Behavioral sciences

Question 1

APGAR score

Answer 1

Assessment of newborn vital signs following labor via a 10-point scale evaluate at 1 minute and 5 minute.

Appearance, Pulse, Grimace, Activity, and Respiration
7=good, 4-6 assist and stimulate, <4 at later time points, there is increased risk that the child will develop long-term neurologic damage.

Question 2

Low birth weight

Answer 2

Defined as <2,500, caused by prematurity or IU growth retardation. Associated with SIDS (sudden infant death syndrome) and other mortality.

Other problems thermoregulation, immune function, hypoglycemia, polycythemia, and impaired neurocognitive/emotional development.

Complications include infection, ARDS, necrotizing entercolitis, intraventricular hemorrhage, and persistent fetal circulation.

Question 3

Developmental milestones:

Infants Birth-3month

Answer 3

Motor: rooting reflex, holds heads up, moro reflex disappears
Social: smile
Verbal: orients and responds to voice

Question 4

Developmental milestones:

Infants 7-9 months

Answer 4

Motor: sits alone, crawls, transfer toys from hand to hand
Social: stranger anxiety
Verbal: responds to name and simple instruction, uses gesture, plays peek a boo

Question 5

Developmental milestones:

Infants 12-15 months

Answer 5

Motor: Walks, babinski disappears.
Social: separation anxiety
Verbal: few words

Question 6

Developmental milestones:

Toddler 12-24 months

Answer 6

Motor: climbs stairs, stacks (age x 3) # of blocks
Social: rapprochement (moves away and return to mom)
Verbal: 200 words and TWO-word phrases at age of TWO

Question 7

Developmental milestones:

Toddler 24-36 months

Answer 7

Motor: Feeds self with for and spoon, kills ball
Social: core gender identity, parallel play
Verbal: toilet training, PEE at age THREE

Question 8

Developmental milestones:

Preschool 3 yr

Answer 8

Motor: rides TRIcycle at THREE, copies lines and circle drawings
Social: comfortably spends part of day away from mother
Verbal: 900 words and complete sentences

Question 9

Developmental milestones:

Preschool 4yr

Answer 9

Motor: Uses buttons and zippers, grooms self (brushes teeth), hops on 1 foot, makes simple drawings (stick figure)
Social: cooperative play, imaginary friends
Verbal: can tell detailed stories and use prepositions.

Question 10

Changes in elderly

Answer 10

Sexual:
Men; slower erection, ejaculation, longer refractory
Women: vaginal shortening, thinning, dryness

Sleep: DECREASED REM and slow-wace sleep; INCREASED latency and awakening

Increased: SI
Decreased: vision, hearing, immunity, bladder control
Compromised: renal, pulm, GI, muscle mass, more fat

However, sexual interest or intelligence do NOT drop.

Question 11

Grief

Answer 11

May last up to 1 year, may experience illusions.

Pathologic grief: excessively intense, prolonged grief lasting 2-6 months, or grief that is delayed, inhibited, or denied. May experience depressive symptoms, delusions, and hallucinations.

Question 12

Sexual dysfunction

Answer 12

desire disorders (hypoactive, aversion), arousal disorder (ED), orgasmic disorder (anorgasmia, premature ejaculation), sexual pain disorder (dyspareunia, vaginismus)

DDx: drug (antiHTN, neuroleptics, SSRIs, ethanol), dz (depression, DM), psychologic (performance anxiety)

Question 13

BMI

Answer 13

weight in KG/height in meter^2

30= obesity
>35=severe obesity
>40=morbid obesity
>45=super obesity

Question 14

Sleep stage

Answer 14

Awake eyes open
Awake eyes closed
Stage N1 5%
Stage N3 45%
Stage N3 25%
REM 25%

Remember, at night, BATS Drink Blood

Question 15

Sleep stage: awake eyes open

Answer 15

Alert, active mental concentration

EEG: Beta (highest freq, lowest amp)

Question 16

Sleep stage: awake eyes closed

Answer 16

EEG: alpha

Question 17

Sleep stage: N1

Answer 17

light sleep

EEG: theta

Question 18

Sleep stage: N2

Answer 18

Deeper sleep; bruxism (teeth grinding)

EEG: sleep spindles and K complexes

Question 19

Sleep stage: N3

Answer 19

Deepest, non-REM sleep (slow wave sleep); sleep walking, night terrors, bedwetting
EEG: delta (lowest freq, highest amp)

Question 20

Sleep stage: REM

Answer 20

Dreaming, loss of motor tone, memory processing function, erections, increased brain O2 use
EEG: Beta

Question 21

Sleep

Answer 21

Raphe nucleus: serotonergic predominance is the key to initiating sleep

Sleep enuresis: treated with oral desmopression DDAVP (ADH); preferred over imipramine

Alcohol/benzo/barbituates associated with reduced REM and delta sleep

Benzo useful for night terrors and sleep walking

Question 22

REM sleep

Answer 22

Occurs every 90 min, duration increasing thru night.
ACH is the principal NT in REM sleep, NE reduces REM sleep.

Increased and variable pulse and BP
EOM during REM due to activity of PPRF (paramedian pontine reticular formation/conjugate gaze center).
Penile, clitoral tumescence.

REM sleep is like sex: increase pulse, penile/clitoral enlargement, decreased freq with age

Because REM has the same EEG patterns as wakefulness, been termed paradoxical sleep and desynchronized sleep.

Question 23

Sleep patterns of depressed pts

Answer 23

• decreased slow wave sleep
• decreased REM latency
• increased REM early in sleep cycle
• increased total REM sleep
• repeated nighttime awakenings
• early morning awakening (IMPORTANT SCREENING Qs)

Question 24

Narcolepsy

Answer 24

Hypnagogic (just before sleep), or hypnopompic 9just before awakening) hallucination.

The pt’s nocturnal and narcoleptic sleep episodes start off with REM sleep.

Cataplexy (loss of all muscle tone following a strong emo stimulus) in some pts.

Strong genetic components. Treated with daytime stimulants (amphetamines, modafinil) and nighttime sodium oxybate (GHB)

Question 25

Circadina rhythm

Answer 25

Suprachiasmatic nucleus (SCN) of hypothalamus
Controls ACTH, prolactin, melatonin, nocturnal NE release

SCN -> NE release -> pineal gland -> melatonin
SCN regulated by environment (light)

Question 26

Sleep terror disorder

Answer 26

Periods of terror with screaming in the middle of the night
Occurs during slow wave sleep.
Most common in children

Occurs during non REM sleep (no memory of arousal) as opposed to nightmares that occurs during REM sleep (memory of a scary dream)

Unknown causes, but might be due to emo stress during the previous day, fever, lack of sleep. Usually self limited.