723 Week 1 and 2

Question 1

What are contraindication to breastfeeding?

Answer 1

1. Infants with galactosemia
2. HIV 1 or 2
3. Mother diagnosis and treatment of cancer
4. Untreated brucellosis
5. Infectious or untreated TB
6. Active herpes simplex lesion on breast (expressed milk ok)
7. Varicella
8. H1N1
9. illicit drug use

Question 2

When can an infant start taking whole milk?

Answer 2

1 year of age. Breast milk up until this time

Question 3

What are the recommended hours of sleep for newborns?

Answer 3

14-17 hrs

Question 4

What are the recommended hours of sleep for infants (4-11 months)?

Answer 4

12-15 hours

Question 5

What are the recommended hours of sleep for toddlers (1-2 yrs)?

Answer 5

11-14 hours

Question 6

What are the recommended hours of sleep for preschoolers (3-5)?

Answer 6

10-13 hours

Question 7

What are the recommended hours of sleep for school aged children (6-13)?

Answer 7

9-11 hours

Question 8

What are the recommended hours of sleep for teenagers?

Answer 8

8-10 hours

Question 9

What are the recommended hours of sleep for young adults (18-25)?

Answer 9

7-9 hours

Question 10

What is the DSM-5 criteria for inattention ADHD for children aged up to 16, and for 17+?

Answer 10

Age <16: 6 or more of the following criteria, 5 or more for 17+. Symptoms must be present for 6+ months

• Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
• Often has trouble holding attention on tasks or play activities.
• Often does not seem to listen when spoken to directly.
• Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
• Often has trouble organizing tasks and activities.
• Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
• Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
• Is often easily distracted
• Is often forgetful in daily activities.

Question 11

People with ADHD show a persistent pattern of _____ and/or _____ that interferes with functioning or development.

Answer 11

inattention, hyperactivity-impulsivity

Question 12

What is the DSM-5 criteria for hyperactivity and/or impulsivity ADHD for children aged up to 16, and for 17+?

Answer 12

6+ symptoms of hyperactivity-impulsivity for children up to age 16, or 5+ for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:

• Often fidgets with or taps hands or feet, or squirms in seat.
• Often leaves seat in situations when remaining seated is expected.
• Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
• Often unable to play or take part in leisure activities quietly.
• Is often “on the go” acting as if “driven by a motor”.
• Often talks excessively.
• Often blurts out an answer before a question has been completed.
• Often has trouble waiting his/her turn.
• Often interrupts or intrudes on others (e.g., butts into conversations or games)6+

Question 13

What are the 3 kinds (presentations) of ADHD?

Answer 13

1. Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
2. Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
3. Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months.

Question 14

Several inattentive or hyperactive-impulsive symptoms were present before age _____.

Answer 14

12 years

Question 15

What are the 3 screening tools for ADHD?

Answer 15

1. Vanderbilt ADHD Diagnostic Teacher (VADTRS)
   Parent Rating Scale (VADPRS)
2. Free Screens for comorbid conditions Normed by age and sex
   Separates inattention and hyperactive/impulsive factors
   Items (43 for VADTRS and 45 for VADPRS) rated on 4- and 5-point scales
3. ADHD-IV Rating Scale
   Free
   Normed by sex and age
   Based on DSM-IV-TR criteria for ADHD
   Separates inattention and hyperactive/impulsive factors
   18 item scale

Question 16

What are the stimulant medications for treatment of ADHD?

Answer 16

1. Methylphenidate (Ritalin): 2.5-5mg BID at waking and 4 hr. later, Increase 2.5-5mg/day at weekly intervals, max 40 mg/day
2. Dexmethylphenidate (focalin): 2.5-5mg BID at waking and 4 hr. later, Increase 2.5-5mg/day at weekly intervals, max 20 mg/day
3. Methylphenidate extended release (Concerta): 18mg each morning, Increase 9-18mg intervals to max 72mg
4. Focalin XR: 5mg each morning, Increase 5mg intervals to max 20mg

Question 17

What is the non-stimulant pharmacological treatment for ADHD (one of these).

Answer 17

Atomoxetine (Strattera) is the only non-controlled, non-stimulant medication approved by FDA as first-line treatment.

This is a Norepinephrine reuptake inhibitor

Effects are not immediate, can take up to six weeks

Question 18

What is the black box warning for Atomoxetine (Strattera)?

Answer 18

Black box risk of increased risk of suicidal thinking in children and adolescents

Question 19

What are the primary side effects (3 of these) of pharmacological treatment of ADHD?

Answer 19

1. CV: Stimulants may cause insignificant increase in HR
2. Suicidal ideation/ attempts: Boxed label warning to atomoxetine for suicidal attempts; advise parent to be on look out for change in mood, depression, mood lability, agitation, suicidal thoughts or gestures and to seek medical help immediately
3. Liver toxicity: stop medication and call provider if sx of dark urine, flu-like illness, fatigue, abd pain or nausea occur.