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Developmental Notes Flashcards

1
Q

What are the characterizations of cerebral palsy? Diagnostic test?

A

motor dysfunction w/ variable impact on other domains

MRI is diagnostic test-shows periventricular leukomalacia.

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2
Q

Spastic diplegia is a form of what?

A

cerebral palsy

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3
Q

What are the 3 domains where you might see delay in autism?

A

social: best indicator: no pointing, looking back
language: echolalia, delays, scripting
behavioral: specific routines, rituals, hand flapping

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4
Q

When do you do MCHAT screening?

A

18-24 mo

failure means that you need some further screening.

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5
Q

Red flags for autism?

A

no babbling by 1 year
no 1word by 15 months
no 2 word sentences by 2 years
or loss of language/social skills

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6
Q

What is the adjunct workup for autism?

A

hearing test
lead level
genetic testing (fragile x)
EEG/MRI

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7
Q

Treatment for sleep issues or anxiety?

A

hydroxyzine H1 antagonist

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8
Q

What is Asperger’s?

A

autism spectrum disorder w/o language impairment
social interaction is professorial or pedantic.
social difficulties

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9
Q

Rett disorder?

A

normal development until 5 months
then decreased head growth and loss of previous learned motor skills 5mo-30mo
then hand wringing or washing will begin

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10
Q

What is the abnormal workup for Rett disorder?

A

EEG abnormal
MECP gene
only seen in females
monozygotic twins 100% concordance.

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11
Q

what are the 3 domains to consider in ADHD? what are the requirements for diagnosis?

A

domains: inattention, hyperactivity, impulsivity
>6 symptoms in 2 or more settings for at least 6 mo
before age 12

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12
Q

What is one thing that has to be ruled out in ADHD diagnosis?

A

lead poisoning

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13
Q

What is the definition of intellectual disability?

A

IQ

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14
Q

What is the number genetic cause of ID?

A

Trisomy 21

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15
Q

What are the features of Down’s syndrome?

A 
heart defects: AV defect, VSD, ASD
GI: duodenal atresia, constipation, Hirsphrung's
cryptochordisim
hypothyroidism
neonatal hypotonia
visual hearing issues
atlanto-axial instability
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16
Q

what is cryptochordism?

A

no testes in the scrotum

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17
Q

What are the features of hypothyroidism in down’s syndrome?

A

prolonged jaundice
hypotonia
constipation
macroglossia

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18
Q

What are some of the physical features of down’s syndrome?

A 
brushfield spots (grey spots on iris)
microcephaly
epicanthal folds
upward slanting palpebral fissures
wide spaced toes
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19
Q

What are some of the consequences of atlanto-axial instability in down’s syndrome?

A

compression of spinal cord
torticollis (head persistently turned to one side)
urinary incontinence
vertebrobasilar symptoms (spasticity, hyperreflexia, + babinski sign)

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20
Q

What is the 2nd most common genetic cause of intellectual disability? Most common inherited form of ID?

A

Fragile X

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21
Q

What are the features of Fragile X?

A 
large jaw
long face
large testicles
big ears
big hands
FMR1 trinucleotide expansion
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22
Q

In female carriers of Fragile X… higher rates of what?

A

psychiatric disorders

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23
Q

What’s the deal with Prader-Willi?

A 
Mom takes over. Dad deletion of chromosome 15
overweight pt, hyperphagia
almond-shaped eyes
hypogonadism
hypotonia
argumentative, aggressive
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24
Q

What’s the deal with Angelman syndrome?

A

Dad takes over, Mom deletion of chromsome 15
Happy puppet
inappropriate laughter, jerky movements, seizures, ataxia

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25
What's the deal with Williams syndrome?
``` elfin facies well developed verbal skills hypercalcemia (too much santa milk) extreme friendliness with strangers like will ferrell ```
26
What's the deal with tuberous sclerosis?
seizures | angiofibromas
27
What are the features of FAS?
microcephaly smooth philtrum thin upper lip ID
28
What is oppositional defiant disorder?
less bad than conduct disorder frequent loss of temper arguments with adults annoying people, anger, resentment
29
What is conduct disorder?
antisocial personality disorder for children | persistent violation of the rights of others
30
What is disruptive mood dysregulation disorder?
severe pervasive irritability and poor frustration tolerance temper outbursts unlike ADHD, no hyperactivity, inattention, disorganization
31
What are the requirements for tourette's?
multiple motor tics and at least one vocal tic onset before age 18 tic free period
32
What brain changes do you see in Tourette's?
impaired regulation of dopamine in the caudate nucleus
33
What is the treatment for tourette's?
atypical antipsychotics clonidine is first line alpha 2 agonists or guanfacine pimozide
34
How do you make the diagnosis of enuresis?
must be older than age 5 at least 2 episodes/wk, 3+ months have to workup with UA-r/o DM, infections. Need to make sure no clinical suspicion for seizures.
35
What is the treatment for enuresis?
enuresis alarm desmopressin TCAs oxybutynin (muscarinic receptor antagonist-for daytime incontinence)
36
What are breath-holding spells?
can be associated with iron deficiency anemia (think of iron man competitor swimmer holding breath) sometimes after crying. workup includes CBC, ferritin.
37
Freud's 0-18 mo?
oral stage sense of security and basic trust of others failure of this stage: urgent demands, extreme dependence, lack of consideration for others, very low tolerance for frustration
38
Freud's 1.5-2.5 yr?
anal stage control over bodily needs success: control, independence, pride failure: problems with self control and rigid behavior patterns. likes ordliness.
39
Freud's 2.5-4yr?
phallic stage explore world autonomously success: stable sense of self-worth
40
Freud's 4-6 yr?
oedipal develops special relationship with same sex parent failure: guilt anxiety, depression, phobias, anxieties perfectionism, hysteria
41
Freud's 6-12 yr?
Latency kids learn to interact with ppers identify with same sex failure: poor social skills, ostracism
42
Freud's teen years?
adolescence | personal identity
43
Erikson's 0-18 mo?
Infancy Trust v. Mistrust
44
Erikson's 2-3 yr?
Early Childhood autonomy v. shame personal skills and self control
45
Erikson's 3-5 yr?
Preschool initiative v. guilt children assert control over their environment success: sense of purpose
46
Erikson's 6-11 yr?
School age industry v. inferiority success: competence
47
Erikson's 12-18 yr?
identity v. role confusion
48
Erikson's 19-40 yr?
intimacy v. isolation
49
Erikson's 40-65 yr?
generativity v. stagnation
50
Erikson's >65 yr?
ego integrity v. despair
51
Children should triple their weight by which year?
year 1
52
What is constitutional growth delay?
bone age
53
What is familial short stature?
bone age=real age | both parents are short
54
What are some developmental questionnaires?
Ages and stages PEDS Denver II
55
When should you do a screening H&H?
12 months | iron intake may be deficient
56
Vision screen and hearing screen when?
vision-3 | hearing-4
57
See dentist when?
first tooth eruption or by age 1
58
Lead screening when? BP screening when?
lead-6 months bp age 3
59
Milestones for 2 mo?
- smiles - looks @ parent - visual tracking across midline - holding head up steadily - coos, gurgles - pushes up on tummy
60
Milestones for 4 mo?
- sits with support - reaches for objects, pushing up on arms - plays - copies facial expressions - babbles - pushes down on legs - rolls tummy-back - check lower milestones too.
61
Milestones for 6mo?
- ah eh oh - knows name - “m”, “b” babbles - passes object from one hand to the other - curiosity - rolls both ways - stranger anxiety - sits on its own - crawls a little - pincer grasp
62
Milestones for 9 mo?
- mama, dada - stranger anxiety - finger points - knows a few words - object permanence: peek a boo - stands holding things - crawls
63
Milestones for 12 mo?
- stacks 3 cubes - separation anxiety - walking - parallel play - drinks from cup - waves bye, shakes head - copies words - brushes hair
64
Milestones for 18 mo?
- remove some clothing - speak six words - copies others - able to name common objects 1 word at a time - 2-4 block towers
65
Milestones for 2 yrs?
- 2 word phrases, 200 words, 50% understandable - throw a ball, kick a ball - jumping - stairs - follows 2 step commands - hops - imitates - brushes teeth
66
Milestones for 3 yrs?
- 3 word sentences - rides a tricycle - draws a circle - 1000 words - friend affection - dresses and undresses - first name, age, sex - 6 block tower - make believe - uses utensils
67
Milestones for 4 yrs?
- draw a square - hop - colors, numbers - cooperative play, board games - stories - scissors
68
What are the guidelines for eating for infants?
breast feeding: 8-12X/d for 10-20 min formula: 4-6 oz q3h by 2mo, 6-8 oz q6-8 h by 6 mo + table foods 9mo-75% of calories from breast milk/formula use cup by 1 year, cow's milk can start then
69
T/F it is okay to use a feeding bottle at 2 yo?
False. increased risk for dental carries
70
Vit D supplement started when?
week 1 of life in infants who are exclusively breastfed.
71
Meconium should be seen by what age?
24-48 hours
72
How does the frequency of meconium vary when pt is formula fed v. breastfed?
formula fed: 4-5 stools/d | breastfed: 1 stool/d
73
How many wet diapers of urination should be produced per day?
first week of life-# of days alive=# of diapers/d | ~6/d for infants
74
What are the expectations for sleeping for infants?
after 4-6 mo: sleep thru the night | by 9 mo->sleep 11 hrs with 1-2 naps/d
75
Weight gain expectations?
15-30 g/d for 2mo then 15-20 g/d for 3 mo then 10-15 g/d for 6-12 mo double body weight by 5 mo, triple by 12 mo
76
When should the primary series of vaccines be completed by? Influenza started?
Primary series completed by no later than 24 mo | influenza started at 6 mo
77
When should you use a rear facing car seat?
until 2yo or until they reach max height and weight 40-50 lb-booster seat with belts. until about 4'9" or 12 yo teenager to ride in the front seat
78
What is considered pubertal delay in girls?
lack of breast development by 14 lack of period by 16 >5 years from initial breast tissue to menarche
79
What is considered pubertal delay in boys?
no testicular enlargement by 14 | >5 yrs from initation to completion of genital development
80
What are the stages for boys puberty development?
``` growth of testicles pubic hair growth of penis and scrotum first ejaculations growth spurt attainment of adult height (17) ```

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