Group Activities for Learning

Disabilities Q
Follow the name list
1. Pravind
2. Kavitha
3. Kathy
4. Ng HS
5. Aida
6. Nabila
7. Farah
8. Yuan
9. Lim WS
10. Azwan
11. Rusna
12. Aishah
13. Sharifah
14. Preshantni
15. Hartini
Group 1
 A mother brings her 6-year-old son to KK complaining that
“there is something very wrong with him”. He just sprinkled
baby powder all over the house, last night he opened a
bottle of ink and threw it on the floor. He is unable to sit still
at school, is easily distracted, has difficulty waiting his turn
in games, has difficulty in sustaining attention in play
situations, talks all the time, always interrupts others, does
not listen when talked to, constantly shifting from one
activity to another.
On exam, there is no physical abnormalities demonstrated.
1. What is the most likely diagnosis in this patient?
a. Mental retardation
b. Childhood depression
c. Attention-deficit hyperactive disorder (ADHD)
d. Maternal deprivation
e. Childhood schizophrenia
 2. Which of the following is (are) associated with
the disorder described? (True / False)
a. Feelings of low self-esteem
b. Feelings of depression
c. Impaired interpersonal relationships
d. A reduction in life successes
 3. Who is the person who usually suspects this
diagnosis?
a. The child psychiatrist
b. The family physician
c. The parents
d. The school teacher
e. The grandparents
 4. The differential diagnosis of this disorder
includes which of the following? (True / False)
a. Adjustment disorder (F)
b. Bipolar disorder (T)
c. Anxiety disorder (T)
d. Childhood schizophrenia (T)
 5. Which of the following is (are) true regarding
the prevalence of this disorder? (True / False)
a. Prevalence rates are higher in preschool
children than in school-age children
b. Affected boys outnumber girls in surveys of
school-age children
c. Prevalence rates decline as a cohort of
children ages into adulthood
Group 2
 6. Which of the following are pharmacologic
treatment options in the disorder described?
(True / False)
a. Methylphenidate or its derivatives
b. Dextroamphetamine or amphetamine
derivatives
c. Magnesium pemoline
d. Modafinil
 A 9-year-old boy comes to KK for URTI. On further review, he
is taking short-acting methylphenidate BD from a
psychiatrist. His mother has noted significant improvement
with morning classes but a significant problem with
hyperactivity and inattentiveness as the day progresses. His
recent report card shows his academic performance is
stronger in his morning classes. His mother is afraid that the
treatment is not working well enough.
7. What is the next appropriate step in the management of
this patient? You plan to write a memo to psychiatrist to:
a. stop the medication and change to dextroamphetamine
b. Increase the dose of his current medication
c. Reassure the mother and continue psychiatrist
appointment in 3 months later
d. Add sertraline (list B medicine) as an adjunct treatment
e. Change to long-acting form of methylphenidate
 One month later, the mother calls to KK and reports to you
that he is doing quite well throughout the school day. His
teachers are reporting significant improvement in focus and
attention. However, his parents note that his appetite has
decreased and it is difficult for him to fall asleep.
8. What is the most appropriate management at this stage?
a. Suggest to increase the dose of his current medication
b. Suggest to stop the methylphenidate and begin
dextroamphetamine
c. Refer psychologist at KK and begin behavioural therapy
d. Reassure the parents and recheck the patient in 1 month
e. Suggest to add an SSRI as an adjunctive treatment
 9. which of the following disorders often appear
together in the same individual at various life
stages?
a. Mental retardation, ADHD, learning disability
b. Childhood depression, ADHA, early-onset adult
schizophrenia
c. ADHD, conduct disorder, anti-social personality
disorder
d. Adjustment disorder, ADHD, major depression
e. ADHD, bipolar disorder, conduct disorder
 10. Which of the following statements regarding the effects of
stimulants on children, adolescents and adults is (are) correct?
a. Treatment with stimulants at an early age in children with
ADHD increases their risk of substance abuse and
dependence as adults
b. Normal and hyperactive children, adolescents and adults
have similar cognitive responses to comparable doses of
stimulants
c. Normal and hyperactive children, adolescents and adults
have similar behavioural responses to comparable doses of
stimulants
d. b and c
e. All correct
Group 3
 A 19-year-old lady comes in for a medical check up. She has been under a
lot of stress in her first year as a college student. She earned outstanding
grades in high school but admits that she resigned herself “to working
twice as hard as everyone else” because she could not stand to do one
thing for too long. She has always been high energy compared with her
friends but believed she was just a little weird. She has been finding
difficult to choose her classes and organize her schedule. On examination,
she is fidgeting and her speech seems slightly pressured. Her vital signs
and physical exam are normal, TSH level normal.
11. Which of the following statements regarding this patient is true?
a. She cannot have ADHD given her academic success while untreated in
the past
b. ADHD cannot be diagnosed in patients older than 18 years old
c. Because of her age, she would be unlikely to benefit from medication
d. Most children with ADHD “outgrow” their diagnosis as they become
adults
e. The diagnosis of adults with ADHD is increasing in frequency
 12. Which of the following statements regarding the treatment
of this case is true?
a. Adult ADHD patients receive nearly 1/3 of all prescriptions
written for this disorder
b. The majority of prescriptions written for this disorder are
for children 5 to 9 years old
c. The number of prescriptions written for the treatment of
ADHD has declined in recent years
d. All patients with ADHD and school difficulties must be
formally tested for learning disability before treatment
with medication
e. Although a genetic link has been established, there is no
known prenatal environmental risk factor for ADHD
 13. A mother brings her 5-year-old son to KK because his teacher is
concerned that he has ADHD. The child frequently makes long-winded
speech about boats in class and is often rocking back and forth in his seat.
He is very independent with few friends and has always been interested
in boats, preferring them over all other toys. You observe that is speech is
monotone and restricted in volume and rate. He never makes eye contact
with you or his mother. Which of the following statements is most
accurate regarding this child?
a. An Asperger-specific screening tool appropriate for the child’s age is
the next important step
b. The most important issue for today’s visit is to administer
vaccinations the child is missing
c. The child should be started on oral amphetamine-like compounds,
which will likely lead to much improved behaviour
d. The parent should be reassured, as the child’s behaviour and
development is most likely a variant of normal
e. It is probable that one of the vaccinations is responsible for the
child’s clinical findings
 14. Which of the following statements is accurate?
a. A previously healthy, normally developing 3-year-old
child begins to lose bladder control and will no longer
speak in sentences, but you should not be too
concerned because this began after the birth of her
younger sibling and she just wants more attention
from her parents
b. No use of single words by 12 months of age in a child
is reason for immediate referral to speech therapy
c. Children with ASD will rarely grow up to be
independent adults
d. You counsel the parents of a 6-year-old son with
autism that their second child is at increased risk for
having an ASD
 15. Which of the following observations during a clinical
examination is concerning for the presence of an ASD?
a. You walk into the examination room and find a
36-month-old child pretending to have tea with her
imaginary friend
b. A 12-month-old child walks over to the sink, and
points toward the faucer, but only utters, “uh” and
does not say water
c. A 2-year-old child is holding tightly to a tattered old
blanker, which is mother says he will not leave the
house without
d. You tap an 18-month-old child on the shoulder, say
“Look” and point to a toy in the corner of the room,
but child ignores you and continues to spin the
wheels on this toy car
 Group 4
HSAH, H. Teluk Intan
 Case-based Discussion
A 6-year-old boy has a long history of poor concentration and
being disruptive in class, and has difficulty in forming peer
relationships. He is aggressive and his school progress is poor.
16. What is the likely differential diagnosis?
17. What issues in the given history support the diagnosis?
18. What additional features in the history would you seek to
support a particular diagnosis?
19. What clinical examination would you perform, and why?
20. What investigations would be most helpful, and why?
21. What treatment options are appropriate?
 Group 5
HSB , H. Taiping
 Case-based Discussion
A 2-year-old boy has a long history of concerns over
communication. He has never babbled or spoken intelligible
words. He plays alone, and is aggressive if his routines are
disturbed.
22. What is the likely differential diagnosis?
23. What issues in the given history support the diagnosis?
24. What additional features in the history would you seek to
support a particular diagnosis?
25. What clinical examination would you perform, and why?
26. What investigations would be most helpful, and why?
27. What treatment options are appropriate?
 Group 6

Hospital Kulim
 Role Play
Halim, a 7 years old standard 1 student, was
brought by mother with complains of poor
performance in class. His mother is very upset
because all his 3 siblings are high achievers in
school. Please proceed with consultation. (you
may design your own scenario)