CLIPP 2

Question 1

autism screening timeline

Answer 1

@ 18 months and @ 2 years of age

Question 2

mandated developmental screening at these ages

Answer 2

@9, 18 and 30 month checkups

Question 3

do not give this type of milk until ___ age because ___

Answer 3

regular cow’s milk until 12 months because it can –>colitis/anemia (cow’s milk protein is okay)

Question 4

caloric daily intake of 1-2month olds and daily average weight gain, as compared to caloric need for preemies and very low birth weight babies

Answer 4

• 100-120 cal/kg/day, 20-30g gain per day
• preterm needs 115-130 cal/kg/day
• VLBW needs up to 150 cal/kg/day

Question 5

palmar reflex and when it goes away

Answer 5

will grasp anything placed in palm. goes away at 3-4 months, key is it must go away for grasping voluntarily.

Question 6

plantar reflex and when it goes away

Answer 6

toes flex when you touch ball of foot. goes away by 8 months and key is it must go away before first steps

Question 7

babinski and when it goes away

Answer 7

stroke lateral aspect of plantar foot–>fanning of toes. goes away at 1-2 years

Question 8

asymmetric neck reflex and when it goes away

Answer 8

turn baby’s head to one side –>ipsi arm extends while contra arm flexes and it key for visual coordination. goes away at 6 months

Question 9

moro and when it goes away

Answer 9

drop the head and then there is symmetric abDUction and extension of arms, and then ADDuction of the arms, goes away at 4 months

Question 10

babies sleep through night by the age of ____

Answer 10

4-6 months

Question 11

can start babies on soft rice cereal w/ spoon at age of __

Answer 11

4 months

Question 12

must drink ___ oz of formula or milk/day otherwise should supplement with __ of __

Answer 12

32 oz (1quart), vit d 400units

Question 13

big car seat milestones

Answer 13

under 2y- rear and back facing carseat
over 4 years - booster seat front facing
over 8 years - booster or regular if outgrown booster
over 13-front or rear

Question 14

these 3 vaccinations are recommended on __ dose schedule over the age of __ months

Answer 14

2, varicella, MMR, hepA over the age of 12 months

Question 15

# of doses over the first 5 years:
DTaP 
IPV
Hib
PCV13 
MMR 
Varicella 
RotaV 
HepA 
HepB

Answer 15

DTaP (5)
IPV (4)
Hib (3 or 4, depending on the vaccine manufacturer)
PCV13 (4)
MMR (2)
Varicella (2)
RotaV (2 or 3, depending on the vaccine manufacturer)
HepA (2)
HepB (3)

Question 16

influenza shot recommendations

Answer 16

6 - 59 months, and anyone who takes care of kids of that age, plus kids under 19 years
-should be given during flue season (i.e. someone who is 6 months old in march probably should wait til 9 month old appt in september to get shot)

Question 17

double their birth weight by __ months and triple by __

Answer 17

4-5 months, triple by 12

Question 18

red reflex in babies is substitute for ___ and in different color skin babies can appear different but as long as there is no ___ its fine and lack of red reflex means ___

Answer 18

fundoscopic exam
white spots, asymmetric coloration
-glaucoma, cataract, chorioretinitis, rb

Question 19

gross motor at 2, 4, 6, 9 months

Answer 19

head up at 45/headup, roll over/sit w/ head steady, sit/rollover, pull to stand/stand holding on

Question 20

fine motor at 2, 4, 6, 9 months

Answer 20

follow to/past midline, follow to 180/grasp, look for dropped yarn/reach, take/pass 2 cubes

Question 21

cognitive/linguisitic/communication at 2, 4, 6, 9 months

Answer 21

laugh/vocalize, turn to rattling sound/laugh, turn to voice/rattling sound, dada/mama/nonspecific / single syllables

Question 22

social/emoitional at 2, 4, 6, 9 months

Answer 22

smile sontaneously/responsively, regard own hand, feed self/work for out of reach toy, wave bye/feed self

Question 23

____ is prelude to stranger anxiety

Answer 23

stranger recognition

Question 24

how often should new foods be added to a 6 month old’s diet

Answer 24

every 5-7 days

Question 25

acetaminophen and vaccines

Answer 25

lowers Ab response thus only should be given if needed

Question 26

at 12 months these are some key developmental milestones

Answer 26

standing alone, many walk well. good pincer grasp. says mama dada and 1-2 other words. hands parent book to read, points when wants something, can imitate things, play ball with examiner

Question 27

in dark complexion patients, where should you look for pallor?

Answer 27

nail beds, conjunctiva, mucous membranes

Question 28

fatty liver dz on exam

Answer 28

palpable liver edge, not a whole abdominal mass

Question 29

wilms tumor age, sx, mass characterisitcs

Answer 29

3yo, often incidental and typically no LAD or jaundice but 50% have abd pain, htn or vomiting, smooth and typically won’t cross midline

Question 30

neuroblastoma

Answer 30

most common asymptomatic mass dx in kids under 2yo and is in chest, abdomen or neck and often can be asymtomatic or have fever, pallor or weight loss

Question 31

best choice for 1st imaging study in infant abd mass

Answer 31

US

Question 32

NB imaging and path

Answer 32

Histopathology reveals “small round blue cells” or small, uniform cells containing dense, hyperchromatic nuclei and scant cytoplasm, forming small cell rosettes.
Urinary HVA/VMA will be elevated in 90-95% of cases.
A CBC may reveal anemia or other cytopenias that are secondary to bone marrow infiltration.
CT scan may reveal calcifications and a heterogenous mass with cystic areas representing either hemorrhage or necrotic tumor.
Metastases are primarily to regional lymph nodes and to the liver, bone marrow, and skeleton.
Chest radiograph will reveal any lymph node involvement in the chest or additional tumors that may present in the posterior mediastinum.

Question 33

hepatoblastoma imaging and path

Answer 33

Radiograph of abdomen will demonstrate hepatic enlargement with hepatic tumors.
CT scan will show tumor and origin of tumor.
Chest CT is indicated to look for pulmonary metastases.
Diagnosis is dependent on histologic examination.
Laboratory studies of liver function are usually normal but liver enzymes and bilirubin may be elevated in 20% of cases.
Alpha-fetoprotein levels will be increased in most patients.

Question 34

wilms imaging and path

Answer 34

Ultrasound may identify the mass as intrarenal.
On CT scan the mass may be heterogenous with areas of low density representing necrosis. A pseudocapsule may be observed because of the sharp demarcation between tumor and normal renal parenchyma.
Pulmonary metastases may be identified on chest radiograph.
CT scan of the chest is indicated to visualize areas of lung below the level of the dome of the diaphragm.
Laboratory findings may include hematuria.

Question 35

teratoma imaging and path

Answer 35

Teratomas and germ-cell tumors are best identified with CT scan.
Tumors appear as well-defined masses with both solid and cystic components.
Teratomas are identifiable on plain x-ray only if calcified components, such as teeth or bony fragments, are present.

Question 36

constipation

Answer 36

Constipation causing a palpable abdominal mass can readily be identified on plain radiographs of the abdomen.
No other radiographic evaluation is necessary.

Question 37

benign renal mass work-up

Answer 37

Hydronephrosis can be diagnosed with ultrasound.

Voiding cystourethrogram will demonstrate any ureteral obstruction or vesicoureteral reflux.

Question 38

stage 4s NB prognosis

Answer 38

though it has spread (
Localized primary tumor as in Stage I or II with dissemination limited to liver, skin or bone marrow.) , these stage of tumors spontaneously regress often, due to embryonic nature of the tumor cells.
Stage 4S neuroblastoma is a special category that is reserved for infants less than 12 months who have resectable primary tumors and metastases to the liver, skin, and bone marrow. Overall survival is over 85 percent.

Question 39

NB staging

Answer 39

1: only area of origin
2: extends beyond area of origin, not cross midline. 2b if involves ipsi nodes
3: croses midline or mets to regional LN
4: disemminated
4s: localized with dissemination limited to skin, liver or BM and may regress

Question 40

key favorable prognostic factors in NB

Answer 40

Non-amplification of the n-myc oncogene
DNA index > 1
Favorable histology (Shimada classification)
Age < 1 year. - infants over 18 mons don’t fair as well
(LAD is not necessarily a bad prognostic factor due to chemo tx these LN i.e. regional LAD is not necessarily awful)

Question 41

genetics of NB

Answer 41

rarely genetic, it is AD with low pentetrance IF it is the familial form and passed along in gametes not in somatic cells (most forms of nb are sporadic and in somatic cells)

Question 42

expressivity vs penetrance

Answer 42

penetrance, which refers to the likelihood of the gene generating its associated phenotype at all. In contrast, expressivity refers to the influence of an expressed gene at the level of particular individuals. Expressivity can therefore be used to characterize qualitatively or quantitatively the extent of phenotypic variation within a particular genotype

Question 43

brainstem auditoriy evoked acoustic emission test indicaiton

Answer 43

brain-stem auditory evoked potential hearing test (BAER) may be indicated in infants who fail to meet language milestones if they cannot cooperate with other more comprehensive testing.

Question 44

age 1

Answer 44

At age one year, gross motor skills include pulling to stand, standing alone, and perhaps first steps. Fine motor skills including putting a block in a cup and banging 2 cubes held in hands. At this age a child should be able to imitate vocalizations/sounds and babble. The majority of children this age will know 1 or 2 words in addition to “mama” and “dada.” Social-emotional milestones at age one year are waving bye-bye and playing pat-a-cake. Running, building towers of blocks, removing clothing, and a 6-word vocabulary are more advanced skills than a 12-month-old would be expected to have.

Question 45

15 months

Answer 45

At 15 months of age, a child should be able to stoop and recover and walk well, put a block in a cup, have a vocabulary of a few words, wave bye-bye, and drink from a cup. Running, building towers of blocks, removing clothing, and a 6-word vocabulary are more advanced skills than a 15-month-old would be expected to have.

Question 46

18 months

Answer 46

At 18 months, a child should be able to walk backward, and 50–90% of children can run at this stage. An 18-month-old should be able to scribble, build a tower of 2 cubes, have 3-6 words in her or his vocabulary, and be able to help in the house and remove garments.

Question 47

2.5 year

Answer 47

At 2 ½ years of age, kids can jump up and throw a ball overhand. They can build a tower of 6–8 cubes, point to 6 body parts, name 1 picture, put on clothing, and wash and dry their hands. Sammy is only able to build a tower of 2 cubes, can remove his clothing but does not yet put clothing on, and his vocabulary is limited to 6 words—leading us to believe he is not 2 ½ years old.

Question 48

3

Answer 48

At age 3, children can balance on each foot for 1 second, wiggle their thumbs, name 4 pictures, name 1 color, name a friend, and brush their teeth with help. Sammy’s vocabulary is only 6 words, he is not able to name a friend, he is only able to stack 2 cubes, and he has just starting running, but is unable to balance on each foot for 1 second.

Question 49

beckwidth wiedmann syndrome associations

Answer 49

Wilms’ tumor is commonly associated with Beckwith-Wiedemann syndrome, a genetic overgrowth syndrome. Other features that may be seen in children with this syndrome include omphalocele, hemihypertrophy, hypoglycemia, large for gestational age, and other dysmorphic features.