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1
Q

What are some commoner features of childhood depression (vs adults)? (7)

A

Apathy / boredom
Irritable mood
Antisocial behaviour
Decline in school performance

Separation anxiety
Social withdrawal
Hypochondriacal ideas

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2
Q

Which features of adult depression are less seen in children? (5)

How is chilldhood depression managed compared to adults?

A 
Slowed movement/thought
Delusional ideas
Loss of sleep
Loss of appetite/weight
Loss of libido

Managed similarly to adults

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3
Q

What are the main 3 psychotic disorders seen in paediatrics?
What Ix can be done into them?

A

Schizophrenia
Bipolar affective disorder
Organic psychosis

Urine dip - drug screen
Exclusion of medication-induced / medical causes / dementia

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4
Q

What questionnaire tool is used regarding self-harm / drug abuse?

A 
PATHOS
P - problems > 1month?
A - alone at the time?
T - overdose planned for >3 hrs
HO - feeling hopeless about the future?
S - feeling sad for most of time before overdose?
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5
Q

What are the diff kinds of sleep problems seen in paediatrics? (4)
What age group is it mostly seen in?
What is the main feature noted by the parents?

A

Difficulty settling
Waking in night
Nightmares
Night terrors

Mainly toddlers
Cannot get to sleep unless parent present

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6
Q

List some reasons for difficulty settling to sleep, that must be asked about in the Hx? (9)

A 
Too much afternoon sleep
Evening overstimulation
Displaced sleep/wake cycle
Poor parental practices (e.g. no bedtime routine)
Use of bedroom as punishment

Separation anxiety
Fear of darkness/silence

Chronic physical illness

Kept awake by noisy sibling / neighbours

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7
Q

What advice is given to parents for difficulty settling to sleep?

A

Introduce bedtime routine
OR
Lengthening periods of time b/wn tucking in bed and returning after mins so child learns how to sleep alone

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8
Q

Whats the difference between nightmares and night terrors?

A

Nightmare - rarely req medical attention unless frequent/stereotyped in content indicating morbid preoccupation or psychiatric symptoms (e.g. PTSD)

Night terrors occurs approx 1.5hrs after settling
Become disorientated/distressed/unresponsive + will have no recollection in morning
Sim origin to sleep walking
Usually due to erratic sleep schedule

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9
Q

What are some diff types of speech impediment? (6)

A 
Stuttering
Lisp
Muteness
Voice disorders
Articulation disorders
Dysarthria
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10
Q

What are the main causes of speech impediment? (4)

How are most speech impediments managed?

A 
Congenital health conditions e.g.: 
Cleft palate
Poor hearing
Defects of facial bones/muscles
Defects of digestive system / larynx

Most can be remediated with speech + lang therapy

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11
Q

Define a stammer/stutter

What age usually seen in?

A

= flow of speech disrupted by involuntary prolongation/repetition of sounds (vowels), syllables, words or phrases and involuntary silent pauses

Ages 2-5 (most resolve after 5)

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12
Q

What are the main contributing factors towards stammer/stutters (4)

A

Genetics (approx 60% have FH)
Interruption/competition with siblings
Difficulty in brains language processing areas
Other speech/lang probs or developmental delay

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13
Q

What are some factors in physical injury that may indicate it as NAI? (6)

A 
Hx
BG of prev abuse
Plausability of explanation
Delay reportind accident
Inappropriate parents reaction
Inconsistent stories from parent/child
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14
Q

What factors in the Hx may indicate neglect? (8)

A 
Lacks immunisations/glasses
Frequent DNAs
Ravenously hungry
Dirty/inadequate clothing
Parent/child involved in alc/drugs
Parent apathetic/depressed
Parent indifferent to child
Child says no-ones home
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15
Q

When should emotional abuse be considered?

A

Born when parental separation/violence

‘Wrong’ gender

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16
Q

How may emotional abuse present in babies?
in toddlers?
in school-age?
in teenagers?

A

Babies: Apathetic, non-demanding, delayed devel, attention seeking, lack of affection

Toddlers: apathetic, fearful, violent

School-aged: wetting/soiling, relationship difficulties, truancy, antisocial behav

Teenagers: self-harm, depression, aggressive/defensive, minor crimes

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17
Q

What does sexual abuse consist of?

A

Physical contact and/or non-contact (watch/take porn/pictures)

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18
Q

What may be some physical indicators of sexual abuse? (2)

A

STI / Pregnancy <13 yrs (= always sexual abuse)

Vaginal bleeding/itching/discharge/rectal bleeding

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19
Q

What may be some behavioural indicators of sexual abuse? (6)

A 
Secondary enuresis
Soiling
Self-harm
Aggressive
Sexual
Poor school performance
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20
Q

What are some causes of induction in Fabrication + Induced Illness?

A

XS substances e.g. salt
XS meds
Suffocation
Poisoning

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21
Q

What is the main clue that may suggest Fabrication/Induced Illness?

A

Presentations only occurring in carer’s presence + no clinical evidence

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22
Q

What features are always seen in Chronic Fatigue Syndrome? (6)
What are some other features commonly (but not always) seen? (5)

A 
Always:
Myalgia
Migratory arthralgia
Headache
Difficulty getting to sleep
Poor concentration
Irritability

Often seen:
Stomach pains
Scalp tenderness
Eye pain
Photophobia
Tender cervical lymphadenopathy
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23
Q

What viruses may contribute towards chronic fatigue syndrome?

A

Cocksackie B virus
EBV
Hepatitis

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24
Q

How is chronic fatigue syndrome managed?

A

Graded exercise
and/or
CBT

Recovery can takes months/years

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25
Define dyspraxia
A developmental coordination disorder of motor planning +/or execution, but with normal neuro exam Affects perception + use of language → education probs
26
What motor functions may be affected in dyspraxia? (5)
``` Handwriting / drawing Poor estab laterality (L/R) Dressing self Cutting food Messy eating ```
27
How is dyspraxia managed? | Why is Dx usually late?
Assessed/advised with OT/speech and lang therapist Mild dyspraxia undetected in early life as achieves normal motor milestones
28
What are the ICD-10 criteria of anorexia nervosa? (3)
Low body weight (BMI < 17.5) Overvalued idea of being fat Self-induced wt loss
29
What are the main endocrine changes that occur in anorexia nervosa? (3)
Amennorhoea / loss of libido Raised GH/Cortisol Reduced thyroxine
30
List some DDx of anorexia/bulimia (5)
``` Depression Psychosis OCD Dementia Alc/substance abuse ```
31
List some causes of daytime enuresis (7)
``` Lack of attention to bladder sensation Detrusor instability Neuropathic bladder (spina bifida / enlarged+fails empty) Bladder neck weakness Ectopic ureter (constant dribbling) UTI Constipation ```
32
What may be seen O/E in daytime enuresis if due to spina bifida? (4)
``` O/E: distension S2-4 sensory loss Abnorm perineal sensation / anal tone Abnorm leg reflexes + gait ```
33
What other Ix can be done in daytime enuresis? (2) | What management strategies (3)
USS w. urodynamic studies Urine MC+S Bladder training / pelvic floor exercises Treat constipation Poss anticholinergics
34
List some causes of secondary enuresis (3)
UTI Emotional upset Polyuria
35
``` What are the main 2 causes of nocturnal enuresis List 3 (uncommon) organic causes ```
Genetic delay in acquiring sphincter competence Emotional stress / interference when learning dry nights UTI Polyuria Faecal retention → bladder neck dysfunc
36
What are the treatment options for nocturnal enuresis (2)
Encouragement/ rewards + no punishment | Desmopression (short term relief e.g. sleepover/holidays)
37
What are mild/moderate/severe/profound learning difficulties defined as? How does each one initially present
``` Mild = IQ 70-80 → only apparent when start school Moderate = IQ 50-70 → delay in speech/lang Severe = IQ 35-50 → developmental delay in infancy Profound = IQ <35 → developmental delay in infancy ```
38
List some prenatal organic causes for LDs (11)
Genetics: Downs, Fragile X, Microcephaly, Hydrocephalus Teratogenic: alc/drug abuse Congenital infection (CMV, HIV, Toxo, Rubella) Endocrine: hypothyroidism, PKU Neurocutaneous syndromes Vascular: occlusion, haemorrhages
39
List some perinatal causes of LDs (4)
Extreme prematurity Birth asphyxia Symptomatic hypoglycaemia Hyperbilirubinaemia
40
List some postnatal causes of LDs (9)
Infection: meningitis, encephalitis Trauma: head injury Metabolic: hypoglycaemia, inborn metab errors Vascular: stroke Hypoxia: seizures, near drowning, suffocation
41
Define school refusal | What are the 2 main causes
= inability to attend school due to overwhelming anxiety ``` Separation anxiety (provoked by adverse life events) Anxiety provoked by some aspect of school ```
42
What are the child's complaints in school refusal? (3) | What are the main principles of management of school refusal (4)
Headache Unwell Nausea Treat underlying emotional disorder Address bullying/educational difficulties Parental encouragement Facilitate return
43
What approach is used to analyse a tantrum | Best management strategies in tantrums (3)
ABC Antedecent: what happens mins before Behav: what episode consists of Consequence: what happened as result Distract Leave room / return in mins Naughty step/ star chart
44
What is conduct disorder defined as? | What is the main age of incidence in boys/girls
= repetitive/persistent pattern of aggression to ppl/animals, property destruction, theft, truancy Boys** <18 + Girls 14-16
45
List some RFs for conduct disorder (4) | What are the main management strategies
Genetic Parental psychopathology Abuse/neglect Education/socioeconomic status CBT/Family/Group therapy
46
What is opposition defiant disorder defined as?
defiant/hostile behaviour that does not violate the law
47
What are the social interaction impairments in ASD? (4) List the communication impairments (3) List the abnormal interests/behaviours (4)
``` Social: Poor eye contact Facial expressions Cannot share Lack friendships ``` Communication: Poor spoken language Lack imaginative play Difficulty initiating/sustaining convo Interests/behavs: Intense preoccupation w. dates/numbers/timetables Inflexible adherance to routine Repetitive motor movements (e.g. clapping) Unusual interest in parts of hard/moving objects
48
What other features may present with ASD (not seen in all) (3)
``` Behav probs (aggression, impulsivity, self-injurous) Mental retardation (norm intelligence) (75%) Epilepsy (25%) ```
49
What is the prognosis like in ASD? | What factors can improve the prognosis (4)
Prognosis poor: 1-2% achieve full independence + 20-30% achieve partial ``` Better prognostic factors: IQ > 70 Good language development by 5-7yrs Home/fam support Education support ```
50
Whats the difference b/wn ASD + aspergers? What personality traits may also be seen in aspergers?
Aspergers has social interaction impairment + restricted/stereotypes behaviours BUT No abnormality in language / cognitive ability Schizoid (solitary/no interest in social relationships) Anakastic (OCD)
51
What are the main features of ADHD (6)
``` Onset <6-7yrs Hyperactivity/impulsivity Impaired attention in work/play Not listening when spoken to Often interrupt others V distractible ```
52
What are some possible causes of ADHD (4)
Genetic Dietary Psychosocial factors Brain damage
53
Within the Dx criteria for ADHD, how long must symptoms have been present for?
Symptoms evident in >1 situation (school + home) | Present for at least 6m
54
Describe the management of ADHD
Pharm: 1st line - works in 3/4 with concentration/academic Methylphenidate (ritalin) Dexamphetamine 2nd line - antidepressants/some antipsychotics Psychotherapy: Behaviour modification Family education (permissive parents not helpful)
55
What is the prognosis for ADHD | What factors are assoc w. worse prognosis? (2)
Improvements in development / remission by 12-20yrs (but persisting symptoms in 15%) Worse prognosis: Unstable family dynamics Conduct disorder
56
What are the 4 main gross motor milestones in early development (<2y/o) + limit ages for these
Head control - 4m Sit unsupported - 9m Standing independently - 12m Walking independently - 18m
57
What are the 4 main fine motor/vision milestones in early development + limit ages for these
Fixes and follows objects - 3m Reaches for objects - 6m Transfers - 9m Pincer grip - 12m
58
When + how (2) does abnormal motor development present?
At 3m-2yrs (when most skill acquisition) Delayed motor milestones OR Abnormal gait / Balance problem / Asymm hand use / Invol movements / Motor skill loss
59
List some causes of abnormal motor development (4)
Central motor deficit e.g. cerebral palsy Congenital myopathy Spinal cord lesions Global development delay
60
What are the 5 main speech milestones in early development + limit ages for these
``` Polysyllabic babble - 7m Consonant babble - 10m 6 words with meaning - 18m Joins words - 2yrs 3-word sentences - 2.5yrs ```
61
List some causes for speech + language DELAY (5) | List some causes for speech + language DISORDERS (5)
``` Hearing loss Speech production difficulty from anatomical deficit (e.g. cleft palate) Global developmental delay Environmental deprivation Normal variant/ familial pattern ``` ``` Language comprehension Language expression (cannot articulate) Phonation + speech production (stammer/dysarthria/verbal dyspraxia) Pragmatics/semantics/grammar Social/communication skills (ASD) ```
62
What are the 5 main social/behavioural milestones + their limit ages
``` Smile - 8wks Fear of strangers - 10m Feeds self/spoon - 18m Symbolic play - 2/2.5yrs Interactive play - 3/3.5 yrs ```

Child Health (14 decks)

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