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PEDS > Week 9 > Flashcards

Week 9 Flashcards

1
Q

Autism Spectrum Disorder (ASD) (2)

A
  • neurodevelopmental disorders characterized by deficits in social communication and interations,
  • with restrictive, repetitive patterns of behaviours, interests, activities
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2
Q

Autism - co morbidities

A
  • likely to have co-occuring mental health disorder
  • less likely to have a medical home (no ‘autism clinic’`
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3
Q

Autism spectrum disorder - communication

A
  • deficit in communication manifested by delay or abnormal language approx 18-24 months
  • child with autism may initially be mute, have a significant delay in language acquisition, or may have a regression in language
  • if child is speaking, he may only exhibit echolalia (repetitive language)
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4
Q

AUtism Spectrum disorder - s and s

A
  • trouble with relationships in same aged peers
  • social deficits = hard to maintain joint attention
  • inability to point to desired object at 18 months
  • pull their caregiver by hand to desired object by hand guiding, may avoid eye contact
  • repetitive and restrictive behaviours
  • strongly desire rigid routine, upset with deviation
  • repetitive motor movements, hand flapping, spining wheels, etc
  • may have difficulty with sleep, restricted food preferences, hypersensitivity to any of 5 senses
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5
Q

Autism - treatment

A
  • high service use rates due to complexity of disorder
  • many may have co-occuring disruptive behaviours (aggression, tantrums, self-injury)
  • several established behavioural and educational therapies to treat symptoms
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6
Q

Comorbidities of AUtism

A
  • anxieties and phobias 1/2 of children with ASD (medication rarely required in clinical practice unless anxiety is debilitating)
  • obsessive-compulsive disorder = second most common, fairly easy to ask parents about, treat with SSRI
  • ADHD - inattentive, hyperactive, combined, treat with stimulants
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7
Q

Screen used with children with ASD (3)

A
  • SEC resource
  • sensory, emotional, communication screening
  • determines approach with a child
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8
Q

Tourette syndrome (3)

A
  • neurodevelopmental disorder
  • chronic vocal and motor tics causing distress and functional impairment
  • presence of both vocal and motor tics over 12 months for tourrette syndrome diagnossis (if one or the other, chronic tic disorder is used)
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9
Q

ADHD - medication and what (2)

A

inattentive, hyperactive, combined,
= treat with stimulants

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10
Q

OCD - what, treatment

A
  • obsessive-compulsive disorder = second most common, fairly easy to ask parents about, treat with SSRI
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11
Q

Trisomy 21 - what (4)

A
  • most common chromosomal birth defect
  • three instead of two copies of chromosome 21
  • intelectual disability
  • physical signs
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12
Q

Trisomy 21 - risk for other health conditions (8)

A
  • cardiac defects
  • hearing loss
  • strabismus (shaky eyes)
  • GI problems
  • orthodontic conditions
  • thyroid disease
  • dermatologic conditions
  • leukemia
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13
Q

Trisomy 21 - signs and symptoms (14)

A
  • congenital cataracts
  • flat nose
  • small low set ears
  • protruding tongue
  • short broad hands
  • single transverse palm crease
  • small head (microcephaly)
  • flattened forhead
  • wide short neck
  • epicanthal eye folds
  • white spots on eye iris
  • wide space between first and second toes
  • hearing loss
  • increased incidence of diabetes, congenital heart defect, leukemia
  • hypotonia
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14
Q

Intellectual disability - categories (3)

A
  • Prenatal errors in development of CNS
  • prenatal or postnatal changes in the biological environment of the person
  • external forces leadning to CNS damage
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15
Q

Intellectual disability (4)

A

severe limiting in cognitive function
manifested by diffrence in social, life skills, adaptive functioning
before age 18

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16
Q

Global developmental delay

A

GDD = developmental milestone delay in regard to : motor, speech, language, cognition, social funcitoning, ADLs
- under 5 years of age developmental disability

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17
Q

Global Developmental Delay - diagnosis (7)

A
  • genetic, molecular, metabolic tests to detect hereditary types of global developmental delay
  • allow for evaluation of abnormalities in body chemistry contributing to developmental delay
  • chromosome testing
  • Rett syndrome (high ranking GDD among girls)
  • test for lead poisoning
  • test for imbalance of thyroid hormone
  • neuroimaging (CT/MIR) –> posible CNS injury
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18
Q

Developmental dysplasia of the hip - what

A
  • femoral head and acetabulum not aligned causing unstable connection (instability, dislocation, subluxation, dysplasia)
  • gestational event 12-18 weeks
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19
Q

Developmental dysplasia of the hip - signs and symptoms

A
  • limited abduction of affected hip
  • assymetry of gluteal and thigh fat folds
  • telescoping or pistoning of the thigh
  • significant limp in older children (r/t pistoning)
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20
Q

Developmental dysplasia of the hip - assessment

A
  • allis sign
  • one knee lower than other when knees are flexed
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21
Q

Developmental dysplasia of the hip - clinical therapy

A
  • pavlik harness
  • surgery (bryant traction)
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22
Q

Pavlik harness (3)

A
  • Developmental dysplasia of the hip
  • <6mo infant
  • dynamic splint (hip flexion and abduction, prevents hip extension or adduction
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23
Q

Developmental dysplasia of the hip - surgery <6mo

A
  • surgery with closed reduction
  • post-op application of hip-spica cast
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24
Q

Developmental dysplasia of the hip - surgery >18 mo

A
  • bruant traction to stretch pre-op
  • open or closed reduction surgery and casting
  • bracing may also be required
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25
Q

Spica cast (6)

A
  • hard cast from nipples to ankles
  • prevents any movement of hips
  • skin integrity is important
  • urinary elimination and constipation rt lack of movement
  • decreased apetite
  • g+D delay r/t limited mobility
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26
Q

Muscular dystrophies - what (3)

A
  • inherited disease characterized by muscle fiber degeneration adn muscle wasting
  • begin early or late in life, onset at birth or gradual
  • terminal disorder can progress over quick or years
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27
Q

Duchenne muscular dystrophy (3)

A
  • most common pediatric
  • missing code for dystrophin protein needed to muscle stabilizer
  • leads to necrosis in fibres and muscle wasting
28
Q

Duchenne muscular dystrophy - clinical manifestation (4)

A
  • muscle weakness (lower limbs early childhood, compensate with upper arms)
  • middle teen years:
    • unable to walk
    • scoliosis, cardiomyopathy, difficulty taking food orally,
      resp distress
29
Q

Duchenne muscular dystrophy - complications (4)

A
  • scoliosis,
  • cardiomyopathy,
  • difficulty taking food orally,
  • resp distress
30
Q

Duchenne muscular dystrophy - clinical therapy (5)

A
  • no treatment *
  • prednisone = preserve muscle and pulmonary function
  • prone for respiratory infection
  • PT/OT
  • mental health consults
31
Q

Scoliosis (4)

A
  • curvature of spine, creating S or C shape rather than straight line
  • child vertebrae curves side to side
  • both vertebrae and spinous process rotate to face opposite directions in curvature = decrease growth
  • as curve progresses it makes change to child’s shoulders, ribcage, pelvis, waist, shape of back
32
Q

What causes scoliosis (4)

A
  • mostly idopathic
  • believed to be hereditary (runs in families)
  • less common causes =
    • neuromuscular conditions (CP, muscular dystrophy)
    • birth defects that affect spine development
33
Q

Diagnosis of scoliosis (5)

A
  • confirmed by X ray, most cases are asymptomatic
  • Cobb method
  • patient is diagnosed when spine curves greater than 10 degreees
  • mild, moderate, and severe classifications
  • forward bend test
34
Q

Types of scoliosis

A
  • s-shape (double scoliosis)
  • c-shape
35
Q

S-shape scoliosis (3)

A
  • more common and dangerous
  • hard to diagnose
  • Two curves - upper cervicothoracic back, and lower thoracolumbar back bending in opposite directions
36
Q

C-shape scoliosis (3)

A
  • harder to manage
  • bending in one direction = C-shaped curve
  • types = 1) dextro-scoliosis (right curve, backwards C), and levo-scoliosis (left curve, C shaped)
37
Q

Mild scoliosis - treatment (3)

A
  • physiotherapy
  • exercise
  • muscle building
38
Q

Moderate scoliosis - treatment (1)

A
  • bracing (boston brace, miluwakee brace)
39
Q

Severe scoliosis treatment

A
  • surgery
40
Q

6 domains of mental health

A
  • depression
  • anxiety
  • irritability
  • hyperactivity
  • obsessions/compulsions
41
Q

Mental health - Children of all ages - pandemic

A

70% children 6-18 experienced deterioration in one of 6 domains
- 66% children 2-5 experience deterioration of one of 6 domains

42
Q

Depression

A
  • major depression = 6-8% of adolescents
  • major morbidity and a recurrence rate of 60-80 after adolescence
  • only half are diagnosed appropriately, half of those diagnosed are treated
  • 25% FN youth report feeling depressed for 2 weeks in a row during the year
43
Q

Diagnosis of depression

A
  • interview with adolescent and family/cargiver
  • investigate DSM-5
44
Q

Diagnosis of depression - pre-pubertal children (4)

A
  • somatic concerns (due to inability to label emotions)
  • psychomotor agitation
  • mood congruent hallucinations
  • phobias, separation anxiety, increased worrying and rumination (crying, irritability, loneliness)
45
Q

Diagnosis of depression - adolescents (8)

A
  • change in appetite, weight, sleep pattern
  • guilt
  • refusal to attend school/poor school performance
  • delusions
  • suicidal ideation or behaviours
  • substance use
  • low self-esteem, apathy, boredom
  • antisocial
46
Q

Treatment of depression

A
  • counselling for both child and caregivers
  • SSRIs
47
Q

Anxiety vs anxiety disorder (3)

A
  • anxiety and worry are common in normal children
  • normally, youger children and females tend to have more anxiety symptoms than older children or males
  • an anxiety disorder is distinguished by having persistent symptoms that impair daily functioning
48
Q

Anxiety disorder - risk factors (5)

A
  • family history of mental illness (esp anxiety)
  • personal history of childhood anxiety
  • stressful of traumatic event
  • female
  • comorbid psychiatric disorder (depression ex)
49
Q

Self injury (3)

A
  • deliberate and often repetitive destruction or alteration of one’s own body tissue without suicidal intent
  • ex = skin cutting, burning, self-hitting, interfering with wound healing, severe scratching, hair pulling, inserting objects into body, bone breaking
  • sites usually chosen so they can be covered (arms, legs, chest, etc.)
50
Q

Self injury - reason (4)

A
  • ineffective coping mechanism providing rapid relief from psychological distress
  • can do it to feel emotions more intensely, or to punish themselves for being bad
  • most often these individuals seek to feel better
  • most of these individuals are not suicidal, but we cannot assume that those who self-harm will never be suicidal
51
Q

Self injury warning signs (5)

A
  • unexplained frequent injuries
  • wearing long pants and sleeves in warm weather
  • low self esteem
  • difficulty in relationships
  • difficulty handling emotions
52
Q

self injury - goals of treatment

A
  • early diagnosis = sucessful outcomes
  • medical treatment as needed
  • ensure counselling is provided (psychologists, family involvement as needed)
53
Q

Suicidal behaviour - factors that contribute (3)

A
  • excessive stress levels
  • issues with self esteem
  • substance and domestic abuse
54
Q

Suicidal behaviour + indigenous people (2)

A
  • suicide rate much higher under 14
  • one in 5 FN youth report a close friend or family member committing suicide in the past year
55
Q

Suicidal behaviour - history

A
  • history taking (what happened over past week, has child hurt themself or treid to?)
  • should be deferred if adolescent’s life is in imminent danger
56
Q

Suicidal behaviour - nonpharmacologic interventions (3)

A
  • individual treatment for children and adolescents
  • aim = self esteem and sence of importance
  • suicide threats = most often communicate despair, frustration, unhappiness = understand sense of distress
57
Q

Psychosis (3)

A
  • a distortion of reality or loss of contact with reality (affects thinking feeling percieving acting)
  • first incidence usually occurs before 25, males experience younger
  • cause is unkown, but psychoactive substacnes can increase risk
58
Q

Psychosis - management (2)

A
  • outcomes improved if psychosis is diagnosed early and treatment is started promptly.
  • all areas are management are same for an acute phase of schizophrenia
59
Q

Eating disorders

A

-increasing in anada
- 12-30% of girls, 9-25% of boys
- eating disorders = 2-4 times greater than type 2 diabetes

60
Q

Eating disorders - early warning signs (11)

A
  • irritability, depression, social withdrawal
  • excessive preoccupation with calories or healthy eating
  • frequent negative comments about their weight and shape
  • restriction of food intake
  • make excuses to avoid eating
  • significant weight loss or gain
  • compulsive exercising
  • frequent eating excessive food in short period
  • consuming food alone at night or secretely
  • laxatives or diet pills
  • going to bathroom immediately after eating
61
Q

Eating disorders and mortality (3)

A
  • highest mortality of any mental illnesss (10-15%)
  • suicide is second leading cause of death after cardiac disease among those with anorexia nervosa
  • 20% of anorexia nervosa and 35% of bulimia nervosa attemmpt suicide
62
Q

Anorexia nervosa (3)

A
  • restriction of energy intake relative to requirements
  • intense fear of becoming fat, persistent behaviour that interferes with weight gain
  • disturbances in which body weight or shape is experienced with lack of recognition
63
Q

Bulimia nervosa (4)

A
  • recurrent episodes of binge eating
  • eating in discrete amount of time that is larger than normal
  • sense of lack of control or overeating
  • followed by recurrent inappropriate compensatory behaviour to prevent weight gain (vomiting, laxatives, etc)
64
Q

Bulimea nervosa diagnosis

A
  • binge eating and compensatory behaviours both occur at least once a week for three months
65
Q

Binge eating disorder

A
  • recurrent episodes of binge eating
  • eating in discrete amount of time that is larger than normal
  • sense of lack of control

PEDS (9 decks)

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