Pediatric

Question 1

What is Intellectual Disability Disorder?

Answer 1

Disorder of cognitive, social and practical functioning

Question 2

Often, there is no identifiable cause for Intellectual Disability Disorder, but what are some common associations? (3)

Answer 2

Fetal Alcohol Syndrome - preventable
Down Syndrome - chromosomal
Fragile X - inherited

Question 3

With Intellectual Disability Disorder, patients will have deficiencies in 1 or multiple domains?

Answer 3

Multiple = IQ and Adaptive functioning

Question 4

The severity of Intellectual Disability Disorder is no longer based on the low IQ but the?

Answer 4

Level of support required for ADLs (activities of daily living)

Question 5

What is the treatment for Intellectual Disability Disorder?

Answer 5

Special education and social skills classes
Education about prevention/prenatal screenings

Question 6

What characterizes Autism?

Answer 6

Impaired social communication + Restricted behavior/interests

Question 7

What characterizes Autism?

Answer 7

Impaired social communication + Restricted behaviors/interests

Question 8

List examples of impaired social communication with Autism

Answer 8

Impaired socialization, empathy, relationships, ability to understand social cues and low eye contact

Question 9

List examples of restrictive behavior/interests with Autism

Answer 9

Fixated interests, inflexibility to change, altered response to sensory input

Question 10

Hand flapping can be present with Autism, what is another syndrome that can have hand-wringing movements and describe it?

Answer 10

Rett Syndrome
= Normal development –> regression + hand-wringing

Question 11

ADHD has 2 domains of symptoms. What are they?

Answer 11

Inattention
Hyperactivity/Impulsivity

Question 12

List some inattention symptoms with ADHD

Answer 12

Poor attention to detail, short attention span, difficulty following and completing tasks

Question 13

List some hyperactivity symptoms with ADHD

Answer 13

Fidgets, interrupts, talks excessively, cannot sit still

Question 14

At what age must ADHD present before?

Answer 14

Usually before 12/13 years old

Question 15

How long must symptoms of ADHD be present and what is the other major caveat for diagnosis?

Answer 15

Symptoms > 6 months
Must be present in > 2 settings - home, school, etc.

Question 16

How long must symptoms of ADHD be present and what is the other major caveat for diagnosis?

Answer 16

Symptoms > 6 months
Must be present in > 2 settings - home, school, etc.

Question 17

If the child with ADHD is less than 6 years old, what is the best treatment?

Answer 17

Behavior therapy

Question 18

If the child with ADHD is greater than 6 years old, what is the best treatment?

Answer 18

Stimulants + behavior therapy

Question 19

What is the first line drug class for ADHD?

Answer 19

Stimulants
ex. Methylphenidate, Dextroamphetamine

Question 20

What are possible side effects that can occur with the Stimulant drug class to treat ADHD?

Answer 20

Insomnia, anxiety, headaches, weight loss, slow growth

Question 21

If stimulants do not work for ADHD, what are 3 other medications that can be considered that have a better side effect profile?

Answer 21

Atomoxetine
Clonidine
Guanfacine

Question 22

If stimulants do not work for ADHD, what is a norepinephrine reuptake inhibitor that can be used?

Answer 22

Atomoxetine

Question 23

If stimulants do not work for ADHD, what are 2 alpha 2 agonists that can be used?

Answer 23

Clonidine
Guanfacine

Question 24

What is present with Tourette’s Syndrome?

Answer 24

Both, and usually multiple, motor and vocal tics

Question 25

When do symptoms usually arise with Tourette's Syndrome?

Answer 25

< 18 years old

Question 26

How long must symptoms be present in order to diagnose Tourette's Syndrome?

Answer 26

> 1 year

Question 27

How long must symptoms be present in order to diagnose Tourette's Syndrome?

Answer 27

> 1 year

Question 28

What 2 conditions are commonly associated with Tourette's Syndrome?

Answer 28

OCD ADHD

Question 29

What is the best initial treatment for Tourette's Syndrome?

Answer 29

Behavior therapy - habit reversal

Question 30

If behavior therapy does not work for Tourette's or it is very disabling, what is the preferred agent to treat?

Answer 30

Tetrabenazine = Dopamine depleting VMAT 2 inhibitor

Question 31

MOA and use for Tetrabenazine?

Answer 31

VMAT 2 inhibitor = dopamine depleting - Used for Tourette's Syndrome

Question 32

If the first line drug does not work for Tourette's Syndrome, what is the next drug class?

Answer 32

Dopamine Antagonists - antipsychotics

Question 33

When is Enuresis normal?

Answer 33

< 7 years old and if they have never made it through the night

Question 34

What things should be ruled out with Enuresis?

Answer 34

Infection, anatomical defects, meds, abuse

Question 35

If a child had been making it through the night and now they are wetting the bed, what 2 workup items should be done?

Answer 35

Urinalysis US

Question 36

If a child had been making it through the night now they are wetting the bed + regression and they have negative urinalysis/us what should be considered?

Answer 36

Abuse or a new stressor

Question 37

What is the treatment for a child that has never made it through the night without wetting the bed and they are above 7 years old?

Answer 37

Desmopressin

Question 38

Conduct disorder has the same symptoms as what personality disorder but what is different?

Answer 38

Anti-Social personality disorder = < 18 years old!

Question 39

How long must the symptoms be present with Conduct Disorder?

Answer 39

> 1 year

Question 40

What is the difference between Conduct Disorder and Oppositional Defiant Disorder?

Answer 40

Conduct disorder -- hurts peers/animals/etc. Oppositional Defiant Disorder -- teen acting out but not harming anyone

Question 41

How long must the symptoms be present with Oppositional Defiant Disorder?

Answer 41

> 6 months

Question 42

What is the best treatment for Conduct Disorder and Oppositional Defiant Disorder?

Answer 42

Psychotherapy

Question 43

If Psychotherapy fails with Conduct Disorder, what is the next treatment option?

Answer 43

Juvenile Detention

Question 44

Oppositional Defiant Disorder is often due to incongruent parenting. What are the main symptoms?

Answer 44

Teen acting out and fighting authority

Question 45

Signs of Conduct Disorder?

Answer 45

CRIMINAL - lacks remorse for hurting others, breaks the law, etc.