Pediatrics

Question 1

What are the core features required to make a diagnosis of mental retardation?

Answer 1

• significantly subaverage intellect (often IQ < 70)
• deficits in adaptive skills
• with onset before age 18

Question 2

What is the most common inherited form of mental retardation? What features accompany this?

Answer 2

fragile X syndrome, which includes macroorchidism and a long face

Question 3

When evaluating patients for a learning disorder, it is important to rule out what other disease process?

Answer 3

a sensory deficit

Question 4

How does ODD differ from conduct disorder?

Answer 4

ODD does not involve physical aggression or the violation of the basic rights of others as is the case with conduct disorder

Question 5

What symptoms characterize oppositional defiant disorder?

Answer 5

• frequent loss of temper
• arguments with adults
• defying adults’ rules
• deliberately annoying people or being easily annoyed
• anger, resentment, or spitefulness
• blaming others for mistakes or misbehaviors

Question 6

If kids get along with their peers but will not comply with expectations from parents or teachers, what diagnosis should come to mind?

Answer 6

oppositional defiant disorder

Question 7

What is the treatment for ODD?

Answer 7

psychotherapy with family involvement and a focus on parent management skills training

Question 8

What are the diagnostic features of conduct disorder?

Answer 8

• a pattern of behavior that violates the rights of others or social norms
• this may include aggression, destruction of property, deceitfulness or theft, and serious rules violations

Question 9

Children with ODD and conduct disorder have a high rate of what comorbidities?

Answer 9

• substance abuse
• mood disorders
• ADHD and learning disorders

Question 10

What is the treatment for conduct disorder?

Answer 10

• implementation of consistent rules and consequences

- medications for aggression as necessary

Question 11

To be diagnosed with ADHD, symptoms must have been present before what age?

Answer 11

before age 12

Question 12

Describe the treatment algorithm for ADHD.

Answer 12

• CNS stimulants are first line agents
• atomoxetine is a non stimulant that has been approved
• a2-agonists guanfacine and clonidine can be used as second line agents or adjuncts to stimulants
• psychotherapy with a focus on behavior modification

Question 13

What are the core features of autism?

Answer 13

• problems with social interaction
• impairments in communication
• repetitive and stereotyped patterns of behavior and activities

Question 14

What is the treatment for autism?

Answer 14

• remedial education
• behavioral therapy
• antipsychotics for aggression, hyperactivity, and mood lability

Question 15

Describe Rett disorder?

Answer 15

• it is a developmental disorder most often seen in girls
• patients develop normally for the first 5ish months before regressing and losing purposeful use of their hands
• treatment is supportive

Question 16

What is childhood disintegrative disorder?

Answer 16

a disorder in which children develop normally in the first 2 years of life and then regress before age 10, often with a comorbid seizure disorder

Question 17

What are the diagnostic criteria for Tourette disorder?

Answer 17

• at least one vocal and one motor tic

- with onset prior to age 18 and at least one year of symptoms almost every day

Question 18

How is Tourette disorder treated?

Answer 18

• atypical neuroleptics and alpha 2 agonists are preferred

- typical neuroleptics may be required for severe cases

Question 19

Describe the presentation and treatment of selective mutism.

Answer 19

• a refusal to speak in certain situations

- treat with psychotherapy, behavior therapy, and anxiety management

Question 20

What is the treatment for separation anxiety?

Answer 20

family therapy, CBT, and low-dose antidepressants

Question 21

What features in a child would be suggestive of sexual abuse?

Answer 21

• presence of an STD
• anal or genital trauma present on exam
• knowledge about specific sexual acts
• initiation of sexual activity with others
• sexual play with dolls