Child & Adolescent. Most of the questions for general psychiatrists are related to identifying, not treating, these disorders, so that is the focus here. All answers come from DSM-IV-TR or First and Tasman unless otherwise indicated. As of 12Aug08. Written exam.
Most of the questions for general psychiatrists are related to identifying, not treating, these disorders, so that is the focus here. All answers come from DSM-IV-TR or First and Tasman unless otherwise indicated.
As of 12Aug08
This PowerPoint is unlikely to be relevant for oral adult boards. It does have material that is likely to be on Part I or on the recertification exam.
Q. IQ level and definition of MR subtypes?
* Beginning in 2006, it is becoming more and more “correct” to use “Intellectual Disorder,” “ID,” for this disorder.
Ans. Mental retardation IQ subtypes:
Profound mental retardation: below 20-25
Severe mental retardation: 20-25 to 35-40
Moderate mental retardation: 35-40 to 50-55
Mild mental retardation: 50-55 to 70
[borderline intellectual functioning, a V code, 71-84.]
Q. Characteristics of Down’s?
Q. Most are caused by?
Ans. Trisomy 21.
Q. Characteristics of Angelman’s syndrome?
1] severe mental retardation
2] can’t speak but periodic laughter
3] ataxia, motor clumsiness
4] have a large mouth
Q. What genetic abnormality is associated with Angelman syndrome?
Ans. If you say “chromosome 15,” that should be sufficient. More specifically, deletion of the section 15q11-q13 of the maternal chromosome.
Q. Features of Prader-Willi?
Q. Genetics of Prader-Willi syndrome?
Ans. Chromosome 15 abnormality, deletions, unlike Angelman syndrome, originate from the father.
Q. Characteristics of fragile X?
1] usually moderate mental retardation
2] oblong face
3] prominent ears and jaw
Q. Features of fetal alcohol syndrome?
Ans. While variable, examiners are likely to expect:
[“fetal alcohol effects” = 2 of these 3.]
Q. Basic criteria of Reading Disorder?
Ans. Reading ability is substantially below what would be expected given pt’s age, schooling, intelligence, and need.*
*”Need” gets to the issue that it has to be problematic in some way.
Q. Criteria for mathematical disorder?
Ans. Mathematical ability is substantially below what would be expected given the pt’s age, schooling, intelligence, and need.
Q. Criteria for Disorder of Written Expression?
Ans. Written expression is substantially below what is expected of the pt given the age, schooling, intelligence, and need.
Q. ‘Criteria for motor skills disorder?
Ans. The pt’s motor skills are substantially below what would be expected of someone of that age, intelligence, training, physical health, and need.
Q. Criteria for expressive language disorder?
Ans. Pt’s expressive language [vocabulary, grammar] are substantially below what would be expected given the age, intelligence, schooling, and need.
Q. What is criteria for phonological disorder?
Ans. Pt’s ability to make correct speech sounds is substantially below what is expected given the person’s age, intelligence, schooling, and need [e.g., “t” sound for “k” sound].
Ans. Pt has disturbance in fluency and time pattering of speech that is inappropriate for someone of his/her age and need – and beyond any neurological deficits.
Q. General treatment for stuttering?
Ans. Speech therapist, who often attempt to modify speech’s rhythm and speed, and as a temporary manner, encourage prolongation of the speech.
Q. The three major areas of psychopathology of autism are?
1] Impaired social interaction
2] Impaired communication
3] Stereotyped patterns of behavior.
Q. DSM expects at least 2 of 4 signs of impaired social functioning. List the 4.
1] impaired social behaviors such as eye-to-eye contact
2] failure to develop peer relationships appropriate to age level
3] lack of seeking social interactions
4] lack of social interaction reciprocity
Q. DSM expects at least one of four communications deficits. Name the four.
Q. DSM expects at least one of four stereotyped behaviors. Name the four.
1] abnormal intensity or focus of interests.
2] inflexible adherence to rituals
3] repetitive motor mannerisms
4] overly persistent preoccupation with parts of objects.
Q. Rett’s has 8 requirements, 3 of which are “normal.” List the 8.
5] loss of previous hand skills, replaced with stereotyped hand movements between 5 and 30 months.
6] loss of social engagement
7] poorly coordinated gait
8] impaired expressive and receptive language.
Q. Gender breakdown with Rett’s?
Ans. Only females.
Q. List the four general requirements of childhood disintegrative disorder.
1] OK for first two years.
2] Lost of language, social, bowel/bladder, play or motor skills between ages 2 and 10.
3] Abnormal social interactions, communications, behaviors evolve after 2 year’s old.
4] Not part of pervasive developmental disorders or early onset schizophrenia.
Q. Criteria for Asperger’s? Lists 4 general findings [findings beyond the DSM’s usual requirements 1] that the Disorder cause significant problems and 2] that the Disorder not be part of another Disorder].
1] Qualitative impairment in social interactions.
2] Stereotyped patterns of behavior.
3] No delay in language skills
4] No delay in cognitive development
Q. List the three main types of ADHD.
1] combined type
2] predominantly inattentive type
3] predominantly hyperactive type
Q. What is the minimum duration of the duration of time, weeks or months, of the psychopathology expected by DSM before you can DX ADHD?
Ans. 6 months or more.
Q. DSM criteria for inattentive type expects 6 of 9 findings. List some of the 9.
1] Fails to pay attention to details
2] Difficulty sustaining a task
3] Does not seem to listen when being spoken to
4] poor on follow through as to a task
5] see next slide
6] Avoids sustained mental effort [exceptions are topics of great interest]
7] loses things
8] easily distracted
Q. DSM expects 6 of 9 signs of hyperactivity/impulsivity. List the 9.
3] runs or climbs excessively
5] see next slide
5. Often on the go
6. Excessively talkative
7. Blurts out answers before other party has finished the question
8. Difficulty in awaiting his/her turn
9. Interrupts others
Q. Kid fully meets the signs and symptoms in school, but in no other setting. DX?
Ans. ADHD NOS as it needs to be seen in two distinct settings for ADHD.
Q. FDA approved for ADHD?
3] chlorpromazine [for hyperactivity]
4] haloperidol [for hyperactivity]
6] pemoline [since withdrawn from market]
Q. There are 15 signs of this Disorder. List the four headings of these 15.
1] Aggression to people and animals
2] Destruction of property
3] Deceitful or theft
4] Serious violation of rules.
Q. DSM list 8 defiant signs expected for 6 months or more. List:
Ans. OFTEN as to each of these:
1] loses temper
2] argues with adults
3] defies complying with adult requests
4] deliberately annoys people
5] blames others for own misdeeds
6] easily annoyed
Q. Criteria for Pica?
Ans. For at least one month, eating nonnutritive substance that is inappropriate to age level and to the person’s culture.
Q. Criteria of rumination disorder?
Ans. Repeated regurgitation and rechewing for at least one month and not part of 1] a general medical condition, 2] anorexia nervosa o 3] bulimia.
Q. Criteria of feeding disorder of infancy or early childhood?
Ans. Before age 6 and lasting at least one month: Persistent failure to eat to where there is significant failure to gain or even to lose weight – and not part of general medical condition.
Q. Criteria for Tourette’s?
1] onset < 18 years old
2] For at least 9 months of a 12 month period, every day the pt has motor or vocal tics.
Q. What is a tic?
Ans. Tic = sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization.
Q. What is most frequent first tic?
Q. FDA approved for Tourette’s?
Q. Criteria of encopresis?
Q. Criteria for enuresis?
Q. Three or more of what 8 signs?
Q. < 18 years old. “Excessive” applies all 8 of:
5] Fearful to be alone.
6] Fearful to go to sleep without a significant attachment nearby.
7] Nightmares involving theme of separation
8] Somatic complaints in the face of separation.
Q. Criteria for selective mutism?
Ans. Despite being able to speak, in specific social situations or places [e.g., school], fails to speak.
Q. Criteria of reactive attachment disorder of infancy or early childhood?
Ans. Onset before the age of 5: Failure to develop socially in the face of pathogenic care of the child.
[Thus joins PTSD, Acute stress disorder and adjustment disorders in being a reaction to untoward events.]
Q. What is Williams syndrome?
Ans. Intellectual limitations, impaired visuospatial construction, language perserveration, and very social.
[Michael Egan presentation, 16Nov07]
Q. What is velocardial facial syndrome?
1] cleft palate
2] cardiac defects
3] learning disabilities and other psychiatric problems [30% psychosis]
4] short statue
[source: Michael Egan presentation, 16Nov07]