare - elevated hepatic enzymes, increased bilirubin with jaundice

41
Q

in children, ADHD medication SE of suicidal ideations

A

atomoxetine

42
Q

in children, ADHD medication SE of exacerbation of tics

A

methylphenidate

43
Q

in children, ADHD medication SE of insomnia

A

methylphenidate

44
Q

in children, ADHD medication SE of psychosis

A

methylphenidate

45
Q

most important aetiological factor associated with school refusal

A

youngest child in the family

46
Q

most important aetiological factor associated with adolescent depression

A

increased cortisol levels

47
Q

most important aetiological factor associated with ADHD

A

maternal smoking during pregnancy

48
Q

most important aetiological factor associated with conduct disorder

A

callous traits in parents

49
Q

most important aetiological factor associated with anorexia nervosa

A

living in the western world

50
Q

Scale helpful in the evaluation of a child with multiple behavioral problems, esp if the child presents with different symptoms in different settings

A

Child behavioral checklist (CBCL)

51
Q

treatment for pediatric ADHD + tics

A

atomoxetine → clonidine

52
Q

treatment for pediatric ADHD + depression

A

TCA - amitriptyline

53
Q

treatment for ADHD + aggressive behavior

A

behavioural therapy

54
Q

prevention strategies for conduct disorder

A

preschool child development programmme
community programme

55
Q

therapy in which there is assessing and promoting the strengths of the young person and the system is paramount

A

multimodal systemic therapy

56
Q

therapy that focuses on improving the communication between parent and young person

A

functional family therapy

57
Q

therapy for conduct problems that includes social skills training and anger management

A

CBT

58
Q

give 2 first line medications for OCD in children

A

sertraline, fluoxetine

59
Q

first line management of aggressive and challenging behavior in ASD

A

risperidone, low dose

60
Q

clinical features of depression in young children (0-5y)

A

poor feeding, failure to thrive, separation anxiety, tantrums, irritability, aggression, hyperactivity, regressed behavior

61
Q

clinical features of depression in older children (6-10y)

A

somatisation, school refusal, poor school performance, acting out

62
Q

clinical features of depression in adolescents (10-19y)

A

low self-esteem, melancholia, suicdal acts, substance misuse, psychotic symptoms

63
Q

essential features of pediatric ASD

A

severe persistent impairment in social interactions, repetitive behavioral patterns and restricted interests, 70% have mild to moderate learning disability

64
Q

essential features of pediatric Asperger’s syndrome

A

severe persistent impairment in social interactions, repetitive behavioral patterns and restricted interests, IQ and language are normal

65
Q

essential features of pediatric Rett’s syndrome

A

almost exclusively females, abnormal hand movements, first 6mos of life are normal (decline starts at 2yo)

66
Q

essential features of pediatric Heller’s syndrome

A

*aka childhood disintegrative disorder
normal development for 2-3 years, loss of acquired skills between 3-4years, disintegrative psychosis

67
Q

essential features of pediatric reading disorder/ dyslexia

A

deficit in phonological processing skills, male predominance 4:1

68
Q

essential features of pediatric disorders of written expression

A

difficulties with spelling, syntax, grammar, and composition, male predominance 3:1

69
Q

essential features of pediatric mathematics disorder

A

often associated with visuospatial deficits (R parietal dysfunction), female predominance

70
Q

stuttering

A

commonly struggles with initial syllables, treatment includes speech therapy

71
Q

features of authoritarian parenting style

A

detached and unaffectionate, power imposed and autocratic, yields compliant but withdrawn and dependent children

72
Q

features of permissive parenting style

A

indulgent and affectionate, associated with immature children who lack purpose, self-control, and self-direction, vulnerable to increased risk of future substance abuse

73
Q

features of authoritative parenting style

A

uses parental authority and household rules/limits with some explanation, attends to child’s view and grant some responsibility to child, yields children who are independent assertive and friendly

74
Q

investigations for the use of methylphenidate

A

height, weight, BP, HR - every 3mos, then 6mos

75
Q

investigations for the use of atomoxetine

A

height and weight, BP, HR - every 3mos, then 6mos

76
Q

investigations for the use of valproate

A

liver function tests - q 6mos, blood count, height and weight