0
Q
Gold standard for autism diagnosis
A
ADOS and ADI-R scales
1
Q
3 main features of autism
A
- Limited range of interests
- Deficits in reciprocal interactions
- Deficits in verbal/nonverbal skills
2
Q
Good prognostic signs in autism
A
Performance IQ >70
Speech by age 5
Highly structured environment
3
Q
What is Rhett’s?
A
A subtype of autism:
- Significant developmental regression
- Deceleration of head growth
- Loss of social engagement
- Deficiency of language/social skills
- MR
4
Q
- Normal for first several years of life
- Regression in 2+ areas before 10 years
- Looks like autism
A
Sensory Disintegration Disorder
6
Q
Hallmark of Asperger’s
A
Social skills not appropriate, academically better
7
Q
A child can perform all of the following:
- stack 2 blocks
- name one body part
- walk
- follow a simple command without gestures
How old are they?
A
24 months
8
Q
“Most children”
A
75-90%
9
Q
“Age is closest to”
A
75-90%
10
Q
“All children”
A
Answer one age group older
11
Q
“Some children”
A
Answer one age group younger
12
Q
Typical HC growth
A
- Birth = ~35cm
- 0-3 months = 2cm/month
- 3-6 months = 1cm/month
- 6-12 months = 0.5cm/month
- 1 inch between 2 and 12 years
13
Q
Typical weight gain
A
- Birth 3-3.5kg
- Regain by 2 weeks
- Double by 4 months
- Triple by 1 year
14
Q
How gross motor proceeds
A
Hed to toe
15
Q
How fine motor development proceeds
A
Proximal to distal
16
Q
When do primative reflexes disappear
A
3-9 months of age
17
Q
When do postural reactions develop
A
Between 3-10 months of age, coinciding with motor skills
18
Q
- Head hangs down in ventral suspension
- Head lag when pulled to sit
- Turn head to side
- Moro, stepping, grasp reflexes
A
Newborn
19
Q
- Head in line with body in ventral suspension
- Lifts head 45 degrees when prone, arms extended
- Follows object past midline
A
2 months
20
Q
- Lifts head to 90 degrees when prone
- Chest up, supported on arms when prone
- No head lag when pulled to sit
- Rolls prone to supine
A
4 months
21
Q
- Chest up, supported on hands, when prone
- Rolls supine to prone
- Sits with support (no support by 7 months)
A
6 months
22
Q
- Gets into sitting position
- Crawls
- Pulls to stand
- May cruise (10-11mo)
A
9 months
23
Q
- Takes a few steps with hand held
- May stand without help or walk independently
A
12 months
24
Q
- Swipes at objects
- Hands open
A
3 months
25
- Hands in midline
| - Grasps objects and brings to mouth
4 months
26
- Transfers objects hand-hand
| - Reaches unilaterally, raking grasp
6 months
27
- Early pincer grasp
| - Eats with fingers
9 months
28
- Mature pincer grasp
| - Releases object voluntarily
12 months
29
- Coos
2 months
30
- Orients to voice
| - "Ah-goo"
4 months
31
- Babbles
6 months
32
- Mama, dada non-specifically
| - Responds to name, no
9 months
33
- Mama, dada specifically
- Immature jargoning (no real words)
- One or more words with meaning
- Understands commands with gestures
12 months
34
- Social smile
| - Regards face
2 months
35
- Laughs
4 months
36
- Start of object permanence
| - Prefers mother, stranger anxiety
6 months
37
- Object permanence: looks over edge
- Plays peek-a-boo, pat-a-cake
- Wave bye-bye
- Uncovers hidden object (10mo)
9 months
38
- Plays simple games
| - Takes pride in accomplishments
12 months
39
- Walks well
| - Walks backwards
15 months
40
- Walks backwards
- Runs clumsily, falls often
- Walks pushing or pulling toys
18 months
41
- Runs well, wide-based gait
24 months
42
- Walks on tiptoes
| - Tandem walks forward
4 years
43
- Tandem walks backwards
| - Skips, alternating feet
5 years
44
- Crawls up stairs
15mo
45
- Walks up stairs with hand held
| - Two feet per step
18mo
46
- Climbs up and down stairs alone
| - Two feet per step
24mo
47
- Climbs up stairs alternating feet
3 years
48
- Climbs down stairs alternating feet
4 years
49
- Sits self in chair
18mo
50
- Kicks ball forwards
- Jumps in place, jumps off step
- Stands on one foot momentarily
24mo
51
- Stands on 1 foot 1-2seconds
- Hops 2-3 times
- Broad jump
3 years
52
- Stands on 1 foot 3-5 seconds
| - Hops 5 times
4 years
53
- 2 cube tower
15mo
54
- 3-4 cube tower
18mo
55
- 6-7 cube towers
24mo (2+4 = 6 cubes)
56
- 8 cube tower
| - Imitates train with chimney
30mo
57
- 9-10 cube tower
| - Imitates bridge with 3 cubes
3 years
58
- Imitates gate
4 years
59
- Imitates steps
5-6 years
60
- Scribbles spontaneously
| - Imitates a stroke
18mo
61
- Imitates vertical and circular strokes
24mo
62
- Imitates horizontal strokes
30mo
63
- Copies circle
3 years
64
- Copies cross
4 years
65
- Copies square
4.5 years
66
- Copies triangle
| - Prints a few letters
5 years
67
- Copies diamond
6 years
68
- Takes off gloves, socks, shoe
18mo
69
- Can put on some clothes
24mo
70
- Dresses with supervision
| - Unbutton
3years
71
- Dresses without supervision
| - Buttons
4 years
72
- Can tie shoelaces
5 years
73
- Uses covered cup with little spilling
15mo
74
- Handles spoon well for solids
18mo
75
- Uses spoon well for semi-solids
24mo
76
- Eats neatly with spoon and fork
3 years
77
- Spreads with a knife
5-6 years
78
- Starting to cut food with the knife
7 years
79
- 2-3 words
| - Immature jargoning
12-13mo (1+2=3)
80
- 4-6 words
15mo (1+5=6)
81
- 7-20 words
| - Mature jargoning
16-17mo (1+7=8)
82
- 50+ words
| - 2 word sentences
21-24mo
83
- Pronouns (appropriately used)
| - Telegraphic speech
30mo
84
- 250+ words
- 3-4 word sentences
- Plurals
- Present tense
3 years
85
- 4-6 word sentences
| - Past tense
4 years
86
- Follows 1 step command without gestures
| - Finds one body part
15mo
87
- Knows 5+ body parts
| - Names pictures or common objects
18mo
88
- Follows 2 step command
24mo
89
- Knows sex, first and last name
| - Understands 2 prepositions
30-36mo
90
- Names 3-4 colors
- Counts 5-10
- Understands 4 prepositions
- Understands opposites
4 years
91
50% Intelligibility
2 years (2/4 = 50%)
92
75% intelligibility
3 years (3/4 = 75%)
93
100% intelligibility
4 years (4/4 = 100%)
94
What milestones are most predictive of developmental problems?
Language milestones
95
Parental concerns about development identify __ % of children who fail screening tests.
80%
96
Physician's judgement alone identifies < __ % of children with significant developmental delays.
50%
97
AAP recommends developmental screening at these well visits
9mo, 18mo, 30mo (or 24mo)
98
What is developmental quotient
Developmenatal age/chronological age X 100
**Does not coorelate with IQ**
99
Language Delay differential diagnosis
- Hearing loss
- Mental retardation
- Developmental language delay
- Autistic-spectrum disorders
- Dysarthria (due to CP etc)
- Psychosocial deprivation
- Stuttering
- Selective mutism (situational, due to anxiety)
100
- 9mo, no response to name
- 10-12mo, not babbling
- 15mo, does not respond to "no" or "bye bye"
- 18mo, no words other than mama, dada; does not point to wants
- 24mo, no 2 word phrases or 2 syllable words; does not understand simple commands
Warning signs for language delay
101
- 36mo; speech not fully intelligible to family; not using pronouns and verbs; no simple sentences; echolalia still present
- 4 years; speech not fully intelligible to strangers
- 5 years; persistent stuttering, frequent letter substitution
- 6 years; speech errors other than s, ch, sh, z, j, v, th, zh
- 8 years; any speech errors
Warning signs for language delay
102
Percentage of SNHL that has a genetic etiology
50% - most common mutation in Connexin 26 gene on chromosome 13
- 80% AR, 18% AD, 2% X-linked
- 2/3 without other abnormalities
103
Most common cause of conductive hearing loss
OME
104
26-40dB
mild hearing loss
| - difficulty with whispers, misses up to 50% speech
105
41-55dB
moderate hearing loss
- misses 50-100% of speech
- often poor voice and speech quality
- hearing device required
106
56-70dB
moderate-severe hearing loss
- loud shout heard as whisper
- needs hearing aids, educational interventions
107
71-90dB
severe hearing loss
| - may have difficulty with hearing aids
108
>90dB
profound hearing loss
- feels vibrations only, does not hear
- relies on vision for communication
109
IQ 55-69 (2SD < mean; mean 100, SD 15)
mild MR
110
IQ 40-54 (3SD < mean)
moderate MR
111
IQ 25-39 (4SD < mean)
severe MR
112
IQ < 25 (5SD < mean)
profound MR
113
- Sudden deterioration in language (receptive, then expressive) at 3-7 years old
- EEG abnormalities (temporal lobe spikes, sharp waves)
- 80% with clinical seizures
- Rx: high-dose steroids, IVIG, anticonvulsants, surgery
Landau-Kleffner Syndrome
114
In this syndrome verbal skills < cognitive function
Down's Syndrome
115
These syndromes may present first with language delays
Klinefelter's, Fragile X
116
This syndrome may have language delay noted early, but eventually verbal skills > cognitive function
William's Syndrome
117
- Physiologically active (increased HR and HR)
- Generalized loss of activity in large muscles
- EEG: low voltage, fast, dysynchronous
- Low threshold to stimuli
- Dreams occur here
REM sleep
118
- This sleep had 4 stages
1. drowsiness, head nodding
2. sleep spindles, K complexes, HR, RR, eye movements slowed, easily awakened
3. 20-50% delta waves (high voltage, slow waves)
4. >50% delta waves, difficult to awaken
Non-REM Sleep
119
Phase of sleep where parasomnias occur
Non-REM (deep) sleep
120
Most of this phase of sleep happens in first 1/3 of night
NREM
121
Most of this phase of sleep happens in last 1/2 of night
REM
122
Percentage of infants that sleep through the night by 9 months
70%
123
Learned sleep associations
Sleep Onset Association Disorder
124
Treatment of sleep onset association disorder
- Putting infant to bed "drowsy but awake"
- Ignoring ("cold turkey")
- Graduated extinction
- Scheduled awakenings
- Use of transitional objects
- Wean nighttime feedings ("learned hunger")
**Often gets worse before it gets better
125
- Occur within 1-2 hours after sleep onset (partial awakenings from deep sleep)
- Present in 3% of 4-12 year olds
- Varies in severity from confusion (infant) to terror (older child)
- Precipitated by stress, illness, sleep deprivation
Night terrors
126
- First 1/3 of night
- Age 4-12yrs
- Stage IV sleep
- Confused, agitated
- Not consolable
- No recall
Night terrors
127
- Second 1/2 of night
- Peak 3y-6y (all ages)
- REM sleep
- Upset but awake
- Consolable
- May recall
Nightmares
Pediatric Board Review
flashcards
Decks in class (17)
# Cards
-
Cardiology36
-
Syndromes104
-
Hematology-Oncology132
-
Pulmonary18
-
Orthopedics5
-
Infectious Disease76
-
Poisoning71
-
Neonatology/Critical Care121
-
General Pediatrics51
-
Gastroenterology90
-
Development/Behavior127
-
Endocrinology107
-
Miscellaneous81
-
Nephrology64
-
Allergy/Immunology59
-
Neurology80
-
Adolescent19
