Exam 1: Lectures Flashcards
What is the high quality recommendation screening for perinatal and postpartum depression?
1, 2, 4, 6, and 9 month well-child visits
When should screening for developmental delays be conducted based on high-quality practice recommendations?
6, 9, 12, 18, 24, and 36 months
Based on high-quality recommendations, when would you screen for social-emotional problems?
4-months, 15 months, 24 or 30 months, and 36 months
When does autism spectrum disorder screening happen according to high-quality recommendations?
18 months and then 24 or 30 months
You have a newborn baby coming to you for this first visit to the practice. What is an important screening to complete?
Domestic violence screening
High-quality recommendations suggest screening for domestic violence at which visits?
1st encounter to the practice, 6 month visit, 18 month visit, 24 or 30 month, 36 months
Is juice recommended for children under the age of 6 months old?
No, it can lead to poor dental health outcomes
Your patient comes in for their 18 month well child visit. They have a few teeth and their mother is concerned about cavity prevention. She would like to know if she should be using toothpaste when brushing the child’s teeth. What do you recommend?
Toothpaste is not recommended for use until 24 month (2 y/o). Continue to brush the child’s teeth twice a day with a soft toothbrush.
How much toothpaste does a child 2-6 y/o need?
A pea-sized amount
When should BP monitoring begin in children?
3 y/o
Vision screenings should occur in children at what ages?
5, 6, 8, 10 and 12 y/o
You have a patient who is 6 y/o in office for their well child exam. Their 5 y/o vision screen was 20/30 and you suggested to repeat it in a year knowing that some children will not reach 20/20 vision until age 6. Today, their vision screening is 20/40. What would you do next?
Refer to ophthalmology
When should you repeat a hemoglobin level on an infant?
9-12 months
When should lead levels be checked?
9-12 months and then 18-24 months
According to the AAP, when do you screen lipid panels?
6 y/o, 8 y/o, annually at 10 y/o
According to USPSTF, when do you screen lipid panels in children?
It is not recommended to screen lipid panels in children according to USPSTF
What are the components of the newborn visit?
A thorough history including prenatal, birth, and current history
Complete physical and vital signs
Anticipatory guidance for the parents
Wrap-up
Height, weight, head circumference, pulse, RR, temp, newborn screening testing, growth chart beginning at birth are components of:
Newborn assessment
Skin texture, plantar creases, breast, eyes, ears, genitals, posture, square window, arm recoil, popliteal angle, scarf sign, heel to ear help determine:
Gestational age
General appearance/temperament
Growth from birth
Skin integrity
Response to environment including muscle tone and symmetry of movement
Hearing/vision screening
Cardiac/Respiratory
Hip dysplasia or bone fractures
Cord healing and circumcision healing
Neurological defects
Abuse/neglect
Newborn physical assessment key aspects
Multiple, firm, pearly, opalescent white papules that exfoliate spontaneously
Milia
Yellow-white papultes generally over the nose, forehead, upper lip and cheeks
Sebaceous hyperplasia
Firm, yellow-white, 1-2 cm papule or pustules with surrounding erythematous flare that developed around 24-48 hours old
Erythema toxicum
Vesicopustules that rupture easily and leave a halo of white scales around a central macule of hyperpigmentation on the trunk, limbs, palms, and soles
Transient neonatal pustular melanosis
Scattered superficial bullae on the upper arms and lips
Sucking blister
Lacy, reticulated, red or blue vascular pattern
Cutis mermorata
Half of the baby’s coloring is red and the other half is pale
Harlequin color change
Yellow, hairless smooth plaque on the head or trunk
Nevus sebaceous
You have a patient that you diagnosis with nevus sebaceous. What would be your next step in the treatment plan for this patient?
Refer to pediatric dermatology as these lesions can develop into a secondary malignancy
If you see a preauricular skin tag or pit what are you concerned for?
Genetic disorders, especially those involving the kidneys
The child you are assessing has a loud diastolic murmur, what is your concern?
For a pathologic disorder
The child has a flow systolic murmur. What is the concern?
No concern, this is normal in infants
Moro, walking/stepping, rooting/sucking, tonic neck, palmar grasp, galant, seimming, and babinski’s are all:
Primitive reflexes seen in the newborn
What are management considerations for the preterm infant?
Additional vision and hearing screenings
Adjusted growth expectations
Supportive services for parent and baby based off of medical needs
Close medical surveillance
MISFITS acronym:
Metabolic disturbances
Inborn errors of metabolism
Sepsis
Formula dilution or over concentration
Intestinal catastrophes
Toxins
Seizures
MISFITS helps with DDx for which population?
Critically ill newborns
Newborns should have how many wet diapers/day?
6-8
G6PD deficiency, isoimmunization, extrvascular blood, polycythemia, sepsis, drugs, hypothyroidism, and bowel obstruction are all causes of what?
Pathologic etiology of hyperbilirubinemia seen with jaundice
The Rule of ‘3’ is helpful for remembering:
Colic
Onset by 3 weeks, gone by 3 months
Poor feeding/appetite or sucking
Fever >100.4
Inconsolable crying >3 hrs
Skin rash, red eyes, jaundice
Irritability, lethargy
Umbilical cord odor, drainage, or redness
Cough, vomiting (not spit-up), diarrhea, abdominal distention
Parents should:
Call the office immediately
Physical/Motor skills:
-Posterior fontanelle closure
-Step and grasp reflex begin to disappear
-Able to lift head to 45 degrees
2 month
Sensory/Cognitive markers:
-Looks at close objects
-Cry differentiates
-Coos, smiles
-Vocal response to familiar voices
2 months
Red flags:
-No startle
-Doll eyes
-Quiet
-Asymmetric movement
-Excessive irritability
2 months
Physical/Motor markers:
-Moro, tonic neck, and rooting reflexes fade
-Little to no head lag
-Able to sit straight if propped
-Raise head to 90 degrees on stomach
-Roll from front to back
-Reaches for objects with hands, can grasp with both hands, loves putting objects in mouth
4 months
Sensory/cognitive markers:
-Well-established close vision
-Starting hand-eye coordination
-Babbles, coos, laughs
-Anticipates feeding by visual cues
-Showing signs of memory development
-Attention seeking via fussing
-Recognize familiar voices and parental touch
4 months
Red flags:
-Lack of social smile
-Doesn’t track or turn to a voice
-No hand/mouth activity
-No attempt to raise head when prone
-Persistent fisting
4 months
Physical/Developmental markers:
-Doubled birth weight
-Vision 20/60
-Imitating sounds
-Enjoys hearing own voice, loves mirrors and toys
-Able to lift chest and head on stomach, bears weight on hands
-Rolls from back to stomach
-Able to grasp and pick up objects
6 months
Sensory/cognitive markers
-Vision 20/60
-Increasing complexity of sound stimulation
-Fear of strangers, recognizes parents
-All primitive reflexes except Babinski is gone
6 months
Red flags:
-No smiling or response to play
-No tracking, reaching, or looking for parents
-No grasping or babbling
-Head lag, no attempt to sit with support
-Persistent primitive reflexes
6 months
Physical/developmental markers:
-More regular elimination patterns
-Able to crawl, sit for prolonged periods of time, pulls self to standing
-Pincer grasp develops, can help feed self
-Throws and shakes objects
9 months
Sensory/cognitive markers:
-Developing depth perception and object permanence
-Responds to simple commands
-Knows their name
-Understands “no”
-May be afraid if left alone
-More interactive with play
9 months
Red flags:
-No eye contact or interactive play
-Does not sit in tripod
-No grasp, no visual/oral response to toys
-Asymmetric crawl
-No response to name
9 months
Physical/developmental markers:
-Triple birth weight, double birth length
-Head circumference = chest circumference
-6-8 teeth present
-Babinski reflex is gone
-Pulls to stand, may start cruising and walking with hand holding, attempting to walk independently
-Sits independently
-Turns pages, has a more precise pincer grasp
12 months (1 y/o)
Sensory/cognitive markers:
-Comprehends several words/simple commands
-“mama”, “dada”, a few other short words
-Imitates sounds and animal noises
-Can develop attachment to objects/toys
-Points to things, waves ‘bye’
-Separation anxiety, clingy to parents
12 months (1 y/o)
Emotional development for the toddler stage
Autonomy v. Shame/doubt
Cognitive development for the toddler stage
Piaget’s object permanence, visual displacement
Red flags/Health watch:
-Cannot walk by 18 month
-Fails to develop heel-toe walking pattern after several months of walking
-Less then 15 words by 18 months
-No two-word sentences
-No imitation of actions or words
-Cannot stack at least 6 blocks
-Doesn’t feed self
-Cannot follow simple instructions
2 y/o concerns