Well Child Visit

Question 1

Developmental age: social smile and eyes follow to midline

Answer 1

2 months

Question 2

Developmental age: babies aware of caregiver and eyes follow past midline

Answer 2

4 months

Question 3

Developmental age: roll over, sits upright, grasps/rakes, babbles

Answer 3

6 months (dog)

Question 4

Developmental age: crawling, grasps with thumb, maybe a word

Answer 4

9 months

Question 5

Developmental age: 2-5 words, pulls to stand (cruising), walks with help, pincer grasp, 2 block tower, stranger anxeity

Answer 5

12 months (rule of 2s)

Question 6

Developmental age: runs/walks backwards, uses spoon and cup, 2-word sentence, copies parent, 4-block tower

Answer 6

18 months

Question 7

Developmental age: walks up and down stairs with help, jumps, 6 block tower, 2-3 word sentences, 50-75 words, follows 2 step commands

Answer 7

2 yrs

Question 8

Developmental age: rides tricycle, copies a circle

Answer 8

3 yrs

Question 9

Developmental age: plays with others, draws a “+” and triangle, 250 words, 4 word sentence

Answer 9

4 yr

Question 10

Developmental age: skipping, draws a stick figure

Answer 10

6yr

Question 11

Baby should be back to birth weight

Answer 11

2 weeks

Question 12

Child weighs double their birth weight

Answer 12

4 months

Question 13

Child weighs triple their birth weight

Answer 13

12 months

Question 14

Child weighs quadruple the birth weight

Answer 14

24 months

Question 15

Anticipated weight gain from 2 yr to 13 yrs

Answer 15

5 lbs per year

Question 16

Causes of inadequate weight gain

Answer 16

poor food intake (including neglect/abuse)
chronic V/D
malabsorption
neoplasms
congenital disease - cardiac, endocrine

Question 17

Childhood obesity risks

Answer 17

rapid growth
sleep apnea
HTN
SCFE
Precocious puberty
increased skin infections
social dysfunction
early DM onset

Question 18

newborn to 3 mo anticipated weight gain

Answer 18

26-31 g per day

Question 19

age that height increases by 50% from birth length

Answer 19

1 yr

Question 20

height double the birth length

Answer 20

4yrs

Question 21

height triple the birth length

Answer 21

13 yrs

Question 22

Anticipated growth rate from 2y to adolescence

Answer 22

2 inches per year

Question 23

Greater than normal height causes

Answer 23

Familial tall stature
precocious puberty
gigantism - elevated growth hormone
hyperthyroidism
Kleinfelter Sn
Marfan Sn
Obesity

Question 24

Lower than normal heath causes

Answer 24

familial short stature
neglect
Turner sn
constitutional growth delay
chronic renal failure
asthma
CF
IBD
immunologic disease
GH deficiency
hypothyroidism
glucocorticoid excess
skeletal dysplasias
neoplasm

Question 25

Failure to thrive definition

Answer 25

wt below 2-3rd percentile, corrected for gestational age Wt less than 80% of ideal weight for age Wt crosses 2 major percentile curves downward on the standard growth curve over time Wt to length ratio less than 10th percentile rate of daily wt gain less than expected for age

Question 26

Causes of macrocephaly

Answer 26

``` TaySachs dz Maple syrup urine disease Neurofibromatosis Tuberous sclerosis Hydrocephalus Increased ICP skeletal dysplasia acromegaly ICH ```

Question 27

Causes of microcephaly

Answer 27

``` fetal toxin exposure (alcohol) Chromosomal trisomies congenital infection (TORCH) Cranial anatomic abnormalities Metabolic disorders Neural tube defects ```

Question 28

Normal growth rate that declines after birth

Answer 28

postnatal onset

Question 29

Growth abnormal from time of birth

Answer 29

prenatal onset

Question 30

Growth low to normal range but eventually closer to mean

Answer 30

constitutional growth delay

Question 31

Growth consistently abnormal

Answer 31

genetic short stature

Question 32

Amblyopia

Answer 32

decreased vision due to disuse/misuse of eye during critical visual development between 3-5 yrs Treat underlying problem Patch good eye to let bad eye develop

Question 33

Strabismus

Answer 33

abnormal eye alignment which impart vision and depth perception -EOM issue Risk amblyopia

Question 34

Esotropia

Answer 34

inward deviation of eye

Question 35

Exotropia

Answer 35

outward deviation of eye

Question 36

Retinoblastoma

Answer 36

MC intraocular malignancy in children MC presentation: leukocoria (white reflex) also can present with strabismus Mets within months ``` Tx: enucleation radiaiton brachytherapy chemotherapy ```

Question 37

Lead poisoning

Answer 37

Early sxs: anorexia, decreased activity, irritability, insomnia Screen children who live in areas where more than 27% of housing built before 1950 Tx for severe toxicity >70 mcg/dL: Dimercaprol AND calcium disodium edatate

Question 38

Child abuse - presentation, evaluation

Answer 38

``` Presentation: FTT multiple fractures of varying ages bruises/burns SDH Retinal hemorrhage Implausible injuries Genital trauma or discharge - suggestive of sexual abuse ``` ``` Evaluation: PT/PTT LFTs STD testing CBC Skeletal survey CT of head ``` Always reports suspected child abuse to CPS regardless of how mild the suspicion

Question 39

Pediatric Hep B vaccination recommendations

Answer 39

Hep B vaccine at birth | If maternal Hep B - give Hep B IG

Question 40

Immunizations and severely immunosuppressed

Answer 40

avoid live vaccines - varicella, MMR, Rotavirus Rotavirus still recommended in HIV patients

Question 41

Risk associated with Rotavirus

Answer 41

risk intussusception | avoid in patient with hx of intussusception and older than 8 mo who are on catch up schedule

Question 42

Sudden infant death syndrome

Answer 42

Peaks 2-4 months Risk: exposure to cigarette smoke, maternal age less than 20, prematurity, prone sleeping, soft bedding, overheating Preventive measures: place on back to sleep, firm sleep surface, no pillows, soft objects or loose bedding, avoid smoking during pregnancy and after delivery Less effective measures: breastfeeding and use of pacifier when sleeping

Question 43

Car seat safety - under 2, 2-5, over 5

Answer 43

under 2: rear facing car seat, middle back seat 2-5y: bigger forward facing car seat with chest harness Over 5: booster seat in back seat until over 4'9" All under 13 yo in rear seats