health supervision

Question 1

microcephaly

Answer 1

2-3 SD below avg.
congenital- abn induction or migration of brain tissue
acquired: late tired -1y. normal at birth then growth stop after insult
P: dev delay, low IQ, cerebral palsy, seizures

Question 2

craniosynostosis

Answer 2

premature closure of 1+ cranial sutures.
80-90% sporatic. rest gentic syndrome or familial (alpert or crouson syndrome). RF- IU constrain, metabolic - hyperthyroidism, hypercalcemia.
P: sutures usually open until brain growth stop at age 5 (90% at age 2). shape dep on which closed. most common= sagittal suture = elongate skull= dolichocephaly

Question 3

passive imunity

Answer 3

VZIG (VZV) and hep b and hep A (bf travel)

Question 4

MMR

Answer 4

live attenuated.

Question 5

Pneumococcal vaccine

Answer 5

two types
Prewar: bc most common cause of acute otitis and invasive bacterial infection in 2yo. adults at risk- SCA + asplenic, immunodef, chronic liver disease, nephrotic syndrome.

Question 6

Tdap CI

Answer 6

if encephalopathy w/in 7 d of vaccination

Question 7

Polio vaccine CI

Answer 7

OPV. don’t give to family of immunodef bc shed in stool.

Question 8

live vaccine CI

Answer 8

preg women

Question 9

hearing test

Answer 9

BAER-most accurate- EEG

EOE- normal cochlear hair cell

Question 10

neonatal metabolic screen

Answer 10

treatable disease that can do irreversible brain damage if not caught early.
all screen congenital hypothyroidism, PKU
most- galactosemia, SCA, other blood dycrasias,

Question 11

screen cholesterol

Answer 11

if fx when >2yo. if >75-90 percentile, get fasting lipid panel

Question 12

Fe def anemia screeening

Question 13

TB screen

Answer 13

if at risk= infected contacts, high risk pop, incarcerated, drugs user, HIV pos. CXR suspicious for TB, endemic area

Question 14

Lead intox

Answer 14

plumbism.

Question 15

circumcision needed if

Answer 15

1) phimosis- can’t retract foreskin. normal bf 6yo unless balloon foreskin when pee
2) paraphimosis- retracted foreskin= turniquet
3) balanitis- inflame of glans of penis- candida or gram neg in infants, STI in adults
CI: bleeding, diathesis, premature

Question 16

tooth eruption

Answer 16

primary- 3-16mo avg 6. all by 2yo = 20teeth
secondary: 6-8yo - 32teeth
delay: >16mo- familial, hypothyroidism, down, ectodermal dysplasia (conical tooth)
early:

Question 17

teenage mom

Answer 17

lbw, vertically acquired STI, poorer dev outcome, incr fetal death

Question 18

cocaine and stimulants

Answer 18

cause placental infuse due to vasoconstriction and lbw. def in cog and information processing. no microcephaly

Question 19

SGA babies risks

Answer 19

hypoglycemia- decr glycogen stores, heat loss, hypoxia, decr gluconeogenesis. usually asx. poor feeding, listlessness
hypothermia- cold stress, hypoxia, hypoglycemia, incr SA, decr subQ insulation
polycythemia- chornic hypoxia, maternal fetal transfusion. ruddy red skin. respiratory distress, food feeding, hyperviscois blood
immunodef, acute RF, GI perforation, meconium aspiration, intrauterine death

Question 20

TORCH

Answer 20

toxo, rubella, CMV, Herpes 2,

Question 21

congenital CMV

Answer 21

small head. calcification of lateral ventricles, lissencephaly= decr # of gyri and abn thick cortex. enlarged ventricles. progressive hearing loss. ck chorioretinitis, jaundice, petechiae, purport, ecchymosis, incr ALT, hepatomegaly, sz, lethargy, incr CSF protein >120.
antiviral tx decr hearing impairment and dev delay. start in 1st mo

Question 22

strabismus assessment

Answer 22

hischberg lift reflex, cover/ncover test.

Question 23

anemia

Answer 23

most common is Fe def in low income kids (35%). so do Fe trial in kids with mild anemia bf workup. f/u in 6wks