Growth and Development

Question 1

What is the significance of “head lag”?

Answer 1

90% of infants diagnosed with autism exhibited head lag as infants. Head lag is a developmental delay in head and neck muscle control. Should be able to control neck muscles by around 4 months of age, so that when she is pulled form lying to sitting position her head should remain in line with torso and not flop back.

Question 2

What is the normal levels for the new born infant thyroid panel?

Answer 2

In congenital hypothyroid the free T4 is low and the TSH is elevated. Normal values are :TSH less then 5.5 and free thryoxine 0.7 - 1.7

Question 3

Questions to ask parent for dyslipidemia screening?

Answer 3

Anyone in the family have a cardiovascular event before age 55? Does either parent have a cholesterol level > then 240? Is family hx unknown? Does the child have personal risk factors such as obesity or HTN?

Question 4

Name the developmental milestones for a 9 month old.

Answer 4

Pulls to stand, gets into sitting position. Starting to pincer grasp, bangs 2 blocks. Waves bye-bye, plays pat a cake . Says Dada and Mama , but nonspecific, makes 2 syllable sounds.

Question 5

Name 18 month old developmental milestones.

Answer 5

Runs, kicks a ball, stacks 4 blocks. removes garment, feeds a doll, says at least 6 words.

Question 6

Name 30 month milestones.

Answer 6

Walks steps alternating feet, broad jump, stacks 8 blocks, wiggles thumb, uses spoon well, spilling little, puts on a t shirt. Names pictures of 75% of speech is understandable to a stranger, says 3 word sentences. Understands concept of tomorrow and yesterday .

Question 7

What is the preferred site for immunizations?

Answer 7

Vastus lateralis- 3 fingers from knee or groin in infant. Have to be able to walk at least one year before you can use dorsal gluteal - ex 29-30 months .

Question 8

What is maximum dose of fluid that can be injected into

VL site in an infant?

Answer 8

2ml

Question 9

What is the leading cause of death in infants?

Answer 9

Accidents

Question 10

At what age is a child too old for the roto vax?

Answer 10

15-18 months.

Question 11

At what age is a child too old to “catch up” on the HIB vac

Answer 11

5 years

Question 12

Most common STD in teens?

Answer 12

Chlamydia and warts.

Question 13

When does anterior fontanel close?

Answer 13

12-15 months

Question 14

When do you start routine BP screening?

Answer 14

3 years of age

Question 15

How long do you measure head circumference ?

Answer 15

Age 2

Question 16

Name some pathological types of newborn jaundice.

Answer 16

ABO incompatibility, Rh factor, biliary atresia

Question 17

What is physiologic jaundice?

Answer 17

Fetal circulation is different then new born circlation. Fetal circulation bypasses lungs and more hemoglobin is needed, After birth jaundice can occur when infants cant keep up with excreting breakdown product of hgb. Needs to drink to poop out . Sun light also helps .

Question 18

Neonatal Chlamydia

Answer 18

Child may aspirate chlamydia during birth, so 2 month old in respiratory distress consider chlamydia as possible cause, takes to colonize so if child 5-6 weeks.

Question 19

How long is strabismus normal for ?

Answer 19

6 months

Question 20

When does physiological jaundice peak?

Answer 20

5th day of life . Higher levels at younger age more concerning because it hasn’t peaked yet.

Question 21

What is the normal age for walking ?

Answer 21

9- 17 months

Question 22

What are 2 live viruses? And they would be contraindicated for what type of pt?

Answer 22

MMR and varicella - contraindicated in pregnant patient.

Question 23

What are initial visit intervals?

Answer 23

Seen in office first week of life (3-5 days) then 1 month - assess weight, jaundice and breast feeding, then 2, 4, 6, 9 months., 12 mos, 15, 18, 24 and 30 months, then yearly