Pediatric Health Supervision

Question 0

Failure to thrive? Most common cause?

Answer 0

Less than expected growth rate (usually weight) which crosses 2 percentile isobars

Reduced calorie intake

Question 1

Purpose of routine well child visit?

Answer 1

1. Anticipatory guidance
2. Prevention (immunizations)
3. Screening (vision, hearing, metabolic screening, TB)
4. Growth and development assessment
5. Prevention of disability (in chronic disease)

Question 2

Expected weight, height and head circumference increases?

Answer 2

Double birthweight by 5 months
Triple birthweight by 12 months

Double length by 4 years
Triple length by 13 years

25% of normal adult had size at birth
75% of normal adult size by one year (12 cm increase since birth )

Question 3

Cephalohematoma?

Answer 3

Subperiosteal hemorrhage of newborn cranium after traumatic delivery

Question 4

Microcephaly? Types? Clinical features?

Answer 4

Head circumference 2 to 3 standard deviations below mean

CONGENITAL (abnormal migration of brain tissue) versus ACQUIRED (cerebral insult)

1. Small brain
2. Developmental delay/intellectual impairment
3. Cerebral palsy/seizures

Question 5

Craniosynostosis? Causes?

Answer 5

Premature closure of cranial sutures

90% SPORADIC
GENETIC (Alpert/Crouzon syndromes)
METABOLIC (hyperthyroid, hypercalcemia)

Question 6

Craniosynostosis Clinical features?

Answer 6

Sagittal suture – Dolichocephaly (elongated skull)
Coronal suture – Brachycephaly (shortened skull) and Optic nerve atrophy
Metopic suture - trigonocephaly (triangle head)

Question 7

Causes of congenital versus acquired microcephaly?

Answer 7

1. Early prenatal infection (HIV/TORCH)
2. Toxins (fetal alcohol)
3. Chromosomal (Trison the 13, 18, 21)
4. Familial
5. Maternal phenoketouria
6. Played third trimester/perineal infections
7. Meningitis/meningoencephalitis during first year
8. Ischemic cerebral insult
9. Metabolic (hypothyroidism, inborn errors of metabolism)

Question 8

TORCH?

Answer 8

Toxoplasmosis, other (syphilis), rubella, CMV, HSV

Question 9

Plagiocephaly? Main cause? Associated with? Management?

Answer 9

Asymmetry of head not associated with premature suture closure

Positional – associated with Congenital muscular torticollis

Motion stretching exercises, repositioning the head during sleep, increased time in prone position

Question 10

Macrocephaly? Does not reflect? Management?

Answer 10

Head circumference >95% for age

Does not reflect brain size

Look for signs of high ICP
CT scan to rule out hydrocephalus
Genetic evaluation if suspectedp

Question 11

Causes of macrocephaly?

Answer 11

1. Familial
2. Overgrowth (Sotos syndrome)
3. Metabolic storage disorders (gangliosidosis, Canavan)
4. Neurofibromatosis
5. Achrondroplasia
6. Hydrocephalus
7. Space occupying lesions (cysts/tumors

Question 12

Live vaccines?

Dead vaccines?

Answer 12

Polio, Varcella, MMR

DTaP, hepatitis A/B, polio, H. influenzae, influenza, pneumococcal/meningococcal

Question 13

Give passive immunization for these diseases?

Answer 13

1. Varicella (if immunocompromised or at higher risk)
2. Hepatitis B (if mother is positive)
3. Hepatitis A (before travel)

Question 14

Types of hearing tests?

Answer 14

1. Brainstem auditory evoked response – EEG waves generated in response to clicks
2. Evoked otoacoustic emission – measures sounds generated by cochlear hair cells

Question 15

Circumcision required if?

Answer 15

1. Phimosis – inability to retract foreskin (ballooning of the foreskin after age 6)
2. Paraphimosis – foreskin cannot be returned to normal position and ask as tourniquet
3. Balanitis – inflammation of glans penis (associated with candida and gram-negative infections in children)

Question 16

Contraindications to circumcision?

Answer 16

Hypospadias, prematurity, bleeding diaphysis

Question 17

Average age of tooth eruption? Type of tooth? Primary teeth established by what age? Secondary tooth eruption by when?

Answer 17

Six months

Lower central incisor

Two years

Seven years

Question 18

Delayed dental eruption? Causes?

Answer 18

Eruption after 16 months

Hypothyroidism, hypopituitarism, down syndrome, ectodermal dysplasia

Question 19

Early dental eruption? Causes?

Answer 19

Before three months

Hyperthyroidism, precocious puberty, growth hormone excess

Question 20

Patients who need flourine supplementation?

Answer 20

1. Exclusively breast-fed children older than six months

2. Order contains <.3 ppm fluoride

Question 21

The most common cause of nursing/bottle caries? Mech?

Answer 21

Streptococcus mutans

Any liquid other than water can serve as a substrate for infection

Question 22

Signs of hydrocephalus in infant?

Answer 22

Bulging fontanelle and split cranial sutures

Question 23

Patient less than 9 months with iron deficiency anemia – possible cause?

Answer 23

Early cows milk – less bioavailable iron (Compared to breast milk or formula)

Question 24

One month milestones?

Answer 24

Formed stools

Question 25

At 2 months parents should?

Answer 25

Encourage vocalizations

Be wary of small object aspiration

Question 26

At four months parents should?

Answer 26

Introduce iron fortified cereal and solid food

Introduce transitional object

Question 27

At six months?

Answer 27

Sleeping through the night
Sunscreen use
No infant Walker

Question 28

At nine months?

Answer 28

Drinks from cup/eats appropriate finger foods
Anxiety separation
Sleep disturbances

Question 29

At 12 months?

Answer 29

Three meals a day plus snacks
Toddler car seat facing forward
Whole milk
Discipline with distraction

Question 30

At 18 months?

Answer 30

Toilet training

Nightmares

Question 31

Two years?

Answer 31

Change to bed from crib
Change to 2% milk
Parallel play/sibling rivalry

Question 32

Three years?

Answer 32

Tricycle

Private parts

Question 33

Four years?

Answer 33

Swimming lessons
Scissor/pencil use
Imitates peers
Imaginative play

Question 34

Earliest to begin vitamin D supplementation?

Answer 34

Nine months