neurology and psychiatry

Question 1

what is reactive attachment disorder

Answer 1

Markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before 5 years

Question 2

risk factors for reactive attachment disorder

Answer 2

adverse childhood events
orphaned at a young age

Question 3

what are the 2 main subtypes of reactive attachment disorder

Answer 3

inhibited and disinhibited

Question 4

what is inhibited RAD

Answer 4

children who continually fail to initiate and respond to social interactions in a developmentally appropriate way

Question 5

give an example of inhibited RAD

Answer 5

a child or infant that does not seek comfort from a parent or caregiver during times of threat, alarm, or distress

Question 6

what is another name for disinhibited RAD

Answer 6

disinhibited social engagement disorder

Question 7

what is disinhibited RAD

Answer 7

a child who has an inability to display appropriate selective attachments

Question 8

co-morbid disorders of RAD

Answer 8

emotional disorders, ADHD, behavioural disorders

Question 9

investigations for reactive attachment disorder

Answer 9

strange situation (1-2 yrs)
modified strange situation (2-4yrs)
story stem attachment profile (4-7yrs)
child attachment interview (7-15) or adult attachment interview

Question 10

management of RAD

Answer 10

parental sensitivity and behaviour training
psychotherapy/CBT for those who have been maltreated

Question 11

what is conduct disorder

Answer 11

repetitive and persistent pattern of behaviour in which major age-appropriate norms or roles are violated

Question 12

what is conduct disorder referred to in younger children

Answer 12

oppositional defiant disorder

Question 13

what are some causes of conduct disorder

Answer 13

brain injury
family circumstances - ACEs
parenting style - inconsistency and lack of rules

Question 14

what are the 2 main types of conduct disorder

Answer 14

mild-moderate and severe

Question 15

mild-moderate conduct disorder

Answer 15

behaviour is restricted to the family environment

Question 16

what are the 2 types of severe conduct disorder

Answer 16

unsocialised and socialised

Question 17

socialised conduct disorder

Answer 17

more covert antisocial acts or better ability to avoid getting involved with the police

Question 18

unsocialised conduct disorder

Answer 18

predominantly violent behaviour and more likely to be dealt with by the police

Question 19

name some comorbidities of conduct disorder

Answer 19

ADHD
RAD
learning difficulties
depression
substance misuse
deviant sexual behaviour

Question 20

diagnosis of conduct disorder

Answer 20

3 of the following in the last 12 months with one in the last 6 months
- Aggression to people or animals
- Destruction of property
- Deceitfulness or theft
- Serious violation of rules

Question 21

pharm management of conduct disorder

Answer 21

risperidone for extreme impulsivity and aggression
SSRIs for depression

Question 22

cerebral palsy

Answer 22

permanent neurological problems resulting from damage to the brain around the time of birth

Question 23

antenatal causes of cerebral palsy

Answer 23

maternal infections
trauma during pregnancy

Question 24

perinatal causes of cerebral palsy

Answer 24

birth asphyxia
pre-term birth

Question 25

post natal causes of cerebral palsy

Answer 25

meningitis severe neonatal jaundice head injury

Question 26

what is duchennes muscular dystrophy

Answer 26

a genetic disease what causes muscle weakness and wasting

Question 27

inheritance seen in duchennes muscular dystrophy

Answer 27

x-linked recessive

Question 28

pathophysiology of duchennes

Answer 28

defective gene for dystrophin on the x chromosome

Question 29

when do people present with duchennes

Answer 29

3-5 years

Question 30

clinical presentation of duchennes

Answer 30

delay fatigue, difficulty getting up from the floor, walking or talking

Question 31

name 2 typical features of duchennes

Answer 31

progressive lordotic posture with marked arching of the back calf pseudohypertrophy

Question 32

what is gowers sign

Answer 32

Children with proximal muscle weakness use a specific technique to stand up from a lying position

Question 33

investigation prior to genetic testing for duchennes

Answer 33

creatine kinase > 10,000

Question 34

management of duchennes

Answer 34

physio steroids surgery ventilatory support

Question 35

inheritance in spinal muscular atrophy

Answer 35

autosomal recessive

Question 36

genetics of spinal muscular atrophy

Answer 36

deletion/mutation of both SMN1 genes on 5q

Question 37

what is affected by spinal muscular atrophy

Answer 37

proximal legs

Question 38

pathophysiology of spinal muscular atrophy

Answer 38

↓SMN protein in spinal cord → degeneration of motor neurones

Question 39

clinical presentation of spinal muscular atrophy

Answer 39

hypotonia progressive weakness bulbar and intercostal weakness

Question 40

investigation for spinal muscular atrophy

Answer 40

genetic testing for SMN1+2

Question 41

what are the 3 main areas of development affected by autism

Answer 41

social interaction communication behaviour