Development Flashcards
1
Q
18 month old who wakes up screaming, inconsolable, parents at loss of what to do. Does not recall events.
A. Reassure
B. EEG
C. MRI
D. Refer to psych
A
A. Reassure
2
Q
The mother of a 3.5 y.o girl is concerned about her speech. She said her first words at 11 months and is speaking in 3 word sentences. There are no concerns with her development. She has begun to have difficulty with speaking. She will repeat the same word (mommy, mommy, mommy) and repeat sounds at the start of words (m-m-m-mommy), pause during speak and insert “uh” in the middle of a sentence. She has associated facial twitches and blinking. What do you recommend ?
A. Reassure B. Follow up in 6 months C. Refer to SLP D. Development assessment E. Audiology
A
C. Refer to SLP
3
Q
3 year old male is brought to you because the mother has concerns about his language. He guides mom’s hand to things that he wants , has 18 single words, and can follow 2 step commands. His fine motor and gross motor development is normal. What is this most consistent with ?
A. Expressive language delay
B. Receptive language delay
C. Normal variant
D. Autism spectrum disorder
A
D. Autism spectrum disorder
4
Q
A 4 month old presents with a narrow elongated head and frontal bossing. What suture is most likely fused ?
A. Metopic
B. Sagittal
C. Lambdoid
D. Coronal
A
B. Sagittal
-scaphocephaly (dolichocephaly)
5
Q
Father worried about size of penis of otherwise healthy 4kg newborn. Penis measure stretched out 3cm. What do you do ?
A. Dose of 17-OH progesterone
B. CGH
C. Reassure
D. DSD
A
C. Reassure
6
Q
Female with autism. Best test to detect underlying diagnosis?
A. Microarray
B. Fragile X testing
A
A. Microarray
7
Q
Toddler with episodes where she doesn’t get her way, cries/throws tantrum, then loses consciousness and sometimes turns blue. These episodes are increasing in frequency. What do you recommend ?
A. Ignore the behaviour and put her in timeout after the episode
B. Refer for behavioural therapy
C. Put her in a time-put before behaviour has a chance to escalate
D. Give in to what she wants
A
C. Put her in time-our before behaviour has a chance to escalate
8
Q
9 year old girl, parents divorced. How does she handle it ?
A. Blames herself
B. ?
C. ?
D. Chooses one parent and takes their side
A
D. Chooses one parent and takes their side
9
Q
About a 9 year old whose parents are getting a divorce and they ask what type of behaviour she will exhibit:
A. Developmental regression
B. Pick sides (mother vs father) and blame the other parent
C. Try to make everyone happy
D. Blame herself for the divorce
A
B. Pick sides (mother vs father) and blame the other parent
10
Q
13 y.o boy breaking things at home, not listening to instructions, and skipping school. He seems angry. What is the next BEST step ?
A. Parent training
B. Start an atypical antipsychotic
C. Start an SSRI
A
A. Parent training
Management of ODD
Treatment often combo of:
- Parent- Management Training Programs and Family Therapy
- Cognitive Problem- Solving skills training
- social- Skills programs and school- based programs
- medication
11
Q
Two year old child is brought in by her parents for concerning behaviour. Cries and screams when she is not able to get what she wants and sometimes these episodes are associated with her turning blue and having jerking movements (breath holding spell). Parents what to know what to do about these episodes ?
A. Ignore the behaviour, then put the child in a time out afterwards
B. Interrupt the behaviour with a time out before it escalates
C. Give the child what they want to avoid the behaviour
A
B. Interrupt the behaviour with a time out before it escalates.
Marked as controversial likely with
A. Ignore the behaviour, then put the child in a time out
12
Q
11 y.o boy who has never been dry at night. Father had nocturnal enuresis until age 10. Having difficulty and not able to spend time at his friends’ houses for sleepovers. What is the best advice regarding management ?
A. Alarm
B. Imipramine
C. DDAVP
D. Oxybutynin
A
A. Alarm
13
Q
Boy with stable ADHD has been on a stable dose of stimulant for the last two years. Had started to become very aggressive when spoken to and gets easily frustrated when he doesn’t get what he wants. You’ve already ruled out psychosocial stressors. What do you want to do as your next step ?
A. Benzo PRN
B. Increase psychostimulatn
C. Add SSRI
D. Add atypical antipsychotic
A
B. Increase psychostimulant
Why ? Need to find source
14
Q
16 y.o boy with history of ADHD on Vyvanse. His mother notes him becoming more withdrawn and secretive over the past year, wanting to spend all of his time in his room and away from friends and family, on his computer. She has also noted money missing from her purse and strange charges on her credit card from an unknown source. What should you do ?
A. Increase his medication dosage
B. Assess him for gambling problems
C. Add a mood stabilizer
D. Reassure
A
B. Assess him for a gambling problem
15
Q
A mother brings in her baby with concerns about his head shape. This is what the head looks like. Photo. What is the most likely diagnosis ?
Description of photo, flattened posterior head on right with right ear forward and flattening of forehead on other side
A. Positional plagiocephaly
B. Lambdoid craniosynostosis
C. Dolicocephaly
D. Scaphocephaly
A
A. Positional plagiocephaly
16
Q
What is the minimum requirement to sit in a car with a seatbelt and no car seat ?
A. 135cm
B. 145 cm
C. 150cm
D. 155cm
A
B. 145 cm
Needs to be 8y.o and 36kg
17
Q
15 month old is seen in your office. What would make you the most concerned ?
A. Not pointing to show interest
B. No words and part of bilingual family
C. Cannot scribble with a crayon
A
Answer A: not pointing to show interest - concern for ASD/no reciprocity
18
Q
A 3 year old boy is in your office. He is very energetic, aggressive and destructive. His height is on the 50th percentile and his weight on the 95th percentile. He is described as having a voracious appetite. He comes to see you and hugs you. He speaks in 1 word sentences. What is the diagnosis ?
A. Emotional deprivation
B. Diencephalic syndrome
C. Prader Willi syndrome
D. ADHD
A
A. Emotional deprivation
For emotional deprivation they can be fat if the parents are over feeding them.
B. Diencephalic syndrome also causes FTT but emaciation
C- prader willi would not be hugging
D- ADHD does not make you fat/voracious appetite
19
Q
A 10 year old boy with previously repaired TAPVD comes to your office with symptoms of ADHD. He is on no medications currently and has been well. Your next best step is:
A. Start stimulants
B. ECG
C. Refer to psychiatry
D. Continue to monitor
A
A. Start stimulants
20
Q
Which of the following would be the most helpful in confirming the diagnosis of ADHD in a 12 y.o male.
A. Symptoms are only at school
B. Difficulty making friends
C. Forgets his homework at school
D. Spends a lot of time playing video games
A
C. Forgets his homework at school
21
Q
Child with I towing and difficulty walking. What would make you suspicious that this is spastic dialectic CP ?
A. Prematurity, global development delay, normal reflexes
B. Prematurity, delayed motor milestones, increased reflexes
C. Birth asphyxia, global development delay, normal reflexes
D. Birth asphyxia, delayed motor milestones, increased reflexes
A
B. Prematurity, delayed motor milestones, increased reflexes
22
Q
A 10 month old baby wakes up every 2 hours and needs to be rocked back to seep by his mom. What is the most likely cause ?
A. Benign Rolandic epilepsy
B. Sleep onset association disorder
C. Night terrors
A
B. Sleep onset association disorder
23
Q
36 month baby what is best predictor of cognition ?
A. Gross motor
B. Fine motor
C. Social
D. Language
A
Answer: D language
Language is linked to both cognition and emotional development. Language delays may be the first indication that a child has mental retardation, has an ASD, or has been maltreated
24
Q
You suspect a 3 y.o female of having autism spectrum disorder. What diagnostic test would MOST likely reveal an abnormality ?
A. Karyotype
B. Very long chain fatty acids
C. Fragile x testing
D. Chromosomal microarray
A
D. Chromosomal microarray
They suggest that all children with ASD receive chromosomal microarray and fragile X testing
25
What is the best way for a 7 year old to ride in the back of a car, in the middle seat with no head rest? (Pictures shown taken from CPS statement)
A. Forward facing car seat
B. Booster seat with no back
C. Booster seat with a full back
D. Seat belt
C. Booster seat with a full back
```
Stage 1 (rear facing) - until at least 1 year and 10kg (22lbs)
Stage 2 (forward facing) - until at least 18kg (40lbs)
Stage 3 (booster) - until at least 8 years old, 36kg (80lbs) and 145cm (4ft 9 inches)
Stage 4 (seatbelt)
```
Weight order is 10kg/20lbs - 20kg/40lbs - 40kg/80lbs
Full/high back booster - provide neck support and should be used for seats without a head restraint.
26
A mom brings in her son for concerns around his school performance, but feels he is cognitively normal. He has trouble with reading, and has trouble understanding when he reads to himself. His teacher has been spending more resource time with him, and when she reads aloud to him, he understands well. What is the most likely diagnosis ?
A. Myopia
B. Dyslexia
C. General learning disorder
D. Speech apraxia
B. Dyslexia - most common LD - causes bu deficits in phonological processing (inability to segment words into smaller units). Deficits are unexpected in relation to the students overall intelligence
A. Myopia - unlikely as they aren’t mentioning visual deficits in any other area
C. General learning disorder -
Unlikely as they aren’t mentioning any other deficits
D. Speech apraxia - impairment in the ability to organize and initiate a motor pattern of speech (ie; problems making sounds, syllables and words - not because of muscle weakness but because the brain has trouble moving the body parts necessary for speech.)
27
8 y.o boy is brought to you because of “difficulties learning “. He has difficulties finding words and with some pronounounciation. He does not comprehend what he reads. However he understands when his parents read to him. What is the most likely diagnosis ?
A. Aspergers
B. Specific language impairment
C. Verbal apraxia
D. Dyslexia
D. Dyslexia
28
Boy with new diagnosis of ADHD and uses drugs. What ADHD meds to prescribe ?
A. Vyvanse
B. Amphetamine slow release (Ritalin)
C. Dextroamphetamine
Or
Kid with Hx of substance abuse. Needs medication for ADHD. Which is BEST option ?
A. Vyvanse
B. Methylphenidate IR
C. Guanfacine
D. Ritalin SR
A. Vyvanse
29
In a 15 month old infant, which of the following is the most indicative of an autism spectrum disorder ?
A. Not babbling frequently
B. Not pointing to indicate interest
B. Not pointing to indicate interest
30
What is the first line intervention for sleep onset association type sleep disorder ?
A. Melatonin
B. Stable bedtime routine
C. Clonidine
B. Stable bedtime routine
31
Parents are concerned about a child’s performance at school. He has normal intellect. He is very clumsy and teachers mention that he has poor handwriting. He has difficulty hopping on one foot and seems to tire easily. He has normal strength on exam but low tone. Diagnosis is most likely ?
A. Duchenne’s muscular dystrophy
B. Cerebral palsy
C. Developmental coordination disorder
C. Developmental coordination disorder - aka clumsy child
32
A 4 year old girl is referred to you for dysfluency. She grimaces when she stutters. What do you do ?
A. Refer to SLP
B. Reassure
C. MRI head
A. Refer to SLP
If the child is grimacing they are upset about it - probably not just developmental dysfluency of preschool children
33
A child is referred to you for assessment of a learning disability. What did you do ?
A. Refer for psychoeducation testing
A refer for psychoeducation testing
34
A teenage boy with addiction issues is diagnosed with ADHD. His mother is concerned about the potential for abuse with some ADHD medications. Which stimulant do you start him on ?
A. Concerta XR
B. Ritalin
C. Vyvanse
C. Vyvanse - because of its pro- drug design, it’s delivery curve is not changed by mode of administration (oral, inhalation or injection), reducing its possible abuse potential, linger effect
A. Concerta - the abuse potential is significantly reduced in comparison to short- acting medication due to the product formulation according to anecdotal reports from Canadian regional addiction Centers.
35
3 year old female, picky eater. Since 8 months of age, weight 15th percentile. Physical exam normal. Difficulties at mealtime specifically. Best option ?
A. Allow kid to choose food
B. Introduce child’s choice plus what family eats at mealtimes
C. Cyproheptadine
D. Offer several small snacks throughout the day plus mealtimes
B. Introduce child’s choice plus whatever family eats at mealtimes
36
In a 5 month old boy, which would be the most concerning ?
A. Doesn’t turn to the sound of his own name
B. Doesn’t sit upright without support
C. Fisting of one of his hands
D. Doesn’t smile all the time at his caregiver
Answer C. Fisting - Extreme handedness at an early age and perisistence of fisting after 4 months is another indicator of potential neuronal migration disorders requiring imaging ie; CP
Sound of name - 10 months
Sits upright - 6 months
Smiling - 6 weeks, but doesn’t have to smile all the time !!
37
The mother of a 2.5 y.o girl is concerned about her speech. She said her frost words at the age of 11 months and is speaking in 3 word sentences. There are no concerns with her development. She has begun to have difficulty with speaking. She will repeat the same word (mommy, mommy,mommy), repeat sounds at the start of words (m-m-m-mommy), pause during speech, and insert ‘uh’ in the middle of a sentence. What do you recommend ?
A. Audiology
B. Full developmental assessment
C. Reassure
D. Refer to speech language pathologist
D. Refer to SLP
| - not this version had no grimacing but you still refer because of parental concern
38
3 year old girl with developmental regression and small head. What is diagnosis ?
Rett syndrome
39
Boy with enuresis, what is a good non pharm way to treat it ?
A. Positive reinforcement
B. Bed alarm
C. DDAVP
D. Bladder training
B. Bed alarm
40
18 month old won’t go to sleep, used to be breastfed at 12 months. What does he have ?
A. Sleep onset association disorder
B. Nightmare
C. Night terror
D. Delayed sleep phase
A. Sleep onset association disorder
41
Child with expressive language delay and otherwise makes 12 point piece puzzle, social. Most likely associated with ?
A. Reading difficulty
B. Autism
Answer: A reading difficulty
42
2.5 y.o girl who stutters. What would make you most concerned ?
A. Repeats whole word
B. Repeats part of word
C. Facial grimacing
D. Pauses between words
C. Facial grimacing
This makes us more concerned that the child is anxious or upset but the stuttering, prompting quick referral to SLP
43
12 y.o boy with school difficulties. Teacher thinks he has a learning disability. Your history and physical exam are negative. What would you do ?
A. CBC, lead levels, TSH
B. Start stimulant
C. Send to psychology
D. Assess short term memory and fine motor skills
C. Send to psychology - the child with a suspected LD needs a psychoeducational assessment
44
18 month old wakes up throughout the night, needs parents to console. Ends up sleeping in parents bed.
A. Sleep wake transition disorder
B. Sleep onset association disorder
C. Night terror
D. Nightmares
Answer B: sleep onset association disorder
45
9 month old with asymmetric tonic neck reflex. Cause ?
A. CP
B. Normal
A. CP
ATNR appears at 35 weeks and is gone by 4 months
46
4y.o girl with night terrors every night at midnight. What do you advise the parents ?
A. Reassure the parents
B. Wake up kid 15min before for half hour
B. Wake up kid 15 min before for half hour - since this is every night at same time
47
What do you tell mom of an ADHD kid on stimulant medication ?
A. It will decrease the risk of drugs dependency
A. No other choice :)
Compared to those without ADHD, children with ADHD have a higher risk of substance abuse. However, children with ADHD who are treated with medication have a lower risk of substance abuse that children with ADHD who are not treated.
48
A mother brings her 6 y.o son to your office with concerns that he has always been ‘awkward’. His teacher has commented on poor writing. On exam, he has normal power, low muscle tone and is unable to hop. Most likely diagnosis ?
A. Developmental coordination disorder
B. Cerebral palsy
C. Muscular dystrophy
D. Tourette syndrome
A. Developmental coordination disorder
49
18 month old child falls asleep with his dad rocking him to sleep. However, he wakes up screaming multiple times per night. He will go back to sleep of calmed down, but often in his parents bed. He was breastfed to sleep for the first 12months. What is the issue?
A. Sleep- wake- transition disorder
B. Sleep association disorder
C. Night terrors
B. Sleep association disorder
50
3.5 year old girl was referred to you for assessment. She speaks 50 words and 50% of her words are intelligible to others. She points to things she wants. She can run well, can kick a ball. She can can walk up and down stairs. She cannot throw a ball overhead. She can use a spoon. What is the MOST likely explanation of her symptoms ?
A. Hearing deficit
B. Developmental delay
C. Language delay
Answer:
| I think this answer is C. Language delay
51
Af what weight and age can a child start to use a front facing car seat ?
A. 9kg, 9 mo
B. 10kg, 12 mo
C. 18kg, 20mo
B. 10kg,12 mo
52
A 14 y.o boy with ADHD is taking 36mg of concerta. His symptoms and school performance have improved and his mother is happy with his improvements. For the past two weeks, however, he has been sad, often crying unpredictably. He also is having difficulty falling asleep at night. What is the next best step in his management ?
A. Decrease the dose of concerta
B. Change from concerta to adderrall
C. Add fluoxetine
D. Add melatonin
OR
Child who you are following for ADHD, and started treatment 2 weeks ago. Mom tells you he has done really well at school, and his grades started to improve. Side effects of difficulty sleeping, sad, moments, moody, poor appetite. His current dose of medication is Concerta 36mg x 7 days. What did you do?
A. Decrease concerta dose to 27mg
B. Add fluoxetine
C. Add melatonin
D. Change to Adderall
Answer: A/A - reduce dose
- concerta is 8- 12h and used in older kids and Adderall XR is shorter acting at 6-8h so It’s not longer acting !! Would worsen symptoms
- mood lability is one of the side effects of stimulants
- if mood lability occurs at the time of peak concentration, can start by reducing the dose or switching to a longer acting preperation.
- irritability, sadness and increased activity as the medication wears off is common when using short acting medication on a morning/noon (twice a day schedule) and in this case adding an afternoon dose or switching to a long-acting form can be tried.
- should also screen for coexisting mood disorder/anxiety disorder
- insomnia - establish a bedtime routine and good sleep hygiene habits; omit or reduce the last dose of the day.
- fluoxetine
Side effects of stimulants: decreased appetite, poor growth, dizziness, mood lability, insomnia, rebound when med wears off, tics , psychosis, diversion/misuse
53
4 year old with various developmental descriptions (stacks 7 cubes, 1 step at a time, 3word sentences). What is their developmental age?
A. 24months
B. 30months
C.33 months
D. 35 months
Answer A. 24 months
Stacks: 6-7 cubes = 2 years
1step at a time = 2years
2-3 word sentences = 2 years
54
A mom comes to see you about her 2 year old, previously well child. The child is having daily episodes where her trunk is writhing, and she becomes flushed and diaphoretic. She also grunts, and breathes rapidly during these episodes. Mom is sure she does not lose consciousness and if she talks to her daughter, she can shorten the duration of the worrisome. They happen when the child is in her car seat or watching tv. What is your next step ?
A. Refer to neurology for an EEG
B. Upper GI to rule out reflux
C. Reassure mom
D. Refer to a psychologist
C. Reassure mom
Masturbation
55
18 month old wakes up 1-2h after going to bed, screaming, difficult to arouse, is confused and diaphoretic. Likely cause ?
A. Nightmares
B. Night terrors
C. Seizures
OR
Child has recurrent episodes of sudden crying, frightening episodes, unaware. Diagnosis?
A. Night terrors
B. Nightmares
Answer B/A
56
Question about child with isolated language delay- what are they at risk for in the future ?
A. Reading disability/dyslexia
57
At what age should a child be able to self- soothe when he awakens at night ?
A. 5-7months
B. 8-10months
C. 11-13 months
D. 14-17 months
A. 5-7months
- sleep regulation or self- soothing involves the infants ability to negotiate the sleep-wake transition, both at sleep onset and following norms awakenings throughout the night.
- the capacity to self soothe begins to develop in the first 12 weeks of life and is a reflection of both Neuro developmental maturation and learning.
- it is important to recommend that parents put their 2-4month old infants to bed “drowsy but awake” to avoid dependence on parental presence at sleep onset and to foster the infants ability to self- soothe.
58
5 year old with 21 y.o old single mom. Teacher says she is hyperactive, hoarding food and not remorseful for inappropriate behaviour. No eye contact with mom, but runs up and hugs you. Most likely diagnosis?
A. ADHD
B. Autism
C. Attachment disorder
D. Oppositional defiant disorder
C. Attachment disorder
59
30 month old child has been introduced to potty training. She has been encouraged to sit on potty after meals whether she can void or not. She has been doing it for one week. Now she is having temper tantrums every time you get her near the toilet. What is your advice on management ?
A. Continue with current toilet training
B. Stop for 1-3months and try again later
C. Punish her
D. Give treat every time she can sit on toilet quietly
B. Stop for 1-3 months and try again later
60
How to diagnose expressive language delay in a 2.5 y.o ?
A less than 100 words
B. No 2 word combinations
B. No 2word combinations
- receptive language refers to ability to understand and expressive language to produce symbolic communication
61
14 month old says specifically “dada” only. What other features makes you worried about language delay ?
A. Not responding to own name
B. Not babbling
A. Not responding to own name
- start to respond to name at 5months and orients well to name by 9 months
- babbling should have already stopped by 14 months so this wouldn’t be concerning
Nelson’s- at 9-10months - babbling becomes truncated into specific words (ie: mama or dada for their parents
62
Whom you would refer to speech and language therapy?
A. 18 month old with no single word
B. 6y.o with phoneme problem
C. 3year old with 3 word sentences
D. 4 y.o with dysfluency
Or
Who to refer to SLP?
A. 6 year old with trouble with phonemes
B. No words by 18 months, in a bilingual household
C. 2 year old, people only understand 50%
Answer A/B - 18 month old with no words
- refer for 15 month old without 3 words, so 18 month old with no words should be referred
- 3 year old should speak in 3 word sentences
- 2 y.o should only be 50% intelligible
- 4 y.o dysfluency - depends on if stuttering present and in what capacity
- 6y.o with phoneme problems - should also probably have assistance but it wouldn’t necessarily be through an SLP
63
3.5 year old, follows 2-step commands, interested in communication, developmentally appropriate girl with 50% intelligible speech and repeats syllables and whole words. Most likely diagnosis ?
A. Developmental dysfluency
B. Normal development
C. Delayed expressive language skills
D. Delayed receptive language skills
Answer C. Delayed Expressive language skills - yes as should have 75% intelligible speech - answer given
Or why not ? (Me)
A- developmental dysfluency -yes repeats words and syllables
Other
B- no not normal development
D- delayed receptive language skills - at 3 should follow 3-step commands but red flags only note to refer if not following 2-step commands by this time
64
Mom comes in wondering if her 2 year old is ready for toilet training. Of the following, which is most likely to show readiness ?
A. Child motivated to please parents
B. Child able to follow two-step commands
C. Child has at least a 100 word vocabulary
OR
Signs of toilet readiness?
A. Able to dress and undress himself ?
B. Desire to please based on positive relationship with parents
C. Can stay dry overnight
D. Can communicate need for toilet use using full sentences
Answer. A/B - desire to please
Just need to be able to follow one step command.
65
Teenage girl with severe ADHD. Started in Concerta 36mg. Medicine is working great for her ADHD, but on follow-up notes to have lost 10 pounds. What would you do ?
A. Switch to straterra
B. Decrease concerta to 5days/week from 7 days/week
Or
Teen with ADHD, 14 pound weight loss. Currently ADHD is better controlled on his long-acting ADHD med. what is best thing to do ?
A. Start Strattera
B. Consult a psychiatrist
C. Change from 7 days a week dosing to 5 days a week
Or
10 y.o girl with ADHD on Concerta 35mg comes after 3 months with 4kg weight loss. What do you do ?
A. Decrease concerta to 5 times a week
B. Change to straterra
Answer: B,C,A - decrease to 5x week
-concerta - extended release methylphenidate- s/e are moderate appetite suppression, mild sleep disturbances, transient weight loss, irritability, emergence of tics
Lowest dose: 18mg, 27mg, 36mg, and 54mg
Strattera - extended release atomoxetine “An atom in the stratosphere” - s/e nervousness, sleep problems, fatigue, stomach upset. Dizziness, dry moth. Can lead in rare cases to severe liver injury or to suicidal ideation
66
5 y.o boy is having difficulties with bad behaviour at school, including stealing objects. His parents have recently divorced and are having difficulties in their relationship. His mother would like advice on how to help with his behaviour. Best advice ?
A. Take parenting classes and learn way to manage his behaviour
B. You need to meet with both parents together to better assess the situation
C. She needs to start discipline her child ASAP
Or
Marital troubles at home, child is acting out at school and daycare. Mom has come in for advice.
A. Give the mom parenting classes
B. Request a meeting with both parents to assess the home situation
C. Give him Ritalin
Answer: B - meet both parents
67
Divorcing parents. What’s best for the kid ?
A. Best if joint custody could be given ASAP
B. Best of child gets to see both parents (ie; joint custody ) even if the parents are fighting all the time
C. Best if parents can settle their differences and not fight in front of kids
C. Not fight in front of kids
68
2.5 year old who is not combining 2-words, has about a 50 word vocabulary and other people understand about 25%. Otherwise, climbs stairs, runs around, throws underhand. Interested in other people. What is this most consistent with ?
A. Isolated language delay
B. Global developmental delay
C. Autism
A. Isolated language delay
69
57 pound (26kg) child. What car seat should you use ?
A. Lap and shoulder belt with seat
B. Seat with built in restraint
C. Lap and shoulder belt, no airbag
D. Lap and shoulder belt, with airbag
A. Lap and shoulder belt with seat
70
An 18kg child is being transported in a car. Which of the following is the best restraint?
A. Car’s lap and shoulder belt
B. Car seat with its own restraining device
C. Car seat with the car’s restraining device
C. Car seat with the car’s restraining device
71
18 month old girl with delayed language. Points to things that she wants. Has two dolls that she loves to cuddle. What is the likely diagnosis ?
A. Isolated language delay
B. Autism
C. Asperger syndrome
A. Isolated language delay
Because she points and shows affection not ASD
72
Child who doesn’t talk at school or make good eye contact with people. Including recess. Doesn’t have any friends. At home speaks normally. Diagnosis?
A. Selective mutism
B. Language delay
C. ASD
A. Selective mutism
Tx: refer to psychologist/psychiatrist for behavioural therapy. Sometimes medications after attempting behaviour therapy (SSRI)
73
Which of the following has the lowest rate of relapse rate when used for primary enuresis in a 7y.o boy?
A. Imipramine
B. DDAVP
C. Alarm system
D. Nighttime fluid restriction
C. Alarm - cure rate just under 50%
Imipramine/DDAVP - used for short term (such as sleep overs)
Fluid restriction - not in CPS statement but true that we ask not to give a lot of fluid right before bed
74
10 month old child has just started to bite his parents. What statement is true?
A. This is an early sign of possible autism spectrum disorder
B. There may be an abusive situation in the family.
C. Baby is developmentally normal and is excited
D. The baby may be emotionally disturbed
C. Baby is developmentally normal and he is excited
- children still learning to talk can bite to express excitement or frustration
* self-biting is an example of a self-injurious behaviour common among ASD patients
75
Mother has questions about her 5 year old sons’ performance at school. She is concerned that he will have reading problems because his father had significant problems with reading. Of the following which predicts a future difficulty with reading ?
A. Delayed walking
B. Delayed language milestones
B. Delayed language milestones
76
30 month old with 50 words, otherwise normal. No history suggestive of autism. What would you tell mom that he is at risk for:
A. Reading problems
B. Autism
C. ADHD
A. Reading problems
77
Which patient requires immediate referral ?
A. Baby doesn’t turn head to voice at 4 months
B. No babbling by 6 months
C. Not following commands at 15 months
D. No two word sentences at 26months
Or
Which is the indication for urgent evaluation ?
A. Baby does not turn to sound at 4 months
B. Baby not babbling at 6 month
C. 15 month old does not follow simple command with gesture
D. 24month without 2 word phrases
Controversial
A- some people say this one as should startle to sound at 1 month but other sources say turn to voice/sound at 4-6months
Vs
D - no two word sentences in a 2 year old
From table red flags
- neonate - infant does not startle to loud sounds
- 2months - does not alert to voice
- 6 months -lack of turning to voice
- 24 months - lack of words and two-word meaningful sentences
Since it’s turning to voice red flag only at 6 months I am going for D !!!
78
20 month old with 3 words, point to pictures in book when asked to, mimics mother at work, stacks 2 blocks. What is diagnosis ?
A. Global developmental delay
B. Speech delay
C. Hearing loss
D. Pervasive development disorder
Controversial
Answer A - global
Developmental delay but other group said B but seems all areas delayed
Verbal- should have 2 word phrases and by 18 months should have 10-25word
Fine motor - should be able to stack 5-6 cube tower
Social- 15 months imitating
79
Autism. Risk for recurrence ?
A. Slightly higher than general population
B. Equal to general population
C. 50% chance because AD
D. Non if avoids MMR
A. Slightly higher risk - actually quite a bit higher
Nelson’s- there is a high recurrence risk (2-19%) for ASD among siblings as well as higher Concordance rate (37-90%) in twin studies
- normal prevalence is 1%
- risk factors: closer spacing of pregnancies, advanced maternal or paternal age, extremely premature birth <26 weeks gestational age) as well as family members with learning problems, psych disorders, and social disability
80
3 year old boy brought for assessment of developmental delay; features of autism: 3 words, no response to name, not interested in play, no identification of body parts, not pointing, wants to play with blocks only. Initial test ?
A. Hearing screen
B. MR of head
C. Psychometric testiing
Or
3 year old kid with very delayed language, no imaginative play, no reciprocal social interaction and some other developmental abnormalities. How to investigate first ?
A. Audiology
B. Psych testing
C. Karyotype
A. Hearing screen
ASD a need
1. Hearing screen
2. Ophthalmology
3. Woods lamp exam for TS
4. Microarray (CMA)
81
A couple wants to adopt a child from overseas, and brings a file for you to review. Which of the following would MOST likely be associated with other problems?
A. Microcephaly in context of normal growth and weight
B. Delayed speech with low weight
C. Microcephaly in proportion to low height
OR
A couple comes in to your office asking advice regarding the adoption of a child. Which scenario gives the worst prognosis ?
A. Significant height and weight restriction
B. Microcephaly proportionate to height reduction
C. Significant microcephaly with normal height and decreased weight
Answer: A,C - microcephaly with normal growth and weight would be indicative of pathology and warrant immediate evaluation
- if it was microcephaly in proportion to low height - may be an endo cause, so not as bad as the causes listed below...
- significant height and weight restriction - could just be FTT
82
7 year old boy still thumb sucking. What to tell mother ?
A. Can lead to malocclusion and facial deformation
B. Topical aversion therapy works well
C. Reassure
D. Is never associated with decreased self esteem
A. Can lead to malocclusion and facial deformity
83
Mother brings 4 year old child in to you worrying that they are delayed. Gross motor: stands on 1foot momentarily, rides tricycle. Fine motor: draws circle, copies cross, speech: counts to 3, remembers 3 numbers, social: washes hands, parallel playZ what is developmental age ?
A. 24mo
B. 30mo
C. 36mo
D. 48mo
```
Or
Mom worried about her 4year old son being developmental delayed. He can say his name and age. Stack 10 blocks. Draw a circle and copy a cross. Stand on 1 foot briefly. Parallel play.
What is developmental age ?
A. 24 mo
B. 36 mo
C. 48 mo
```
C, B - 36 months /3years
Gross motor delayed
Fine motor delayed
Speech delayed should be able to count to 4
Social: parallel play is 24 months, washes hands is 30months
84
Which child would you send for further speech and language evaluation ?
A. 3 year old with dysfluency with repetitions of words and syllables
B. 2y.o with 75 words and understood by 50% of strangers
C. 6 year old with rouble with phonemes
D. 18 month old from bilingual household with no words
Or
Who should you get referred to SLP ?
A. 3 year old with occasional dysfluency
B. 6 year old with trouble with certain phonemes
C. 18 month old from bilingual home with no single words
D, C - 18 month old with no words
Notice how second question is clearer
Should have 10-25 words and bilingualism is not a reason for speech delay.
But 6 year old with rouble with phonemes would also make me consider for dyslexia....
85
Giving advice to parents about a 4 month old with positional plagiocephaly. You would
A. Suggest they do neck exercises to prevent torticollis
B. Suggest a child stay in car seat at home
C. Babe to sleep on their side
D. Encourage tummy time
D. Encourage tummy time
Need to teach parents about positional changes and tummy time and refer to PT in cases of congenital torticollis
86
Etiology of primary enuresis as opposed to secondary:
A. Holding urine during the day
B. Family history
C. Abuse
B. Family history
Primary = bladder control has never been obtained
Secondary = if incontinence recurs after > 6 months of continence
CPS on primary enuresis - family history is often present
Secondary enuresis: often due to a stressful event( ie; parent divorce, birth of sibling); could be due to constipation, sleep apnea, DM, DI, UTI, neurologic/spinal cord abnormalities, sickle cell, chronic kidney disease, psychogenic polydipsia
87
Question on car seat indications. When can the child use regular seat belt ?
A. When child weighs 41lbs
B. If child is > 6years old
C.When child, while in booster seat, has level of ears over headrest of the seat
D. When child has a sitting height at or greater than 63 cm
Answer C.
Ruled out A, B, D so must be C
88
8 month old baby is not sleeping through the night. She is waking up one hour after being put down in her crib. Which of the following is true:
A. This should improve if she learns to fall asleep in her crib vs being rocked to sleep
B. She should be allowed to cry to seep to solve this problem
C. Giving the baby a pacifier is a proven technique
D. She should be given a bottle of war milk to help her fall asleep in her crib
A. Should improve if lears to fall asleep on own
89
A 2y.o child cries when mother is leaving for work everyday. She is also attached to a “special” teddy bear. What should be done?
A. Remove child’s teddy bear since this is abnormal attachment to an object
B. Reassure parents that this is normal separation anxiety appropriate for child’s developmental level
B reassurance
Separation anxiety normal 18-24months
90
An infant can sit with a round back using his hands for support, can roll from prone to supine, stands with support, has a player grasp, laughs, and babbles. What is his most likely age ?
A. 3 months
B. 6 months
C. 8 months
D.12 months
Answer C. 8 months vs 6 months (me) likely going with 6 months
Sits using hands for support - 6 months
Rolling prone to supine - 4 months
Palmer grasp - 5 months
Laughs out loud - 4 months
Babbling - 5-6 months
Stand with support - unable to find age ?
- standing with one hand held - 10 months
- at 7 months - sits with pelvis supported, leaning forward on hand with back rounded, babies, grasps using racial palm, May support most of weight, bouncing actively, rolls over when prone
According to Denver II developmental assessment milestones chart, infants can usually stand holding on to things btw 6.5 -8.5 months. Pull to standing btw 8-10 month
91
```
A 12 month old child has psychosocial deprivation. What is the most likely finding ?
A. Poor appetite
B. Microcephaly
C. Normal
Development
D. Absence of cuddling response
```
D. Absence of cuddling response
92
4 year old boy has trouble with expressive language (at approx) 1.5 y.o level, no echolalia. Currently speaks only 50 words and is using 2 word phrases. His receptive language is good. Development otherwise normal. Builds 12 piece puzzle and house with LEGO. What is she most likely at risk for ?
```
A. Developmental disability/disorder
B. Difficulty with reading/reading disorder
C. ASD
D. ADHD
E. Pervasive developmental disorder
```
B. Difficulty with reading/ reading disorder
93
Child with expressive sleep delay. Parents should be encouraged to do all the following EXCEPT:
A. Read to him at night
B. Make him repeat incorrectly pronounced words over and over again
C. Make him stop his activity and look at you when you talk
D. Don’t complete his sentences
Answer B make him repeat
94
3 year old girl was normal developmentally for a while but has shown regression in the past year. Now she has microcephaly, and abnormal hand movement s.
A. Rett
B. Fragile x
C. Autism
A. Rett
95
What places infant are risk for SIDS ?
A. Exposure to environmental cigarette smoke
B .exposure to cold
A. Cigarette smoke
96
Which is true of ADHD?
A. Teacher and parent reporting of symptoms on a checklist frequently agree
B. Check for lead poisening in each kid with ADHD
C. 25% of kids with ADHD have comorbid anxiety disorder
D. Kids with ADHD often have thyroid hormone abnormalities
C. 25% anxiety disorders
Comorbid disorders
- LD: 15-25%
- language disorders: 30-35%
- anxiety disorders: 20-25%
- May also have sleep disorders, memory impairment, decreased motor skills
97
Which of these patients can give a valid consent:
A. Teenager who is currently drunk who was sexually assaulted 36h ago
B. Down’s syndrome with femur fracture
C. 14 y.o who wants an abortion
D. A patient who is hallucinating
E. Person who is unconscious who needs surgery
C. 14y.o wants an abortion
We have talked about consent in other subjects. Basically there is no age of consent, based on your assessment of whether or not they are mature enough to make that decision.
98
A baby can transfer a rattle hand to hand, sit with a rounded back using hands for support. What is his age ?
```
A. 3 months
B. 4 months
C. 6 months
D. 9 months
E. 12 months
```
C. 6 months
Nelson’s
- at 7 months sits with pelvis supported, leaning forward on hands with back rounded, babbles, transfers objects from hand to hand
99
Child who is 2 years old. Speaks 8 words. Points and gestures. Socially appropriate. What is the most likely diagnosis ?
A. Global developmental delay
B. Developmental language disorder
C. PDD
B. Developmental language disorder
- PDD no longer exists
- assuming that he has no motor delays because then it could also be GDD
100
Which is true regarding children in foster care:
A. In older kids, occasional visits with parents is warranted if child previously had developed a strong attachment to parents
B. Disruption of continuity of care may be potentially detrimental to all children (this was the exact wording)
C. If they are in a loving foster home for their first year of life, they will do well long term
D. Child should be placed with grandparents for best long-term outcome
B. Disruption in continuity of care
CPS - physicians should advocate for Perlman year planning including placement stability and personal intervention plans which establish a child or youth’s long- term life goals.
101
4 y.o sucks thumb while watching tv. What do you tell mom?
A. Put a bitter tasting substance on her thumbs
B. Reassure
C. Prescribe a mouth appliance
D. Implement behaviour modification with timeouts
B. Reassure
Normal in infancy and toddlerhood
102
```
What is true of a normal 9 month old child ?
A. Just acquired Palmer grasp
B. Says mama/dada and one other word
C. Has object permanence
D. Has name for objects
```
C. Has object permanence
A- palmar grasp starts at 4 months
B. Extra word at 12 months
D. Not till > 12 mo
103
What kind of car seat does a 10kg, 13mo baby need ? Where, what direction ?
A. Infant, back seat, facing back
B. Infant, back seat, facing front
C. Infant, front seat, facing front
D. Infant, front seat, facing back
B. Infant, back seat, facing front
104
Parents bring their son into the ER in the middle of the night. He had awoken screaming, was awake but non-responsive, then went back to sleep. You:
A. Reassure them and send them home
B. Order CT, EEG
C. Admit for observation
A. Reassure them and send them home
Night terrors
105
The most plausible theory of ADHD is that it occurs due to a dysfunction of which of the following neurotransmitters ?
A. Adrenaline
B. Dopamine
C. Glutamate
D. Serotonin
B. Dopamine
106
Among the following, the factor that would have the most adverse effect on the long-term prognosis of an 8 y.o boy who has a specific learning disability:
A. Adjustment reaction to parents divorce
B. Associated ADHD
C. IQ of 85
D. myelomeningocele at L5-S1
D. Myelomeningocele at L5-S1
- vast majority -95% have Chianti II malformation - abnormal spine and a small posterior fossa with descent of the brainstem and cerebellar tonsils.
107
An infant is speaking 6 words including mama and dada. He is also able to follow one-step commands without a gesture and can walk alone. He age is closest to:
A. 12mo
B. 15mo
C. 18mo
D. 21mo
B. 15mo
15months - 3-5 words, walks holding toy
12 months - points to desired object, follows 1 step commands with gesture
18 months - 10-25 words
108
A child brought to the clinic for a routine exam. She can dress with help, ride a tricycle, knows her own age, and can speak in short sentences. She had difficulties in copying a square.
A. 30mo
B. 36mo
C. 48mo
D. 60 mo
B. 36 mo (3y.o)
109
An infant moves his head from side to side while following a moving object, can lift his head from a prone position to 45 degrees, smiles when encouraged and makes coping sounds, cannot maintain a seated position.
A. 3mo
B. 5mo
C. 7 mo
D. Not enough information to conclude
A. 3 mo
110
Which of the following treatment to help reduce symptoms of colic?
A. Behavioural support to parents
B. Elimination of cow’s milk from the diet of the breastfeeding mother
C. Use of low lactose formulas in the bottle fed infants
D. Use of soy milk formula in bottle fed infants
A. Behavioural support to parents
111
7 y.o boy with last history of speech delay. His reading is now below a grade 1 level. Teacher thinks that he has ADD. What would be the most appropriate next step ?
```
A. Investigate for learning disorder
B. Psychotherapy
C. Behavioural therapy
D. Ritalin 5mg BID
E. Ritalin 20mg BID
```
A. Investigate for a learning disorder but also work up for ADHD questionnaire
112
A 10 y.o boy has headaches, abdominal pain, lethargy anytime of the day. He has missed 30 days of school in 4 months. He has:
A. Migraines
B. School phobia
C. Brain tumor
B. School phobia
113
6 y.o boy in grade 1 is not paying attention, disruptive, in danger of failing. He does not read or write as well as his classmates. Appropriate action:
A. Fail him
B. Full psychoeducational assessment
C. Ritalin
D. Classic slow learner
B. Full psychoeducational assessment
114
A mother brings her 1 y.o child for concern of head banging. Physical exam is normal. The parents are worried about brain damage. What should you do?
```
A. Reassure
B. EEG
C. CT head
D. Use a helmet to prevent head injury
E. Family psychological assessment
```
A. Reassure
Head banging beyond 3 years is unusual. You want to screen for autism.
115
A mother is concerned that her 3y.o child was able to speak 3-4 words sentences at 22 months of age but now she seems to be stammering a lot. What next:
A. Reassure
B. Audiology testing
C. Refer to SLP
D. Complete Neuro developmental assessment
E. Emotional disturbance can be the cause of stammering
Answer C. Refer to speech pathologist
Mom is concerned. Stuttering typically starts 2-5y.o, more in boys, don’t know why it happens
Don’t need psychoeducation or hearing testing but stuttering that isn’t resolved can have long-term effects on learning/academic performance and social situation.
116
You are asked to assess a child for autism. Which of the following statements would best support the diagnosis ?
A. Child takes toys from other children in the examining room
B. Child consistently displays a startle response to a ringing telephone
C. Child spends much of the examination spinning a wheel on a toy truck
D. Child brings each of the toys I got the exam room to show his mother
E. He looks at you during the interview
C. Child spends much of the examination spinning a wheel on a toy truck
117
All of the following are features of sleepwalking EXCEPT:
```
A. Occurs during stage 4 non-REM sleep
B. Positive family history
C. Can walk around furniture
D. Do not walk into dangerous areas
E. Resolve spontaneously in later childhood
```
D. Do not walk into dangerous areas
A- true - stage 4 non- REM
B- true - family history
C. True - can be found at parents bedside
D. false - go outside on winter nights
E. True most resolve by early adolescence
118
Which of the following is characteristic of RETT syndrome
A. Ataxia
B. Seizures
C. Head bobbing
D. Hand wringing
D. Hand wringing
119
Mother used IV heroin before and during her pregnancy. Her 10 month old child is now losing acquired milestones and developing bilateral spasticity. The most likely cause is:
A. HIV
B. CMV
C. Cerebral palsy
D. Syphillis
A. HIV
IV drug user - so think of something transmitted in that way
B- CMV - congenital infection - most are asymptomatic but end up with CP
C- cerebral palsy - not CP because not progressive and don’t loose milestones, just don’t gain them
D. Syphillis - onset <2years: hepatomegaly, jaundice, nasal discharge “snuffles”, rash, generalized lymphadenopathy, skeletal abnormalities
HIV encephalitis is a well known complication defined by one or more of the following:
A. Failure to attain dvlp milestones, loss of milestones, or loss of cognitive ability
B. Impaired brain growth or acquired microcephaly as determined by head circumference measurements, or brain atrophy demonstrated by CT or MRI
C. Acquired symmetric motor deficits manifested by two or more of the following: paresis, pathologic reflexes, ataxia, or gait disturbances
120
6 y.o with night terrors disturbing the whole family.
A. List 2 features that differentiate between night terrors and nightmares
B. List 2 differential diagnosis
C. List 2 non-pharmacological approaches for night terrors.
A. List 2 features that distinguish
1. Night terrors during stage 4 non-REM sleep and nightmares occur during REM sleep
2. Child does not remember night terrors but does remember nightmares
B. 2 ddx
1. Sleep association disorder
2. Sleep-wake transition disorder
C. 2 non-pharmaceutical tx
1. Good sleep hygiene
2. Waking 15 min before night terrors x 7 days
121
Girl who refuses to talk at school but talks at home perfectly well.
A. What is the diagnosis ?
B. What are 2 management options for her ?
A. Dx - selective mutism
B. 2 management options
1. Behavioural therapy
2. SSRI
122
Baby with flattening of right side of head.
A. Most important sign to distinguish btw positional and craniosynostosis
B. 3 things you can do
C. 3 limitations to using the helmet And
A. Most important differentiating factor
- Ear position
B. 3 things you can do
1. Tummy time
2. Physiotherapy to prevent torticollis
3. Re-positioning crib
C. 3 limitations to using helmet
1. Expensive/coverage
2. Time - needs to be on for significant amount of time to be effective
3. Side effects ie; skin irritation/pressure sores, infection
123
Mom of 3 year old boy telling him to swallow his toothpaste because she thinks it prevents caries.
A. Name 1 physical exam finding consistent with severe fluorosis
B. Name 1 indication for fluoride supplementation in a child over 6 months
A. Physical finding
- mottled enamel
B. Indication for fluoride supplementation
- living in area where water supply has no or little fluoride
124
14 y.o girl with CP has trouble with drooling. It is beginning to bother her at school.
A. What are 3 pharmacological treatments
B. What are three known side effects you should warn her about for these medications ?
A. 3 meds
1. Anticholinergics
- Glycopyrrolate
- Scopolamine patch
- Benztropine
2. Salivary glands botulinum neurtoxicin
3. Not a med but Surgery excision of sublingual
Gland
* not sure if naming 3 anticholinergics is acceptable as I couldn’t find any other meds
B. 3 side effects of these meds
- Antocholinergics = swallowing difficulties (xerostomia) + blurred vision + hyperactivity + constipation + urinary retention
- botulinum = fever, transient pain, local irritation/bruising
- surgery = Ranu Ka, dry mouth, difficulty swallowing, changes consistency of saliva
125
A 1 month old baby has been having poor weight gain, only about 5g per day. On exam, he has ankyloglossia but otherwise a normal physical exam. His mother reports that she is breastfeeding but having difficulties because he has a poor latch, slips off the breast, and also it is very painful for the mom. They have already seen a lactation consultant. What 2 things do you recommend for management ?
2 things for management
1. Express breast milk and offer by bottle till the issue is resolved, nipple shield
2. Referral for tongue toe release (frenotomy)
3. Oral examination of neonate and address underlying issue
CPS - benefits of frenotomy
- reduce nipple pain
- better latching
- Improve breastfeeding
Management
- usually conservative, requiring not intervention
- provide parents education and reassurance
- if complete tongue tie - and surgical procedure required - medical expert and proper analgesia
- frenotomy complications = bleeding, pain, infection or injury to Wharton’s duct, scarring and further limitation of tongue movement
126
Childhood toxic stress can lead to problems with mental health in adulthood.
A. Name 3 examples of toxic stress that a child may be exposed to
B. What is the relationship between toxic stress exposure and poor outcomes in adulthood ?
A. 3 examples
1. Exposure to domestic violence
2. Physical hostility, especially when it is directed toward children
3. Abusive bahviour (emotional and physical) towards the child
4. Caregiver mental heath problem
5. Caregiver substance use disorder
6. Chronic neglect
7. Burdens of family economic hardship
B. Rlt
- the more toxic stress the more it has a cumulative effect with increased risk of mental heath concerns ie; depression etc and decreased resilience
- decrease self esteem
- poor neurocognitive dvlp
- constant exposure to adrenaline rush and stress at home affect growth and dvlp.
127
List 6 things beside putting the baby to sleep on their back that decrease the risk of SIDS ?
1. Preventing exposure to tobacco smoke, before and after birth
2. Put infant to seep in a crib, cradle or bassinet that meets current Canadian regulations
3. Infants who share a room with parent/caregiver, sleeping in their own crib/bassinet
4. Breastfeeding provides a protective effect on SIDS
5. Pacifiers appear to provide protective effect for SIDS
6. Avoid overheating the infant
7. Avoid bumpers on crib, blankets or loose toys
8. Avoid sleeping on same bed with infant
128
You see an 18 month old boy with young parents. They are coming to you because he wakes up throughout the night, crying and screaming, and will only go to sleep with a bottle, in his mother’s arms, with soothing.
A. What are 5 recommendations you would make
5 recommendations for sleep onset association disorder
1. Put the child in bed to sleep while drowsy but awake
2. Avoid associations of sleeping for example bottle to bed or contact with caregivers
3. Set regular bedtime routine, avoid bedtime routine longer than 30 min
4. Encourage soothing activities prior to bedtime for example having a bath or reading a book
5. Reassure parents that majority of babies have periods of waking between sleep cycles and encourage them to teach the child to self- soothe back to sleep when it happens.
6. Avoid feedings overnight when age allows
129
A 14 month old boy is brought by his mother to your clinic for sleep problems. He wakes up several times during the night and needs to be fed a bottle each time. He only ever falls asleep in his mother’s arms.
A. What are 3 things you would do to improve this child’s sleep ?
1. Routine and sleep hygiene is very important
2. Allow babies to learn how to fall asleep on their own
3. Allow children to learn to sleep in their own crib
4. Recognition of REM sleep and “false awakening” explain parents about this
5. Avoid feeding sober night when age allows
6. Parents should put child awake
7. Travel or sickness may disrupt routine (especially in toddlers
8. 9-18 month separation anxiety can make things difficult
9. Use a transition object “blanket”, stuffed toy
10. Parents should leave the room - so child can fall asleep on own
11. Structure is best - always encourage a good bedtime routine
130
What are 4 strategies recommended by the CPS to prevent early childhood caries in First Nations/Inuit communities ?
4 strategies
1. Utilize motivational interviewing and anticipatory guidance for the parents and caregivers of infants and children on oral hygiene and diet
2. Promote the supervised use of fluoridated toothpaste in all Indigenous and other high- risk children after the first tooth has erupted (‘smear’ of toothpaste for infants and ‘green pea size’ for children )
3. Ensure that all Indigenous children have access to a) the series of fluoride varnish and b) an assessment to determine the need for sealant placement on deep grooves and fissures
4. Community heath nurses, family physicians, or paediatricians should perform oral heath screening during child heath assessments and provide referrals as needed to dents health providers
5. Provide women with preconception and prenatal screening for oral health, anticipatory guidance for oral health and hygiene, and referral for dental care if required.
131
Four features of dyslexia
1. Difficulty reading due to poor word recognition
2. Poor spelling and decoding abilities
3. Normal cognition and comprehension when read to aloud
4. Can be associated with secondary consequences such as reduced reading comprehension and reduced reading experience
Other
- difficulty understanding combination of phonemes
- have word finding difficulties, spoken word lacks fluency, mispronunciations
132
Child with ODD (they give you this)
A. What management would you suggest (2)
B. What 3 comorbidities are associated (3)
A. 2 management
- parent management training
- cognitive problem skills training
- social emotional skills training
```
B 3 comorbidities
- ADHD
- anxiety
Depression
Bipolar
PTSD
Substance abuse
Impulse control
Learning
Communication disorders
```
133
6 or 7 month old boy that his mother is concerned about his development. He rolls both sides, is unable to sit without support, he babbles and his mother thinks he is right handed because he crosses the midline to grab with his right hand when objects are on the left.
A. Of those findings what one thing is the MOST worrisome oh history ?
B. Explain why?
Handedness as can be a sign of CP
Rolls front to back - 4 months
Rolls back to front - 5 months
Inability to sit without support red flag at 9 months
Handedness - usually establishes by 3rd year. Early hand preference can be a sign of CP - hemiplegic CP
134
A 6 y.o old boy in grade ? Is brought to your office because the school says he is at risk for academic failure and wants him assessed for ADHD. In class, he is inattentive, occasionally defiant. What are 5 other things that would be on you differential for his presentation ?
1. Specific learning disability
2. Language disorder
3. Autism spectrum disorder
4. Hearing and visual impairment
5. Obstructive sleep apnea
6. Others: intellectual disability, emotional and behaviour disorders like oppositional defiant disorder, anxiety disorder
135
Name 5 characteristics of Rett syndrome
1. Normal development in the first year of life
2. Loss of speech
3. Loss of purposeful hand use and onset of stereotypical hand movements
4. Gait abnormalities
5. Deceleration of head growth (acquired microcephaly)
6. Seizures
7. Intermittent breathing abnormalities - sighing with intermittent periods of apnea/cyanosis
8. ANS dysfunction
9. Cardiac abnormalities- cardiac arrhythmias
10. Sleep disturbances
11. Autism
12. Feeding difficulties, poor weight gain
136
A 9 y.o boy with autism is on risperidone.
A. What are 5 possible side effects of risperidone?
B. What are 4 clinical or laboratory things you should monitor ?
A. 5 s/e of risperidone
1. Increased weight gain/overweight/obesity
2. Insulin resistance and hyperglycaemia
3. Hyperlipidemia
4. Hypertension
5. Galactorrhea
6. Others: sedation, EPS
B. 4 clinical or lab things to monitor
Clinical
- abdominal girth
- BMI
Lab
- Fasting blood sugar
- lipid profile - total cholesterol, fasting TG
Other
- height, weight
- BP
- EPS
- prolactin
137
3 year old single mom brings her 4y.o girl in because of concerns regarding her sleep. She says that she sleeps only 9-10h per night and does not nap anymore. The mom is upset because this used to be her quiet time. Also she sleepwalks sometimes.
A. What are 2 questions that you would ask to get a better sense of the sleeping pattern
B. What is your impression of this sleeping pattern
C. What is the most important thing to do regarding the sleep walking ?
A. 2 questions about sleeping pattern
1. What is her bedtime and quality of sleep - what is her sleep latency (troubles falling asleep), sleep interruptions or awakenings at night/difficulty getting back to sleep, and early terminations ? When did she stop napping?
2. What is her sleep environment (own room, co-sleeping or shared bed with parents, transition item, any fears) ?
B. Impression
- normal sleep pattern - only 26% of 4 y.o take a nap
C. Sleep walking
- safety of the child
- ensure gates are at top of stairs
- doors and windows are locked and secured
- install bedroom door alarms
138
A 7 y.o old boy fights when going to bed and takes an hour to fall asleep. What are five pieces of advice you would give the parents for improving sleep hygiene ?
5 sleep hygiene
1. Establish a regular bedtime routine
2. Consistent bedtime and wake up times both weekdays and weekends
3. Identify and eliminate any maladaptive associations
4. Eliminate screens (tv, phone, tablets, video games) from bedroom
5. Don’t send child to bed hungry - have a night time snack
6. Avoid products containing caffeine for at least several hours before bedtime
7. Make sure the child spends time outside everyday
8. Make the hour before bed shared quiet time. Avoid any high energy activities
9. Keep the bedroom quiet and dark
10. Make sure temperature is good
11. Don’t use bedroom for time out or punishment
139
A 9 y.o girl has a short temper, is argumentative, and disrespects her parents. What are 5 key features of a parenting plan for this child ?
1. Establish consistent rules that all caregivers follow
2. Identify negative behaviours that parents want to target interventions at instead of addressing all annoying behaviours: prioritize negative behaviours that harm self or harm others or property
3. Set reasonable and consistent limits
4. Parents should implement consequences immediately after a negative behaviour
5. Praise the child and catch them being good. Reinforce positive behaviour
6. Developing a warm supportive relationship with the child
140
A 6y.o is referred to you for school difficulties. He is previously healthy and was born at term. What information on history would help confirm your suspicion of reading disability (dyslexia)? They had 5 lines but did not specify how many points they wanted
1. Normal development in other domains
2. History of mistakes in spoken language (ie; mispronunciations, dysfluency)
3. History of avoiding reading and disliking reading
4. History of word finding difficulty or delay/inability to come up with and Ora response quickly when asked a question
5. Family history of dyslexia
6. Other: understands what others read to him
- reads slow
Or
1. Difficulty reading aloud
2. Difficulty with reading comprehension
3. Understanding when someone reads to him
4. Normal intelligence/cognition in other spheres of learning
5. Word finding difficulties, spoken word lacks fluency, mispronunciations (phonological processing)
141
Name 5 sleeping advice
Safe sleeping advice
1. Sleep in supine position (never prone)
2. Baby should sleep clothed in a light sleeper or blanket - avoid overheating
3. No crib runners, bumpers, soft objects, toys in crib
4. For the first 6 months, babies should co-sleep in the same room as their caregivers in a bassinet or crib that meets Canadian regulations
5. Do not share the same sleeping surface with an adult (ie; bed, couch)
6. Others: firm surface with tight fitting mattress, no waterbed, no tobacco smoking
142
You noticed that the community has a high rate of dental caries, what 5 things can you do at the community level to decrease dental caries ?
5 things
1. Fluoride in public water
2. Advocate for public dental screening programs for children (ie; in schools) so that early childhood caries can be identified earlier
3. Create public health campaign that educate parents about dental hygiene (ie; proper tooth brushing 2x daily with fluoridated toothpaste, avoiding sugary snacks)
4. Advocate for recruitment of more dental health professionals
5. Advocate to government for universal dental care coverage or programs that help lower income families seek dental care
6. Other: advocate for oral health for pregnant women
Or
1. Ensure that all children in their respective jurisdictions be afforded equal access to basic treatment and preventive oral care, regardless of where they live or their family’s socioeconomic status
2. Ensure that every child has a dental home by one year of age
3. Support the CPS and the Canadian dental association recommendations on fluoride supplementation
4. Create leadership positions to represent the specific interests of children and youth on oral health issues
5. Develop an ongoing surveillance system to capture key data and to reflect the state of pediatric oral health.
143
A 28 week prem is now 10 months old (chronologically). He is able to sit alone for 5min, is commando crawling,, can transfer objects hand to hand and can stand if supported. He does not have a pincer grasp.
A. What is his developmental level
B. How should you advise parents
A. 7-8 months
B. Appropriate for corrected gestational age
10 months old, 28weeks = 7 months cGA
```
Sitting without support - 6 months
Transferring objects hand to hand - 6 months
Stand if supported - 7-9 months
Pincer grasp - 9 months
Crawling - 6-9 months
```
144
Name 4 biological factors that influence a child’s development
1. Prenatal exposures (teratogens, drugs, alcohol)
2. Intrauterine infections (TORCH)
3. Prematurity
4. Genetic conditions ie: T21
5. Hearing/visual impairment
6. Illness/disease states (metabolic, neurologic)
7. Genetic potential
8. Congenital CNS malformations
9. Presence of seizure disorder
10. Postnatal illnesses ie; meningitis, traumatic brain injury
145
Teacher concerned about 4y.o child who can’t use scissors, can’t copy a square. She wonders about developmental coordination disorder. List 2 diagnostic criteria for developmental coordination disorder
1. Performance of coordinated motor skills is substantially below that expected given the child’s chronological age and opportunity for skill learning and use
2. The poor performance significantly and persistently interferes with activities of daily living appropriate to chronological age and impacts academic/school productivity, provocation and vocational activities, leisure and play
3. The symptoms began in early developmental period
4. The impairment in motor skills deficits are not better explained by intellectual disability or visual impairment and cannot be attributed to another neurological or neuromuscular condition affecting movement (ie; CP, muscular dystrophy, degenerative disorder)
Short version
1. Motor skills below that expected for age
2. Interferes with ADLs/play/school
3. Began early
4. Not better explained by another condition
146
5 things you would tell a boy to improve his sleep hygiene
1. Establish a regular bedtime routine (30-60min of winding down time before bed )
2. Regular bedtime and regular wake -up time - do not sleep in by more than 1 hour on weekends
3. Avoid caffeinated drinks after dinner time
4. Eliminate screens (tv, tablets, phones, computers) from the bedroom
5. Avoid high energy or vigorous activity before bedtime
6. Age appropriate number of hours in bed
147
School refusal: what three recommendations would you make ?
3 recommendations
1. Identify underlying etiology: bullying, separation anxiety, school work too difficult (ie learning disability)
2. Work with work with school personnel
To come up with a plan
3. Calmly send child to school and reward child for each completed day of school
4. If child calls to come home in the middle of the day, encourage child to stay at school (identify a safe quiet space where they can spend time)
5. CBT
148
Table of 5 different developmental milestones for an 18 month old. Mark as normal or abnormal:
A. Walked at 14 months, not yet doing stairs
B. Speaks a 2 word vocabulary
C. Follows 1 step command
D. Cries for wants but does not point to needs
E. Points to face but does not know any other body parts
A. Walked at 14 months, not yet doing stairs
- normal, red flag if not walking by 24 months, and stairs later
B. Speaks a 2 word vocabulary
- abnormal, by 18 months should have 6 words
C. Follows one step command
- normal, 12 months one step command with gesture and without gesture at 14-15 months
D. Cries for wants but does not point to needs
- abnormal, at 12 months should be pointing to get desired object
E. Points to face but does not know any other body parts
- Abnormal, should point to 3 body parts
149
Mom brings in her 6 month old child. Noted to not be using the left hand, and left arm and leg appear stiff., but unable to sit even with support. Otherwise looks well. What is your first management step ?
1st management step
| - MRI brain
150
List 3 criteria for autism that you would be able to identify in your office.
3 criteria for autism
1. Abnormal non-verbal communication (ie; poor eye contact)
2. Deficits in social-emotional
Reciprocity (ie; not back and forth conversation, reduced pointing/sharing of interest
3. Stereotyped/repetitive movements, use of objects or speech (ie; hand flapping, ordering toys, echolalia, opening/closing doors)
4. Highly restricted/fixated interests (ie; preoccupied with certain objects/parts of objects)
5. Increased/decreased response to sensory inputs (adverse response to certain sounds, excessive touching/spelling objects).
151
A kid brought into your office. Teachers feel he is inattentive at school, and has poor school performance. List 4 DDX:
4 DDX
1. ADHD
2. Hearing impairment
3. Learning disability
4. Intellectual disability
5. Psychosocial stressors at home
6. Depression
7. Substance abuse
152
A mother is concerned that her 7 month old baby is not sitting independently. She thinks that the baby is right handed and is able to transfer objects across the midline using her right hand. Do you have any concerns about this child’s development ?
Concerns
| - yes as already showing handedness and should not have preference until 2-3years of age
153
The parents of a 3 y.o girl what advice about toilet training. What are four signs of toilet readiness ?
4 songs of toilet readiness
1. Able to walk to potty chair
2. Stable while sitting on the potty
3. Able to remain dry for several hours
4. Receptive language skills allow the child to follow simple (one and two step) commands
5. Expressive language skills permit the child to communicate the need to use the potty with words or reproducible gestures
6. Desire to please based on positive relationship with caregivers
7. Desire for independence, and control of bladder and bowel function
154
What are four features of infantile colic ?
4 features infantile colic
The Rome III criteria for functional
gI disorders defines infantile colic as including all of the following in infants you get than 4 months of age
-paroxysm of irritability, fussiness or crying that start and stop without obvious cause;
- episodes lasting 3h or more per day and occurring at 3 days per week for at least one week; and
- no FTT
* must be in infants younger than 4 months
155
Description of a child with autism. His physical
| Exam is normal and he has no history of developmental regression. What are 3 tests you wild order ?
3 tests autism
1. Hearing screen
2. Microarray
3. Wood’s lamp exam
4. Fragile X
156
List 4 diagnostic features of Autism
DSMV autism
A. Persistent deficits in social
Communication and social interaction across multiple contexts, as manifested by the following, currently or by history:
1. Deficits in social- emotional reciprocity
2. Deficits in non-verbal communication behaviours used for social interaction
3. Deficits in developing, maintaining, and understanding relationships
B. Restricted, repetitive patterns of behaviour, interests, or activities, as manifested by at least 2 of the following, currently or by history :
1. Sterotyped or repetitive motor movements, use of objects, or speech.
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or non- verbal behaviour
3. Highly restricted, fixates interests that are abnormal in intensity or focus
4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment
C. Symptoms must be present in the early developmental period ( may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life)
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or GDD
157
A mom has brought her 2y.o son in for a regular visit. She has the following concern and asks for your advice: when she says “no” for whatever reason, he screams and hits her. There are other otherwise no concerns in behaviour or development. What are 3 recommendations you can give her ?
CPS statement: Effective discipline for children
1. Reinforce desirable behaviour
2. Apply rules consistently
3. Set reasonable and consistent limits
4. State acceptable and appropriate behaviour that is attainable
5. Time outs or withdrawal of privileges
158
A mom wonders if her autistic 2 year old daughter could have Retts. Name 3 characteristics of Retts (besides autism)
Main criteria
1. Partial or complete loss of acquired purposeful hand skills
2. Partial or complete loss of acquired spoken language
3. Gait abnormalities: impaired (dyspraxia) or absence of ability
4. Stereotypic hand movements such as hand wringing, clapping,
Mouthing/rubbing automatisms
159
Devlopmentally delayed child. Brother I special class. Maternal cousin has autism. Diagnosis and test ?
Fragile X ? Very hard to tell with this stem.
Investigations with the highest diagnostic yield in GDD
1. Microarray
2. Fragile X testing in boys with family history
3. MECP2 testing in girls
4. Metabolic - only if other symptoms or consanguinity
160
Picture of child (large ears, macrocephaly). He is hyperactive. 50th percentile for height and weight + 95th percentile for HC. Identify diagnosis ?
Fragile X
161
Description of child with florid autism
A. Name three tests you would order
B. Which two consultants or services would you involve to help you with your diagnosis ?
A. Three tests
1. Hearing and visual screen
2. Microarray
3. Fragile X
4. Wood’s lamp
Other: ADOS
B. 2 consultants
1. Developmental pediatrician
2. Psychologist or psychiatrist
162
Child comes to office because his teacher wants him investigated for disruptive behaviour and is concerned for ADHD. Parents may have some concerns about his attention but none about his behaviour
A. What do you think is the diagnosis ?
B. What are 4 things to request to investigate for this diagnosis ?
A. ADHD - concerned about his attention and disruptive behaviour - which could be from inattention or hyperactivity/impulsivity
B 4 things to investigate for diagnosis
1. History and developmental assessmen with physical exam: want to rule out - emotional or behavioural disorders (anxiety, depression, ODD, and conduct disorders)
-
Developmental disorder (LDs, language or other Neuro dvlp)
2. Questionnaires for parents and teachers
- Connors 3 questionnaire - gold standard
- SNAP IV and SWAN (free on internet)
3. Hearing and vision testing
4 Psychoeducation assessment
163
Description of night terrors. List two things to do for management.
```
2 things for
Management
1. Reassure
2. Anticipatory awakening
3. Rarely would need Benzo
```
164
10 month old with cerebral palsy. What are 3 signs/symptoms clinically that might confirm CP
3 signs/symptoms in CP at 10 months
1. Spasticity
2. Hyperreflexia
3. Delayed gross motor development
4. Handedness
165
Name 3 diagnostic criteria for ADHD -inattentive subtype and 3 for hyperactive/impulse subtype
A persistent pattern of inattention and/or hyperactivity- impulsivity that interferes with Functioning or development:
1. For children 6 or more symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level, and that negatively impacts directly on social and academic activities. Symptoms must not be solely a manifestation of ODD, defiance, hostility, failure to understand tasks or instructions. If over 17 needs 5
2. Present before age 12
3. 2 or more settings
4. Interferes with social/acedemic
5. Not attributed to other medical condition
Inattentive 6/9
1. Fails to pay close attention to details/careless errors
2. Lacks sustained attention
3. Does not seem to listen
4. Fails to follow through or does not finish
5. Disorganized
6. Avoids /dislikes homework
7. Loses things
8. Distractable
9. Forgetful
Hyperactive/ impulsive 6/9
1. Often fidgets of squirms in seat
2. Leaves seat what remaining seated is expected
3. Inappropriately runs around about/climbs
4. Difficulty with quiet leisure activities
5. “On the go”, driven by a motor
6. Talks excessively
7. Blurts out answers before questions are completed
8. Difficulty waiting turn
9. Interrupts or intrudes on others
166
Name 2 milestone in each of the following criteria for a 36 month old: 1 line each
```
Gross motor
Fine motor
Speech
Social
Self care
```
3 y.o
Gross motor- rides tricycle, balance on one foot
Fine motor - copies circle
Speech - 3-4 word phrases. 75% intelligible, 200+ words, knows name
Social - role playing, cooperative play
Self care - undresses, puts on shoes (without laces)
167
4 y.o child with symptoms of autism.
A. What is dx
B. What 2 neurological disorders are a/w this
A. Autism
| B. Fragile x, rett, tuberous sclerosis
168
Toddler with description of breath-holding spells. Your presumptive diagnosis is breath holding spells. What treatment if any would you recommend for mom
1. Reassurance - ignore breathholding and usually without reinforcement will
Disappear
2. Do not respond with punitive anger as can reinforce behaviour
3. Parents best advised to avert defiance by giving the child choices; once child has begun a tantrum, the child can be given a timeout. After it’s over tell
Child while frustration is understandable defiance isn’t
169
Parents bring 18 month old so. To see you because of concern for head banging. What treatment of any do you offer ?
Reassure, ignore behaviour, positive reinforcement for good behaviour
170
2019 Q: At what age are most children sure of their gender identity
A. 4
B. 6
C. 8
D. 10
A. Age 3-4
171
2019 question: 8y.o boy with 1 year history of worsening tics including blinking, lip smacking, tugging at his ears, clearing throat, other vocal tics. Very distressed by this and teased by kids at school. What do you do ?
A. Reassure
B. Refer for psychological assessment
C. Start alpha 2 agonist
D. Start a benzodiazepine
B. Refer for psychological assessment
- psychoeducation- habit reversal therapy
A reassure - not its bothering hiM
c. Alpha 2 agonist - only if severe
D. Benzo - no
172
2019 Q: school aged child, difficulty making friends, doesn’t get invited to birthday parties. Doing well academically. Has a very organized desk and gets upset with people when they touch it. Does not make eye contact with classmates
A. OCD
B. ASD
C. Social anxiety
D. ?
Not sure not enough info.
Going with B ASD - poor eye contact, difficulty making friends, gets upset when people touch desk
A. OCD - no mention of obsessions caisson compulsions
C. Social anxiety - could be this one but not sure why needs desk organized
173
2019 Q: 2 year old with stuttering. Speaks in 3-4 word sentences. What would make you most concerned ?
A. Pauses between words
B. Repeats full words
C. Repeats parts of words
D. Tension in face
D. Tension in face - indicates they are worried about it
174
2019 Q: 4 months old with eruption of 2 new teeth, what do you do ?
A. Brush with water only
B. Brush with fluoride toothpaste
C .send to dentist now and every 6 months
D. Discontinue night time feed
B. Brush with fluoride toothpaste
A. Brush with water only- some sources say this is ok too
C. Send to dentist now and every 6 months - no it’s around 12 months
D. Discontinue night time feeding - your for that
175
2019 Q: A 10 year old boy with ADHD and is stable on stimulants for 2 years. He presents with increased aggressive behaviour and difficulty following limits. His seep and appetite are otherwise normal. After ruling out psychological stressors. Which of the following is the most appropriate action ?
A. Increase his stimulant dose
B. Use Benzo PRN
C. Add atypical antipsychotic
D. Add an SSRI
A. Increase his stimulant dose- can’t find the source for this
Why can’t it be C. Atypical antipsychotic ?
176
2019Q: 10 year old boy with poor school performance, behaviour issues and decreased attention who was diagnosed with ADHD by his family doctor and not responding to stimulants. What are 4 other possible causes of his symptoms ?
4 ddx
1. Learning disorder
2. Intellectual disability
3. ODD
4. Anxiety
5. ASD
6. Genetic disorder
177
2019Q: name 3 differences between regular childhood tantrums and tantrums experienced by children with autism spectrum disorder.
1. Goal Oriented vs overload/lol overwhelmed by sensory input/information or change in routine
2. willfull behaviour showed by rewarding desired behaviours and decreases with age vs meltdown can occur across lifespan and don’t go away
3. Tantrums need an audience and stops when ignored vs tantrums occur in autism when alone - response to external stimulus
