Pediatric and Newborn Visit

Question 1

How is the age cohort of neonate or newborn defined?

Answer 1

First 28 DOL

Question 2

How is the age cohort of infant defined?

Answer 2

29 DOL to 1 year

Question 3

How is the age cohort of early childhood defined?

Answer 3

1-4 years old

Question 4

How is the age cohort of middle childhood defined?

Answer 4

5-10 years old

Question 5

How is the age cohort of adolescence defined?

Answer 5

10-20 years old

Question 6

Age specific milestones are

Answer 6

predictable

Loss/delay of a milestone is always concerning

Question 7

Is the range of normal wide or narrow in children?

Answer 7

Wide

Question 8

What are the goals of well child visits?

Answer 8

Disease Detection
Disease Prevention
Health Promotion
Anticipatory guidance (age specific advice)

Question 9

What is an important component of pediatric visits that are often missed?

Answer 9

Observation of parent/child interactions

Question 10

What are the components of developmental surveillance?

Answer 10

Ongoing process
Done at every visit
Parental history
Skilled, experienced observation

Question 11

What are the components of developmental screening?

Answer 11

Formal process
Uses a standardized tool
Universal screening at specified ages
Selective screening when risk assessment raises a concern

Question 12

What are the main differences in a child HPI compared to the adult visit?

Answer 12

History from parent
Need both parent and patients perspective
Note parent-child interaction
Parental emotions and behaviors

Question 13

It is important to note what since the last visit?

Answer 13

Any changes
General Status
Other priorities based on age

Question 14

What are the additional past medical history components to the pediatric visit?

Answer 14

Prenatal history of the mother
Birth history
Newborn history (included in all children < 3 or if pertinent)

Question 15

What is included in the health maintenance section of the pediatric visit?

Answer 15

Feeding/Nutrition
Growth and Development
Immunizations
Sleep Patterns
Elimination patterns
Dental Care
Safety

Question 16

What is included in the feeding history/nutrition component of the visit?

Answer 16

Breast vs. bottle fed; how much, how frequently
Weaning
Solid foods: when, what types
Current diet
Food likes/dislikes, appetite, intolerances
Vitamin supplements

Question 17

What is the immediate care in the evaluation of the newborn at delivery?

Answer 17

drying, clearing, airway, warming

Question 18

When are APGARs done?

Answer 18

1, and 5 minutes in all newborns

Question 19

What does the APGAR score at 1 minute assess?

Answer 19

Does the baby need to be resuscitated (0-4 APGAR)

Question 20

What is a reassuring 5-minute APGARs score?

Answer 20

7-10

Question 21

Does APGAR’s predict mortality and morbidity?

Answer 21

No, it is only used to assess need for resuscitation

Question 22

What parts of the exam do you do first when the baby is quiet?

Answer 22

Heart and Lungs

Question 23

What parts of the exam do you do last?

Answer 23

Spine and hip assessment

Question 24

What is the normal respiratory rate in a newborn?

Answer 24

35-60 breaths/minute

Question 25

At what age do we start routinely getting blood pressures?

Answer 25

Age 3

Question 26

What growth parametric is done at every visit until age 2?

Answer 26

Head circumference

Question 27

What is lanugo and who is it common in?

Answer 27

Fine downy growth of hair over the entire body, more prominent in preemies

Question 28

What is vernix caseosa?

Answer 28

Milky chunky white covering present at birth

Question 29

If there is central cyanosis and cyanosis of mucus membranes what should be evaluated?

Answer 29

Congenital heart disease

Question 30

What race is pustular melanosis more common?

Answer 30

African Americans

Question 31

What race is Mongolian spot’s more common?

Answer 31

Asian neonates (85-100%)

Question 32

What is a Mongolian Spot?

Answer 32

Blue-gray patch, usually in sacral-gluteal region or shoulders. Usually disappear in 1-2 years of life.

Question 33

What are you concerned for when there is a port wine stain in V1?

Answer 33

Sturge-Weber syndrome (rare, congenital)
Capillary-venous malformations in the brain and eye

Question 34

When does the Anterior fontanelle close?

Answer 34

4 and 26 months of age (most commonly around 18)

Question 35

When does the Posterior fontanelle close?

Answer 35

Closes by 2 months of age

Question 36

What can ear abnormalities be sometimes associated with?

Answer 36

Kidney congenital defects or congenital hearing loss

Question 37

What is a characteristic finding of Turner’s Syndrome in the neck?

Answer 37

Webbed neck

Question 38

Why can female genitalia more prominent at birth?

Answer 38

Exposure to mother’s estrogen

Question 39

What spine findings can be associated with neural tube defects?

Answer 39

Pigmented spots, hairy patches, deep pits

Question 40

What should be done as part of the neurologic exam?

Answer 40

Note muscle tone
Symmetry of movement
Moving all extremities
Primitive reflexes

Question 41

What are the primitive reflexes?

Answer 41

Moro reflex (startle reflex)
Grasp reflex
Stepping reflex
Rooting reflex
Babinski
Asymmetrical tonic neck reflex

Question 42

What is part of preventative care at birth?

Answer 42

Erythromycin ophthalmic ointment to prevent gonococcal conjunctivitis

Vitamin K to prevent vitamin K deficient bleeding

Hepatitis B vaccination

Question 43

What is done as part of universal newborn screening?

Answer 43

Hearing
Metabolic and genetic disorders, endocrine disorders, and hemoglobinopathies in newborn screen