W13_06 common issues in the older child Flashcards Preview

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Flashcards in W13_06 common issues in the older child Deck (31)
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1
Q

define primary enuresis

A

never been dry since birth for more than 6 months in a row

2
Q

define secondary enuresis

A

has been dry at some point for more than 6 months in a row

3
Q

define diurnal enuresis

A

wetting themselves when they’re awake

4
Q

define nocturnal enuresis

A

wetting themselves when asleep

5
Q

when to worry about enuresis?

A

diurnal enuresis in school agers;
secondary enuresis

6
Q

note: diurnal enuresis is almost never a result of a severe disease when it’s in isolation

A

it’s usually other things, like constipation or other more motivating things like playing games

7
Q

note that it’s more difficult to wake up those with nocturnal diuresis

A

ok

8
Q

what’s the workup for primary nocturnal enuresis?

A

do nothing. Watchful waiting

9
Q

should you give imipramine to bedwetting children?

A

not recommended unless exceptional;
can cause torsades de pointes

10
Q

should you give desmopressin (DDAVP) to bedwetting children?

A

decent efficacy;
take an hour before bed and don’t drink water

11
Q

should you give sleep-alarms to bedwetting children?

A

no mostly - don’t give them the wrong message. Convince it’s not a problem.
In older, more motivated kids, can use these

12
Q

which gender is more affected by ADHD?

A

boys

13
Q

which ages are more affected by ADHD

A

under 12 years

14
Q

what are factors associated with ADHD?

A

single parent fam;
low parent education;
low family income;
low birth weight;
developmental problems

15
Q

what are factors identified in infancy that can predict ADHD?

A

prenatal smoking;
maternal depression;
poor parenting practices;
living in a disadvantaged neighborhood

16
Q

is ADHD genetic?

A

yes, it’s inherited. Dopamine identified

17
Q

what are some gene-environment interactions that can contribute to ADHD?

A

epigenetics;
intergenerational effects (e.g. young mother with ADHD has substance use during pregs, and gives her child more ADHD);
poor behaviour can cause ill parenting, then ill parenting causes more worse behaviours

18
Q

what are some higher-order controls of cognition?

A

preparing
stopping
switching
working mem
error detection
response inhibition

19
Q

what are the primary treatments of ADHD to improve cognition?

A

d-amphetamine;
methylphenidate

20
Q

what are some structural changes of the brain in children with ADHD?

A

reduced size of many brain parts, including total cerebral volume, right cerebral volume, right caudate, cerebellum, splenium of corpus callosum, frontal regions

21
Q

note: psychostimulants seem to make rate of change of cortex to be closer to the normal brains

A

ok

22
Q

what are the DSM-V criteria for ADHD?

A

INATTENTION;
hyperactivity/impulsivity;
symptoms < 12 yrs;
two or more settings (school likely one of them);
functionally impairing;
not due to another mental health disorder

23
Q

what factors to consider when trying to make the diagnosis?

A

history, school input, psychoeducational assessment

24
Q

note: long term improvement in ADHD treatment is unproven and meds have side effects

A

but untreated ADHD has a poor outcome.

25
Q

note: the big clinical study found that medication is a more effective treatment for ADHD

A

ok

26
Q

note: kids performed better when their PARENTS were treated for ADHD also

A

ok

27
Q

when is behaviour modification recommended as monotherapy for ADHD?

A

ADHD in pre-schoolers

28
Q

what are side effects of ADHD stimulants?

A

appetite suppression;
insomnia (rare);
emotional after school;
anxiety in pre-disposed

29
Q

what’s the effect of ADHD stimulant medication in those with tourette’s?

A

nothing - no extra tics

30
Q

what’s the effect of ADHD stimulants on cardiac dysrrhythmias?

A

suspected, but evidence seems to show no effect;
good to monitor blood pressure in those taking the meds

31
Q

note: ritalin (methylphenidate) has a wide range of dosing

A

ok

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