NP619 9 & 10

Question 1

Divorce effects on infants

Answer 1

spitting up
upset stomach
they feel the tension of the parents

Question 2

Pre-school children

Answer 2

three to five years of age frequently believe they have caused their parents’ divorce.
may show baby-like
behavior, such as wanting their security blanket or old toys, or they begin wetting the bed.
may become uncooperative, depressed, or angry.
disobedient and aggressive.

Question 3

School age children

Answer 3

School-age children are old enough to understand that they are in pain
because of their parents’ separation.
may experience grief, embarrassment, resentment, divided loyalty and intense anger.
may complain
of headaches or stomachaches.

Question 4

Adolescents

Answer 4

experience anger, fear, loneliness, depression and guilt.
Teens may respond to parents’
low energy level and high stress level by trying to take control over
the family.
They may also feel pressure to “choose” one of their parents over the other, or to fault one parent over
the other for the “cause” of the divorce.

Question 5

Researchers are now finding that boys raised by fathers and girls raised by mothers may do better than children
raised by the parent of the opposite sex. School age boys living with their fathers or in joint living arrangements
seem to be less aggressive.

Answer 5

Girls raised with mothers tend to be more responsible

and mature than girls raised by their fathers.

Question 6

The most important factor for children’s well being seems to be limiting the amount and intensity of
conflict between parents.

Answer 6

Agreement between the parents on discipline and child rearing, as
well as love and approval from both parents, contributes to the child’s sense of well being and selfworth.

Question 7

ADHD-must appear before 7, be greater than 6 months and significant impairment in two settings

Answer 7

in-attention
impulsiveness
hyperactivity
shortage of dopamine
(Ritalin) increases dopamine

Question 8

ADHD-how to diagnose

Assess children 4-18

Answer 8

Impairment in more than one major setting
Behavior therapy as first line treatment in 4-5 year old
then refer

Question 9

ADHD medication

Answer 9

methylphenidate-Ritalin

Titrate to achieve maximum benefit

Question 10

Downs-

Answer 10

Stage it presents: In utero or after
Features & labs: Karyotype, TSH, CBC, echo, celiac, neck, hearing
Suspected DS should undergo echocardiography and an ECG examination during the first weeks of life.
If no cardiac symptoms, echo should be repeated before the age of 2 months.
Eyes should be regularly examined by an ophthalmologist starting at the age of 6 months
Hearing testing :during the first year of life, and continue thereafter yearly throughout childhood, in order to optimise speech development.
TSH at the age of 6 and 12 months and then annually. If the result is normal, TSH every 2 years throughout life.
Risk factors: maternal age. Its a chromosomal nondisjunction
Same schedule as other children
Refer if heart trouble, or breathing issues.
Long-term can get alzheimers

Question 11

Cystic Fibrosis-hereditary metabolic disease

autosomal and recessive.

Answer 11

Intestinal obstruction caused by a meconium plug is the most common symptom of CF in newborn children (seen in 10% of the patients)
A sweat chloride concentration of less than 40 mmol/l is normal; a result above 60 mmol/l strongly supports the diagnosis of CF.
Failure to thrive
Refer to CF clinic
pulmonary problems. Dx in early infancy
live to about 50 years

Question 12

Sickle Cell-most common inherited hemoglobinopathy

autosomal recessive

Answer 12

Early transcranial Doppler screening (and MRI every 2 years after age 5 years)
Diagnosis is made by hemoglobin electrophoresis, demonstrating sickle hemoglobin of greater than 40%.
Chronic physical findings may include stunted growth and development, jaundice, hyposplenia, or lack of a spleen
BC that demonstrates anemia; a peripheral blood film that demonstrates sickled cells
Treat for pain and with folic acid
Every 3 months, assess steady-state lab values and give appropriate preventive treatment.
Routinely asses the CBC, comprehensive metabolic panel, LDH, reticulocyte count, and urine microalbumin.
Follow-up patients treated chronically with opioids more closely.
At risk, African Americans, Asian
Team of people to care for. Hematologist, sickle cell center.
Get HTN, stroke, kidney disease
screen as newborns•

Question 13

Diabetes 1 and II

Answer 13

I=impaired beta cell function
II=resistance to insulin
Type I presents with the 3 P’s=DKA and urinary frequency for type I
Obesity the cause of Type II
Labs: Serum and urine for glucose and then a chem panel
team to handle the child. DM education,
Can cause eye and cardiac problems in Type II
Type I DKA is the cause of mortality

Question 14

Wilms Tumor=Nephroblastoma

Answer 14

rapid abdominal swelling
painless hematuria
They will have an abdominal mass, HTN, congenital anomalies
Arises in the kidney, usually a painless mass, found while bathing a child. Could have fever, abdominal pain, or hematuria
Urinalysis

Question 15

Neuroblastoma-which migrate throughout the sympathetic nervous system, explaining the multiple organ sites where these tumors occur.

Answer 15

Median age at diagnosis is 22 months, with a peak incidence between 2 years and 3 years. It is more common in boys
Abdominal mass or bone pain
“raccoon eyes”
nystigmus
diarrhea or constipation
spinal cord compression symptoms
Serrum ferritan, CBC, LDH, Bone marrow aspirate
Increased serum catecholamines and urinary catecholamine metabolites, such as VMA or HVA.
Fever or weightloss
USN
Biopsy is the gold standard for diagnosis

Question 16

ITP

Answer 16

common acquired bleeding disorder which presents in infancy or early childhood.
acute is due to autoantibodies directed against platelets.
Between 2 and 4 the child presents with diffuse petechiae, bruising and occasionally “wet” bleeding (gums or nose) Often a hx of vaccine or viral illness
CBC, large platelets, A lot will resolve. Chronic exists beyond 6 months (Usually older than 10, female. Chronic has platelets between 40,000 to 80,000 and bleeding symptoms are minimal

Question 17

Henoch-Schonlein purpura

Answer 17

common in children younger than 7. Median is 4 yrs old. sudden onset of severe diffuse abdominal pain, vomiting, and hematochezia following a viral illness during the winter and early spring and about a week after the appearance of purpuric skin lesions on the buttocks and lower extremities
May have renal abnormalities
complete blood count, CRP, throat culture, antistreptolysin titre and a urine dipstick test.
Consult a gastroenterologist

Question 18

Acute lymphoblastic leukemia (ALL)
majority of chromosome translocations and preleukemic clones arise in the uterus during fetal hematopoiesis, with secondary genetic events occurring postnatally

Answer 18

CBC, chemistries, coagulation studies, and bone marrow with cytochemistry and immunophenotyping
Bone pain, fatique, pallor, bleeding, bruising and infections.
Bone marrow aspirate
CBC, with platelet, PT, PTT, Serum electrolytes, BUN, CSF, crytology

Question 19

Autism:Although ASDs are neurodevelopmental conditions
with strong genetic underpinnings, their exact etiology is
unknown.
Thus, it has become more
and more apparent that the etiology is multifactorial
with a variety of genetic and, to a lesser extent, environmental
factors playing a role

Answer 19

impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction. Takes 6 of the criteria to dx autismenvironmental factors may modulate phenotypic expression.
Advanced paternal age and maternal age
have been shown to be associated with an increased risk of having offspring with ASDs, possibly because of de novo spontaneous mutations and/or alterations in genetic imprinting.

Question 20

Autism

Answer 20

lack of appropriate gaze;
● lack of warm, joyful expressions with gaze;
● lack of the alternating to-and-fro pattern of vocalizations
between infant and parent that usually occurs at
approximately 6 months of age (ie, infants with ASDs usually continue vocalizing without regard for the parent’s speech);
● lack of recognition of mother’s (or father’s or consistentcaregiver’s) voice;
● disregard for vocalizations (ie, lack of response to
name), yet keen awareness for environmental sounds;
● delayed onset of babbling past 9 months of age;
● decreased or absent use of prespeech gestures (waving, pointing, showing);
● lack of expressions such as “oh oh” or “huh”;
● lack of interest or response of any kind to neutral
statements (eg, “Oh no, it’s raining again!”)

Question 21

Autism

Answer 21

lack of appropriate gaze;
● lack of warm, joyful expressions with gaze;
● lack of the alternating to-and-fro pattern of vocalizations
between infant and parent that usually occurs at
approximately 6 months of age (ie, infants with ASDs
usually continue vocalizing without regard for the
parent’s speech);
● lack of recognition of mother’s (or father’s or consistent
caregiver’s) voice;
● disregard for vocalizations (ie, lack of response to
name), yet keen awareness for environmental sounds;
● delayed onset of babbling past 9 months of age;
● decreased or absent use of prespeech gestures (waving,
pointing, showing);
● lack of expressions such as “oh oh” or “huh”;
● lack of interest or response of any kind to neutral
statements (eg, “Oh no, it’s raining again!”)

Question 22

autism categories

Answer 22

impairment in social interaction,
impairments in communication
repetitive and stereotyped patterns of behavior, interests, and activities,

Question 23

ASD

Answer 23

The
AAP also recommends that all children be screened with a standardized developmental tool at specific intervals (ie, at the 9-, 18-, and 24- or 30-month visits) regardless of whether a concern has been raised or a risk has been
identified during the surveillance process

Question 24

ASD

Answer 24

Is there a family hx?
extremes of temperament and behavior ?
questions about their concerns regarding the
child’s development and behavior
concerns about inconsistent hearing or unusual responsiveness also are important
Have milestones been met?

Question 25

ASD-Why prevelence is so much higher now

Answer 25

A)more children were being diagnosed at a younger age and (b) more children with milder characteristics were being diagnosed.

Question 26

ASD surveillance starts @ 9 months

Usually dx around 4 but now can be earlier.

Answer 26

18- and 24-month physical checkups should be an ASD screen

Question 27

Refer ASD older than three

Answer 27

Public school system

Individuals With Disabilities Education Act (IDEA)