CMN 571 UPDATED EXAM SCRIPT QUESTIONS AND
ANSWERS GRADED A+
✔✔Definition of enuresis - ✔✔Repeated urination into the lcothing during the day and
into the bed at night by a child who is *chronologically and developmentally older than 5
years*. Pattern must occur at least *twice a week* for *three months*.
Hay p 80
✔✔Definition and cause of monosymptomatic enuresis - ✔✔Definition: Uncomplicated
nocturnal enuresis (NE). Must never have been dry at night for over 6 months with no
daytime accidents.
Cause: Maturational disorder of the urologic and neurologic systems, with no underlying
organic problem
Hay p 80
✔✔How long must a bedwetting alarm be used consistently to achieve results? - ✔✔At
least 3 months, every night.
Most common cause of failure is if the child doesn't wake up and the parents do not
wake up the child.
Hay p 81
✔✔Benefits and drawbacks of medication use for nocturnal enuresis - ✔✔Benefits:
DDVAP and imipramine have been shown to be very effective
Drawbacks: Imipramine has a risk of overdose. When either drug is stopped, there is a
high relapse rate.
Hay p 81
✔✔Definition and cause of non-monosymptomatic enuresis - ✔✔Definition: Daytime
incontinence
Cause: Consider underlying pathology, as daytime continence is usually achieved
between ages 3 - 6.
Hay p 81
✔✔When is daytime continence achieved by most children? - ✔✔70% are continent by
age 3 years
90% are continent by age 6 years
,Hay p 81
✔✔Definition of constipation - ✔✔*≥ TWO* of the following events for *2 months*:
1) < 3 BMs per week
2) > 1 episode of encopresis per week
3) Impaction of rectum with stool
4) Passage of stool so large it obstructs the toilet
5) Retentive posturing and fecal withholding
6) Pain with defecation.
Hay p 81
✔✔Definition of encopresis - ✔✔Repeated passage of stool into inappropriate places
(such as the underpants) by a child who is developmentally or chronologically *older
than 4 years*. It occurs *each month* for at least *3 months* and is not due to the
physiologic effects of a substance of medical condition, except for constipation.
Hay p 81
✔✔Highest prevalence of encopresis is between what ages? - ✔✔5 and 6
Hay p 81
✔✔What percentage of cases of encopresis are the result of constipation? - ✔✔More
than *NINETY (90) PERCENT*!!
Hay p 81
✔✔Initial intervention in treatment of encopresis? - ✔✔Treatment of constipation (in the
absence of any gastrointestinal abnormalities).
Hay p 81
✔✔What should be prescribed when medical management of constipation in children is
indicated? - ✔✔1) Oral medication, or
2) Enema for "bowel cleanout" followed by oral medication
** Fiber or mineral oil can also be used to help the child have daily bowel movements
Hay p 81
✔✔Food refusal may be an expression of __________ in children - ✔✔depression
Hay p 84
,✔✔Examples of environmental cues that entrain a child's sleep/wake cycle into a 24
hour rhythm - ✔✔+ Light-dark
+ Ambient temperature
+ Core body temperature
+ Noise
+ Social interaction
+ Hunger
+ Pain
+ Hormone production
Hay p 85
✔✔Most mature individual spend about half their time in WHAT stage of sleep? -
✔✔NREM Stage 2 (i.e slowing of eye movements, slowing of respiratoins and heart rate
and relaxation of muscles)
Hay p 85
✔✔When does the deepest NREM sleep occur? - ✔✔During the first 1 - 3 hours after
going to sleep.
Hay p 85
✔✔Define parasomnias - ✔✔Abnormalities of arousal, partial arousal and transitions
between stages of sleep.
NOTE: Occur *most often* early in the night during deep NREM sleep, but can occur
during REM sleep as well. Some NREM examples:
+ Confusional arousals
+ Night terrors
+ Sleeptalking (somniloquy)
+ Sleepwalking (somnambulism)
Hay p 85
✔✔Most children stop napping between what ages? - ✔✔Between 3 and 5 years of age
Hay p 85
✔✔How many hours a night do school-aged children typically sleep? - ✔✔10 - 11 hours
per night
Hay p 85
, ✔✔Night terrors: When do they occur, in what ages are they most common, and
description of an NT event - ✔✔WHEN: Usually within 2 hours of falling asleep, often in
the deepest stage of NREM
WHAT AGES: Most often between 3 - 8 years
DESCRIPTION: Incoherent and often unresponsive to comforting. Screaming,
thrashing, sweating, tachycardia and rapid breathing. No memory of event the next day.
Hay p 86
✔✔Sleepwalking: At what point in the sleep cycle do the occur, and at what ages is it
most common? - ✔✔WHEN: During slow wave/deep sleep
WHAT AGES: Most common between 4 - 8 years
Hay p 86
✔✔Management of night terrors and sleepwalking - ✔✔+ Reassure parents
+ Avoid stressing child
+ Promote regular sleep schedule for child
+ Avoid sleep deprivation (which prolongs deep sleep when these events occur)
Hay p 86
✔✔Nightmares: When in the sleep cycle do they occur, at what ages are they most
common, and what are characteristics of these events? - ✔✔WHEN: During REM sleep,
which usually occurs in the latter part of the night.
WHAT AGE: Peak occurrence between 3 - 5 years
DESCRIPTION: Frightening dreams. Child is alert, can describe images and talk about
it next day. Will respond to parental reassurance. Will have difficulty going back to sleep
and will want to stay with parents.
Hay p 87
✔✔Management of nightmares - ✔✔Usually self-limiting and need little treatment. Can
be associated with:
+ Stress
+ Trauma
+ Anxiety
+ Sleep deprivation (which can cause a rebound in REM sleep)
+ Medications which increase REM sleep
Hay p 87
✔✔Definition of sleep-disordered breathing, and during what ages does it commonly
occur in children? - ✔✔DEFINITION: Obstructed breathing during sleept accompanied
ANSWERS GRADED A+
✔✔Definition of enuresis - ✔✔Repeated urination into the lcothing during the day and
into the bed at night by a child who is *chronologically and developmentally older than 5
years*. Pattern must occur at least *twice a week* for *three months*.
Hay p 80
✔✔Definition and cause of monosymptomatic enuresis - ✔✔Definition: Uncomplicated
nocturnal enuresis (NE). Must never have been dry at night for over 6 months with no
daytime accidents.
Cause: Maturational disorder of the urologic and neurologic systems, with no underlying
organic problem
Hay p 80
✔✔How long must a bedwetting alarm be used consistently to achieve results? - ✔✔At
least 3 months, every night.
Most common cause of failure is if the child doesn't wake up and the parents do not
wake up the child.
Hay p 81
✔✔Benefits and drawbacks of medication use for nocturnal enuresis - ✔✔Benefits:
DDVAP and imipramine have been shown to be very effective
Drawbacks: Imipramine has a risk of overdose. When either drug is stopped, there is a
high relapse rate.
Hay p 81
✔✔Definition and cause of non-monosymptomatic enuresis - ✔✔Definition: Daytime
incontinence
Cause: Consider underlying pathology, as daytime continence is usually achieved
between ages 3 - 6.
Hay p 81
✔✔When is daytime continence achieved by most children? - ✔✔70% are continent by
age 3 years
90% are continent by age 6 years
,Hay p 81
✔✔Definition of constipation - ✔✔*≥ TWO* of the following events for *2 months*:
1) < 3 BMs per week
2) > 1 episode of encopresis per week
3) Impaction of rectum with stool
4) Passage of stool so large it obstructs the toilet
5) Retentive posturing and fecal withholding
6) Pain with defecation.
Hay p 81
✔✔Definition of encopresis - ✔✔Repeated passage of stool into inappropriate places
(such as the underpants) by a child who is developmentally or chronologically *older
than 4 years*. It occurs *each month* for at least *3 months* and is not due to the
physiologic effects of a substance of medical condition, except for constipation.
Hay p 81
✔✔Highest prevalence of encopresis is between what ages? - ✔✔5 and 6
Hay p 81
✔✔What percentage of cases of encopresis are the result of constipation? - ✔✔More
than *NINETY (90) PERCENT*!!
Hay p 81
✔✔Initial intervention in treatment of encopresis? - ✔✔Treatment of constipation (in the
absence of any gastrointestinal abnormalities).
Hay p 81
✔✔What should be prescribed when medical management of constipation in children is
indicated? - ✔✔1) Oral medication, or
2) Enema for "bowel cleanout" followed by oral medication
** Fiber or mineral oil can also be used to help the child have daily bowel movements
Hay p 81
✔✔Food refusal may be an expression of __________ in children - ✔✔depression
Hay p 84
,✔✔Examples of environmental cues that entrain a child's sleep/wake cycle into a 24
hour rhythm - ✔✔+ Light-dark
+ Ambient temperature
+ Core body temperature
+ Noise
+ Social interaction
+ Hunger
+ Pain
+ Hormone production
Hay p 85
✔✔Most mature individual spend about half their time in WHAT stage of sleep? -
✔✔NREM Stage 2 (i.e slowing of eye movements, slowing of respiratoins and heart rate
and relaxation of muscles)
Hay p 85
✔✔When does the deepest NREM sleep occur? - ✔✔During the first 1 - 3 hours after
going to sleep.
Hay p 85
✔✔Define parasomnias - ✔✔Abnormalities of arousal, partial arousal and transitions
between stages of sleep.
NOTE: Occur *most often* early in the night during deep NREM sleep, but can occur
during REM sleep as well. Some NREM examples:
+ Confusional arousals
+ Night terrors
+ Sleeptalking (somniloquy)
+ Sleepwalking (somnambulism)
Hay p 85
✔✔Most children stop napping between what ages? - ✔✔Between 3 and 5 years of age
Hay p 85
✔✔How many hours a night do school-aged children typically sleep? - ✔✔10 - 11 hours
per night
Hay p 85
, ✔✔Night terrors: When do they occur, in what ages are they most common, and
description of an NT event - ✔✔WHEN: Usually within 2 hours of falling asleep, often in
the deepest stage of NREM
WHAT AGES: Most often between 3 - 8 years
DESCRIPTION: Incoherent and often unresponsive to comforting. Screaming,
thrashing, sweating, tachycardia and rapid breathing. No memory of event the next day.
Hay p 86
✔✔Sleepwalking: At what point in the sleep cycle do the occur, and at what ages is it
most common? - ✔✔WHEN: During slow wave/deep sleep
WHAT AGES: Most common between 4 - 8 years
Hay p 86
✔✔Management of night terrors and sleepwalking - ✔✔+ Reassure parents
+ Avoid stressing child
+ Promote regular sleep schedule for child
+ Avoid sleep deprivation (which prolongs deep sleep when these events occur)
Hay p 86
✔✔Nightmares: When in the sleep cycle do they occur, at what ages are they most
common, and what are characteristics of these events? - ✔✔WHEN: During REM sleep,
which usually occurs in the latter part of the night.
WHAT AGE: Peak occurrence between 3 - 5 years
DESCRIPTION: Frightening dreams. Child is alert, can describe images and talk about
it next day. Will respond to parental reassurance. Will have difficulty going back to sleep
and will want to stay with parents.
Hay p 87
✔✔Management of nightmares - ✔✔Usually self-limiting and need little treatment. Can
be associated with:
+ Stress
+ Trauma
+ Anxiety
+ Sleep deprivation (which can cause a rebound in REM sleep)
+ Medications which increase REM sleep
Hay p 87
✔✔Definition of sleep-disordered breathing, and during what ages does it commonly
occur in children? - ✔✔DEFINITION: Obstructed breathing during sleept accompanied
