Well Child 1

Question 1

What are the 5 types of developmental milestones?

Answer 1

• Physical (maturation, growth, puberty)
• Motor (gross & fine motor skills)
• Cognitive (achievement of milestones, language, school performance)
• Emotional (self efficacy, self esteem, independence, morality)
• Social (social competence, self responsibility, integration w/ family & community)

Question 2

AAP recommends well visits at what ages? (10)

Answer 2

• birth
• 1 month
• 2 months
• 4 months
• 6 months
• 9 months
• 12 months
• 15 months
• 18 months
• 2 years
• Then annually –> adolescence

Question 3

Newborn & Pediatric Growth Curves

• Compares what 4 measurements to the population?
• Measured in percentiles %%%
• BMI is used starting at approximately what age?

Answer 3

• height, weight, head circ., BMI
• 2 yrs

Question 4

Newborn & Pediatric Growth Curves

• Head circumference is tracked until about __ - ___ y/o
• Head circumference is important to assess for what?

Answer 4

• 2 - 3 yrs
• Brain growth

Question 5

Growth charts vary based on what?

Answer 5

Gestational age

• premature infants
• syndromes (Down syndrome, fragile X)

Question 6

Give the %

• Overweight
• Obesity
• Underweight

Answer 6

• Overweight: 85-95%
• Obesity: >95%
• Underweight: <5%
  *

Question 7

Give the %

• Microcephaly
• Macrocephaly

Answer 7

• Micro: <3%
• Macro: >97%

Question 8

How many weeks?

• Preterm
• Term
• Post-term

Answer 8

• Pre: <37 weeks
• Term: 37-42 weeks
• Post: >42 weeks

Question 9

Classification of Birth Weight (g)

• Extremely low BW: ___ g
• Very low BW: ___ g
• Low BW: ____ g
• Normal BW: ___ g

Answer 9

• Extreme L: <1000 g
• Very L: <1500 g
• Low: <2500 g
• Normal: >2500 g

Question 10

Give the %

• Small for gestational age (SGA)
• Appropriate for gestational age (AGA)
• Large for gestational age (LGA)

Answer 10

• SGA: <10%
• AGA: 10-90%
• Large: >90%

Question 11

Give the ages

• Infancy
• Neonatal period
• Postneonatal period

Answer 11

• Infancy: 1st yr of life
• Neonatal: 1 - 28 days
• Postneonatal: 29 days - 1 year

Question 12

What is the key assessment of the newborn immediately after birth?

Answer 12

Apgar

Question 13

• The apgar is scored how long after birth?
• What do the scores range from?
• Scoring may continue at __ minute intervals until the score is what?

Answer 13

• 1 and 5 minutes after birth
• Range: 0 - 10
• 5 min intervals until >7

Question 14

Describe the population wide testing for metabolic & genetic diseases

Answer 14

Blood sample from heel stick:

• before discharge
• again at 7-14 days

(varies from state to state)

Question 15

General PE

• T/F: mild cyanosis can be normal at birth
• Peripheral cyanosis (finger tips) can be normal for how many days?
• Jaundice- can be difficult based on what?

Answer 15

• True, but baby should pink soon thereafter
• Peripheral: 1 - 2 days
• Baby’s race

Question 16

Terminology?

• Cheesy white covering
• Decreases as term approaches
• Made from fetal corneocytes / sebaceous gland activity
• “rich lipid matrix”

Answer 16

Vernix Caseosa

Question 17

Condition?

• Pinpoint white papules w/o surrounding erythema
• Caused by what?
• Commonly on noase, chin, forehead, cheeks
• Usually appears within the first few weeks & disappears over several weeks

Answer 17

Milia

• blocked sebaceous glands

Question 18

Condition?

• aka congenital dermal melanocytes
• blue patches of pigment
• commonly seen over lumbar area, buttocks, extremities
• generally fade w/ time
• Common which 5 races?

Answer 18

Mongolian Spots

• Asian
• Native American
• Hispanic
• East Indian
• African Americans

Question 19

Diagnosis?

Answer 19

Mongolian Spots

• aka: “congenital dermal melanocytes”
• blue patches
• fade over time
• Asian, Native American, Hispanic, East Indian, African descent

Question 20

Condition?

• yellow eosinophillic papules on red base
• may appear on 2nd to 4th day of life
• mostly seen on trunk
• unknown etiology but thought to be due to what?
• typically disappear w/in 1 week of birth

Answer 20

Erythema Toxicum

• due to: the immaturity of the pilosebaceous follicles

Question 21

Diagnosis?

Answer 21

Erythema Toxicum

• yellow eosinophilic papules on red base
• 2nd - 4th day of life
• trunk
• d/t immaturity of pilosebaceous follicles
• disappear within 1 w of birth

Question 22

Sutures

• Name the 4 sutures
• Birth process can result in what?
• What is a sign of elevated ICP (due to meningitis or hydrocephalus)
• What sign suggests craniosynostosis (which needs neurosurgery)

Answer 22

• 4: sagittal / coronal / lambdoid / frontal
• Birth process: molding / overriding of sutures
• Incr ICP: widely split sutures
• Cranio: raised, bony ridge at a suture line

Question 23

Fontanelles

• Areas where major sutures intersect
• ALWAYS palpate (should be soft/flat)
• Bulging may indicate what?
• Sunken may indicate what?
• Large fontanelle can be 1st sign of what?

Answer 23

• Bulging: increased ICP (bleed vs. meningitis)
• Sunken: dehydration
• Large: 1st sign of hypothyroidism

Question 24

Fontanelles

• Anterior is located at the juncture of what 3 sutures?
• Posterior at juncture of what 2 sutures?

Answer 24

• Anterior: Metopic, sagittal, coronal
• Posterior: sagittal & lambdoid

Question 25

**Which Extracranial Finding?** * Swelling/collecting of blood over one or both parietal bones * Does NOT cross suture lines * Resolves in weeks to months

Answer 25

Cephalohematoma

Question 26

**Which Extracranial Finding?** * Edema of the scalp * CAN cross suture ines * Resolved in days

Answer 26

Caput succedaneum

Question 27

Diagnosis?

Answer 27

**Bilateral Cephalohematoma** * Does NOT cross suture lines * swelling/collection of blood over one or both parietal bones * resolves in weeks to months

Question 28

Diagnosis?

Answer 28

**Caput succedaneum** * CAN cross suture line * edema of the scalp * resolves in days

Question 29

**Eyes** * Term for abnormally wide eyes * What is common from birth trauma * Red reflexes should be present/symmetrical

Answer 29

* Hypetelorism * Subconjunctival hemorrhages

Question 30

**Nose/Ears** * Infants under what age are nose breathers (ensure no obstructions) * Over 2-3 yrs old: pull auricle which way? * Under 2-3 yrs old: pull auricle which way? * Preauricular pits/tags are common * ALWAYS screen for hearing

Answer 30

* **Nose breathers:** \< 1 month * **\>2 yrs:** pull upward * **\<2** yrs: pull down

Question 31

**Mouth: which finding?** * Small, white, benign, inclusion cysts * On palate * No tx needed (resolve spontaneously) * 2 - 4 months old

Answer 31

Epstein's pearls

Question 32

* Where are Bohn nodules usually seen? * Where are Epstein's pearls seen?

Answer 32

* **Bohn:** gingival ridge * **Epstein:** palate

Question 33

Diagnosis?

Answer 33

**Epstein's pearls** * small, white, benign, inclusion cysts * Palate * No tx * 2 - 4 months old

Question 34

**Condition?** * Congenital short lingual frenulum * Can limit tongue movement * Can cause pain w/ nursing * Usually see puckering of midline tongue tip w/ movement * May lead to speech difficulty / dental problems

Answer 34

**Ankyloglossia** "tongue tie"

Question 35

Tx for Ankyloglossia "Tongue Tie"

Answer 35

Frenotomy / Frenulotomy in neonatal period

Question 36

Diagnosis?

Answer 36

**Ankyloglossia (Tongue Tie)** * congenital short lingual frenulum * Tx w/ frenotomy/frenulotomy

Question 37

**Neck** * Position for palpation for infants? Position for older children?

Answer 37

* **Infants:** supine * **Older**: sitting upright

Question 38

**Congenital Torticollis** * Another name? * Results from bleeding into _which muscle_ during the stretching process of birth? * Appears as a firm fibrous mass within the muscle _how many weeks after birth?_ * Disappears over how long?

Answer 38

* "wry neck" * sternocleidomastoid * 2 - 3 weeks after birth * months