Pediatrics

Question 1

Female sexual maturity:
Breast: small nipples, no breasts
Pubic hair: no pubic hair

Answer 1

Stage 1

Question 2

Female sexual maturity:
Breast: breast and nipples have just started to grow, the areola has become larger. Breast tissue bud feels firm behind nipple
Pubic hair: initial growth of long pubic hairs (straight, no curls), light color

Answer 2

Stage 2

Question 3

Female sexual maturity:
Breast: Breasts and nipples have grown additionally. Areola is darker, breast tissue bud is larger.
Pubic hair: Pubic hair is wider-spread, hair is darker and curls may have appeared

Answer 3

Stage 3

Question 4

Female sexual maturity:
Breast: Nipples and areolas are elevated and form an edge toward the breast. The breast has grown a little larger
Pubic hair: More dense curly hair growth with curls and dark hair. Still not entirely as an adult woman

Answer 4

Stage 4

Question 5

Female sexual maturity:
Breast: Fully developed breast. Nipples are protruding and the edge between areola and breast has disappeared.
Pubic hair: Adult hair growth, dense, culry hair extending toward the inner thigh

Answer 5

Stage 5

Question 6

How does fetal development occur?

Answer 6

Cephalocaudal (head-to-toe)

Question 7

When does the auditory canal stop curving in/up?

Answer 7

3 years old

Question 8

If you see nystagmus and strabismus in a child under 6 months, is this normal?

Answer 8

Yes

Question 9

Finding shotty lymph nodes in the anterior and posterior cervical chains is a common finding in children?

Answer 9

Yes

Question 10

If you discover palpable supraclavicular, epitrochlear, and popliteal lymph nodes in a child, is this normal?

Answer 10

No this is never a normal finding in any patient of any age

Question 11

When do teeth begin to erupt?

Answer 11

6-8 months

Question 12

When should the child have all teeth but the second molars erupted?

Answer 12

30 months

Question 13

You are assessing a child and hear an inspiratory S2 split, is this normal?

Answer 13

Yes, this is common in children

Question 14

You have a child come in for their 4 year old well visit. You ask the parent history-taking questions and the child chimes in. At what age can a child start assisting in history-taking with age appropriate questions?

Answer 14

Around 4-5 years old

Question 15

When does the one-on-one portion of the exam of you and the child begin?

Answer 15

In adolescents and can be chaperoned by a staff member that is not the parent to establish a rapport with the patient

Question 16

When does the AAP recommend developmental surveillance screenings besides with each patient encounter?

Answer 16

Ages 9 months, 18 months, 24 or 30 months

Question 17

The head-to-toe is how you traditionally exam a patient. However, children move more, can cry often at the doctors, and are not the easiest to get to sit still. What is the approach used for examining children?

Answer 17

Quiet to active

Question 18

Is percussion a routine part of the examination on a child?

Answer 18

No

Question 19

When does BP become a normal part of assessment during pediatric patient encounters?

Answer 19

3 years old

Question 20

Where can a checklist for CV clearance for sports participation be found?

Answer 20

AHA

Question 21

If you have a child with Stage I or Stage II HTN and NO organ damage, do they have sports participation restrictions?

Answer 21

No, AHA believes that the sports participation and CV effort can help improve the HTN

Question 22

When doing a sports participation physical exam, what should be palpated throughout?

Answer 22

Every joint

Question 23

When you are assessing for a sports participation physical, you should auscultate the heart in a squatting or Valsalva maneuver position for what reason?

Answer 23

Murmurs and extra sounds of cardiomyopathy are not always heard during the non-dynamic auscultation of the heart

Question 24

When you are discussing safety with a child/adolescent, what should be added into this disccusion?

Answer 24

Internet safety such as social media, video games/apps

Question 25

When are basic hearing screenings completed?

Answer 25

Every child well-visit

Question 26

When do the maxillary sinuses develop?

Answer 26

Age 4

Question 27

In a newborn, is there an A/P to transverse diameter difference?

Answer 27

No, A/P=transverse diameter in newborns (barrel chested little munchkins)

Question 28

During puberty stage 5, what occurs in the bones?

Answer 28

The epiphyseal (growth plates) plates fuse and this is now the patient’s adult height

Question 29

When do you assess immunization need?

Answer 29

Every encounter

Question 30

Who has an immunization schedule and a catchup schedule available as a resource for practitioners?

Answer 30

The CDC

Question 31

When do annual BMI screenings begin?

Answer 31

Age 2

Question 32

When is it recommended to start screening for depression in children?

Answer 32

Age 12-18 with every encounter

Question 33

Key Findings/Physical Exam:
-generally asymptomatic
-SOB with exertion, palpitations, chest pain, lightheadedness, syncope especially during exercise, HTN
-midsystolic murmur at the apex raditation to the axilla that increases in intensity with a Valsalva or squat-to-stand
-S4, arrhtymias, MVR, abnormal EKG

Answer 33

Hypertrophic cardiomyopathy

Question 34

Key Findings/Physical Exam:
-FBN1 mutation, autosomal-dominant disease
-aortic root aneurysm/dissection, mitral valve prolapse
-joint hyperflexibility, increased limb length, pectus deformities
-hindfoot deformities, connective tissue disorders, scoliosis
-dolichocephaly, downward slanting palpebral fissures, enophthalmos, retrognathia, malar hypoplasia
-striae in uncommon location such as the mid-back, lumbar region, upper arm, axillary region

Answer 34

Marfan syndrome

Question 35

Key Findings/Physical Exam:
-hallmark is menstrual, energy, and bone density abnormalities
-harmful dieting/disordered eating patterns
-depression, fear of weight gain, poor body image, anxiety disorders, low energy, fatigue
-low body mass, low bone density
-secondary amenorrhea
-stress fractures, weakened immune system, susceptible to injuries, diminished athletic performance

Answer 35

Female athlete triad