PEDI PSYCH
3 Question Warm-Up
1. A fter a m inor car accident, a woman wears a neck brace and requests permanent disability. W h a t’s the most likely diagnosis?
2. In which disease would you find atrophy o f the m ammillary bodies?
3. W h a t is the most common cause o f sensorineural hearing loss? W h a t is the most common cause o f conductive hearing loss?
Attention-Deficit Hyperactivity Disorder (A D H D )
4. W hat other medications can be used in the treatment of A D H D in children who fail to respond to stimulants or atomoxetine?
5. W hat are the common complications of A D H D stimulant medications, and how are these complications managed?
Stimulants
° Insomnia ~ > address sleep hygiene, take meds earlier in the day, change to shorter duration formulation, clonidine at night
0 Appetite suppression and weight loss administer meds after meals rather than before
° Tics —> usually transient, choose low-moderate dose methylphenidate which does not worsen tics
° Psychosis or mania —> discontinue (no need to taper)
° Decreased growth velocity -> reassure parents that adult height is not affected, drug- holidays may help with “catch-up” growth
Atomoxetine
° Increased risk of suicidality —* close observation and usually discontinuation
° Liver injury —» discontinue
[ 68 ] I
Tourette Syndrome
6. W hat therapeutic options are available for Tourette syndrome?
° Counseling/psychotherapy for social adjustment and coping
° If interfering with necessary functions of life —> anti-dopamine agents: fluphenazine, pimozide or tetrabenazine (which are all tolerated better than haloperidol in these patients)
° If only focal motor or vocal tics —» Botox injections into affected muscles
° I f impulse control problems —> clonidine or SSRIs
° I f refractory to medical management —* consider deep brain stimulation of globus pallidus, thalamus or other subcortical target (undergoing clinical trials)
Autism Spectrum Disorder
7. W hat are some of the characteristic features of autism spectrum disorder?
° “Living in his own world”
° Symptoms evident prior to age 3
° Lack of responsiveness to others, poor eye contact, absence of social smile
° Impairments in communication, language delay, repetitive phrases
° Peculiar repetitive, ritualistic habits (e.g., spinning around, hand flapping)
° Fascination with specific, seemingly mundane objects (vacuum cleaners, sprinklers)
° Usually below-normal intelligence
PEDI PSYCH
End of Session Quiz
8. H ow is A D H D diagnosed?
9. W hich childhood psychiatric disorder matches each o f the following statements?
Females only. Loss o f previously acquired purposeful hand skills between 6-30 months Impairments in social interactions,
communications, play. Repetitive behaviors Characterized by hostility, annoyance, vindictiveness, disobedience and resentfulness Multiple motor and vocal tics
Impulsive and inattentive
10. W hen treating a child suspected o f having a learning disorder, what must first be investigated?
E ndocrinology
1 Type 1 D iabetes 2 Type 2 D iabetes 3 In su lin Therapy
4 A cute C om plications o f D iabetes 5 C h ro n ic C om plications o f D iabetes
6 N o rm al Thyroid F u n ctio n and H y p erth y ro id ism
7 H y p o th y ro id ism and Thyroid C ancer 8 P arathyroid D isorders
9 P itu ita ry D isorders
10 C u sh in g Syndrom e and H yperaldosteronism 11 O th e r A d re n al D isorders
D IA B E T E S
EV A LU A T IO N O F H Y P E R - H Y P O T H Y R O ID IS M ) A N D LESS CO M M O N PRO BLEM LES, A E V A R IO U S SYN D R O M
A D R E N A L IN SU FFIC IE N C Y A N D A D R E N A L E X C E S S ),
EN D O C R IN O LO G Y
TYPE I DIABETES
3 Question Warm-Up
1. W h a t is the treatm ent for neuroleptic m alignant syndrome?
2. W h a t is the m ost com m on complication o f recurrent otitis media?
3. W h a t is the treatm ent for delirium tremens (DTs)?
4. W hat anti-islet antibodies can be seen in patients with type I diabetes mellitus?
° Anti-insulin (IAA)
° Anti-islet cell cytoplasm (ICA)
° Anti-glutamic acid decarboxylase (GAD)
° Anti-tyrosine phosphatase (IA-2)
End o f Session Quiz
5. W h a t lab test is used in diabetic patients to assess the adequacy o f glycemic control over the last three months?
6. W h a t is the leading cause o f death in diabetics?
7. W h y m ust 3-blockers be used w ith caution in diabetics?
8. W h a t can cause hypoglycemia in a non-diabetic patient?
TYPE2 DIABETES
TYPE 2 DIABETES
3 Question Warm-Up
1. W h a t medications other than stimulants are used in the treatment o f A D H D ?
2. W h a t are the three reasons for involuntary psychiatric hospitalization?
3. W h a t is the psychiatric condition in which a person travels a long distance, takes a new name and has no memory o f his prior life?
4. W hich of the oral agents used in the control of type 2 diabetes has the following characteristics:
[
7 4]
Lactic acidosis is a rare but worrisome side effect
M ost common side effect is hypoglycemia
Oldest and cheapest of the oral agents Often used in combination with any of the other oral agents
Also helps lower triglycerides and LDL cholesterol levels
N ot safe in settings of C H F
Should not be used in patients with elevated serum creatinine
Should not be used in patients with inflammatory bowel disease
Hepatic serum transaminase levels should be carefully monitored when using these agents Not associated with weight gain, often used in overweight diabetics
Metabolized by liver, excellent choice in patients with renal disease
Primarily affects postprandial hyperglycemia, taken with meals
H-<
6. W h a t skin finding can be a sign o f having insulin resistance?
7. W h ich diabetic medications should be avoided in patients w ith heart failure?
8. A type 2 diabetic has been well-controlled on a regimen o f metformin,
pioglitazone and glyburide, but now he is developing some episodes o f sweating, tachycardia and confusion. These episodes resolve quickly if he eats something.
W h ich o f his medications would be most likely to cause hypoglycemia?
9. M atch the diabetes drug w ith its m echanism o f action:
Decreases G I absorption o f starch and disaccharides
Stimulates insulin release
Decreases hepatic gluconeogenesis
Increases tissue glucose uptake and improves insulin sensitivity
M imics the action o f GLP-1: i glucagon, T insulin, delays gastric emptying
Inhibits DPP-IV, leading to 1 glucagon, T insulin, delays gastric emptying
5. W hat are the criteria for the diagnosis of metabolic syndrome?
Diagnosis based on any three of the following:
° ____________________ : Waist circumference > 40 in (102 cm) in men, or > 35 in (88 cm) in women (ID F criteria is > 94 cm in men and > 80 cm in women)
° ___________________ > 150 mg/dl
° ____________________ < 40 mg/dl in men, or <50 mg/dl in women
° ____________________ > 130/85 mmHg
° ____________________ > 100 mg/dl (or 2-hour post oral glucose > 140 mg/dl)
I [75]