Pediatric Board Review - Psychosocial Issues

Front 1

What are acceptable/normal hours of crying for an infant up to 6 weeks? What about beyond 6 weeks?

Back 1

2 hours per day for first 6 weeks, 3 hours per day beyond that.

Front 2

A new parent of a 3 month old complains that she just can't get her child to sleep through the night or even get a solid nap. She wants to know if this is normal. What do you say?

Back 2

This is normal, and it is just the baby's temperament.

Front 3

How do you manage colic?

Back 3

Hand over the baby to another caregiver!

Front 4

A frustrated mother of a 2 month old comes in because her infant cries non-stop. The crying starts at 5AM for 2 hours and again at 1AM for an hour. What should the parents do?
A) Thicken the formula
B) Give tylenol
C) Give antacids
D) Give benadryl
E) Reassure

Back 4

E.

Front 5

A toddler presents with language delay, hand waving, repetitive play. The family has missed multiple appointments. What is your diagnosis?

Back 5

Child neglect.

Front 6

In which age group is head banging okay in an otherwise healthy child?

Back 6

8 months - 4 years

Front 7

If they present a child older than age 4 who has signs and symptoms consistent with a neurological defect, what do you suspect?

Back 7

Lesch-Nyhan Syndrome.

Front 8

A preschool aged kid is seen by his nanny masturbating. What is the most appropriate intervention.

Back 8

Reassure.

Front 9

By what age are 75% of kids potty trained?

Back 9

36 months.

Front 10

What are 5 causes of enuresis?

Think Soap SUDS!

Back 10

Sacral problem
Sickle Cell Trait
UTI
Diabetes
Seizures

Think Soap SUDS!

Front 11

What is the initial workup for new-onset enuresis?

Back 11

H/P and U/A

Front 12

What is the probability of enuresis if one parent had it in childhood? What if both parents had it?

Back 12

40% for 1; 70% for 2

Front 13

What is a short term option for treating enuresis?

Back 13

Desmopressin intranasal

Front 14

How common is nocturnal enuresis in 5yo?

Back 14

20%

Front 15

Which of the following statements regarding enuresis are true and which are false.
1. 15% resolve without intervention
2. Enuresis alarms are a good long term solution
3. U/A is a sufficient workup.
4. Non-organic workup includes small bladder, excessive fluids, and deep sleeping.

Back 15

All are true

Front 16

A patient has diurnal enuresis after attaining continence what 4 causes should you look for?

Back 16

UTI, DM, DI or kidney disease

Front 17

What is the cause of diurnal enuresis in 97% of cases? What is the treatment?

Back 17

non-organic, eg. behavioural withholding pattern. Voiding schedule

Front 18

What is the treatment for a 3 yo who is in the process of being potty trained but is now withholding stools?

Back 18

Put him back in diapers.

Front 19

When are laxatives okay for treating constipation?

Back 19

Laxatives are okay for older kids only if there is encopresis.

Front 20

True or False.
Chronic encopresis is associated with UTI.

Back 20

True. This is because the pressure pushes on the bladder and causes stasis and urinary retention.

Front 21

How do you distinguish a simple breath holding spell form a complex one?

Back 21

If simple, the child becomes pale or cyanotic.
If complex, the child keeps crying till he goes unconscious

Front 22

True or False.
There is an association between anemia and breath-holding spells.

Back 22

True

Front 23

True or False.
Treatment of anemia reduces or stops breath holding spells.

Back 23

True

Front 24

True or False.
Anemia causes breath holding spells

Back 24

False

Front 25

What is the best intervention for a toddler who sucks his thumb?

Back 25

Positive reinforcement for not sucking his thumb.

Front 26

True or false.
Somatization and regression of developmental milestones is normal in divorce or family stress.

Back 26

True

Front 27

A couple has a 3 yo, an 8yo, a 10yo and a 15yo. The couple is getting a divorce. How will each one respond?

Back 27

The preschooler will likely regress from their latest developmental milestone.
The 8yo will have overt grieving, fears of rejection, guild and fantasies that the parents will reunite.
The 10yo will be angry and upset about broken family
The Teenager will be depressed, and may have suicidal ideation

Front 28

What is the typical response to a death in the family of a 4yo, 8yo, and 16yo?

Back 28

The 4yo will regress and throw tantrums.
The 8yo will have somatic complaints, sleep problems and decreased school performance
The teen will act out.

Front 29

What are the stages of mourning?

Back 29

Denial
Anger/Resentment
Bargaining
Depression

Front 30

Which of the following statements are true and which are false regarding conversion disorder?
A) It is more common in girls than in boys in teens
B) It is unintentional
C) There is no psychologic explanation
D) A) It is more common in boys than in girls in teens

Back 30

D is false. In children conversion disorder is equal in boys and girls.

Front 31

True or False.
The degree of somatization and regression is related to the child's perceived ability to control the situation.

Back 31

True

Front 32

True or false.
School phobias occur more in single parent households.

Back 32

True.

Front 33

Is it a proven fact that television increases violence, influences toy choice, and cereal choice by kids?

Back 33

Yup.

Front 34

Place in order of time spent per week.
Sleep
School
TV watching

Back 34

Sleep is most
TV watching (23 hours)
School

Front 35

How much TV should be watched?

Back 35

2 hours/day with parent.

Front 36

A 5yo boy goes to bed at 9pm and frequently wakes up at around midnight and sleep walks or has sweats, tachycardia and heavy breathing. When his mother finally awakens him, he is disoriented and does not remember the event. What are these?

Back 36

Night terrors

Front 37

What is the most helpful intervention for a family with a child who has a chronic disease?

Back 37

Increase the home resources.

Front 38

Of all siblings: older, younger, brother, sister who is at highest risk of negative outcome?

Back 38

Older sisters, then older brothers

Front 39

What are the three core symptoms of ADHD?

Back 39

Impulsiveness
Inattentiveness
Disorganization.

Front 40

A young mother would like to know why her two kids both have ADHD, yet her son is hyperactive and her daughter just can't pay attention. She also wants to know if they will outgrow this. How do you respond?

Back 40

3% of kids have it
Hyperactivity is more in boys
Inattentiveness is more in girls
50% of kids do not outgrow ADHD, but the hyperactivity changes to fidgety behaviour in adulthood.

Front 41

How old does a child need to be before diagnosing ADHD?

Back 41

6yo, but they must have had symptoms prior to this age.

Front 42

True or False
Sugar and diet contribute to ADHD

Back 42

False

Front 43

A child has been inattentive and disruptive in class and at home. She is noted to be lethargic, has poor appetite and intermittent abdominal pain. What is her diagnosis?

Back 43

Lead poisoning

Front 44

True or False
Stimulant medication response is a good confirmation of ADD/ADHD diagnosis.

Back 44

False. All kids will improve attention with stimulants, but that doesn't mean they all have ADHD.

Front 45

True or False. Check each one.
1. Sexual orientation is biologically based
2. Homosexual teens are at higher risk for substance abuse, suicide, dropping out of school and being homeless.
3. Sexual activity is a choice
4. Same sex experimentation is a harbinger of homosexuality

Back 45

1, 2 and 3 are true. 4 is false.