Pediatric Psychiatry, Neurology, Ophthalmology Flashcards
ADHD subdivisions
- ADHD/I: ADHD with at least 6 of 9 inattention behaviors
- ADHD/HI: ADHD with at least 6 of 9 hyperactivity and impulsivity behaviors
- ADHD/C: Both of the above combined
Requisites for a diagnosis of ADHD
- Fulfills 6 of 9 of the ADHD/I or ADHD/HI criteria
- Present for at least 6 months in two or more settings
- Some symptoms present before age 7
- Must result in impaired function
Therapy for ADHD
- Coordination with caregivers and teachers is key
- Referral to child psychiatry is a must, as there are often comorbid pediatric psychiatric conditions or learing disabilities
- Behavioral modification and coordinated plan with teachers and caregivers is first-line
- Medical therapy comes next:
- Methylphenidate or dextroamphetamine are tried first
- Atomoxetine (a SNRI) has shown benefit
- Tricyclics and buproprion may be attempted if the above fail
- 50% of individuals with childhood ADHD will function well in adulthood, while others will demonstrate continued inattention and impulsivity symptoms
“Simple” vs “Complex” seizures
“Simple” : no LOC
“Complex” : LOC
Grand mal seizure
Generalized complex seizure
Treatment for absence seizures
Ethosuximide
Treatment for trigeminal neuralgia
effetively a seizure of the trigeminal nerve
Treat w/ carbamazepine
Most common antiepileptic for non-absence seizures
Levetiracetam
Usually the best choice. However, may be too expensive or unavailable. In that case, phenytoin, valproate, or lamotrigine may be used.
Antiepileptics in febrile seizures
Start them for complex, not for simple
Remember: Complex febrile seizure is an unmasking of underlying epilepsy due to the epileptogenic state of fever in the developing brain
Infantile Spasms aka West syndrome
- NOT A TRUE SEIZURE, it is a seizure mimic
- Patient will be < 1 year old and present with bilateral symmetric jerking
- Will NOT be generalized and there will be NO fever
- Dx: Interictal EEG showing hypsarrhythmia
- Treat with ACTH
- Often associated with developmental delay and tuberous sclerosis
Tuberous sclerosis
- Genetic disease
- Patient will typically be < 2 years old, have ash leaf spots (visible w/ Wood’s lamp) and angiofibromas on skin, afebrile or complex febrile seizures
- On brain imaging, cortical tubers
- Diagnose w/ CT or MRI of brain
- Treatment of supporting
- Risk of development of benign tumors anywhere in body
Special features of absence epilepsy
- Loss of consciousness, but no loss of tone
- No post-ictal state
- Hundreds to thousands of seizures per day
- “Spacing out” or “ADHD”
- Diagnose with EEG, treat w/ ethosuximide (valproate as backup or if combined generalized seizures)
Prerequisite to genetic screening for intellectual disability disorder
Mother must be willing to terminate
Otherwise, the procedure only puts both mom and fetus at risk
Diagnosis of intellectual disability disorder
Clinical diagnosis based upon loss of adaptive functioning
Stereotypy
Doing the same thing over and over, repetitive behaviors
Symptom of autism spectrum
Tic disorder diagnosis and treatment
- Consistent vocal or motor tic
- Patient < 18 years of age
- Duration > 1 year
- Clinical diagnosis
- Treatment is D2 antagonist and cognitive-behavioral therapy
Learning disability
- Must rule-out vision and hearing problems, language incongruence, and dyslexia
- Often ADHD, ASD, or IDD
Managing enuresis
- Two conditions: dry vs not dry (could hold vs never learned)
-
Not dry:
- Typically < 7
- Need training in form of alarm blankets and positive reinforcement
- Try less water before bed
- ddAVP theoretically, but probably not right answer
-
Dry:
- Functional problem
- Get UA and ultrasound
- UTI, regression, or anatomical problem
- Keep T1DM in mind
- Keep in mind that UTI and regression may both be caused by sexual abuse
Conduct disorder vs oppositional defiant disorder
- Conduct disorder:
- “Criminal behavior”, effectively anti-social personality disorder but < 18 years old
- Fights peers, fights authority
- Bullying, destruction, rule violating
- Hurt animals, force sex
- Diagnosis is clinical, treatment is juvenile detention and rehabilitation
- Oppositional-defiant disorder:
- “Teen acting out”
- Pathology is incongruent parenting
- Cooperates with peers, fights authority
- May lie, cheat, steal
- No bullying, no harming animals, no cruelty or torture
- Diagnosis is clinical, treatment is. . . rehab for the parents. Teach the parents how to parent.
Selective mutism
Child consistently refuses to speak when expected to (e.g., when asked a question in school) although his/her communication skills are not impaired.
Typically has a negative impact on normal life (e.g., academic performance) and is not exhibited in settings in which the child feels comfortable and safe (e.g., talking to family members or friends).
Reactive attachment disorder
Reactive attachment disorder occurs in children with a history of neglect or abuse and typically manifests before 5 years of age.
Affected children show a consistently withdrawn behavior towards caregivers, express minimal emotion towards others, and do not seek comfort when distressed.
Social communication disorder
Children with social communication disorder present at an early age with difficulties in both verbal and nonverbal communication, such as adapting to social settings (e.g., being quiet during a performance) and using communication methods adequately (e.g., body language, eye contact).
Amblyopia is ___ and may develop through ___ or ___
Amblyopia is a form of cortical blindness and may develop through strabismus or congenital cataract
Congenital strabismus must be fixed by ___ to prevent amblyopia.
Acquired strabismus must be fixed by ___ to prevent amblyopia.
Congenital strabismus must be fixed by surgery before 6 months of age to prevent amblyopia.
Acquired strabismus must be fixed by patching of good eye or glasses to prevent amblyopia.
Two ways to have “congenital” cataracts
- If they were truly there at birth, TORCH infection
- If they appear in the first few days, inborn error of metabolism (namely galactosemia)
__ must be differentiated from congenital cataracts
Retinoblastoma must be differentiated from congenital cataracts
No red reflex, DEEP white mass (as opposed to more superficial cloudy cataract)
Diagnosis is clinical, treatment is surgical removal of globe. DO NOT use radiation – this will trigger cancer in the other eye.
If discovered, patient is high risk for osteosarcoma.
Retinopathy of prematurity usually occurs in the context of. . .
. . . premature infant with lung dysfunction who is receiving high FiO2
Treat w/ ablation of abnormal neovascularization
These infants are at high risk for bronchopulmonary dysplasia
Agents that cause chemical conjunctavitis in a neonate
Silver nitrate
If a baby missed its chance to get topical erythromycin and presents with suspected gonorrheal conjunctavitis, treat with. . .
. . . ceftriaxone
but do make sure to get cultures or PCR to ensure you know what you are treating. Remember that Neisseria species grow on chocolate agar.
Most non-gonococcal, non-chlamydial conjunctavitis in the newborn presents at day. . .
. . . 5-14, just like chlamydia
So we will take cultures, treat presumptively for gonorrhea and chlamydia, and change course depending on culture results
