Well Child 2

Question 1

Abdomen

• What are the vessels of the umbilical cord?
• Definition: develops at base of navel, pink granulation tissue formed during the healing process

Answer 1

• Cord: 2 umbilical arteries, 1 umb vein
• Umbilical granuloma

Question 2

What is this?

Answer 2

Umbilical Granuloma

• develops at base of navel
• pink granulation tissue formed during healing process

Question 3

Male GU

• Presence of testes, size of penis, appearance of scrotum
• 30% of pre term male infants are born w/ what?
• Definition: abnormal ventral placement (check before what?)
• Definition: abnormal dorsal placement (uncommon)

Answer 3

• 30%: undescended testicle
• Hypospadias (Hypo-below)
• Epispadias (Epi-eye)

Question 4

Male GU

• What are 2 common scrotal masses in newborns?
• What side are they most common on?

Answer 4

• hydroceles & inguinal hernias
• RIGHT

Question 5

Which mass?

• Overlie the testes & spermatic cord
• Not reducible
• Can be transilluminated
• Usually resolves by __ months
• Refer to urology to r/o what?

Answer 5

Hydrocele

• 18
• hernia

Question 6

Which mass?

• Separate from the testes
• Usually reducible
• Often DO NOT transilluminate
• Do not resolve

Answer 6

Hernias

Question 7

Female GU

• Often a milky white discharge present, but what may be present?
• Labial adhesions
• What may be noted at birth?

Answer 7

• Blood tinged
• imperforate hymen

Question 8

Anus / Spine

• Imperforate anus is not always obvious. Cannot assume until baby passes what? Usually passes within how many hours?
• If there is a sacral dimple, must get what test?

Answer 8

• Meconium / 48 hours
• US (to check for spina bifida)

Question 9

Extremities

• Count fingers/toes
• Check for what 2 things?

Answer 9

• Syndactyly (webbed or conjoined fingers or toes)
• Palmar crease (single palmar crease - simian crease associated w/ trisomy 21)

Question 10

Hip

• Evaluation for what condition?

Answer 10

Developmental dysplasia of the hips (DDH)

Question 11

5 risk factors for Developmental Dysplasia of the Hips (DDH)

Answer 11

• breech
• caucasian
• 1st born female
• family hx
• prematurity

Question 12

Hip

• What would prompt a further work up of DDH?
• Which tests for ability to sublux or dislocate an intact, but unstable hip? (IN)
• Which tests for posteriorly discolated hip? (OUT)
• What other finding is suggestive of DDH?

Answer 12

• Audible “click” heard w/ maneuvers
• In: Barlow
• Out: Ortolani
• Asymmetry of leg creases

Question 13

Tx for DDH?

Answer 13

• Ortho eval & pavlik harness
• If untreated can lead to degenerative hip disease

Question 14

Palmar Grasp

• Primitive Reflex
• Place your finger into baby’s hand and press (baby will flex all fingers to grasp your finger)
• What age?

Answer 14

• Birth - 3/4 months

Question 15

Plantar Grasp Reflex

• Primitive Reflex
• Touch sole at base of toes
• Toes will curl
• Age?

Answer 15

• Birth - 6/8 months

Question 16

What reflex?

• Hold baby supine while supporting head, back, legs
• Abruptly lower entire body about 2 feet
• –> arms should abduct & extend
• –> hands open & legs flex (baby may cry)
• Age?
• Persistence beyond what age suggests what?
• Asymmetric response indicates what?

Answer 16

Moro Reflex (Startle Reflex)

• birth - 4 months
• 6 months –> neurological dz: CP
• Fx of clavicle or brachial plexus injury

Question 17

Which primitive reflex?

• with baby supine, turn head to one side, holding jaw over shoulder
• the arms/legs on side to which head is turned extend (think bow & arrow)
• the opposite arm/leg flex
• What age?
• Persistence beyond this age suggests what?

Answer 17

Asymmetric Tonic Neck Reflex

• Birth - 2 months
• asymmetric central nervous system development

Question 18

Which reflex?

• Hold the baby around the trunk & lower until the feet touch a flat surface
• the hips, knees & ankles extend & baby stands up, partially bearing weight, sags after 20-30sec
• What age?
• Lack of reflex = hypotonia or flaccidity

Answer 18

Positive Support Reflex

• Birth - 2/6 months

Question 19

Which reflex?

• stroke the perioral skin at the corners of the mouth
• the mouth will open & baby will turn the head toward the stimulated side
• Age?

Answer 19

Rooting Reflex

• Birth - 3/4 months

Question 20

Which reflex?

• Support the baby prone w/ one hand
• stroke one side of the back 1cm from midline, from shoulder to buttocks
• the spine will curve TOWARD the stimulated side
• Age?
• Absence suggests what?

Answer 20

Trunk Incurvation (Galant’s Reflex)

• Birth - 2 months
• Transverse spinal cord lesion or injury

Question 21

Which reflexes?

• hold baby upright from behind (as in positive support reflex)
• have one sole touch the tabletop
• the hip & knee of that foot will flex & the other foot will step forward
• alternate stepping will occur
• What age?

Answer 21

Placing & Stepping

• Birth (best after 4 days) - variable age to disappear

Question 22

Vision

• Always check for what?
• Ages 3-5: 20/40
• Ages 6+: 20/30
• The AAP recommends annual photo screening between what ages?
• What is the MC cause of childhood blindness?

Answer 22

• Red reflex
• 1 - 3 yrs
• Amblyopia

Question 23

Hearing Screening

• AAP recommends universal hearing screening before when?

Answer 23

Before leaving the hospital

Question 24

Blood Pressure

• Start checking at what age?
• Check before this age if pt has risk factors:
  
  • Kidney disease, prematurity, congenital heart disease, recurrent UTIs, hematuria, proteinuria
  • Other conditions associated w/ HTN: neurofibromatosis, tuberous sclerosis)

Answer 24

• 3 yrs

Question 25

**Additional Screening** * Check what level to screen for iron deficiency at 9 months or 12 months? * CDC recommends universal screening of what for children age 1-2 yrs old? * Autism screening at what ages? * STI testing for high risk adolescents

Answer 25

* **Iron def:** Hemoglobin * **1-2 yrs:** Lead (targeted screening for those in communities w/ high risk = homes before 1950) * **Autism:** 18mo & 24mo

Question 26

**Lipid Panel** * Fasting lipid screening is recommended for children between what ages? * (if what 6 certain RF are present?) * Controversial if need to screen if pt/adolescent has no RF or Fam hx

Answer 26

* 2 - 10 yrs 1. Fam hx of HLD 2. Fam hx of early CV disease 3. Obesity 4. Overweight 5. HTN 6. DM

Question 27

**Dental** * Wash gums/teeth prior to 1st dental visit * 1st dental visit between what ages? * Brush 2x/day * Floss 1x/day * Dental visit how often?

Answer 27

* **1st:** 12mo - 3yrs * Every 6 months

Question 28

**Dental: _Baby Teeth_ eruption ages: UPPER** * Central incisor * Lateral incisor * Canine

Answer 28

* **Central:** 8-12 months * **Lateral:** 9-13 months * **Canine:** 16-22 months

Question 29

**Dental: _Baby Teeth_ eruption ages: UPPER** * 1st molar: * Second molar:

Answer 29

* **1st**: 13-19 months * **2nd:** 25-33 months

Question 30

**Dental: _Baby Teeth_ eruption ages: LOWER** * 1st molar: * 2nd molar: * Canine: * Lateral incisor: * Central incisor:

Answer 30

* **1st molar:** 14 - 18 mo * **2nd molar:** 23 - 31 mo * **Canine:** 17-23 mo * **Lateral incisor:** 10 - 16 mo * **Central incisor:** 6 - 10 mo

Question 31

**Permanent Teeth Eruption - UPPER** * Central incisor * Lateral incisor * Canine * 1st premolar * 2nd premolar

Answer 31

* **Central incisor:** 7-8 yrs * **Lateral incisor:** 8-9 yrs * **Canine:** 11-12 yrs * **1st premolar:** 10-11 yrs * **2nd premolar:** 10-12 yrs

Question 32

**Permanent Teeth Eruption - UPPER** * 1st molar: * 2nd molar: * 3rd molar:

Answer 32

* **1st molar:** 6-7 yrs * **2nd molar:** 12-13 yrs * **3rd molar:** 17-21 yrs

Question 33

**Permanent Teeth Eruption - LOWER** * Central incisor * Lateral incisor * Canine * 1st premolar * 2nd premolar

Answer 33

* **Central incisor:** 6-7 yrs * **Lateral incisor:** 7-8 yrs * **Canine:** 9-10 yrs * **1st premolar**: 10-12 yrs * **2nd premolar:** 11-12 yrs

Question 34

**Permanent Teeth Eruption - LOWER** * 1st molar: * 2nd molar: * 3rd molar:

Answer 34

* **1st molar:** 6-7 yrs * **2nd molar:** 11-13 yrs * **3rd molar:** 17-21 yrs

Question 35

**Car Safety** * Rear facing car seat until how old? * Booster seat until how tall? * No front seat until what age?

Answer 35

* **Rear facing:** 2 yrs * **Booster:** 4'9" * **Front seat:** 13 yrs

Question 36

**Safety at Home** * Keep what 3 things away from kids in the house? * What number should you have on hand?

Answer 36

* Button batteries * Laundry pods * cleaning products * Poison control

Question 37

**Milestones of what age?** * fixes/follows on face * some head control * responds to sounds/noises * spontaneous smile

Answer 37

1 month

Question 38

**Milestones of what age?** * Responsive smile * coos/vocalizes * lifts head when prone * follows to midline

Answer 38

2 months

Question 39

**Milestones of what age?** * rolls from tummy to back * good head control * laughs, squeals * follows past midline * grasps toys/objects

Answer 39

4 months

Question 40

**Milestones of what age?** * sits w/ support * bears weight on legs * vocalizes “ba, da-da” * reaches out for toys * follows 180 degrees * stranger danger/separation anxiety

Answer 40

6 months

Question 41

**Milestones of what age?** * crawls * pulls up to stand & cruises on furniture * says mama/dada * immature pincer grasp * responds to name

Answer 41

9 months

Question 42

**Milestones of what age?** * walks (however, may be delayed up until __ months) * waves bye-bye * says mama/dad * points w/ index finger * self feeds w/ fingers

Answer 42

12 months * 18 mo

Question 43

**Milestones of what age?** * 3-6 words * walks well * climbs stairs * imitates actions

Answer 43

15 months

Question 44

**Milestones of what age?** * 5-15 words * some 2 word phrases * uses spoon/fork * scribbes * follows simple commands * runs, walks backward

Answer 44

18 months

Question 45

**Milestones of what age?** * 20-50 words or more * 2 word phrases * kicks ball * builds 3-4 block tower * 50% speech understandable

Answer 45

24 months