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580 Cards in this Set
- Front
- Back
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Why would you do a vision test at 18 months?
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With Parental complaint or abnormal fundoscopic exam
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What is the definition of colic?
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Unexplained crying between 3 weeks and 3 months of life last for 3 or more hours a day on three or more days a week in infants who do not suffer other conditions that may cause crying
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What is the etiology of colic?
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Unknown
Multifactorial Innate temperament Sleep/wake activity |
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What is the treatment plan for colic?
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Physical exam
Review feeding history Observe feeding Counseling Bio Gaia (lactobacillus reuteri may have a role in infant colic) |
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At the 15 month visit, what's important to assess as far as communication and social development?
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Individualization, separation, pay attention to how child communicates wants and interests and signs of shared attention
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At the 15 month visit, what's important to assess as far sleep?
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If the patient has a regular bedtime routine, nighttime waking problems, make sure there's no bottle in the bed
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At the 15 month visit, what's important to assess as far as discipline?
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Conflict predictions, distraction techniques, praising the child for accomplishments and the importance of consistency
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At what age do you counsel parent regarding healthy teeth, including brushing and bottle usage?
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15 months
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What are the major safety concerns for the 15 month old?
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Car safety belts, parental use of safety belts, poison and fire safety
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T or F: Temper tantrums are not common in the 15 old?
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False, very common
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At what age should bottles and pacifiers be gone?
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By 18 months
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What universal screenings are done at the 15 month visit?
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None
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Why would you do a BP screen at 15 months?
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For children with a specific risk condition
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Why would you do a vision screening at 15 months?
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Parental concern, abnormal fundoscopic exam or cover/uncover test
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Why would you do a hearing screen at 15 months?
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A positive risk on screening questions
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What's the first sign of being ready to toilet train?
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Dry diaper in the morning
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At the 18 month visit, what should you assess regarding family support?
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Parental well-being, adjustment to toddlers growing independence and occasional negativity, queries about a new sibling or on the way
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At the 18 month visit, what should you assess as far as child development and behavior?
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Adaptation to nonparental care and anticipation of return to clinging, other changes connected to new cognitive gains
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At the 18 month visit, what should you assess regarding language?
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Encourage language, use of simple words and phrases, engagement in reading/singing/talking
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At the 18 month visit, what should you assess regarding safety?
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Car safety seats, parental use of seat belts, falls, fire safety, burns, poison and guns
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What universal screenings are done at the 18 month visit?
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Developmental Milestones
MCHAT Autism screening |
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Why would you do a oral health screen at 18 months?
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If the patient doesn't have dental bone
If water supply doesn't have fluoride |
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Why would you do a BP screen at 18 months?
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If the patient has specific risk conditions
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Why would do you a hearing screen at 18 months?
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Positive on risk screening questions
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Why would you assess hearing at the 18 month exam?
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A positive risk on screening questions
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Why would you do an anemia screen at 18 months?
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Positive risk on screening questions
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Why would you assess for anemia at the 18 month visit?
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With risk factors
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Why would you do a lead screen at 18 months?
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If no lead screen done before
A change in risk factors |
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Why would you check lead at the 18 month visit?
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If previous screening was not done or if there is a change in risk
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Why would you do a TB screen at 18 months?
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Positive risk on screening questions
Esp. international travel |
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Why would you assess for TB at the 18 month visit?
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With a specific risk such as international travel
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At what age do you start yearly visits?
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2 years
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At what age do patient start having yearly healthcare visits?
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2 years
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At 2, what should you assess as far as language development?
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How child communicates
Expectations for language |
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What's most important to assess at the 2 year visit?
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Language
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At 2, what should you assess for temperament and behavior?
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Sensitivity
Approachability Adaptability Intensity |
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What age do you really start promoting reading?
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2 years
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At 2, how should you assess toilet training?
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What parents have tried
Techniques Personal hygiene |
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At the 2 year visit, what should be assessed regarding language?
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How child communicates, expectations for language
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At 2, how should you assess television viewing?
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Limits on viewing
Promotion of reading Promotion of physical activity Safe play |
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At the 2 year visit, what should be assessed regarding temperament and behavior?
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Sensitivity, approachability, adaptability and intensity
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At 2, what safety concerns should you assess?
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Car seats
Parental seat belt use Bike helmets Outdoor safety Guns |
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At 2 years, what should be assessed regarding toilet training?
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What parents have tried, techniques, personal hygiene
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At what age should 2nd MCHAT be done?
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2 years
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At 2 years, what should be assessed regarding television viewing?
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Encourage limits on viewing, promotion of reading and physical activity and safe play
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What 2 universal screenings should be done at 2 years?
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2nd MCHAT
Lead |
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At 2 years, what should be assessed regarding safety?
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Car safety seats, parental use os seat belts, bike helmets, outdoor safety and gun
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According to the AAP, when should patients be screened for dyslipidemia?
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Age 9-11 but Bright Futures says 2 years
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At 2 years, what universal screenings should be done?
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Lead
Repeat MCHAT for Autism |
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How many calories should a toddler eat?
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1,000/day
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When does the AAP say you should start for screening for dyslipidemia?
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9-11 years but Bright Futures says at 2 years
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How many meals do toddlers eat daily?
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2 meals/day because they have a decreased appetite
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How many calories daily should a 2 year old have?
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1,000
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What happens if a toddler has too much juice?
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Diarrhea, ew.
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What happens when a toddler has too much juice?
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Diarrhea - ew.
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What's the most common parental concern in toddlers?
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Toddlers don't eat very much because they're not growing very fast so it's OK
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T or F: Toddlers have decreased appetites?
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True, they usually only have 2 meals/day
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What is the feeding development of a 12-18 month old?
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More independence
Stop bottle Practice eating with spoon |
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What's a major parental concern during toddlerhood?
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The patient isn't eating but this is OK because they're not growing very much
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What is the feeding development of 18 month - 2 year olds?
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Growth slows
Not as interested in eating Encourage self feeding with utinsils |
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How should parents encourage feeding development in 12-18 mos?
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Stop the bottle
Practice eating with a spoon |
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What is the feeding development of 2-3 year olds?
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Intake varies
Don't fight independence Want to exert control |
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How should parents encourage feeding development in 18 mo - 2 yr olds?
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Encourage self feeding with all utensils
Growth slows during this time Kids aren't as interested in eating |
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What are the origins of toddler obesity?
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Demographic risk factors
Environmental factors in utero Infant/Toddler feeding practices Child rearing practices |
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What's the feeding development of 2-3 yr olds?
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Intake varies
Will be independent and want to exert control Parents shouldn't fight independence |
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What are the environmental risk factors in utero causing obesity?
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Maternal smoking
Maternal obesity Excessive weight gain in pregnancy Birth weight over 4000g and under 2500g Genetic problems (Prader Willi, Cohen, Leptin Syndrome) |
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What is the age of toddlers?
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1 to 3
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What are the origins of toddler obesity?
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Demographic risk factors
Environmental factors in utero Infant and toddler feeding practices Child rearing practices Cultural and societal factors |
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What are the environmental risk factors in utero causing toddler obesity?
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Maternal smoking
Maternal obesity Excessive weight gain during pregnancy Birth weight greater than 4,000g or less than 2,500g Genetic mutations (Prader-Willi, Cohen Syndrome, Leptin deficiency) |
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Why do premies have a high risk of being obese?
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Because they usually have metabolic problems
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How much juice should a 1 to 6 year old have?
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4oz
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Why do premies have a high risk of being obese during toddlerhood?
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They have a high risk of having a metabolic problem
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Which feeding practices cause obesity?
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Over nutrition in infancy
Rapid catch up growth Parents ignoring satiety cues Solid food induction - too much too soon |
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How much juice should a 6 to 18 year told have?
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8oz but 4 is better. RMJ hates juice
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What infant and toddler feeding practices contribute to obesity?
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Over nutrition during infancy
Rapid catch up growth Parents ignoring satiety cues Solid food introduction - too much, too soon |
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Which child rearing practices cause obesity?
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Sleep less than 12 hours
TV viewing |
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Which child rearing practices cause obesity?
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Sleep less than 12 hours
TV viewing |
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Which child rearing practices cause obesity?
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Sleep less than 12 hours
TV viewing |
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Which child rearing practices cause obesity?
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Sleep less than 12 hours
TV viewing |
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T or F: Temperament becomes less evident during toddlerhood?
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False becomes more evident because of negativity, terrible 2's and temper tantrums
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Which child rearing practices cause obesity?
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Sleep less than 12 hours
TV viewing |
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What child rearing practices contribute to obesity?
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Sleep duration - less than 12 hours
TV viewing - more than 8 hrs/week |
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What is the age of toddlers?
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1 to 3
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What cultural aspects contribute to obesity?
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Excessive body fat is valued in some cultures especially Chinese/Latino
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What cultural aspects contribute to obesity?
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Excessive body fat is valued in some cultures especially Chinese/Latino
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What cultural aspects contribute to obesity?
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Excessive body fat is valued in some cultures especially Chinese/Latino
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What cultural aspects contribute to obesity?
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Excessive body fat is valued in some cultures especially Chinese/Latino
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What cultural aspects contribute to obesity?
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Excessive body fat is valued in some cultures especially Chinese/Latino
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What cultural/societal aspects contribute to obesity?
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Excessive body fat valued in some cultures
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How much juice should a 1 to 6 year old have?
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4oz
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T or F: The fat Asian baby is cute?
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True. Cutest baby ever
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T or F: The fat Asian baby is cute?
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True. Cutest baby ever
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T or F: The fat Asian baby is cute?
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True. Cutest baby ever
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T or F: The fat Asian baby is cute?
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True. Cutest baby ever
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T or F: The fat Asian baby is cute?
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True. Cutest baby ever
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T or F: the fat Asian baby in this slide is adorable?
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True. Cutest baby ever.
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How much juice should a 6 to 18 year told have?
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8oz but 4 is better. RMJ hates juice
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What are the complications of early onset obesity?
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CV disease
Metabolic disease Asthma Obesity later in life Non-alcoholic fatty liver disease Gross motor delays |
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What are the complications of early onset obesity?
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CV disease
Metabolic disease Asthma Obesity later in life Non-alcoholic fatty liver disease Gross motor delays |
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What are the complications of early onset obesity?
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CV disease
Metabolic disease Asthma Obesity later in life Non-alcoholic fatty liver disease Gross motor delays |
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What are the complications of early onset obesity?
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CV disease
Metabolic disease Asthma Obesity later in life Non-alcoholic fatty liver disease Gross motor delays |
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What are the complications of early onset obesity?
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CV disease
Metabolic disease Asthma Obesity later in life Non-alcoholic fatty liver disease Gross motor delays |
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What are the complications of early onset obesity?
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Cardiovascular disease
Metabolic disease Asthma Continued obesity later in life Non-alcoholic fatty liver disease Gross motor delays |
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What is the age of preschoolers?
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3-5
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What do you do if BMI is above 95th? Why?
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A CBC, liver function test, BMP
Because liver disease is a serious complication |
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What do you do if BMI is above 95th? Why?
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A CBC, liver function test, BMP
Because liver disease is a serious complication |
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What do you do if BMI is above 95th? Why?
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A CBC, liver function test, BMP
Because liver disease is a serious complication |
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What do you do if BMI is above 95th? Why?
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A CBC, liver function test, BMP
Because liver disease is a serious complication |
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What do you do if BMI is above 95th? Why?
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A CBC, liver function test, BMP
Because liver disease is a serious complication |
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All toddlers who have a BMI greater than 95 should get what? Why?
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CBC, liver function and CMP because non-alcoholic fatty liver disease is a very serious complication of obesity
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When do kids start to socialize and have friends?
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Preschool
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What kind of obesity is the worst?
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Central
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What kind of obesity is the worst?
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Central
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What kind of obesity is the worst?
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Central
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What kind of obesity is the worst?
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Central
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What kind of obesity is the worst?
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Central
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What do you assess for an obese patient during an office visit?
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Detailed history
Growth parameters Head to toe physical Lab eval if complications are suspected Assess for developmental delays |
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What's the worst kind of obesity?
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Central
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What age is parallel play common?
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3 years
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What do you assess for an obese patient during an office visit?
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Detailed history
Growth parameters Head to toe physical Lab eval if complications are suspected Assess for developmental delays |
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What do you assess for an obese patient during an office visit?
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Detailed history
Growth parameters Head to toe physical Lab eval if complications are suspected Assess for developmental delays |
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What do you assess for an obese patient during an office visit?
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Detailed history
Growth parameters Head to toe physical Lab eval if complications are suspected Assess for developmental delays |
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What do you assess for an obese patient during an office visit?
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Detailed history
Growth parameters Head to toe physical Lab eval if complications are suspected Assess for developmental delays |
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According to the AAP, how much juice should a 1-6 year old have?
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4oz/day
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What needs to be included in the office visit of an obese toddler?
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Detailed history
Growth parameters Head to toe physical Lab eval if complications are suspected Assess for developmental delays |
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What type of play happens at age 5?
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Cooperative play
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According to the AAP, how much juice should a 1-6 year old have?
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4oz/day
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According to the AAP, how much juice should a 1-6 year old have?
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4oz/day
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According to the AAP, how much juice should a 1-6 year old have?
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4oz/day
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According to the AAP, how much juice should a 1-6 year old have?
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4oz/day
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According to the AAP, how much juice should a 6-18 year old have?
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8oz/day but 4 is better. RMJ hates juice
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How can parents improve child's nutrition?
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Parents choose mealtimes
Give nutrient dense food Pay attention to portion size Limit snacking Limit sedentary behaviors Teach self regulation |
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At what age can someone begin to anticipate the consequences of actions?
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Preschool
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According to the AAP, how much juice should a 6-18 year old have?
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8oz/day but 4 is better. RMJ hates juice
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According to the AAP, how much juice should a 6-18 year old have?
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8oz/day but 4 is better. RMJ hates juice
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According to the AAP, how much juice should a 6-18 year old have?
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8oz/day but 4 is better. RMJ hates juice
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According to the AAP, how much juice should a 6-18 year old have?
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8oz/day but 4 is better. RMJ hates juice
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What is the NP role in obesity prevention?
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Prevent obesity
Encourage low juice/low sugar Prenatal education Parental education re: satiety cues Facilitate transition to solid foods Encourage parents to decrease sedentary time |
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According to the AAP how much juice should a 1-6 yr old have?
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Limit to 4oz/day
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What is the conflict of toddlerhood?
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Autonomy vs shame and doubt
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What is the NP role in obesity prevention?
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Prevent obesity
Encourage low juice/low sugar Prenatal education Parental education re: satiety cues Facilitate transition to solid foods Encourage parents to decrease sedentary time |
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What is the NP role in obesity prevention?
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Prevent obesity
Encourage low juice/low sugar Prenatal education Parental education re: satiety cues Facilitate transition to solid foods Encourage parents to decrease sedentary time |
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What is the NP role in obesity prevention?
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Prevent obesity
Encourage low juice/low sugar Prenatal education Parental education re: satiety cues Facilitate transition to solid foods Encourage parents to decrease sedentary time |
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What is the NP role in obesity prevention?
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Prevent obesity
Encourage low juice/low sugar Prenatal education Parental education re: satiety cues Facilitate transition to solid foods Encourage parents to decrease sedentary time |
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According to the AAP, how much juice should a 7-18 yr old have?
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Limit to 8oz/day but 4oz is better - RMJ hates juice
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What is the conflict of Preschool?
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Initiative vs guilt
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What is the age range of toddlers?
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1-3
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What is the role of NP in obesity prevention?
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Prenatal education
Help parents understand satiety cues Facilitate transition to solid foods Encourage parents to decrease sedentary time Advocate for participation in community programs |
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What is the cognitive development of toddlerhood?
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Touching, looking, listening, beginning to understand function, object permanence
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What are the important advancements in the toddler years?
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Language
Intrapersonal skills Development of pretend play |
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What is the age range of toddlers?
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1-3 years
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What is the cognitive development of Preschoolers?
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Symbolic/action thought, egocentric, magical thinking, imaginary friends
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T or F: Temperament is not very evident during the toddler years?
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False, becomes more evident during this time with negativity, terrible 2's, temper tantrums
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How does temperament become more evident during toddlerhood?
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Negativity
Terrible 2's Temper tantrums |
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What are the development tasks of a Toddler?
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Language acquision, toilet training, day/care, pre-school entry
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What is the age range for Preschoolers?
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3-5
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What are the major advances of toddlerhood?
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Language/interpersonal skills
Development of pretend play |
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What are the development tasks of a Preschooler?
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School readiness, verbal ability to communicate needs
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At what age do people begin to anticipate consequences of actions?
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Preschool
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What is the age range of preschoolers?
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3-5 years
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What age do kids start school?
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Age 3
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Parallel play happens at what age?
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3
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At what age do people begin to anticipate the consequences of their actions?
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Preschool years
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When should biting stop?
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Age 2
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What play is typical at age 5?
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Cooperative
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At 3 years, _______ play is really common?
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Parallel
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How do you assess Preschool Readiness?
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Ability to separate from parents, verbal ability, self care skills, can follow directions
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When do people start to socialize and have friends?
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Preschool age
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At _____ years cooperative play develops?
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5
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What rituals are important?
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Mealtimes, bedtime, fears, security blanket
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What is the major conflict in toddlers?
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Autonomy vs shame and doubt
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What is the major conflict of toddlerhood?
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Autonomy vs Shame and Doubt
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When are rituals most important?
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1-2 years
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What is that major conflict of Preschoolers?
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Initiative vs guilt
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What's the major conflict of Preschool?
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Initiative vs Guilt
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When is masturbating a sign of sexual abuse?
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Done in public and persistent
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What is the cognitive development of a toddler?
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Touching, looking, listening
Beginning to understand function Object permanence |
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What is the cognitive development for a toddler like?
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Touching, looking, listening
Beginning to understand function Object permanence |
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How long should a time out be?
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1 minute per year of life
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What is the cognitive function for Preschoolers like?
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Symbolic action/thought
Egocentric Magical thinking Imaginary friends |
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What is the A of ABC of behavior?
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Antecedent, what triggers the behavior
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What are the developmental tasks for a toddler?
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Language acquision
Toilet training Discipline and limit setting Day-care/preschool entry |
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What’s the B of ABC of behavior?
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Behavior, frequency, duration, intensity
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What are the developmental tasks for a Preschooler?
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School readiness
Verbal ability to communicate needs |
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What are internal problems of behavior?
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Learning problem, reading problem, intrusive thoughts
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When do kids usually start school?
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Age 3
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What are motor problems of behavior?
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Hyperactivity, tics, tantrums
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When should you stop biting?
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2 years
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What are physiologic problems of behavior?
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Anxiety or depression
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How do you assess Preschool readiness?
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Ability to separate from parents
Verbal ability Self-care skills Follow directions |
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What is very aggressive behavior usually a sign of?
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Speech delay
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When does the need for rituals peak?
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1-2 years
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What is the C of ABC of behavior?
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Consequence, what immediately follows the behavior
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What are examples of rituals that are important to kids?
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Mealtime
Bedtime Fears Security blanket |
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How do you assess behavior?
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Interviews, Self report, rating scales, direct observation
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When is masturbation a sign of sexual abuse?
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When it's done in public
When it's persistent |
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What is reinforcement?
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Meant to increase behavior, is most effective if it’s contingent, immediate and obvious
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What are ways to manage undesirable behavior?
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ABC
Avoid certain situations Time outs Interruption of privileges |
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What are the 2 types of punishment?
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Verbal punishment, corporal punishment
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How long should a time out be?
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1 minute for 1 year of life
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What are alternatives to physical punishment?
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Positive reinforcement, praise, modeling, structure, routine, setting/maintaining limits, realistic expectations, following through, verbal cues, time outs, logical consequences
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What is the "A" in assessing behavior?
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Antecedent: what triggers the behavior
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What are social reinforcers?
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Praise, approval, acknowledgement
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What is the "B" in assessing behavior?
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Behavior: it's frequency, duration, intensity, what does it look like
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What are token economies?
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Giving poker chips, points, stickers for secondary goods
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What's very aggressive behavior usually a sign of?
|
Speech delay
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What is tangible reinforcement?
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Giving stickers, candy, toys, TV time after good behavior is observed
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What is the "C" in assessing behavior?
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Consequences: what maintains, reinforces or discourages the behavior. What immediately follows the behavior?
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What is extinction?
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Withdrawal of withholding of reinforcers following bad behavior
Ignoring |
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How do you gather information about behavior?
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Interviews
Self report Direct observation |
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When is time out most effective?
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If child is removed from a reinforcing situation
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What is positive reinforcement?
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Applies following a behavior that they want to increase
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What are the strategies for improving behavior?
|
Consistency, creating a predictable outcome, Time in, increasing positive attention, giving effective direction, ignoring minor problems, choosing battles wisely, time out, sensible consequences
|
|
|
What is reinforcement?
|
Meant to increase behavior
Must immediately follow the behavior you want to continue Most effective if: contingent, immediate and obvious Ex. "I'm proud of how you're acting" |
|
|
What are the common behavior traps for parents?
|
Ignoring good behavior, modeling bad behavior, ineffective instructions, inconsistency
|
|
|
What is reinforcement?
|
Meant to increase behavior
Must immediately follow the behavior you want to continue Most effective if: contingent, immediate and obvious Ex. "I'm proud of how you're acting" |
|
|
What is reinforcement?
|
Meant to increase behavior
Must immediately follow the behavior you want to continue Most effective if: contingent, immediate and obvious Ex. "I'm proud of how you're acting" |
|
|
What are the 2 types of punishment?
|
Verbal
Corporal |
|
|
What are the 2 best ways to change behavior?
|
Change antecedent or change consequence
|
|
|
What are the 2 types of punishment?
|
Verbal
Corporal |
|
|
What are the 2 types of punishment?
|
Verbal
Corporal |
|
|
What are good alternatives to physical discipline?
|
Positive reinforcement
Praise Modeling Structure and routine Setting and maintaining limits Realistic Expectations/Following through Time outs Verbal punishment Problem Solving |
|
|
What is the definition of OSAS?
|
Disorder of breathing sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction that disrupts normal ventilation during sleep and normal sleep patterns
|
|
|
What are good alternatives to physical discipline?
|
Positive reinforcement
Praise Modeling Structure and routine Setting and maintaining limits Realistic Expectations/Following through Time outs Verbal punishment Problem Solving |
|
|
What are good alternatives to physical discipline?
|
Positive reinforcement
Praise Modeling Structure and routine Setting and maintaining limits Realistic Expectations/Following through Time outs Verbal punishment Problem Solving |
|
|
What are social reinforcements?
|
Praise
Approval Acknowledgement |
|
|
What are the nighttime symptoms of OSAS?
|
Paradoxical chest/abdomen motion, retractions, observed apnea, observed difficulty breathing during sleep, cyanosis during sleep
|
|
|
What are social reinforcements?
|
Praise
Approval Acknowledgement |
|
|
What are social reinforcements?
|
Praise
Approval Acknowledgement |
|
|
What is token economy reinforcement?
|
Ex. poker chips, points or stickers
|
|
|
What are the daytime symptoms of OSAS?
|
Nasal obstruction with mouth breathing, excessive daytime sleepiness
|
|
|
What is token economy reinforcement?
|
Ex. poker chips, points or stickers
|
|
|
What is token economy reinforcement?
|
Ex. poker chips, points or stickers
|
|
|
What is tangible reinforcement?
|
Ex. Candy, stickers and TV watching.
Only allowed after good behavior is observed |
|
|
What are the severe symptoms of OSAS?
|
Cor pulmonale, developmental delay, failure to thrive
|
|
|
What is tangible reinforcement?
|
Ex. Candy, stickers and TV watching.
Only allowed after good behavior is observed |
|
|
What is tangible reinforcement?
|
Ex. Candy, stickers and TV watching.
Only allowed after good behavior is observed |
|
|
What is extinction?
|
Withdrawal or withholding reinforcements following a behavior
Ignoring the problem behavior |
|
|
What happens with Cor Pulmonale?
|
R ventricular hypertrophy, will need ICU stay post-op
|
|
|
What is extinction?
|
Withdrawal or withholding reinforcements following a behavior
Ignoring the problem behavior |
|
|
What is extinction?
|
Withdrawal or withholding reinforcements following a behavior
Ignoring the problem behavior |
|
|
When is a time out most effective?
|
When a child is removed from the situation
|
|
|
What are the risk factors for OSAS?
|
Adenotonsillar hypertrophy (esp. 3-7), obesity, craniofacial anomalies, neuromuscular disorders (ex. MD)
|
|
|
When is a time out most effective?
|
When a child is removed from the situation
|
|
|
When is a time out most effective?
|
When a child is removed from the situation
|
|
|
What are some good strategies for improving behavior?
|
Consistency
Creating predictable routine Creating special time Increasing positive attention Giving effective direction Ignoring minor problems Choosing battles wisely Time out from reinforcement Sensible consequences |
|
|
What are the associated feature of OSAS?
|
Impaired somatic growth, sudden nocturnal awakenings, gastroesophageal reflux, increased risk of nasopharyngeal aspiration, hypoxemia, hypercarbia, neuropsychiatric disturbances
|
|
|
What are some good strategies for improving behavior?
|
Consistency
Creating predictable routine Creating special time Increasing positive attention Giving effective direction Ignoring minor problems Choosing battles wisely Time out from reinforcement Sensible consequences |
|
|
What are some good strategies for improving behavior?
|
Consistency
Creating predictable routine Creating special time Increasing positive attention Giving effective direction Ignoring minor problems Choosing battles wisely Time out from reinforcement Sensible consequences |
|
|
What are common traps for parents in behavior improvement?
|
Ignoring desirable behavior
Modeling inappropriate and aggressive behavior Ineffective intrusions Inconsistency |
|
|
What are the predisposing factors to OSAS?
|
Anything that interferes with the caliber, increases the collapsibility or interferes with neural control of the nasopharyngeal airway, obesity, down syndrome, craniofacial syndromes, achondroplasia, mucopolysaccharide storage disease, neurologic disorders, Turners Syndrome
|
|
|
What are common traps for parents in behavior improvement?
|
Ignoring desirable behavior
Modeling inappropriate and aggressive behavior Ineffective intrusions Inconsistency |
|
|
What are common traps for parents in behavior improvement?
|
Ignoring desirable behavior
Modeling inappropriate and aggressive behavior Ineffective intrusions Inconsistency |
|
|
What are the growth complications of OSAS?
|
Failure to thrive, short stature, impaired growth hormone release
|
|
|
What are the best responses to bad behavior?
|
Change antecedent condition
Change consequence |
|
|
What are the best responses to bad behavior?
|
Change antecedent condition
Change consequence |
|
|
What are the best responses to bad behavior?
|
Change antecedent condition
Change consequence |
|
|
What are the CV complications of OSAS?
|
Cor pulmonale, pulmonary HTN, Polycythemia, chronic respiratory acidosis, systemic HTN
|
|
|
What is the definition was Obstructive Sleep Apnea Syndrome?
|
Disorder of breathing sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction that disrupts normal ventilation during sleep and normal sleep patterns
|
|
|
What is the definition was Obstructive Sleep Apnea Syndrome?
|
Disorder of breathing sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction that disrupts normal ventilation during sleep and normal sleep patterns
|
|
|
What is the definition was Obstructive Sleep Apnea Syndrome?
|
Disorder of breathing sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction that disrupts normal ventilation during sleep and normal sleep patterns
|
|
|
What are the GI complication of OSAS?
|
Feeding difficulties, gastroesophageal reflux
|
|
|
What are the nocturnal symptoms of Obstructive Sleep Apnea?
|
Snoring
Paradoxical chest abdominal motion Retractions Observed apnea Observed difficulty breathing during sleep Cyanosis during sleep/disturbed sleep |
|
|
What are the nocturnal symptoms of Obstructive Sleep Apnea?
|
Snoring
Paradoxical chest abdominal motion Retractions Observed apnea Observed difficulty breathing during sleep Cyanosis during sleep/disturbed sleep |
|
|
What are the nocturnal symptoms of Obstructive Sleep Apnea?
|
Snoring
Paradoxical chest abdominal motion Retractions Observed apnea Observed difficulty breathing during sleep Cyanosis during sleep/disturbed sleep |
|
|
What are the pulmonary complications of OSAS?
|
Chronic aspiration, pulmonary edema, pectus excavatum
|
|
|
What are the daytime symptoms of Obstructive Sleep Apnea?
|
Nasal obstruction with mouth breathing
Excessive daytime sleepiness |
|
|
What are the daytime symptoms of Obstructive Sleep Apnea?
|
Nasal obstruction with mouth breathing
Excessive daytime sleepiness |
|
|
What are the daytime symptoms of Obstructive Sleep Apnea?
|
Nasal obstruction with mouth breathing
Excessive daytime sleepiness |
|
|
What are the behavioral complications of OSAS?
|
Development delay, behavioral problems, school problems
|
|
|
What are the severe symptoms associated with Obstructive Sleep Apnea?
|
Associated with Cor Pulmonale
Developmental Delay Failure to Thrive |
|
|
What are the severe symptoms associated with Obstructive Sleep Apnea?
|
Associated with Cor Pulmonale
Developmental Delay Failure to Thrive |
|
|
What are the severe symptoms associated with Obstructive Sleep Apnea?
|
Associated with Cor Pulmonale
Developmental Delay Failure to Thrive |
|
|
What are the Neuro complications of OSAS?
|
Enuresis, increased ICP, lethargy, dull affect, hypoxia induced headaches
|
|
|
What is Cor Pulmonale associated with?
|
R ventricular hyperthrophy occurs especially with long standing obstruction these patients will need ICU stay post-op during treatment
|
|
|
What is Cor Pulmonale associated with?
|
R ventricular hyperthrophy occurs especially with long standing obstruction these patients will need ICU stay post-op during treatment
|
|
|
What is Cor Pulmonale associated with?
|
R ventricular hyperthrophy occurs especially with long standing obstruction these patients will need ICU stay post-op during treatment
|
|
|
What are the surgical complications of OSAS?
|
Post surgical dehydration, hemorrhage, respiratory compromise, pulmonary edema, death
|
|
|
What are the risk factors for Obstructive Sleep Apnea?
|
Adenotonsillar Hypertrophy (esp at 3-7 yrs)
Obesity Craniofacial anomalies Neuromuscular Disorders (Muscular Dystrophy) |
|
|
What are the risk factors for Obstructive Sleep Apnea?
|
Adenotonsillar Hypertrophy (esp at 3-7 yrs)
Obesity Craniofacial anomalies Neuromuscular Disorders (Muscular Dystrophy) |
|
|
What are the risk factors for Obstructive Sleep Apnea?
|
Adenotonsillar Hypertrophy (esp at 3-7 yrs)
Obesity Craniofacial anomalies Neuromuscular Disorders (Muscular Dystrophy) |
|
|
What should clinician ask about re: OSAS?
|
Snoring more than 3 times/week, labored breathing during sleep, gasps, snorting, noises and observed apnea, sleep in seated position or with neck hyperextended, cyanosis, AM headache, daytime sleepiness, ADHD/hyperactive/learning problem
|
|
|
Will removal of tonsil in obese patient with Obstructive Sleep Apnea help?
|
NO
|
|
|
Will removal of tonsil in obese patient with Obstructive Sleep Apnea help?
|
NO
|
|
|
Will removal of tonsil in obese patient with Obstructive Sleep Apnea help?
|
NO
|
|
|
What’s the PE for OSAS?
|
Over or under weight, tonsillar hypertrophy, adenoidal facies, micognathia/retrognathia, high arched palate, failure to thrive, HTN
|
|
|
What are the associated features of Sleep Obstructive Apnea?
|
Impaired somatic growth
Sudden nocturnal awakenings Gastroesophageal Reflux Increased risk of nasopharyngeal aspiration Hypoxemia Hypercarbia Neuropsychiatric disturbances |
|
|
What are the associated features of Sleep Obstructive Apnea?
|
Impaired somatic growth
Sudden nocturnal awakenings Gastroesophageal Reflux Increased risk of nasopharyngeal aspiration Hypoxemia Hypercarbia Neuropsychiatric disturbances |
|
|
What are the associated features of Sleep Obstructive Apnea?
|
Impaired somatic growth
Sudden nocturnal awakenings Gastroesophageal Reflux Increased risk of nasopharyngeal aspiration Hypoxemia Hypercarbia Neuropsychiatric disturbances |
|
|
What’s the gold standard for diagnosing OSAS?
|
SLEEP STUDY
|
|
|
What are predisposing factors for developing Obstructive Sleep Apnea?
|
Anything that reduces the calliber, increases collapsibility or intereferes with neural control of the nasopharyngeal airway, ie
Obesity Down Syndrome Craniofacial Anomalies Achondroplasia Mucopolysaccharide storage disease Turners Syndrome Neurologic disorders |
|
|
What are predisposing factors for developing Obstructive Sleep Apnea?
|
Anything that reduces the calliber, increases collapsibility or intereferes with neural control of the nasopharyngeal airway, ie
Obesity Down Syndrome Craniofacial Anomalies Achondroplasia Mucopolysaccharide storage disease Turners Syndrome Neurologic disorders |
|
|
What are predisposing factors for developing Obstructive Sleep Apnea?
|
Anything that reduces the calliber, increases collapsibility or intereferes with neural control of the nasopharyngeal airway, ie
Obesity Down Syndrome Craniofacial Anomalies Achondroplasia Mucopolysaccharide storage disease Turners Syndrome Neurologic disorders |
|
|
If no polysomnography is available and you suspect OSAS?
|
Nocturnal video recording, nocturnal oximetry, daytime nap polysomnography and ambulatory polysomnography
|
|
|
What are the growth complications of OSA?
|
Failure to thrive
Short Stature Impaired growth hormone release |
|
|
What are the growth complications of OSA?
|
Failure to thrive
Short Stature Impaired growth hormone release |
|
|
What are the growth complications of OSA?
|
Failure to thrive
Short Stature Impaired growth hormone release |
|
|
If a patient has OSAS and clinical exam shows tonsillar hypertrophy and there’s no contraindication to surgery, what should you do?
|
T&A except in obese kids this might not work
|
|
|
What are the cardiovascular complications of OSA?
|
Cor Pulmonale/Pulmonary HTN
Polycythemia Chronic Pulmonary Acidosis Systemic HTN |
|
|
What are the cardiovascular complications of OSA?
|
Cor Pulmonale/Pulmonary HTN
Polycythemia Chronic Pulmonary Acidosis Systemic HTN |
|
|
What are the cardiovascular complications of OSA?
|
Cor Pulmonale/Pulmonary HTN
Polycythemia Chronic Pulmonary Acidosis Systemic HTN |
|
|
Who needs a sleep study?
|
Kids with OSAS, kids with behavioral or poor quality or restless sleep, suspected central sleep apnea, excessive daytime sleepiness, progressive muscular disorders (ex. MD) obesity (neck circumference more than 17.5 inches)
|
|
|
What are the GI complications of OSA?
|
Feeding difficulties
Gastrointestinal reflux |
|
|
What are the GI complications of OSA?
|
Feeding difficulties
Gastrointestinal reflux |
|
|
What are the GI complications of OSA?
|
Feeding difficulties
Gastrointestinal reflux |
|
|
What are the pulmonary complications of OSA?
|
Chronic aspiration
Pulmonary edema Pectus excavatum |
|
|
What are the contraindications for a sleep study?
|
No tonsils, very small tonsils/adenoids, morbid obesity + small tonsils, bleeding disorder, submucus cleft (bifid uvula or tented soft palate), medical conditions causing unstable patient
|
|
|
What are the pulmonary complications of OSA?
|
Chronic aspiration
Pulmonary edema Pectus excavatum |
|
|
What are the pulmonary complications of OSA?
|
Chronic aspiration
Pulmonary edema Pectus excavatum |
|
|
What are the behavioral complications of OSA?
|
Developmental delay
Behavioral problems School problems |
|
|
What causes someone to be admitted post-op T&A?
|
Pain, dehydration, anesthetic complications, upper airway obstruction during induction, hemorrhage, velopharyngeal incompetence, nasopharyngeal stenosis and death
|
|
|
What are the behavioral complications of OSA?
|
Developmental delay
Behavioral problems School problems |
|
|
What are the behavioral complications of OSA?
|
Developmental delay
Behavioral problems School problems |
|
|
What are the neurologic complications of OSA?
|
Enuresis
Increased ICP Lethargy Dull affect Hypoxia induced headache |
|
|
Who needs reevaluation after T&A?
|
Especially abnormal baseline polysomnography, obese, remain symptomatic and objective problems (?)
|
|
|
What are the neurologic complications of OSA?
|
Enuresis
Increased ICP Lethargy Dull affect Hypoxia induced headache |
|
|
What are the neurologic complications of OSA?
|
Enuresis
Increased ICP Lethargy Dull affect Hypoxia induced headache |
|
|
What surgical complications after adenotonsillar removal?
|
Post surgical dehydration, hemorrhage or respiratory compromis
Pulmonary edema |
|
|
What’s the most commonly accepted treatment of OSAS?
|
T&A
|
|
|
What surgical complications after adenotonsillar removal?
|
Post surgical dehydration, hemorrhage or respiratory compromis
Pulmonary edema |
|
|
What surgical complications after adenotonsillar removal?
|
Post surgical dehydration, hemorrhage or respiratory compromis
Pulmonary edema |
|
|
T or F: It doesn't matter if a child snores
|
False. It matters according to the AAP you should ask about this
|
|
|
What are the complications of T&A?
|
Post operative death, hemorrhage, pain, airway compromise, respiratory distress and dehydration
|
|
|
T or F: It doesn't matter if a child snores
|
False. It matters according to the AAP you should ask about this
|
|
|
T or F: It doesn't matter if a child snores
|
False. It matters according to the AAP you should ask about this
|
|
|
According to the AAP what should you ask about re: sleep in the dx of OSA?
|
Snoring 3 or more times weekly
Labored breathing during sleep Gasps during sleep Sleep enuresis Sleep in seated position or with neck hyperextended Cyanosis Morning headache Daytime sleepiness ADHD/hyperactivity/learning problem |
|
|
If cannot do T&A, what should you do?
|
Give CPAP
|
|
|
According to the AAP what should you ask about re: sleep in the dx of OSA?
|
Snoring 3 or more times weekly
Labored breathing during sleep Gasps during sleep Sleep enuresis Sleep in seated position or with neck hyperextended Cyanosis Morning headache Daytime sleepiness ADHD/hyperactivity/learning problem |
|
|
According to the AAP what should you ask about re: sleep in the dx of OSA?
|
Snoring 3 or more times weekly
Labored breathing during sleep Gasps during sleep Sleep enuresis Sleep in seated position or with neck hyperextended Cyanosis Morning headache Daytime sleepiness ADHD/hyperactivity/learning problem |
|
|
According to the AAP, what should you look for on PE in the dx of OSA?
|
Under or over weight
Tonsillar hypertrophy Adenoidal facies Micrognathia/retrognanthia High arched palate Failure to thrive HTN |
|
|
What are the indications for CPAP?
|
Failed T&A, Obesity, craniofacial anomalies, Down Syndrome and with intraoral appliances
|
|
|
According to the AAP, what should you look for on PE in the dx of OSA?
|
Under or over weight
Tonsillar hypertrophy Adenoidal facies Micrognathia/retrognanthia High arched palate Failure to thrive HTN |
|
|
According to the AAP, what should you look for on PE in the dx of OSA?
|
Under or over weight
Tonsillar hypertrophy Adenoidal facies Micrognathia/retrognanthia High arched palate Failure to thrive HTN |
|
|
If you suspect a child has OSA what should order?
|
A SLEEP STUDY!!!!!!!
(Gold standard) |
|
|
What should always be recommended in patients with OSAS?
|
Weight loss!
|
|
|
If you suspect a child has OSA what should order?
|
A SLEEP STUDY!!!!!!!
(Gold standard) |
|
|
If you suspect a child has OSA what should order?
|
A SLEEP STUDY!!!!!!!
(Gold standard) |
|
|
If you can't get a sleep study for a patient for whom you suspect OSA what can you do?
|
Nocturnal video recording
Nocturnal oximetry Daytime nap polysomnography Ambulatory polysomnography |
|
|
Where does lead live forever?
|
In soil and long bones.
|
|
|
If you can't get a sleep study for a patient for whom you suspect OSA what can you do?
|
Nocturnal video recording
Nocturnal oximetry Daytime nap polysomnography Ambulatory polysomnography |
|
|
If you can't get a sleep study for a patient for whom you suspect OSA what can you do?
|
Nocturnal video recording
Nocturnal oximetry Daytime nap polysomnography Ambulatory polysomnography |
|
|
If a patient has OSA and exam shows tonsillar hypertrophy and there's no problem with having surgery what should you do?
|
Tonsillectomy can be recommended as first line treatment
In obese children this might not work |
|
|
If a patient has OSA and exam shows tonsillar hypertrophy and there's no problem with having surgery what should you do?
|
Tonsillectomy can be recommended as first line treatment
In obese children this might not work |
|
|
If a patient has OSA and exam shows tonsillar hypertrophy and there's no problem with having surgery what should you do?
|
Tonsillectomy can be recommended as first line treatment
In obese children this might not work |
|
|
Does lead have a biological function?
|
No
|
|
|
Who needs a sleep study?
|
Suspect OSA
Hx of behavioral, learning or mood issues with a hx of sleep problems Suspected Central Sleep Apnea Excessive daytime sleepiness Progressive muscular disorders (ex. Muscular Dystrophy) Obesity (neck circumference greater than 17.5 inches) |
|
|
Who needs a sleep study?
|
Suspect OSA
Hx of behavioral, learning or mood issues with a hx of sleep problems Suspected Central Sleep Apnea Excessive daytime sleepiness Progressive muscular disorders (ex. Muscular Dystrophy) Obesity (neck circumference greater than 17.5 inches) |
|
|
Who needs a sleep study?
|
Suspect OSA
Hx of behavioral, learning or mood issues with a hx of sleep problems Suspected Central Sleep Apnea Excessive daytime sleepiness Progressive muscular disorders (ex. Muscular Dystrophy) Obesity (neck circumference greater than 17.5 inches) |
|
|
Ideally, what should a lead level be?
|
ZERO
|
|
|
What are the contraindications for a adenotonsillectomy?
|
No tonsils
Very sm tonsils or adenoids Morbid obesity with sm tonsils/adenoids Bleeding disorder Submucus cleft (bifid uvula, tented soft palate) Medical conditions causing unstable patient |
|
|
What are the contraindications for a adenotonsillectomy?
|
No tonsils
Very sm tonsils or adenoids Morbid obesity with sm tonsils/adenoids Bleeding disorder Submucus cleft (bifid uvula, tented soft palate) Medical conditions causing unstable patient |
|
|
What are the contraindications for a adenotonsillectomy?
|
No tonsils
Very sm tonsils or adenoids Morbid obesity with sm tonsils/adenoids Bleeding disorder Submucus cleft (bifid uvula, tented soft palate) Medical conditions causing unstable patient |
|
|
What does lead compete with for binding sites?
|
Calcium and Iron
|
|
|
What happens to high risk patients undergoing a T&A?
|
Inpatient admission post-op
|
|
|
What happens to high risk patients undergoing a T&A?
|
Inpatient admission post-op
|
|
|
What happens to high risk patients undergoing a T&A?
|
Inpatient admission post-op
|
|
|
What are the sources of lead?
|
Paint until (1978), petrol, household dust, ceiling dust, occupational, solder, ceramic glaze, pesticides, cigarettes, mines, TVs, computer monitors, batteries, Xray shields, non-stick lining for pots
|
|
|
What are the risks factors of having a T&A?
|
Pain
Dehydration Anesthetic Complication Upper airway obstruction during induction Hemorrhage Velopharyngeal incompetence Nasopharyngeal stenosis DEATH |
|
|
What are the risks factors of having a T&A?
|
Pain
Dehydration Anesthetic Complication Upper airway obstruction during induction Hemorrhage Velopharyngeal incompetence Nasopharyngeal stenosis DEATH |
|
|
What are the risks factors of having a T&A?
|
Pain
Dehydration Anesthetic Complication Upper airway obstruction during induction Hemorrhage Velopharyngeal incompetence Nasopharyngeal stenosis DEATH |
|
|
Where do children absorb lead well?
|
Orally
|
|
|
Who get a reevalutation after a T&A?
|
Especially abnormal baseline polysomnography
Obese Remain symptomatic post treatment |
|
|
Who get a reevalutation after a T&A?
|
Especially abnormal baseline polysomnography
Obese Remain symptomatic post treatment |
|
|
Who get a reevalutation after a T&A?
|
Especially abnormal baseline polysomnography
Obese Remain symptomatic post treatment |
|
|
When is lead absorption enhanced?
|
If diet is poor in iron or calcium
|
|
|
What's the most commonly accepted treatment of OSA?
|
T&A
|
|
|
What's the most commonly accepted treatment of OSA?
|
T&A
|
|
|
What's the most commonly accepted treatment of OSA?
|
T&A
|
|
|
What is one of the worst risk factors for lead poisoning?
|
Pica
|
|
|
What are the complications of a T&A?
|
DEATH
Hemorrhage Pain Airway compromise Respiratory Distress Dehydration |
|
|
What are the complications of a T&A?
|
DEATH
Hemorrhage Pain Airway compromise Respiratory Distress Dehydration |
|
|
What are the complications of a T&A?
|
DEATH
Hemorrhage Pain Airway compromise Respiratory Distress Dehydration |
|
|
T of F: Pregnant women who have had lead exposure pass the lead to their fetus?
|
True
|
|
|
What's the treatment of OSA if a T&A is not indicated?
|
CPAP
|
|
|
What's the treatment of OSA if a T&A is not indicated?
|
CPAP
|
|
|
What's the treatment of OSA if a T&A is not indicated?
|
CPAP
|
|
|
T or F: Lead cannot be inhaled but can penetrate the skin?
|
False, it can be inhaled
|
|
|
What are the indications of using a CPAP?
|
Failed T&A
Obesity Craniofacial anomalies Down Syndrome Intraoral appliances |
|
|
What are the indications of using a CPAP?
|
Failed T&A
Obesity Craniofacial anomalies Down Syndrome Intraoral appliances |
|
|
What are the indications of using a CPAP?
|
Failed T&A
Obesity Craniofacial anomalies Down Syndrome Intraoral appliances |
|
|
When else, besides pregnancy is lead released in old ladies?
|
During menopause
|
|
|
What should be recommended to all patients with OSA?
|
Weight loss
|
|
|
What should be recommended to all patients with OSA?
|
Weight loss
|
|
|
What should be recommended to all patients with OSA?
|
Weight loss
|
|
|
In childhood, what do lead levels reflect?
|
Environmental exposure, exogenous lead
|
|
|
If patient doesn't want to have a T&A, what can you try?
|
Intranasal steroids
|
|
|
If patient doesn't want to have a T&A, what can you try?
|
Intranasal steroids
|
|
|
If patient doesn't want to have a T&A, what can you try?
|
Intranasal steroids
|
|
|
According to the CDC, what is the lead level?
|
5
|
|
|
Where does lead stay forever?
|
In soil and long bones
|
|
|
Where does lead stay forever?
|
In soil and long bones
|
|
|
Where does lead stay forever?
|
In soil and long bones
|
|
|
What is primary dietary prevention of lead exposure?
|
Ensure getting enough calcium and iron
|
|
|
Ideally, what should a kids lead level be?
|
ZEEEEERRRRRRRROOOOOOO
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Ideally, what should a kids lead level be?
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ZEEEEERRRRRRRROOOOOOO
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Ideally, what should a kids lead level be?
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ZEEEEERRRRRRRROOOOOOO
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When do children get ongoing monitoring of their BLL?
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If one is over 5
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T or F: Lead has a biological function
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False
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T or F: Lead has a biological function
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False
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T or F: Lead has a biological function
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False
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Should someone with lead poisoning get iron supplementation?
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Yes if they’re iron deficient
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What does lead compete with for binding in the body?
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Calcium
Iron |
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What does lead compete with for binding in the body?
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Calcium
Iron |
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What does lead compete with for binding in the body?
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Calcium
Iron |
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What do even low levels of lead cause?
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Affects IQ
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What are the uses and sources of lead?
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Paint (until 1970's)
Petrol Household dust Ceiling dust Occupational Solder Ceramic glazes Pesticides Cigarettes Mines/TVs/Xray shields/Pot linings |
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What are the uses and sources of lead?
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Paint (until 1970's)
Petrol Household dust Ceiling dust Occupational Solder Ceramic glazes Pesticides Cigarettes Mines/TVs/Xray shields/Pot linings |
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What are the uses and sources of lead?
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Paint (until 1970's)
Petrol Household dust Ceiling dust Occupational Solder Ceramic glazes Pesticides Cigarettes Mines/TVs/Xray shields/Pot linings |
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What do lead levels above 10 affect?
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Cognitive, CV, immunological and endocrine function as well as behavioral effects
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How do children best absorb lead?
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Orally
Bad because they also have lots of hand to mouth activity |
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How do children best absorb lead?
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Orally
Bad because they also have lots of hand to mouth activity |
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How do children best absorb lead?
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Orally
Bad because they also have lots of hand to mouth activity |
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What are things that enhance the absorption of lead?
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Pregnancy or breastfeeding, poor diet, low iron or calcium, pica, age, proximity to lead industries, renovating an old house
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Lead absorption is increased if diet is poor in ______ or ______.
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Iron, calcium
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Lead absorption is increased if diet is poor in ______ or ______.
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Iron, calcium
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Lead absorption is increased if diet is poor in ______ or ______.
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Iron, calcium
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Where does most of the lead get distributed to?
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Long bones
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T or F: Most lead poisoning has symptoms.
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False, it is usually asymptomatic
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Can lead be inhaled?
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Yes
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Can lead be inhaled?
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Yes
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Can lead be inhaled?
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Yes
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What should you clean with to get rid of lead?
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Spic and span
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What is one of the worst risk factors for lead poisoning?
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Pica
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What is one of the worst risk factors for lead poisoning?
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Pica
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What is one of the worst risk factors for lead poisoning?
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Pica
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What are common sources of lead?
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Paint in houses before 1978, water pumped via leaded pipes, imported items like clay pots, consumer products like makeup, imported home remedies
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Can pregnant women who have been exposed to lead in the past pass lead to their fetus?
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Yes, via osteolysis
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Can pregnant women who have been exposed to lead in the past pass lead to their fetus?
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Yes, via osteolysis
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Can pregnant women who have been exposed to lead in the past pass lead to their fetus?
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Yes, via osteolysis
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When is BLL required for Medicaid patients?
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12 and 24 months
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In childhood, what do lead levels reflect?
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Environmental lead exposure (exogenous)
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In childhood, what do lead levels reflect?
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Environmental lead exposure (exogenous)
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In childhood, what do lead levels reflect?
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Environmental lead exposure (exogenous)
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At what type of visit is BLL done?
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Well child visit
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What does the CDC set the lead level at?
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5
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What does the CDC set the lead level at?
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5
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What does the CDC set the lead level at?
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5
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Children over 72 months should be screened when if they haven’t been tested before?
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ASAP
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What's the primary prevention for lead poisoning via diet?
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Ensure getting enough iron and calcium
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What's the primary prevention for lead poisoning via diet?
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Ensure getting enough iron and calcium
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What's the primary prevention for lead poisoning via diet?
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Ensure getting enough iron and calcium
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When should all immigrant, refugee and internationally adopted children get BLL?
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As soon as they arrive in the US
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What should happen if a child has a lead level over 5?
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Undergo BLL testing
Assess iron deficiency, calcium, vitamin c If iron deficient give supplements Communicate with families Find out where they're getting lead |
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What should happen if a child has a lead level over 5?
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Undergo BLL testing
Assess iron deficiency, calcium, vitamin c If iron deficient give supplements Communicate with families Find out where they're getting lead |
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What should happen if a child has a lead level over 5?
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Undergo BLL testing
Assess iron deficiency, calcium, vitamin c If iron deficient give supplements Communicate with families Find out where they're getting lead |
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Neonates and infants need screening if ____?
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Mom was exposed to lead during pregnancy or lactation
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What can even low lead levels cause?
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Low IQ
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What can even low lead levels cause?
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Low IQ
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What can even low lead levels cause?
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Low IQ
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What education is needed for lead?
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Dietary (Ca and Fe) and environmental
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What can lead levels over 10 cause?
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Cognitive function
Cardio problems Immunological problems Endocrine problems Behavioral effects |
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What can lead levels over 10 cause?
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Cognitive function
Cardio problems Immunological problems Endocrine problems Behavioral effects |
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What can lead levels over 10 cause?
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Cognitive function
Cardio problems Immunological problems Endocrine problems Behavioral effects |
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What is done for lead greater than 5 but less than 45?
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Education, follow up monitoring, complete hx and PE, iron status, H and H, environmental investigation, neurodevelopmental monitoring, Abd Xray if indicated
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Where does most of the lead in your body get distributed to?
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Long bones (95%)
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Where does most of the lead in your body get distributed to?
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Long bones (95%)
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Where does most of the lead in your body get distributed to?
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Long bones (95%)
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When should iron chelation therapy be considered?
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Lead between 45 and 70
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T or F: most humans with lead poisoning have symptoms?
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False, usually asymptomatic
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T or F: most humans with lead poisoning have symptoms?
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False, usually asymptomatic
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T or F: most humans with lead poisoning have symptoms?
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False, usually asymptomatic
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When does a BLL over 5 need to be reconfirmed?
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1 to 3 months
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What should people clean their floors with to get rid of lead?
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Spic and Span
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What should people clean their floors with to get rid of lead?
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Spic and Span
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What should people clean their floors with to get rid of lead?
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Spic and Span
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Children with BLL over 45 need what?
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Confirmatory test in 48 hours
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What are common sources of lead?
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Paint in homes before 1978
Water pumped through leaded pipes Imported household items like clay pots Some consumer products like candles Imported home remedies |
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What are common sources of lead?
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Paint in homes before 1978
Water pumped through leaded pipes Imported household items like clay pots Some consumer products like candles Imported home remedies |
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What are common sources of lead?
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Paint in homes before 1978
Water pumped through leaded pipes Imported household items like clay pots Some consumer products like candles Imported home remedies |
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BLL 5-9 should be confirmed when?
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1-3 months
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Medicaid patients get tested for lead at which ages?
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12 and 24 months
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Medicaid patients get tested for lead at which ages?
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12 and 24 months
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Medicaid patients get tested for lead at which ages?
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12 and 24 months
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BLL 10-44 should be confirmed when?
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1 week to 1 month
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When should lead testing occur?
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During routine well child visits
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When should lead testing occur?
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During routine well child visits
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When should lead testing occur?
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During routine well child visits
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BLL 45-59 should be confirmed when?
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48 hours
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T or F: kids who are older than 72 months who have missed lead screening at a younger age should be tested ASAP?
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True
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T or F: kids who are older than 72 months who have missed lead screening at a younger age should be tested ASAP?
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True
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BLL 60-69 should be confirmed when?
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24 hours
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When should immigrant/refugee and internationally adopted children be assessed for lead?
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At time of arrival because of increased risk
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When should immigrant/refugee and internationally adopted children be assessed for lead?
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At time of arrival because of increased risk
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BLL over 70 should be confirmed when?
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Urgently
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When should you screen neonates and infants for lead?
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When they are born to women with lead exposure during pregnancy or lactation
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When should you screen neonates and infants for lead?
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When they are born to women with lead exposure during pregnancy or lactation
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T or F: Capillary blood is good enough for BLL testing?
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False, tests must be backed up by venous blood
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What needs to be included in lead education?
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Dietary things about iron and calcium
Exposure |
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What needs to be included in lead education?
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Dietary things about iron and calcium
Exposure |
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What are the moderate symptoms of lead poisoning?
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Muscle pain, paresthesia, mild fatigue, aggressiveness, irritability, lethargy and abdominal discomfort
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What is the evaluation and treatment of lead greater than 5 but less than 45?
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Education
Follow up BLL monitoring Complete hx and physical Iron status, h/h Environmental investigation Neurodevelopmental monitoring Abdominal Xray if indicated |
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What is the evaluation and treatment of lead greater than 5 but less than 45?
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Education
Follow up BLL monitoring Complete hx and physical Iron status, h/h Environmental investigation Neurodevelopmental monitoring Abdominal Xray if indicated |
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What are the severe symptoms of lead poisoning?
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Arthralgia, general fatigue, poor concentration, tremor, headache, diffuse abdominal pain, constipation and weight loss
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When should iron chelation therapy be considered?
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If lead levels are between 45 and 70
If lead safe environment cannot assured |
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When should iron chelation therapy be considered?
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If lead levels are between 45 and 70
If lead safe environment cannot assured |
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What symptoms are a medical emergency for lead poisoning?
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Paresis, paralysis, brain edema, stupor/coma, fits/vomiting, gingival lead line, colic and death
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By when must a high BLL be confirmed?
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1 to 3 months
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By when must a high BLL be confirmed?
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1 to 3 months
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If a kid has a BLL above 45, how soon must you confirm this?
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48 hours
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How did Kramer describe autism?
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Children with austistic distubances of affective contact born with preconditions. Congenital inability of relate to others, language disturbances and stereotyped behaviors
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If a kid has a BLL above 45, how soon must you confirm this?
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48 hours
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All ______ blood tests need to be confirmed by venous blood.
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Capillary
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T or F: Current research suggests that autism is caused by differences in development of the brain and central nervous system.
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True
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All ______ blood tests need to be confirmed by venous blood.
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Capillary
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If lead is 5-9, when do you retest?
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1 to 3 months
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What other factors are being investigated as causing austism?
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Infectious, metabolic, neurobiologic, genetic and environmental
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If lead is 5-9, when do you retest?
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1 to 3 months
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If lead is 10-44, when do you retest?
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1 week to 1 month
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What is the concordance rate of autism with monozygotic vs dizygotic twins?
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Mono is 60% and di is 5%
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If lead is 10-44, when do you retest?
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1 week to 1 month
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If lead is 45-59, when do you retest?
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48 hours
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What genetic disorder is commonly accompanied by autism?
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Fragile X
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If lead is 45-59, when do you retest?
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48 hours
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If lead is 60-69, when do you retest?
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24 hours
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What is the neurobiological etiology of austism?
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Macrocephaly, failure to active temporal lobe, high rates of eeg abnormalities/seizure disorder, abnormalities with limbic system and circuitry within the temporal and frontal lobes
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If lead is 60-69, when do you retest?
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24 hours
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If lead is greater than 70, when do you retest?
|
ASAP - this is an emergency
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What do the MRI’s of autistic people show?
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Brain size normal at birth but accelerates in size during year 1, between 2-4 yrs brain size in 5-10% larger than nrm, after 4 brain size decelerates by adulthood is only slightly larger than nrm, enlargement is greatest in the temporal and frontal lobes and there’s more white matter
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If lead is greater than 70, when do you retest?
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ASAP - this is an emergency
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What are the moderate symptoms of lead poisoning?
|
Muscle pain
Paresthia Mild fatigue Aggressiveness Irritability Lethargy Abdominal discomfort |
|
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What are autism spectrum disorders?
|
A group of neuropsychiatric disorders characterized by specific delays and deviance in social, communicative and cognitive development with onset in the first year of life
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What are the moderate symptoms of lead poisoning?
|
Muscle pain
Paresthia Mild fatigue Aggressiveness Irritability Lethargy Abdominal discomfort |
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What are the severe symptoms of lead poisoning?
|
Arthralgia
General fatigue Poor concentration Tremor Headache Diffuse abdominal pain Constipation Weight loss |
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What is the triad of core symptoms in autism?
|
Delay/impairment of social skills, delay/impairment in speech and language skills, restricted, repetitive and stereotyped behaviors
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What are the severe symptoms of lead poisoning?
|
Arthralgia
General fatigue Poor concentration Tremor Headache Diffuse abdominal pain Constipation Weight loss |
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What are the medical emergencies symptoms of lead poisoning?
|
Paresis/paralysis
Brain edema Stupor/coma Fits/vomiting Gingival lead line Colic Death |
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Is emphasis placed on discrete autistic disorder or the whole spectrum?
|
The whole spectrum
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What are the medical emergencies symptoms of lead poisoning?
|
Paresis/paralysis
Brain edema Stupor/coma Fits/vomiting Gingival lead line Colic Death |
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How does Kanner describe autistic kids?
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Congenital inability to relate to others, language disturbances and stereotyped behaviors
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Who’s more likely to ASD, boys or girls?
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Boys
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How does Kanner describe autistic kids?
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Congenital inability to relate to others, language disturbances and stereotyped behaviors
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How is Aspergers described?
|
A group of children with normal IQ, restricted interests and stereotyped behaviors
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What percent of ASD kids are nonverbal?
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40
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How is Aspergers described?
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A group of children with normal IQ, restricted interests and stereotyped behaviors
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What is the current research about genetic and neurobiological etiologies of ASD?
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Suggests a difference in development of the brain and central nervous system cause autism
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What are the problems with early screening for ASD?
|
Average age of dx is 4, average parent first reports signs at 14-15 months and at 11 months, PCP is usually first point of contact, only a minority of providers screen for ASD, visits are too short
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What is the current research about genetic and neurobiological etiologies of ASD?
|
Suggests a difference in development of the brain and central nervous system cause autism
|
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What are factors are being investigated in relationship to autism?
|
Infections
Metabolic Neurobiological Genetic Environmental |
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At what age can ASDs be dx?
|
18months
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What are factors are being investigated in relationship to autism?
|
Infections
Metabolic Neurobiological Genetic Environmental |
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What is the consensus about the genetics of autism?
|
There is a genetic susceptibilty involving multiple genes
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How early can ASDs be dx?
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8 mos
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What is the consensus about the genetics of autism?
|
There is a genetic susceptibilty involving multiple genes
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What is the monozygotic vs dizygotic corcordance of autism?
|
Mono: 60%
Di: 5% |
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There is a better prognosis is ASD is dx before ________.
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3 yrs
|
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What is the monozygotic vs dizygotic corcordance of autism?
|
Mono: 60%
Di: 5% |
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When should you screen for ASD?
|
18 and 24 mos
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What is the dx criteria for ASD in regards to reciprocal social relatedness?
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Must have 2 of these: lack of nonverbal behavior (ex. Eye contact), failure to develop peer relationships, lack of seeking to share enjoyment or lack of social/emotional reciprocity
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What is the dx criteria for ASD with regards to communication?
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Absent/delayed language w/o attempts to compensate, fails to initiate or sustain conversation, stereotyped or repetitive language or lack of varied, spontaneous make believe play
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What is the dx criteria for ASD with regards to behavior?
|
Must have 1 of these: Preoccupation with one thing, inflexible adherence to a ritual, stereotyped mannerisms or preoccupation with parts of object
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What is PPD NOS?
|
Severe and pervasive impairment, reciprocal social interaction associated with impairment in either verbal or nonverbal communication skills or presence of stereotyped behaviors, interests and activities. Atypical autism late age onset
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What is Aspergers?
|
Absence of language delay, language impairment
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What’s Rett’s Disorder?
|
Apparently normal prenatal/perinatal development, apparently normal psychomotor development, normal HC at birth followed by the onset of: deceleration of head growth, loss of hand skills, loss of social engagement, coordination problems and severe impairment of speech and communication
|
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What is Childhood Disintegrative Disorder?
|
Nrm development for 1st 2 years, loss of previously acquired skills before 10 yrs in at least 2 of these: language skills, social skills/adaptive behavior, bowel/bladder control, play, motor skills. Abnormalities in social interaction, communication and restrictive behviors
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What are the earliest signs of ASD?
|
Abnormalities in joint attention, social interaction, play behavior and language
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What is joint attention?
|
Ability to coordinate one’s own attention between an object and another person to indicate a need or share an interest. Universal and specific to autism
|
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What is theory of mind?
|
Lack of realization that others have thoughts or emotions independent from one’s own. Inability to take perspective of another.
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When should someone have reciprocal smiling?
|
2 months
|
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When should someone have gaze monitoring?
|
8 months
|
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When should someone follow a point?
|
9 months
|
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When should someone show objects?
|
10 months
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When should someone point to obtain an object?
|
12 months
|
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When should someone point to indicate interest?
|
14 months
|
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What are the early signs of ASD related to social relatedness?
|
No/reduced smiling, no cuddling, no/reduced eye contact, no response to name at 8 months and tunes other out
|
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What are the early signs of ASD related to communication?
|
No babbling at 9 months, no pointing to objects at 12 months, no single words at 16 months, no functional 2 words phrases at 24 months, no advanced talk at 24 months, lack of make believe or social imitative play
|
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What are the early signs of ASD related to play?
|
Persistent sensory motor play, likes routines, plays with parts of toys, unusual/intense/narrow interests
|
|
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What are early signs of ASD related to body movements?
|
Stereotypic motor movements, mannerisms and clumsiness
|
|
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What are early signs of ASD related to behavior?
|
Inattentive, hyperactive, impulsive behavior, anxiety, self-injury behavior, unusual sensory seeking or avoiding, does not cry if in pain, severe tantrums
|
|
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What are early signs of ASD related to cognitive characteristics?
|
Hyperlexia, reads without understanding, cognitive impairment, unevenness of skills, savant skills
|
|
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What are the signs of autism under 12 months?
|
Perceived as different, decreased eye contact, no big smiles, no joyful expression, extremes of temperament
|
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What are the signs of ASD at 12 months?
|
No back and forth gesturing, decreased eye contact, no babbling, regression
|
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What are the sign of ASD at 15-18 months?
|
No pointing or showing, lack of eye contact, no words by 16 months, regression, lack of pretend play/imitation
|
|
|
What are the signs of ASD at 24 months?
|
Abnormal gaze monitoring, lack of response to name, no spontaneous meaningful 2 word phrases, repetitive movements
|
|
|
What are the absolute indications for ASD eval?
|
Abnormal gaze monitoring, no pointing/gestures by 12 months, absent babbling at 12 months, no single words at 16 months, no spontaneous phrases at 24 months
|
|
|
What is the treatment for ASD?
|
There is no treatment
|
|
|
What is the educational intervention for ASD?
|
Child specific curriculum, planned and structured instructional time promotes learning, 1:1 intensive direct instruction
|
|
|
What should early intervention be aimed at in ASD?
|
Should include intensive, structured intervention appropriate to the child’s needs and family’s needs. Research says ASD kids should have early intervention
|
|
|
What is applied behavior analysis?
|
Teaching skills using discrete trial, promotes generalization of skills, incidental teaching, direct relationship
|
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|
What is the early start Denver model?
|
Shows to be very effective. RMJ doesn’t explain what it is.
|
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|
How much do I hate my life?
|
A lot.
|
