RECALL: Neurodevelopmental + Impulse d/os + Genetic d/os + ADHD + Autism + Gender/Dissoc/Somatisation

Question 1

“109. Developmental Coordination Disorder, which is true?
a. Greater prevalence in females than males
b. Asymmetry in movements
c. Have trouble in school
d. Have increased self-harm”

Answer 1

“C) Have trouble in school

Can impact academic achievement = in criteria

A) FALSE. Males >
B) FALSE? Not reported in DSM.
C) TRUE. Given this is obviously true, can also help make the others false.
D) FALSE. Or at least not in DSM.”

Question 2

“136. What is true of development of child with Down’s syndrome?
A) Good behaviour until age 10
B) Trouble socializing
C) Early strong language
D) Cognitively normal until age 10”

Answer 2

“B) Trouble socializing = true

KS FULL 10e P.3507
- Says the good social thing is meh

KSS 11e p1123 (table 1130)
- Clinical repors: placid, cheerful, cooperative, adapt easily at home
- Language function is a relative weakness; whereas social skills (interpersonal cooperation and conformity with social conventions) are relative strengths
- In adolescence, picture changes → more social and emotional difficulties and behaviour disorders, increased risk of psychiatric disorders
- Common medical issues: cardiac, thyroid, GI
- Cognitive deterioration by 20s (language, memory, self-care, problem-solving)

_______________

A) FALSE. Age 10 thing could be fragile x (IQ drops relatively in adolescence) or Hunter’s (language loss around 8-10)

B) TRUE.

C) FALSE. ““specific delays in learning to use spoken language relative to their non-verbal understanding. Almost every child will have expressive language that is delayed relative to their language comprehension. The children experience two types of expressive difficulty - delay in mastering sentence structures and grammar, and specific difficulties in developing clear speech production.”” from website downsyndrome.org

D) FALSE. Definitely.”

Question 3

“28. Which is true regarding adjustment of children of divorced parents:
a. Most children of divorced parents are well adjusted
b. Children of divorced parents are as likely to drop out of school as children from intact families
c. Frequency of contact between fathers and children is a reliable predictor of favourable outcome
d. Sole custody, as opposed to joint custody, is a protective factor”

Answer 3

“A) Most children of divorced parents are well adjusted. TRUE

B) FALSE. More likely (lower educational attainment a risk factor mentioned a bunch)
C) FALSE. NOT&raquo_space;reliable&laquo_space;predictor (some weak evidence)
D) FALSE. Sole custody is NOT protective (some say neither better, some say joint better, but not conclusive anyway)

[https://www.justice.gc.ca/eng/rp-pr/fl-lf/divorce/2004_2/p2.html]
““most children who experience parental separation and divorce will develop into adults without identifiable psychological or social scars or other adverse consequences””

[https://www.justice.gc.ca/eng/rp-pr/fl-lf/parent/2004_3/cust-gar.html]
““The majority of the research literature has found no relationship between the type of custody and child outcomes.””

[https://www.justice.gc.ca/eng/rp-pr/fl-lf/divorce/2002_2/p2.html]

https://www.justice.gc.ca/eng/rp-pr/fl-lf/divorce/2000_3/pdf/2000_3.pdf - has some stuff on fathers
“

Question 4

what is the course of subacute sclerosing panencephalitis

Answer 4

post-measles–> usually onset 10 years post infection (many cases acquired around 2 years old)

rapid neurodegenerative course starting with apathy is classic

Question 5

what is the cause and course of progressive multifocial leukoenecphalopathy

Answer 5

caused by reactivation of the polyomavirus JC (JCV)–> can be found in 86% of adults

can reactivate in context of profound cellular immunosuppression

usually manifests as subacute neurologic deficits including altered mental status, motor deficits (hemiparesis, monoparesis), limb ataxia, gait ataxia, visual symptoms (diplopia etc)

Question 6

which is preferred for tics, habit reversal or ERP?

Answer 6

both are first line recommendations for tics but habit reversal is preferred

Question 7

what does habit reversal therapy focus on

Answer 7

HRT = Awareness training, competing response training, relaxation training, contingency management, social support, relapse prevention
Supportive & family therapy can be useful re: consequences of d/o

Question 8

at what age should kids be able to go UP stairs with alternating feet

Answer 8

age 3

Question 9

at what age should kids be able to go DOWN stairs with alternating feet

Answer 9

age 5

Question 10

“87. True of stuttering:
a. Word substitution, circumlocutions are common
b. Mean age of onset 4 or 5
c. Anxiety related
d. Often diagnosed by teachers in class (literal trans)”

Answer 10

“Poorly remembered. Different versions

A) TRUE. Part of DSM criteria
B) ? Age 2-7, 2 peaks: 2-3.5, 5-7
C) TRUE. Part of DSM criteria
D) ?”

Question 11

what is best treatment for conduct disorder for kids under 11? kids older than 11?

Answer 11

depending on guidelines, “cut off” is age 8 vs 11

under 11–> parent management training

over 11–> multisystemic therapy = best, then individual like CBT, problem solving

Question 12

what is a mnemonic to remember sx of ODD

Answer 12

• 4/8 ARE BRATS criteria = annoying, resentful, easily annoyed, blames others, rule breaker, argue with adults, temper, spiteful/vindictive

(needs sx for 6+ months)

Question 13

what is one way to distinguish between fire setting in ASPD vs pyromania

Answer 13

in pyromania, fire is NOT set for secondary gain like money, concealing crime, express anger/vengeance etc

Question 14

what is a mnemonic to remember sx of CD

Answer 14

TRAP mnemonic: theft, rule breaking, aggression, property damage

Question 15

“19. Patient presenting for evaluation of suspected schizophrenia. Has cleft palate, cardiac abnormalities, learning disorder. Which chromosome would expect to find an abnormality on?
a) 6
b) 18
c) 21
d) 22”

Answer 15

“D) 22

22q11 (CATCH22)
Cardiac abnormality (commonly interrupted aortic arch, truncus arteriosus and tetralogy of Fallot)
Abnormal facies
Thymic aplasia
Cleft palate
Hypocalcemia/hypoparathyroidism”

Question 16

“3. Which disorder is x linked recesive
a. Wilson’s
b. Lesch Nyhan
c. Infantile Gaucher’s disease
d. PKU”

Answer 16

Lesch Nyhan

(the rest are autosomal recessive)

Question 17

“41. 25yo man diagnosed with PKU from birth but treated with low phenylalanine diet and has no sequelae. What is the chance that his sons and daughters will have PKU?
1) 25%
2) 50%
C) 25% in girls, 50% in boys
D) almost 0%”

Answer 17

“D) Almost 0% = TRUE

PKU = Autosomal recessive.
.: Would need to marry another PKU carrier to have chances to pass the illness.
““PKU affects between 1 in 10,000 and 1 in 20,000 depending on the country of origin”” (https://www.npkua.org/What-is-PKU/About-PKU)

So first need to find a woman with PKU (super rare), then 25% chance they will have PKU (1/2 * 1/2).

A) FALSE
B) FALSE
C) FALSE
D) TRUE”

Question 18

“44. You are asked to assess a patient with intellectual disability. Good social and communication skills, needs minimal supports. Diagnosis?

a. Prader Willi
b. Angelman
c. Smith Magenis
d. Cri du chat”

Answer 18

“A) Prader Willi

Odd that they’re not asking about characteristic signs, but likely getting at the level of ID

Diff sources say diff things for intellectual disability. Sticking JUST with KSS:
- PW = borderline to moderate intellectual disability –> go with this
- SM = severe ID
- Angelman = profound ID
- Cri du Chat = severe ID”

Question 19

“61. All are facial anomalies to look for in MR except:
a. Shortened palpebral fissures
b. Transverse palmar crease
c. Geographic tongue
d. High arched palate”

Answer 19

“C) Geographic tongue (not in MR)

A) TRUE. Shortened palprebral fissures → FASD, Williams Syndrome
B) TRUE. Transverse palmar crease → single crease in Down Syndrome
C) FALSE. NOT associated with MR. No sx other than appearance [Wikipedia]
D) TRUE. High-arched palate → Down syndrome, many others”

Question 20

are people with klinefelter tall or short

Answer 20

tall

Question 21

“83. Tall young man presents with mother. Some developmental delay, now developing gynecomastia. Dx?
a. CAH
b. Androgen insensitivity
c. Klinefelter”

Answer 21

“C) Klinefelter = TRUE

Klinefelter syndrome (47, XXY). Males only, tall, dx later often (after puberty)

A) FALSE. Masculinizing females
https://www.uptodate.com/contents/congenital-adrenal-hyperplasia-the-basic

B) FALSE. If XY, looks like girl young (androgens don’t do their thing)

C) TRUE”

Question 22

“1- A woman presents to your office. She is 10 weeks pregnant. She has what seems to be a mixed episode (likely bipolar II). She has passive suicidal ideations, she lost weight and she expresses a lot of guilt concerning her other child. Considering the risks and the benefits, what is the best treatment for her and the foetus?
a) Zoloft
b) Lamotrigine
c) ECT
d) Aripripazole”

Answer 22

“C) ECT = probably best choice

Losing weight, guilt about child. Seems higher risk, so would probably still go with ECT over lamotrigine (which takes time to titrate up).

ALANAS THOUGHTS: would probably depend on stem, and acuity of symptoms; if deteriorating quickly, and need fast response, then ECT. If not, then lamotrigine

A) Sertraline - first line for depression, second line for bipolar II depression (if pure depression), but risky if mixed episode…safe in pregnancy
B) Lamotrigine - second line for bipolar II depression, safe in pregnancy (small risk of cleft palate), but slow
C) ECT - second-line if need rapid response
D) Aripiprazole - second line for MDD, no evidence for bipolar II depression, safe in pregnancy”

Question 23

what is first line for perimenopausal depression

Answer 23

desvenlafaxine or CBT

then second line is transdermal estradiol (level 2 evidence) followed by citalopram/escitalopram/duloxetine/mirtaz/quet/venlafax

Question 24

“51. True about Postpartum Psychosis:
a. 50% have a family history of bipolar disorder
b. Usually occurs 6 weeks after delivery
c. Incidence of 1-2%
d. “PD are associated””

Answer 24

Alana–> i think probably misremembered answers, and C was supposed to be 0.1-0.2%. However, if not, then answer A is best.

“A) 50% have a family hx of bipolar disorder = BEST answer

B) FALSE (usually within 2 weeks of delivery, as per Dr. Deirdre Ryan’s AFD lecture)
C) FALSE (0.1 - 0.2%)
D) FALSE

[BC Repro 2014]
Postpartum psychosis:
Women at increased risk of developing postpartum psychosis include:
⦁Women with a personal history of psychosis with previous pregnancies – relapse rates of 50% – 60%
have been reported.246
⦁Women with bipolar disorder – rates of 25-50% of women who gave birth and have a history of bipolar
disorder have been reported.247,248
⦁Family history (first degree relative) of postpartum psychosis – rates as high as 74% have been reported
for women with bipolar disorder who also have a family history of postpartum psychosis.248
⦁Women with a family history (first degree relative) of bipolar disorder.
⦁Use of drugs – i.e., drug-induced psychosis.”

Question 25

“84. ADHD stimulant meds
a. decreases height significantly
b. take with meals if side effects of anorexia/weight loss
c. change from short acting to long acting if insomnia or nightmares”

Answer 25

“A) Decreases height significantly

2 cm decr in height [CADDRA 2020, OR2020, MTA study]
- data unclear if you’ll catch up, but consistent after 10 years

B) FALSE.
Isn’t WRONG but not specifically what CADDRA recommends (p 81)
In cases of appetite reduction:
* Nutrition should be maximized during periods when appetite-suppression is not in effect (e.g. breakfast and after medication has worn off in the evening).
* Reduce portions but increase snack times, including mandatory snack time in the evening.
* Consider nutritional supplements or meal replacements.
* Consider dose reduction, change to alternate agent, or drug holidays for low body mass index or familial short stature.

C) FALSE. Switch from long to short acting
“

Question 26

“7. What is appropriate starting dose for atomoxetine for child, 49kg, 12yo (same in French exam)
a. 25mg
b. 40mg
c. 10mg
d. 18mg”

Answer 26

“A) 25 mg

Atomoxetine dosing:
0.5mg/kg/day starting, up to 1.2mg/kg”

Question 27

whats the “best therapy” for ASD

Answer 27

applied behaviour analysis

Question 28

“120. Which abnormality with language is most consistent with autism?
A) Expressive
B) Phonemic
C) Pragmatic
D) Receptive”

Answer 28

“C) Pragmatic.

Pragmatic language impairment, also known as social communication disorder, is one of the more widely known and recognized symptoms of autism. The DSM5 diagnosis of ““social (pragmatic) communication disorder”” is basically ASD without the repetitive/restrictive component.

A) FALSE. Issues with production of vocal, gestural, or verbal signals (Language Disorder, DSM5 p.42)
B) FALSE. Phonemic abnormalities involve interference with knowledge of the individual songs that make up words (phonemes). See DSM5 Speech Sound Disorder p.44.
C) TRUE. Language for social communication. See DSM5 for Social Pragmatic Communication Disorder.
D) FALSE. Issues with receiving and comprehending language messages (Language Disorder, DSM5, p.80)”

Question 29

“68) how to tell difference between autism and schizoid?
a) insistence on routine/sameness
b) awkward social interactions
c) no delay in language development
d) odd behavior”

Answer 29

“A) Insistence on routine/sameness = TRUE

Criteria B of ASD: Repetitive, restricted interests, behaviors, insistences on sameness.

A) TRUE
B) FALSE. Awkward social interactions could be seen in both.
C) FALSE. Can have normal formal language development in ASD. (is a specifier)
D) FALSE. Both can have odd behavior.”

Question 30

“138. Woman comes to ER because of leg pain, can’t stand, when you spy on her between the curtains, she is standing and fine. She has legal charges and upcoming court date. Dx?
A) Malingering
B) Factitious Disorder
C) Somatic symptom disorder
D) Conversion disorder”

Answer 30

“A) MALINGERING -TRUE

Malingering - main takeaway point is that the individual has some sort of secondary gain behind their motives. i.e. money, avoidance or work/jail etc

A) TRUE.
B) FALSE . Factitious disorder, sick role is the gain, not obvious secondary gain
C) FALSE. Not conscious lying.
D) FALSE. Not conscious or incongruent neuro”

Question 31

“34. Difference between malingering vs conversion
a. Malingerers tell an elaborate/detailed story for the history
b. Conversions less likely to accept disability-modified work placement
c. Malingerers are collaborating and pleasant on exam
d. Conversions less likely to want evaluation”

Answer 31

“A) Malingerers tell an elaborate/detailed story for the history = TRUE

A) TRUE
B) FALSE. Conversion MORE likely to accept modifications.
C) FALSE. Malingerers NOT cooperative.
D) FALSE. Conversion MORE likely to want evaluation.”