Pediatrics Flashcards

Question 1

Q

Routine management of the newborn

Answer

A

physical exam

apgar

eye care

dz prevention and screeing

Question 2

Q

Routine management of the newborn

right after birth

Answer

A

mouth and nose are suctioned

clamping and cutting of umpbilical cord

dried wrapeed in clean towels and placed under a warmer

gentle rubbing or sitmulating hte heels helps to stimulate crying and breathing

Question 3

Q

Routine management of the newborn

intubation and ABG analysis are indicated if

Answer

A

resp distress

Question 4

Q

Routine management of the newborn

nasogastric tube

Answer

A

indicated when GI decompression isneeded

Question 5

Q

Routine management of the newborn

antibiotics

Answer

A

indicated for sepsis

Question 6

Q

late preterm neonate

Answer

A

34-37 weeks

Question 7

Q

Term neonate

Answer

A

38 weeks or more

Question 8

Q

Normal vital signs in a newborn

Answer

A

RR - 40-60

HR - 120-160

Question 9

Q

vital signs in a newborn are always

Answer

A

higher, babies are faster

Question 10

Q

APGAR Score: Newborn Assessment

overview

Answer

A

measurement for the need and effectiveness of resuscitation, it does not predict mortality

Question 11

Q

APGAR Score: Newborn Assessment

one minute score

Answer

A

evaluates conditions during labor and delivery

Question 12

Q

APGAR Score: Newborn Assessment

five minute score

Answer

A

evaluates the response to resuscitative efforts

Question 13

Q

a low apgar score is not associated with

Answer

A

cerebral palsy

Question 14

Q

APGAR Score: Newborn Assessment

what it stands for

Answer

A

appearance
pulse
grimace
activity
respiration

Question 15

Q

APGAR Score: Newborn Assessment

appearance

Answer

A

skin color/complexion

0 - blue all over

1 - normal except extremities

2 - normal all over

Question 16

Q

APGAR Score: Newborn Assessment

pulse

Answer

A

pulse rate

0 - <60bpm or asystole

1 - >60 bpm but <100bpm

2 - >100bpm

Question 17

Q

APGAR Score: Newborn Assessment

grimace

Answer

A

reflex irritability

0 - no response

1 - grimae/feeble cry

2 - sneeze/cough

Question 18

Q

APGAR Score: Newborn Assessment

activity

Answer

A

Muscle tone

0 - none

1 - some flexion

2 - active movement

Question 19

Q

APGAR Score: Newborn Assessment

respiration

Answer

A

breathing

0 - absent

1 - weak or irregular

2 - strong

Question 20

Q

Newborn Eyecare

conjunctivitis day 1

Answer

A

mostl iley cause is chemical irritation (silver nitrate, this is not an allergy)

Question 21

Q

Newborn Eyecare

conjunctivitis days 2-7

Answer

A

most likely neisseria gonorrhoeae (gram neg diplo, prevent w/ ointments, treattwith ceftriaxone)

Question 22

Q

Newborn Eyecare

conjunctivitis day more than 7 days after deliver

Answer

A

most likely due to chlamydia trachomatis (not effectively prevented by prophylaxis, treate with oral erythromycin)

Question 23

Q

Newborn Eyecare

conjunctivitis 3 weeks or more after delivery

Answer

A

mostl likely due to herpes infection (treate with systemic acyclovir and topical vidarabine)

Question 24

Q

Newborn Eyecare

conjunctivitis treatment

Answer

A

2 types of ab drops to prevent ophtamoa neonatuorum which is attributed to neisseria gonorrhoeae or chlamydia trachomatis:

erythroycin or tetracycline ointments
silver nitrate solution

Question 25

Q

Vitamin K Deficient Bleeding

Definition

Answer

A

as the neonates colonic flora has not adequately colonized, E coli is not present in suffcient quantities to make neough vitamin k to produce clottting factors II, VII, IX, and X and proteins C and S. W/o tese factors the newborn is omrel ikely to have bleeding fromt he GI tract, belly button, and urinar tract

Question 26

Q

Vitamin K Deficient Bleeding

prophylactic treatment

Answer

A

to prevent Vitamin K Deficient Bleeding (formerly know as hemorrhagic disease of the newborn), a single im dose of vit k is recommended and has been shown to decrease the incidence of Vitamin K Deficient Bleeding

Question 27

Q

Screening Tests

all neonates must be screened for wht prior to discharge?

Answer

A

PKU
congenital adrenal hyperplasia (CAH)
biotinidase
beta thalassemia
galactosemia
hypothyroidism
homocysteinuria
cystic fibrosis

Question 28

Q

Most commonly tested disorders in newborns

Answer

A

g6pd deficiency
pku
galactosemia
congenital adrenal hyperplacia
congenital hypothyroidism
hearing test
cystic fibrosis

Question 29

Q

G6PD deficiency

Answer

A

x linked recessive disease, characterized by hemolytic crises.

treatment involves reducing oxidative stress and specialized diets

Question 30

Q

PKU

Answer

A

autosomal recessive genetic disorder characterized by a deficiency in the enzyme phenylalanine hydroxylase (PAH) that leads to mental retardation.

Treatement is with a special diet low in phylalanine for at least the first 16 years of the patient’s life

Question 31

Q

Galactosemia

Answer

A

rare genetic disorder that precludes normal metabolism of galactose.

Treatment is to cut out all lactose-containing products

Question 32

Q

Congenital Adrenal hyperplasia

Answer

A

any of several autosomal recessive diseases resulting in errors of steroidogenesis.

treatment is to replace mineralocorticoids and glucocorticoid deficiencies and possible genital reconstructive surgery.

Question 33

Q

Congenital hypothyroidism

Answer

A

a condition affecting 1 in 4000 infants that can result in cretinism

Question 34

Q

Hearing test

Answer

A

excludes congenital sensory-neural hearing loss. necessary for early detection to maintain speech patterns and assess the need for cochlear implantation

Question 35

Q

Cystic Fibrosis

Answer

A

autosomal disorder causing abnoramlly thick mucus.

Question 36

Q

Cystic Fibrosis

Best initialtest:

Answer

A

sweat chloride

Question 37

Q

Cystic Fibrosis

Most accurate test:

Answer

A

genetic analysis of the CFTR gene

Question 38

Q

Cystic Fibrosis

Classic findings on the USMLE

Answer

A

Combination of an elevated sweat hloride, presence of mutationsin CFTR gener, and/or abnormal functioning in at least one organ system

Question 39

Q

Hepatitis B Vaccination

Answer

A

Every child gets a hepatitis B vaccination, but only those with HBsAG-Positive mothers should receive hepatitis B IG (HBIG) in addition to the vaccine

Question 40

Q

Transient polycythemia of the newborn

Answer

A

hypoxia during delivery stimulates erythropoeitin and acaues an increase in ciriculating red blood cells. the newborn’s first breathwill increase O2 and cause a drop in erythropoeitin,which in turn will ead to normalization of hb

splenomegaly is a normal finding in newborns

Question 41

Q

Transient Tachypnea of the newborn

Answer

A

compression of the rib cage by passin throuh the omther’s vaginal canal helpt so remove fluid in the lungs. Newborns who are delivered bia cesarean birth may have excess fluid in the lungs and therefore by hypoxic. if tachypnea lasts more than 4 hours, it is considered sepsis and must be evaluated with blood and urine culutres.lumbar puncture with csf analysis and culture is done when the newborn displays neurological signs such as irritability,lethargy, temp irregularity, and feeding problems.

Question 42

Q

transient hyperbilirubinemia

Answer

A

over 60% of all newborn infants are jaundiced. This is due to the infant’s spleen removing excess red blood cells that carry Hgb F. This excess breakdown or RBCs leads to a physiological release of hb and in turn a rise in bilirubin.

Question 43

Q

Deliver-Associated injury in the newborn

Subconjunctival hemorrhage

Answer

A

minute hemorrhages may be present in the eyes of the infant due to a rapid rise in intrathoracic pressure as the chest is compressed while passing through the canal. no treatment is indicated

Question 44

Q

Deliver-Associated injury in the newborn

skull fractures

Answer

A

Linear: most common

Depressed: can cause further cortical damage w/o surgical intervention

Basilar: most fatal

Question 45

Q

Deliver-Associated injury in the newborn

scalp injuries

Answer

A

Caput succedaneum is a swelling of thesoft tissues of the scalp that does notcross suture lines. cephalohematoma is a subperiostealhemorrhage that does not cross suture lines. diagnosis is made clinically and improvement occurs gradually without treatment over a few weeks to months

Question 46

Q

Deliver-Associated injury in the newborn

Brachial Palsy

Etiology

Answer

A

brachial plexus injuries are secondary to births with traction in the event of shoulder dystocia. Brachial palsy is most commonly seen in macrosomic infants of diabetic mothers and has 2 major forms:

duchenne-erb paralysis: C5-C6
klumpke paralysis: c7-c8+/-T1

Question 47

Q

Deliver-Associated injury in the newborn

duchenne-erb paralysis: C5-C6

Answer

A

waiter tip appearance; secondary to shoulder dystocia

the infant is unabelt o uabduct the shoulder or externally rotate and supinate the arm

diagnosis is made clincially and immobilization is the best treatment

Question 48

Q

Deliver-Associated injury in the newborn

klumpke paralysis: c7-c8+/-T1

Answer

A

claw hand due to a lack of grasp reflex

paralyzed hand with horner syndrome (ptosis, miosis, and anhydrosis)

diagnosis is made clincially and immobilization is the best treatment

Question 49

Q

Deliver-Associated injury in the newborn

clavicular fracture

Answer

A

this is the most common newborn fracture as a result of hsoulder dystocia. xray is the best diagnostic test, and the fracture is treated with immobilization, splinting, and physical therapy

Question 50

Q

Deliver-Associated injury in the newborn

facial nerve palsy

Answer

A

facial nervye palsy is paralysis of structures innervated by the facial nerve, caused by trauma secondary to forcep use in deliver. diagnosis is made clinically and improvement occurs gradually over a few weeks to months. however, if no recovery is seen, then surgical nerve repair is necessary.

Question 51

Q

Deliver-Associated injury in the newborn

amnioticfluid abnormalities and associated manifestations

Answer

A

in amniotic fluid, 80% is a filtrateof the mothers plasma

the baby produces the remianing 20% by swallowing, absorbing, filtering, and urinating

Question 52

Q

Deliver-Associated injury in the newborn

amnioticfluid abnormalities and associated manifestations

polyhydramnios

Answer

A

too much fluid secondary to fetus not swallowing

causes:
neuro, werdnighoffman (infant unable to swallow)

GI, intestinal atresia

Question 53

Q

Deliver-Associated injury in the newborn

amnioticfluid abnormalities and associated manifestations

oligohydramnios

Answer

A

too little fluid bc fetus cannot urinate

causes:
prune-belly: lack of abdominalm uscles so unablet o bear down and urinate. treat with serial foley catheter placements but carries high risk of UTI

renal agenesis: incompatible with life, associated with potter syndrome

flat facies due to high atmospheric pressure causing compressio of the fetus that is normally buffered by the amniotic fluid

Question 54

Q

When does shoulder dystocia occur?

Answer

A

after delivery of the head when the babys anterior shoulder gets stuck behind the mother’s pubic bone

Question 55

Q

Abnormal abdominalf findings

Answer

A

diaphragmatic hernia

omphalocele

umbilical hernia

gastroschisis

wilms tumor

neuroblastoma

Question 56

Q

diaphragmatic hernia

Answer

A

a hole in the diaphragm that allows the abdominal contents to move into the thorax

bowel sound int he chest can be heard

air fluid levels are seen on chest xray

two types:

morgagni: defect is restrosternal or parasternal
bochdalek: defect is posterolateral

Question 57

Q

bochdalek

Answer

A

most common diaphragmatic hernia

commonly occur on the left side

Question 58

Q

Omphalocele

Answer

A

defect in which intestines and organs from beyond the abdominal wall with a sac covering. Results from failure of the GI sac to retract at 10-12 weeks gestation

screening is conducted by maternal alpha fetoprotein levels and us. surgical reintroduction of contents in needed. highly associated with edwards syndrome (tri 18)

Question 59

Q

elevated afp levels indicate

Answer

A

neural tube defects and abdominalw all defects

Question 60

Q

most common cause of elevated afp is

Answer

A

incorrect dating

Question 61

Q

Umbilical hernia

Answer

A

there is a congenital wall weakness of the rectus abdominis muscle which allows for protrusion of vessels and bowel. it is highly associated with congenital hypothyroidism. ninety percent close spontaneously by age 3. after the age of 4, surgical intervention is indicated to prevent bowel strangulation and subsequent necrosis

Question 62

Q

Gastroschisis

Answer

A

a wall defect lateral to midline with intestines and organs forming byoned the abdominal wall with no sac covering. multiple intesintal atresias can occur. treatment calls for immediates surgical itnervetnion with gradual introduction of bowel and silo formation. overly agressive surgical reintroduction of the bowel will ead to third psacing and bowel infarction.

Question 63

Q

Wilms Tumor

Answer

A

A large palpable abdominal mass is felt. it is caused by hemihypertrophy of one kidney due to its increased vascular demands. aniridia is highly associated wtih this malignancy and is usually the clinicians most valuable clue. an affected child will show signs of consitpation and complain of abdominal pain that is accompanied by nausea and vomiting

Question 64

Q

wilms tumor

diagnostic tests

Answer

A

best initial: abdominal us

most accurate: contrast-enhanced CT

Answer 65

A

total nephrectomy with chemotherapy and radiation may be indicated based upon staging. bilateral kidney inolvement indicated partial nephrectomy

Answer 66

A

wilms tumor

Answer 67

A

Wilms tumor
aniridia
genitourinary malformations
retardation

results from a deletion on chromosome 11

Answer 68

A

adrneal medullar tumor similar o a pheochormocytoma but with fewer cardiac manifestation. the percentageof cases presenting with metastases ranges from 50% to 60%

Answer 69

A

Hypsarrhythmia (on EEG) and opsomyoclonus are hallmark findings.the prefix opso- refersto the presenceof intermittent jerky eye movements (dancing eyes) and the root myoclonus refers to myoclonic jerks andcerebellar ataxia (dancing feet).

increased vanillyl mandelic acid (VMA) and meanephrines on urin collection are diagnostic.

Answer 70

A

neuroblastoma

Answer 71

A

hydrocele

varicocele

cryptorchidism

hypospadias

epispadias

Answer 72

A

sucking reflex - baby will automatically suck on a nipplelike object
grasping reflex
babinski reflex - toe extension
rooting reflex - if you touch the baby’s cheek, the baby will turn to that side.
moro reflex - arms spread symmetrically when the baby is scared
stepping reflex - walking like maneuvers when toes touch the ground
superman reflex - when held facing the floor, arms go out

Answer 73

A

hydrocele is a painless, swollen gluid filled sac along the spermatic cords within the scrotum that transilluminates upon inspection

remnant of tunica vaginalis
usually will resolve within 6 months
must differentiatefrom inguinal hernia

Answer 74

A

varicocele isa varicose wein in the scrotal veinscausing swelling of pampiniform plexus and increased pressure. the most common compalint is a dull ache and heaviness in the scrotum

Answer 75

A

best initial testis pe coinciding with bag of worms sensation
most accurate test is us of the scrotal sac showing dilatation of the vessels of the pampiniform plexus >2mm. (always us the other testicle, it is a b/l disease and so if present on one side it is probably indolent on the other side)

Answer 76

A

indicated for delayed growth of the testes or in the those with evidence of testicular atrophy

Answer 77

A

is the absence on one testicle in the scrotum, and is usually found within the inguinal canal

90%of cases can be felt in the inguinal canal
orchipexy is indicated to bring the testicle down into the scortum after the age of 1 to avoid sterility

Answer 78

A

an increased risk for malignancy regardless of surgical intervention

Answer 79

A

the opening of the urethra is found ont he ventral surgace of the penis

high association with cryptorchidism and inguinal hernias
needssurgical correction
circumcision is ci due to difficulties in surgical correction of the hypospadias

Answer 80

A

the opening of the urethra is found on the dorsal surface

high association with urinary incontinence
must evaluate for concomitant bladder exstrophy
needs surgical correction

Answer 81

A

tetrology of fallot

transposition of the great vessels

hypoplastic left heart syndrome

truncus arteriosus

total anomalous pulmonary venous return

Answer 82

A

tetralogy of fallot

Answer 83

A

tetralogy of fallot

Answer 84

A

overriding aorta

pulmonary stenosis

Right ventricular hypertrophy

ventricular septal defect (VSD)

Answer 85

A

cause is thorugh to be due to genetic facors and enfironemenal factors. is is associated iwth Chromosome 22 deletions

Answer 86

A

Cyanosis of the lips and extremities

holosystolic murmur best heard at the lower left sternal border

squatting after exertive exercises
-causes and increased preload and increased systemic vascular resistance. this decreases the right to left shunting, leading to increased pulmonary blood oxygen saturation.

Answer 87

A

cxr showing boot shaped heart

decreased pulmonary vascular marking

Answer 88

A

surgery is the only definitive therapy

Answer 89

A

Down (tri21)
edwards (tri 18)
patau (tri 13)

Answer 90

A

mitral regurg
tricuspid regurg
VSD

Answer 91

A

endocardial cushion defect of atrioventricular canal

Answer 92

A

this condition is characterized by an aorta that origniates fromt he right ventricel and pulmonay artery that comes fromt he left ventricle.no oxygenation of blood can occur without a patent ductus arteriosus (PDA), ASD or VSD.

Answer 93

A

Early and severe cyanosis is seen. A single S2 isheard. CXR will show an egg on a string

Answer 94

A

neonates must have an open ductus arteriosus (PDA). they require prostaglandin E1 to keep the ductus open, and NSAIDS (especially indomethacin) are ci bc they will cause closure of the ductus.

2 seperate surgeris are necessary; however, each surgery carries a 50% mortality rate. Therefore, only 1 in 4 will survive the surgeries.

Answer 95

A

the neonatal period

Answer 96

A

the neonatal period

Answer 97

A

sign of left ventricular systolid dysfunction

Answer 98

A

sign of hypertrophic obstructive cardioyopathy (HOCM)

Answer 99

A

in aortic regurgitation

Answer 100

A

aortic stenosis

Answer 101

A

cardiac tamponade and tension pneumothorax

Answer 102

A

atria fibrillation

Answer 103

A

this is a syndrome consisting of left ventricualr hypoplasia, mitral valve atresia, and aortic valve lesions

Answer 104

A

absent pulses with a single S2

increased right ventricular impulse

gray rather than bluish cyanosis

Answer 105

A

cxr will show a globular shaped hehart with pulnonary edema.

echo is the most accurate diagnostic test

Answer 106

A

only therapy is 3 seperate surgeries or a heart transplant. each surgery carries and extremely high mortality

Answer 107

A

occurs when a single trunk emerges from both right and left ventricles and gives rise to all major circulations.

Answer 108

A

symptoms occur whtin the first few days of life and are characterized by

severe sypnea
early and frequent respiratory infections
single s2 is heard as there in only one semilunar valvee and a systolic ejction murmur is heard bc these valve leaflets are usually abnormal in functionality.
peripheral pulses are bounding

Answer 109

A

cxr will show cardiomegaly with increasedpulmonary markings

Answer 110

A

the omst severe sequela of this condition is

Answer 111

A

congenital condition in which there is no venous return between pulmonary veins and the left atrium, oxygenated blood instead returns to the superior vena cava. there are 2 forms: with or wihtout obstruction of the venous return. obstruction refers to the anlge at which the veins enter the sinus.

Answer 112

A

early in life with respiratory distress and severe cyanosis

Answer 113

A

xcr shows pulmonary edema

echo is definitive

Answer 114

A

surgery is the definitive choice for treatment

Answer 115

A

age 1-2 years with right heart failure and tachypnea

Answer 116

A

cxr shows snowman or figure 8 sign

mosta ccurate test is echo (diagnosed by echo and not cxr)

Answer 117

A

surgical intervention to restore proper blood flow

Answer 118

A

vsd with right ventricular hypertrophy

Answer 119

A

r to l shunt

vsd

surgery

Answer 120

A

r to l shunt

pda dependent

surgery

Answer 121

A

r to l shunt

pda dependent

surgery

Answer 122

A

r to l shunt

vsd

surgery

Answer 123

A

r to l shunt

surgery

Answer 124

A

most common congenital heart lesion

Answer 125

A

dyspnea with respiratory distress

high-pitched holosystolic murmur over lower left sternal border

loud pulmonic s3

Answer 126

A

cxr shows increased vascular markings

echocardiogram is diagnostic and cardiac catheterization is definitive

Answer 127

A

smaller lesions usually close in the first 1 to 2 years while larger or more symptomatic lesions require surgical intervention. diuretics and digoxin can be used for more conservative treatment. if left untreated complications can lead to chf, endocarditis, and plumonary htn

Answer 128

A

holosystolic=throughout systole

Answer 129

A

a hole in the septum between both atria that is twice as common in women as in men

Answer 130

A

primum defect: concomitatnt mitral valve abnormalities
secundum defect: most common and located in the center of the atrial septum
sinus venosus defect: least common

Answer 131

A

usually asyptomatic except for a fixed wide splitting of s2

Answer 132

A

the most definitive test is cardiac catheterization. However, echo is less invasive and can be just as effective

cxr shows increased vascular markings and cardiomegaly

Answer 133

A

vast majority close spontaneously

surgery or transcatheter closure is indicated for all symptomatic pts

dysrhytmias and possible paradoxical emobli from dvts later in life

Answer 134

A

defined as the failure of spontaneous closure of the ductus. it usually closes when PO2 rises above 50 mmhg. low po2 can be caused by pulmonary compromise due to prematurity. areas of high altitude have an increased occurrence of PDA due to low levels of atmospheric oxygen

Answer 135

A

first 12 hours of life, after 24 it is considered pathologic

Answer 136

A

machinery like murmur

wide pulse pressure

bounding pulses

Answer 137

A

high occurrence of respiratory infections and infective endocarditis

Answer 138

A

cardiac catheterization

Answer 139

A

may show lvh secondary to high systemic resistance

Answer 140

A

give indomehtacin (nsaid inhibits prostaglandins) to close the pda unless it is needed to live in convurrent conditions like tof

Answer 141

A

pop open a pda

Answer 142

A

inhibit popping open of pda

Answer 143

A

pericardial effusion

Answer 144

A

primary pulmonary artery htn

Answer 145

A

coarctation of the aorta

Answer 146

A

hearing loss, syncope, normal vitals and exam, fam hx of sudden cardiac death

Answer 147

A

congenital narrowing of the aorta in the area of the ductus arteriosus. it has a grequent assocation iwth turner syndrome

Answer 148

A

severe CHF and resp distress withint he first few months of life

diffpresuresa ndpulses betweenthe upper and lower extremities

reduced pulses in the lower extremities and htn in the upper extremities due to narrowing

Answer 149

A

rib nothcing and 3 sign are seen on cxr

cardiac catheterization is the omst accurate test

Answer 150

A

primary treatment is surgical resection of the narrowed segment and then balloon dilation if recurrent stenosis occurs

Answer 151

A

turner and coarctation of the aorta

Answer 152

A

it appears on the first day of life

bilirubin rises more than 5 mg/dl/day

bilirbuin rises above 19.5 mg/dl in a term child

direct bilirubin rises above 2 mg/dl at any time

hyperbilirubinemia persists after the second week of life

Answer 153

A

the deposition of bilirubin the basal ganglia called kernicterus.

kernicterus presents with hypotonia, seizures, choreoathetosis, and hearing loss

Answer 154

A

direct and indirect bilirubin levels

check blood type of infant and mother for ABO and Rh incompatibility

analyze peripheral blood smear and retic count for hemolysis

Answer 155

A

phototherapy with blue-green light helps break down bilirubin to excretable components. consider exhcange transfusion if bilirubin rises to 20-25 mg/dl

Answer 156

A

in esophageal atresia, the esophagus ends blindly. in nearly 90% or cases it communicates with the trachea through a fistula known as a tracheoesophageal fistula (TEF)

Answer 157

A

the child willtypically exhibit vomiting with first feeding or choking/coughing and cyanosis due to the TEF. there will be a hx of possible polyhdramnios

Answer 158

A

a gastric air bubble and esophageal air bubble can be seen on cxr

coiling of the ng tube seen on cxr and an inability to pass it into the stomach are diagnostic

ct or esophagram can also be used

Answer 159

A

surgical repair must be done in 2 steps to correct the anomaly

antibiotic coerage for anaerobes must also be considered due to high risk of lung abscess formation secondary to aspiration

fluid resuscitation before surgery must be done to prevent dehydration of the infant

Answer 160

A

ea with distal tef (80-90% of cases)

Answer 161

A

isolated ea w/o tef

Answer 162

A

ea with both proxiam and distal tefs

Answer 163

A

h type tef

Answer 164

A

pyloric stenosis

Answer 165

A

intussuusceptions

Answer 166

A

achalasia

Answer 167

A

a hypertrophic pyliric sphincter prevents proper passage of GI contents from the stomach intot he duodenum. ost comon cuase is idiopathic

Answer 168

A

hypertrophy of the pylorus is not commonly found at birth but rather becomes more pronounced by the first month of life. and an present as alst as 6 months old

auscultation will reveal a succussion splash, which is the sound of stomach contents slapping into thepylorus like waves on a beach.

nonbiilous projectile vomiting is the hallmark feature. metabolic imbalance demonstrates a hypcholoremichypokamiec metabolic alkalosis due to the vast loss of hydrogen ionsi n the vomitus. the potassium loss also worsens from aldosterone realease in response to hypovolemia. aldosterone increases urinary excretion of potassium

olive sign, which delineates aplapabe mass the size on an olive felt in the epigastric region, is highly associated with this condition

Answer 169

A

olive sign

Answer 170

A

abdominal us that will show a thickened pyloric sphincter

Answer 171

A

upper gi series that will show 4 signs:

string sign: thin column of barium leaking through the tightened muscle

shoulder sing: filling defect in the antrum due to prolapse ofmuscle inward

mushroom sign: hypertophic pylorus against the duodenum

railroad trach sign: excess mucosa int he pyloric lumen resulting in 2 columns of barium

Answer 172

A

hypochloremic, hypokalemic metabolic alkalosis

Answer 173

A

blind esophagus

no resp distress at rest

Answer 174

A

frothing, cough, cyanosis, and respiratory distress with feeds

no resp distress at rest

Answer 175

A

aspiration pneumonia

Answer 176

A

byccopharyngeal membrane wtih resp distress

Answer 177

A

pass ng tube

Answer 178

A

secure airway

Answer 179

A

failed duodenal canalization

Answer 180

A

no resp distress

bilious vomiting

Answer 181

A

axr

double-bubble

common in tri 21

Answer 182

A

IV fluids

Answer 183

A

prelace lost volume with iv fluids, replace lost electorlytes, specifically postassium, as the closure of the anion gap is crucial. ngt must be used to decompress the bowel. surgical myotomy must follow

Answer 184

A

commonly tested know it

Answer 185

A

C: coloboma of the eye, cns amomalies
H: heart defects
A: atresia of the choanae
R: retardation of growth and/or development
G: genital and/or urinary defects (hypogonadism)
E: ear anomalies and/or deafness

Answer 186

A

the infant is born witha membrane between the nostrils and pharyngeal space that prevents breathing during feeding. this condition is associaed with charge syndrome

Answer 187

A

child will turn blue when feeding and then pink when crying.this recurrent series of events is clinically diagnostic

Answer 188

A

surgery to perforate the membrane and reconnect the pharynx to teh nostrils

Answer 189

A

a congenital alck o innervatios of the distal bowel by the auerback plexus.this lack causes a constant contracture of muscle tone. there is frequent assocations with down sydnrome and it is more common in boys than in girls (4:1)

Answer 190

A

of unaffected infatns, 90% pass first meconium within 24 hours, wehras children with Hirschspurng disease do not pass meocnium for over 48 hours or fail to pass meconiun at all

extreme constipation is followed by large bowel obstruction

rectal exam shows an extremely tight sphincter, an inability to pass flatus is also common

Answer 191

A

plain zrays hosw distended bowel loops with lack of air in the rectum. contraxt enemas swill show retention of barium for greater than 24 hours

manometry will show high pressures int he anal sphincter

the mainstay of diagnosis is a full thckness biopsy that reveals a lack of ganglionic cells in the submucosa

Answer 192

A

a 3 stage surgery procedure is curative

Answer 193

A

the opening tot eh anus is missing and the rectum ends ina blind pouch with conservation of the sphincter. the cause is unkknown but has a high assocation wth down syndrome

Answer 194

A

complete failure to pass meconium

Answer 195

A

pe with no anus, not barium or manometry

Answer 196

A

surgery is curative

Answer 197

A

V: vertebral anomalies
A: anal atresia
C: cardiovascular anomalies
T: tracheoesophageal fistula
E: esophageal atresia
R: renal anomalies
L: limb anomalies

Answer 198

A

a lack or absence of apoptosis (programmed cell death) hat leads to improper canalization of the lumen of the duodenum.

Answer 199

A

annular pancreas and down syndrome

Answer 200

A

onset of bilious vomiting 12 hours after birth

Answer 201

A

cxr shows double bubble sign

Answer 202

A

replace lsot volume with IV fluids, taking special care to replace lost electrolytes . potassium is often low from vomiting. NGT must be used to decompress the bowel. surgucal duodenostomy is the most common surgical procedure and definitive treatment

Answer 203

A

A volvulus is a bowel obstruction in which a loop of bowel has twisted on itself abnormally

Answer 204

A

midgut, usually ileus

Answer 205

A

the signs are nonspecific and include vomiting and colicky abdominal pain

Answer 206

A

multiple air fluid levels can be seen and on upper GI series a bird beadk appearance is typically seen at the site of rotation

Answer 207

A

surgucal or endoscopic untwitsting is emergently needed; bowel necrosis with perforation can lead to life-threatening sepsis

Answer 208

A

endoscopic deompression and the omst effect therapy is surgical decompression

Answer 209

A

rotavirus vaccine and henoch schonlein purpura

Answer 210

A

currant jelly stool, sausage-sahped mass, neurologic signs, and abdominal pain.

Answer 211

A

a condition in which part of the bowel telexcopes into another segment of bowl distal to it. it can be caused by a polyp, hard stool, or lymphoma, or even have a viral origin. most often however there is no clear etiology.

Answer 212

A

colicky abdominal pain, bilious vomiting, and currant jelly stool. a right quadrant sausage-shaped mass can be palpated

Answer 213

A

ultrasound and it iwll showa dougnut sign or toarget sign, which is generated by concentric alternating echogenic (mucoas) and hypechogenic (submucosa) bands.

Answer 214

A

is both diagnostic and theapeutic and therefore the most accurate test. however, it is ci ifthe child has signs of peritonitis, shock, or perforation.

Answer 215

A

fluid resuscitation and balancing of electorlytes (k ca and mg) are the most improtatn initial steps followed by ngt decompression of the bowel.

barium enema

child must be observed bc about 10% of them recur whiing 24 hours, if barium enema doesnt work then need to go into surgery

Answer 216

A

meckesl diverticulum, do a meckesl scan (technetium 99m pertechnetate scan is the most accurate test

Answer 217

A

duodenal atresia

volvulus

intussusception

Answer 218

A

Onset - within the first day of life

initial test - axr

first step - double bubble iv fluids

treatment - surgery

Answer 219

A

Onset - within the first year of life

initial test - axr

first step - iv fluids

treatment - surgery

Answer 220

A

Onset - within the first year of life

initial test - us doughnut

first step - iv fluids

treatment - air enema

Answer 221

A

the only true congenital diveritculum in which the vitellin duct persists int he small intestinal tract, it can contain ectopic gastric tissue

Answer 222

A

the classic presentation is with painless rectal bleeding. assive frank bright red blood per recutm is due to gastric acid secrtion by the extopic titssue causing searing of the nearby small bowel tissue

Answer 223

A

most accurate test is a technetium 99m scan is it so accurate that is has been dubbed teh meckel scan

Answer 224

A

true and involves all layers of the bowel

Answer 225

A

2% of population

within 2 feet of the ileocecal valve

2 types of tissue (gastric and pancreatic)

males 2x more effected

Pt<2 yo

2% symptomatic

2 inches long

Answer 226

A

acute diarrhea-the acute loss of lfuids and electoryluyes in the stool due to underlying pahtologic process- is the second most common cause of infant death worldwide. gastroenteritis is the inflammation of the GI tract secondary to microbiologic infiltrate and spread

Answer 227

A

infalmmatory diarrhea will have fever, abdoinal pain, and possibly blood diarrhea

noninflammatory diarrhea will have vomiting, carampy pain and water diarrhea

Answer 228

A

send stool for blood and leukocyte count to detect the presence of invasive toxins

stool cultures with O&P for identifiying hte causative agent

possible sigmoioscopy to exam in for pseudomembranes int eh setting of cdiff

Answer 229

A

most improtant next step is rehydration

mild cases: oral fluids
severe cases: IV fluids

Answer 230

A

are always the wrong answer

Answer 231

A

rotavirus

adenovirus

small,round

Answer 232

A

most common in winter

fever,emesis, no blood, <7 days

viral prodrome

vaccine

Answer 233

A

endemic, year round

fever, emesis, no blood, <7 days

viral prodrome

Answer 234

A

norwalk

epi-demic

explosive, cramping, pain

1-2 days

Answer 235

A

start abs right away

vanco, gentamixin, and metro

get xrays to dtermine if perforation has happened

Answer 236

A

a condition seen in premature infants where the bowel undergoes necrosis and bacteria invade the intestinal wall. the condition carries a mortality of up to 30%

Answer 237

A

child vorn severely premature with low birth weight

vomiting and abdominal distension

fever

Answer 238

A

axr will reveal the pathonomonic “pneumatosis intestinalis” or air wihin the bowel wall and ct will reveal air in the portal vein, dilted bowel loops, and pneumoperitoneum

frank or occult blood in stool

Answer 239

A

feeding must be dced for bowel rest
iv fluids must be started immediately
ngt must be placed for bowel deocmpression
if medical management does not lead to resolution, then surgery is indicated to remove the affected bowel

Answer 240

A

macrosomia

small left colon syndrome

cardiac abnomralities

renal vein thrombosis

metabolic findings and effects

Answer 241

A

with macrosomia all organs are enlarged except for the brain. an increased output fromt he bone marrow leads to polycythemia and hyperviscosit. possible left shoulder dystocia and brachial plexus palsy can also be in the history

Answer 242

A

a congenitally smaller descending colon leads to distension from constipation. it can be diagnosed by a barium study and treated with saller and more frequent feeds

Answer 243

A

the major cardiac change in idm is asymmetric septal hypertrophy due to boliteration of the left ventricular lumen, leading to decreased cardiac output. it is diagnosed with ekg and echo and treated with bblockers and iv fluids

Answer 244

A

flank mass and possible buit can be appreciated

hematuria and thrombocytopenia

Answer 245

A

hypoglycemia: seizures
hypocalcemia: tetany, lethargy
Hypomagnesemia: hypocalcemia and pth decrease
hyperbilirubinemia: icterus and kernicterus

Answer 246

A

21 hydroxylase deficiency

Answer 247

A

an inherited defect of steroids synthesis tha thas 3 forms

21 hydroxylase
17 hydroxylase
11beta hydroxylase

Answer 248

A

most comomn is a hypotensive child with severe electrolyte abnormalities

genitalia are ambiguos in girls, boys do not itnially exhibit any abnormalities, but begin to lose their defining sexual features as they age. inappropriate facial hari, virilization, and menstural abnormalitites are also seen

hyponatremia, hypcholeremia, hypglycemia, and hyperkalemia are seen as a result of decreased aldosterone and cortisol production. this also results in acidosis due to hydrogen ion retention

Answer 249

A

cah is diagnosed at birth by serum electorlytes and increased 17ohprogesterone levels

Answer 250

A

fluid and electrolyte replacement along iwth lifelong steroids to maintain adequate levels of mineral/gluc levels

specific psychiatric couanseling to aid with gender identity issues

Answer 251

A

aldosterone level - i
cortisol level - d
sex hormone levels -d 
11doc - 
hypertensive/hyptensive - hyper
sex development girls - normal at birth
sex development boys - pseudo-hermaphroditism
electrolyte abnormalities - hypokalemia

Answer 252

A

aldosterone level - d
cortisol level - d
sex hormone levels - i
11doc - 
hypertensive/hyptensive - hypo salt wasting  shock 
sex development girls - virlized
sex development boys - normal at virth
electrolyte abnormalities - hypo-na,cl and k

Answer 253

A

aldosterone level - d
cortisol level - d
sex hormone levels - i
11doc - i
hypertensive/hyptensive - hyper
sex development girls - virilized
sex development boys - normal at birth
electrolyte abnormalities - few

Answer 254

A

disroder caused by a lack of biamin d, calcium, or phosphate.it leads to softening and weakening of the bones, making there more susceptible to fractures. children 6 to 24 months are at highest risk bc their bones are rapidly forwing

Answer 255

A

vitamin d deficient rickets caused by a lack of enough vitamin di ni the childs diet
vitamin d dependent rickets is the inability to convert 250h to 1,25oh and therefore the infant is dependent on vitamin d supplementation
xlinked hypophosphatemia ricketsoccurs when an innated kiney defect results in the inability to reain phosphate. whitout phosophate , adeuate bone mineralization cannot take place and bones are weakened

Answer 256

A

child will present with ulnar/radial bowing and a waddling gait due to tibial/femoral bowing

Answer 257

A

rachitic rosary like appearance on cxr of the costochondral joints with cupping and fraying of the epihyses

bowlegs is a characteristic sign

Answer 258

A

rpelacement of phosphate, calcium, and vitamin D in the form of ergocalciferol or 1,25oh, calcitrol and annual blood vitamine d montioring

Answer 259

A

at age 2 montsh

Answer 260

A

calcium - normal or d
phosphate - d
1,25oh - d
25oh - d

Answer 261

A

calcium - d
phosphate - n
1,25oh - d
25oh - n

Answer 262

A

calcium - n
phosphate - d
1,25oh - n
25oh - n

Answer 263

A

cbc with diff
blood and urine cultures
ua
cxr
lumbar puncture

Answer 264

A

pneymonia

meningitis

Answer 265

A

gropu b strep
e coli
s aureus
listeria

Answer 266

A

blood cultures and urin cultures

cxr

Answer 267

A

ampicillin and gentamicin

Answer 268

A

gropu b strep
ecoli
listeria

Answer 269

A

staph
ecoli
group b strep

Answer 270

A

T: toxoplasmosis
O:other infections such as syphilis
R: rubella
C: cytomegalovirus
H: herpes simplex virus

Answer 271

A

chorioretinitis, hydrocephalus, and multiple ring-enhancing lesions on ct caused by toxoplasma condii

Answer 272

A

best initial test is elevated igm to toxoplasm

most accurate is pcr for toxo

Answer 273

A

pyrimethamine and sulfadiazine

Answer 274

A

rash on the palms and osled, snuffles, frontal bossing, hutchingson eight nerve palsy, and saddle nose

Answer 275

A

best initial test is VDRL or RPR

most accurate test is FTA ABS or dark field microscopy

Answer 276

A

penicillin

Answer 277

A

pda, cataracts, deafness, hepatosplenomegaly, thrombocytopenia, blueberry muffin rash, and hyperbilirubinemia

Answer 278

A

maternal igm status along with clinical diagnosis. each disease manifestioan must be individually addressed

Answer 279

A

supportive

Answer 280

A

periventricular calcifications with microencephaly, chorioretinitis, hearing loss, and petechiae

Answer 281

A

best initial test is urin or saliva viral titers

most accurate test is urine or salive pcr for viral dna

Answer 282

A

ganciclovir with signs of end organ damage

Answer 283

A

week1 - shock and dic
week2 - vesicular skin lesions
week3 - encephalitis

Answer 284

A

best initial test is tzanck smear

most accurate test is pcr

Answer 285

A

acyclovir and supportive care

Answer 286

A

varicella zoster virus

Answer 287

A

multipole highly pruritic vesicular rash begins ont he face, possible fever and malaies

Answer 288

A

best initial test is tzanck smear showing multinucleated giant cells

most accurate test is viral culture

Answer 289

A

paramyxovirus

Answer 290

A

the 3 cs, cough, coryza, andconjucntivitis with koplik spots (grayish macule on buccal surgace)

Answer 291

A

clincial diagnosis

mosta ccurate is measles igm anitbodies

Answer 292

A

parovirus b19

Answer 293

A

starts with fever and uri andprogresses to rash with slapped cheek appearance

Answer 294

A

hhv 6 and 7

Answer 295

A

fever and uri progressing to diffuse rash

Answer 296

A

paramyxovirus

Answer 297

A

fever precedes classic parotid gland swelling with possible orchitis

Answer 298

A

supportive care

Answer 299

A

a diffuse erythematous eruption that is ocncurrent with pharyngitis.it is caused by erythrogenic toxin made by strep pyogenes and typically lasts 3 to 6 days

Answer 300

A

presents wtih a classic pentad of

fever
pharyngitis
sandpaper rash over trunk and extremities
strawberry tongue
cervical lymphadenopathy

Answer 301

A

clinical

can be with elevated antistreptolysin o titer, esr and crp

Answer 302

A

penicllin, azithromycin, or cephalosporins

Answer 303

A

infectious upper airway condition characterized by severe inflammation. it is mostly commonly cause dby parainfluenza virus types 1 and 2, rsv is the second most common cause

Answer 304

A

barking cough, coryza, and inspiratory stridor

the child will have more difficulty breathing when lying down and may show signs of hypoxia such as peripheral cyanosis and accessory muscle use

Answer 305

A

hsowes the classic steeple sign, a narrowing of the air column in the trachea. however, xray is rarely done and is always the wrong answer

Answer 306

A

clinically but can be helped by rads if the sx are mild

hypoxia aids in diff croup from epiglottitis

Answer 307

A

for mild disease give steroids

for moderate and severe sx give racemic epinephrine

Answer 308

A

on presentation

Answer 309

A

severe, life-threatening welling of the epiglottis and arytenoids due to haemophilus influenzatype B

Answer 310

A

vaccination delinquency with

hot potatto voice
fever
drooling in the tripod psotions
refusal to lie flat

Answer 311

A

pe shows extremely hot cherry-red epiglottis

xray may show classive thumbprint sign

Answer 312

A

intubate the hcild in the or, the or is preferred setting in case unsuccessful intubation makes tra necessary

administer ceftriaxone for 7-10 days

rifampin must be given to all close contacts

Answer 313

A

from bonchitits caused by bordetella pertussis

Answer 314

A

Catarrhal stage: severe congestion and rhinorrhea-14 day sin duration

paroxysmal stage: severe coughing episodes with extreme gasp for aire (inspiratory whoop) followed by vomiting - 14-30 day sinduration

convalescent stage decrease in frequency of coughing, 14 days in duration

Answer 315

A

clinically made diagnosis with whooping inspiration, vomiting, and burst blood vessels in eyes

buttergly patter on cxr

pcr of nasal secrestion or bordeteela pertussis toxin ELISA

Answer 316

A

erythromycin or azithromycin aids only in the catarrhal stage, not in the paroxysmal stage.

isolate the hcild and macrlides must be gien fro all cose contatcts

dtap vaccin had decreased incidency

Answer 317

A

various bacteria and viruses causing inflammation of the airways

Answer 318

A

productive cough lasting 7-10 days with fever

Answer 319

A

supportive

Answer 320

A

infalmmation of the phayrnx and adjacent structures caused by froup a beta hemolytic strep

Answer 321

A

cervical adenopathy, petechiae, fever above 104F, and othe ruri sx; acute rhumatic fever and glomerulonephritis

Answer 322

A

rapid dnase antigen detection test

Answer 323

A

oral penicclin for 10 days or maclides for penicillina llergy

Answer 324

A

membranous infalmmation of the phayrnx due to bacterial invasion by Corynebacterium diphteriae

Answer 325

A

gray hgihly vascular pseudomembanouns plaques on teh pahrygneal wall

do not scrape

Answer 326

A

culture of a small portion of superficial membrane

Answer 327

A

antitoxin, remember antibiotics do not work

Answer 328

A

Age- infants
presntation- usually found on newborn exam screening
diagnosis- orolani and barlow maneuver with a click or clunk in the hip
treatment- pavlik harness

Answer 329

A

Age- 2-8
presntation- panful limp
diagnosis- xrays show joint effusions and widening
treatment- rest of nsaids follow eith surgery on both hiops, if one necroses eventually so will theo other

Answer 330

A

Age- adolescence, especially in obese pts
presntation- painful limp, externally rotated leg
diagnosis- xray shows wiedning of joint space
treatment- internal fixation with pinnin

Answer 331

A

deficiency - poor night vision, hypoparathyroidsism

toxicity - pseudotumor cerebir, hyperparathyroidsism

Answer 332

A

deficiency - beriberi, wernickes encepalpathy

toxicity - water sluble, thereforeno toxicity

Answer 333

A

deficiency - angula chelosis, stomatitis, glossitis

toxicity - water soluble, no toxicity

Answer 334

A

deficiency - pellagra (4 ds, diarrhea, ermatitis, dementia, death)

toxicity - water soluble, no toxicity

Answer 335

A

deficiency - burning feet syndrome

toxicity - water soluble, no toxicity

Answer 336

A

deficiency - peripheral neuropathy, must be given with INH

toxicity - water soluble, no toxicity

Answer 337

A

deficiency - megaloblstic anemia, hypersegmented neutrophils

toxicity - water soluble, no toxicity

Answer 338

A

deficiency - megaloblastic anemia, hypersegmeneted neutorphils, peripheral neuropathy of the dorsal column tracts

toxicity - water soluble, no toxicity

Answer 339

A

deficiency - scurvy (ecchymosis, bleeding gums, and petechiae

toxicity - water soluble, no toxicity

Answer 340

A

deficiency - rickets in kids

toxicity - hypercalcemia, polyurea, polydipsiea

Answer 341

A

deficiency - increaed pt/inr, signsn and sx of mild to severe bleeding, analogous to warfarin therapy

toxicity - toxicity is rare and an upper limit has not ben established

Answer 342

A

Makes jerky, quivering arm thrusts
Brings hands within range of eyes and mouth
Moves head from side to side while lying on stomach
Head flops backward if unsupported
Keeps hands in tight fists
Strong reflex movements

Answer 343

A

Focuses 8 to 12 inches (20.3 to 30.4 cm) away
Eyes wander and occasionally cross
Prefers black-and-white or high-contrast patterns
Prefers the human face to all other patterns
Hearing is fully mature
Recognizes some sounds
May turn toward familiar sounds and voices

Answer 344

A

Prefers sweet smells
Avoids bitter or acidic smells
Recognizes the scent of his own mother’s breastmilk
Prefers soft to coarse sensations
Dislikes rough or abrupt handling

Answer 345

A

Sucks poorly and feeds slowly
Doesn’t blink when shown a bright light
Doesn’t focus and follow a nearby object moving side to side
Rarely moves arms and legs; seems stiff
Seems excessively loose in the limbs, or floppy
Lower jaw trembles constantly, even when not crying or excited
Doesn’t respond to loud sounds

Answer 346

A

Raises head and chest when lying on stomach
Supports upper body with arms when lying on stomach
Stretches legs out and kicks when lying on stomach or back
Opens and shuts hands
Pushes down on legs when feet are placed on a firm surface
Brings hand to mouth
Takes swipes at dangling objects with hands
Grasps and shakes hand toys

Answer 347

A

Watches faces intently
Follows moving objects
Recognizes familiar objects and people at a distance
Starts using hands and eyes in coordination
Smiles at the sound of your voice
Begins to babble
Begins to imitate some sounds
Turns head toward direction of sound

Answer 348

A

Begins to develop a social smile
Enjoys playing with other people and may cry when playing stops
Becomes more communicative and expressive with face and body
Imitates some movements and facial expressions

Answer 349

A

Doesn’t seem to respond to loud sounds
Doesn’t notice her hands by two months
Doesn’t smile at the sound of your voice by two months
Doesn’t follow moving objects with her eyes by two to three months
Doesn’t grasp and hold objects by three months
Doesn’t smile at people by three months
Cannot support her head well at three months
Doesn’t reach for and grasp toys by three to four months
Doesn’t babble by three to four months
Doesn’t bring objects to her mouth by four months
Begins babbling, but doesn’t try to imitate any of your sounds by four months
Doesn’t push down with her legs when her feet are placed on a firm surface by four months
Has trouble moving one or both eyes in all directions
Crosses her eyes most of the time (Occasional crossing of the eyes is normal in these first months.)
Doesn’t pay attention to new faces, or seems very frightened by new faces or surroundings
Still has the tonic neck reflex at four to five months

Answer 350

A

Rolls both ways (front to back, back to front)
Sits with, and then without, support of her hands
Supports her whole weight on her legs
Reaches with one hand
Transfers object from hand to hand
Uses raking grasp (not pincer)

Answer 351

A

Develops full color vision
Distance vision matures
Ability to track moving objects improves

Answer 352

A

Responds to own name
Begins to respond to “no”
Distinguishes emotions by tone of voice
Responds to sound by making sounds
Uses voice to express joy and displeasure
Babbles chains of consonants

Answer 353

A

Finds partially hidden object
Explores with hands and mouth
Struggles to get objects that are out of reach

Answer 354

A

Enjoys social play
Interested in mirror images
Responds to other people’s expressions of emotion and appears joyful often

Answer 355

A

Seems very stiff, with tight muscles
Seems very floppy, like a rag doll
Head still flops back when body is pulled up to a sitting position
Reaches with one hand only
Refuses to cuddle
Shows no affection for the person who cares for him
Doesn’t seem to enjoy being around people
One or both eyes consistently turn in or out
Persistent tearing, eye drainage, or sensitivity to light
Does not respond to sounds around him
Has difficulty getting objects to his mouth
Does not turn his head to locate sounds by four months
Doesn’t roll over in either direction (front to back or back to front) by five months
Seems inconsolable at night after five months
Doesn’t smile spontaneously by five months
Cannot sit with help by six months
Does not laugh or make squealing sounds by six months
Does not actively reach for objects by six to seven months
Doesn’t follow objects with both eyes at near (1 foot) [30 cm] and far (6 feet) [180 cm] ranges by seven months
Does not bear some weight on legs by seven months
Does not try to attract attention through actions by seven months
Does not babble by eight months
Shows no interest in games of peekaboo by eight months

Answer 356

A

Closing of soft spot at the back of the head (posterior fontanelle)
Several newborn reflexes, such as the stepping reflex (baby appears to dance or step when placed upright on solid surface) and grasp reflex (grasping a finger), disappear
Less head lag (head is less wobbly on the neck)
When on stomach, able to lift head almost 45 degrees
Less flexing of the arms and legs while lying on the stomach

Answer 357

A

Beginning to look at close objects
Coos
Different cries means different things
Head turns from side to side with sound at the level of the ear
Smiles
Responds to familiar voices
Healthy babies can cry up to 3 hours per day. If you are worried that you baby cries too much, talk to you doctor.

Answer 358

A

Expose your baby to sounds outside those of the home
Take your baby for rides in the car or walks in the neighborhood
The room should be bright with pictures and mirrors
Toys and objects should be bright colors
Read to your baby
Talk to your baby about objects and people in his or her environment
Hold and comfort you baby if they are upset or crying. DO NOT worry about spoiling your 2-month-old.

Answer 359

A

Slow in weight gain to about 20 grams (almost two thirds of an ounce) per day
Weigh 2 times more than their birth weight
Have almost no head droop while in a sitting position
Be able to sit straight if propped up
Raise head 90 degrees when placed on stomach
Be able to roll from front to back
Hold and let go of an object
Play with a rattle when it’s placed in their hands, but won’t be able to pick it up if dropped
Be able to grasp a rattle with both hands
Be able to place objects in the mouth
Sleep 9 to 10 hours at night with 2 naps during the day (total of 14 to 16 hours per day)

Answer 360

A

Have well-established close vision
Increase eye contact with parents and others
Have beginning hand-eye coordination
Be able to coo
Be able to laugh out loud
Anticipate feeding when able to see a bottle (if bottle-fed)
Begin to show memory
Demand attention by fussing
Recognize parent's voice or touch

Answer 361

A

Place the baby in front of a mirror.
Provide bright-colored toys to hold.
Repeat sounds the infant makes.
Help the infant roll over.
Use an infant swing at the park if the baby has head control.
Play on the stomach (tummy time)

Answer 362

A

Able to hold almost all weight when supported in a standing position
Able to transfer objects from one hand to the other
Able to lift chest and head while on stomach, holding the weight on hands (often occurs by 4 months)
Able to pick up a dropped object
Able to roll from back to stomach (by 7 months)
Able to sit in a high chair with a straight back
Able to sit on the floor with lower back support
Beginning of teething
Increased drooling
Should be able to sleep 6 to 8 hour stretches at night
Should have doubled birth weight (birth weight often doubles by 4 months, and it would be cause for concern if this hasn’t happened by 6 months)

Answer 363

A

Begins to fear strangers
Begins to imitate actions and sounds
Begins to realize that if an object is dropped, it is still there and just needs to be picked up
Can locate sounds not made directly at the ear level
Enjoys hearing own voice
Makes sounds (vocalizes) to mirror and toys
Makes sounds resembling one-syllable words (example: da-da, ba-ba)
Prefers more complex sounds
Recognizes parents
Vision is between 20/60 and 20/40

Answer 364

A

Read, sing, and talk to your child
Imitate words such as “mama” to help baby learn language
Play peek-a-boo
Provide an unbreakable mirror
Provide large, bright-colored toys that make noise or have moving parts (avoid toys with small parts)
Provide paper to tear
Blow bubbles
Speak clearly
Start pointing to and naming parts of the body and the environment
Use body movements and actions to teach language
Use the word “no” infrequently

Answer 365

A

Gains weight at a slower rate, about 15 grams (half an ounce) per day, 1 pound (450 grams) per month
Increases in length by 1.5 centimeters (a little over one-half inch) per month
Bowel and bladder become more regular
Puts hands forward when the head is pointed to the ground (parachute reflex) to protect self from falling
Is able to crawl
Sits for long periods
Pulls self to standing position
Reaches for objects while sitting
Bangs objects together
Can grasp objects between the tip of the thumb and index finger
Feeds self with fingers
Throws or shakes objects

Answer 366

A

Babbles
Has separation anxiety and may cling to parents
Is developing depth perception
Understands that objects continue to exist, even when they are not seen (object constancy)
Responds to simple commands
Responds to name
Understands the meaning of “no”
Imitates speech sounds
May be afraid of being left alone
Plays interactive games, such as peek-a-boo and pat-a-cake
Waves bye

Answer 367

A

Provide picture books.
Provide different stimuli by going to the mall to see people, or to the zoo to see animals.
Build vocabulary by reading and naming people and objects in the environment.
Teach hot and cold through play.
Provide large toys that can be pushed to encourage walking.
Sing songs together.
Avoid television time until age 2.
Try using a transition object to help decrease separation anxiety.

Answer 368

A

Be 3 times their birth weight
Grow to a height of 50% over birth length
Have a head circumference equal to that of their chest
Have 1 to 8 teeth
Stand without holding on to anything
Walk alone or when holding 1 hand
Sit down without help
Bang 2 blocks together
Turn through the pages of a book by flipping many pages at a time
Pick up a small object using the tip of their thumb and index finger
Sleep 8 to 10 hours a night and take 1 to 2 naps during the day

Answer 369

A

Begins pretend play (such as pretending to drink from a cup)
Follows a fast moving object
Responds to their name
Can say momma, papa, and at least 1 or 2 other words
Understands simple commands
Tries to imitate animal sounds
Connects names with objects
Understands that objects continue to exist, even when they can’t be seen
Participates in getting dressed (raises arms)
Plays simple back and forth games (ball game)
Points to objects with the index finger
Waves bye
May develop attachment to a toy or object
Experiences separation anxiety and may cling to parents
May make brief journeys away from parents to explore in familiar settings

Answer 370

A

Provide picture books.
Provide different stimuli, such as going to the mall or zoo.
Play ball.
Build vocabulary by reading and naming people and objects in the environment.
Teach hot and cold through play.
Provide large toys that can be pushed to encourage walking.
Sing songs.
Have a play date with a child of a similar age.
Avoid television and other screen time until age 2.
Try using a transitional object to help with separation anxiety.

Answer 371

A

Has a closed soft spot on the front of the head
Is growing at a slower rate and has less of an appetite compared to the months before
Is able to control the muscles used to urinate and have bowel movements, but may not be ready to use the toilet
Runs stiffly and falls often
Is able to get onto small chairs without help
Walks up stairs while holding on with 1 hand
Can build a tower of 2 to 4 blocks
Can use a spoon and cup with help to feed self
Imitates scribbling
Can turn 2 or 3 pages of a book at a time

Answer 372

A

Shows affection
Has separation anxiety
Listens to a story or looks at pictures
Can say 10 or more words when asked
Kisses parents with lips puckered
Identifies 1 or more parts of the body
Understands and is able to point to and identify common objects
Often imitates
Is able to take off some clothing items, such as gloves, hats, and socks
Begins to feel a sense of ownership, identifying people and objects by saying “my”

Answer 373

A

Encourage and provide the necessary space for physical activity.
Provide safe copies of adult tools and equipment for the child to play with.
Allow the child to help around the house and participate in the family’s daily responsibilities.
Encourage play that involves building and creativity.
Read to the child.
Encourage play dates with children of the same age.
Avoid television and other screen time before age 2.
Play simple games together, such as puzzles and shape sorting.
Use a transitional object to help with separation anxiety.

Answer 374

A

Able to turn a door knob.
Can look through a book turning one page at a time.
Can build a tower of 6 to 7 cubes.
Can kick a ball without losing balance.
Can pick up objects while standing, without losing balance. (This often occurs by 15 months. It is a cause for concern if not seen by 2 years.)
Can run with better coordination. (May still have a wide stance.)
May be ready for toilet training.
Should have the first 16 teeth, but the actual number of teeth can vary widely.
At 24 months, will reach about half final adult height.

Answer 375

A

Able to put on simple clothes without help. (The child is often better at removing clothes than putting them on.)
Able to communicate needs such as thirst, hunger, need to go to the bathroom.
Can organize phrases of 2 to 3 words.
Can understand 2-step command such as, “Give me the ball and then get your shoes.”
Has increased attention span.
Vision is fully developed.
Vocabulary has increased to about 50 to 300 words, but healthy children’s vocabulary can vary widely.

Answer 376

A

Allow the child to help around the house and take part in the daily family chores.
Encourage active play and provide enough space for healthy physical activity.
Encourage play that involves building and creativity.
Provide safe copies of adult tools and equipment. Many children like to mimic activities such as cutting the grass or sweeping the floor.
Read to the child.
Try to avoid television watching at this age (recommendation of the American Academy of Pediatrics).
Control both the content and quantity of television viewing. Limit screen time to less than 3 hours per day. One hour or less is better. Avoid programming with violent content. Redirect the child to reading or play activities.
Control the type of games the child plays.

Answer 377

A

Gains about 4 to 5 pounds (1.8 to 2.25 kilograms)
Grows about 2 to 3 inches (5 to 7.5 centimeters)
Reaches about half of his or her adult height
Has improved balance
Has improved vision (20/30)
Has all 20 primary teeth
Needs 11 to 13 hours of sleep a day
May have daytime control over bowel and bladder functions (may have nighttime control as well)
Can briefly balance and hop on one foot
May walk up stairs with alternating feet (without holding the rail)
Can build a block tower of more than 9 cubes
Can easily place small objects in a small opening
Can copy a circle
Can pedal a tricycle

Answer 378

A

Has a vocabulary of several hundred words
Speaks in sentences of 3 words
Counts 3 objects
Uses plurals and pronouns (he/she)
Often asks questions
Can dress self, only needing help with shoelaces, buttons, and other fasteners in awkward places
Can stay focused for a longer period of time
Has a longer attention span
Feeds self easily
Acts out social encounters through play activities
Becomes less afraid when separated from mother or caregiver for short periods of time
Fears imaginary things
Knows own name, age, and gender (boy/girl)
Starts to share
Has some cooperative play (building tower of blocks together)

At age 3, almost all of a child’s speech should be understandable.

Temper tantrums are common at this age. Children who have tantrums that often last for more than 15 minutes or that occur more than 3 times a day should be seen by a health care provider.

Answer 379

A

Provide a safe play area and constant supervision.
Provide the necessary space for physical activity.
Help your child take part in – and learn the rules of – sports and games.
Limit both the time and content of television and computer viewing.
Visit local areas of interest.
Encourage your child to help with small household chores, such as helping set the table or picking up toys.
Encourage play with other children to help develop social skills.
Encourage creative play.
Read together.
Encourage your child to learn by answering his or her questions.
Provide activities related to your child’s interests.
Encourage your child to use words to express feelings (rather than acting out).

Answer 380

A

Gains weight at the rate of about 6 grams (less than one quarter of an ounce) per day

Weighs 40 pounds (18 kilograms) and is 40 inches (1 meter) tall
Has 20/20 vision
Sleeps 11 to 13 hours at night, usually without a daytime nap
Grows to a height that is double the birth length
Shows improved balance
Hops on one foot without losing balance
Throws a ball overhand with coordination
Can cut out a picture using scissors
May still wet the bed

Answer 381

A

Has a vocabulary of more than 1,000 words
Easily puts together sentences of four or five words
Can use the past tense
Can count to four
Will be curious and ask a lot of questions
May use words they do not fully understand
May begin using vulgar words
Learns and sings simple songs
Tries to be very independent
May show increased aggressive behavior
Talks about personal family matters to others
Commonly has imaginary playmates
Has an increased understanding of time
Is able to tell the difference between two objects based on things like size and weight
Lacks moral concepts of right and wrong
Rebels if too much is expected of them

Answer 382

A

Encourage and provide space for physical activity.
Show your child how to participate in and follow the rules of sporting activities.
Encourage play and sharing with other children.
Encourage creative play.
Teach your child to do small chores, such as setting the table.
Read together.
Limit screen time (television and other media) to 2 hours a day of quality programs.
Expose your child to different stimuli by visiting local areas of interest.

Answer 383

A

Gains about 4 to 5 pounds (1.8 to 2.25 kilograms)
Grows about 2 to 3 inches (5 to 7.5 centimeters)
Vision reaches 20/20
First adult teeth start breaking through the gum (most children do not get their first adult teeth until age 6)
Has better coordination (getting the arms, legs, and body to work together)
Skips, jumps, and hops with good balance
Stays balanced while standing on one foot with eyes closed
Shows more skill with simple tools and writing utensils
Can copy a triangle
Can use a knife to spread soft foods

Answer 384

A

Has a vocabulary of more than 2,000 words
Speaks in sentences of 5 or more words, and with all parts of speech
Can identify different coins
Can count to 10
Knows telephone number
Can properly name the primary colors, and possibly many more colors
Asks deeper questions that address meaning and purpose
Can answer “why” questions
Is more responsible and says “I’m sorry” when he or she makes mistakes
Shows less aggressive behavior
Outgrows earlier childhood fears
Accepts other points of view (but may not understand them)
Has improved math skills
Questions others, including parents
Strongly identifies with the parent of the same sex
Has a group of friends
Likes to imagine and pretend while playing (for example, pretends to take a trip to the moon)

Answer 385

A

Reading together
Providing enough space for the child to be active
Teaching the child how to take part in – and learn the rules of – sports and games
Encouraging the child to play with other children, which helps develop social skills
Playing creatively with the child
Limiting both the time and content of television and computer viewing
Visiting local areas of interest
Encouraging the child to perform small household chores, such as helping set the table or picking up toys after playing

Answer 386

A

School-age children usually have smooth and strong motor skills. However, their coordination (especially eye-hand), endurance, balance, and physical abilities vary.

Fine motor skills may also vary widely. These skills can affect a child’s ability to write neatly, dress appropriately, and perform certain chores, such as making beds or doing dishes.

There will be big differences in height, weight, and build among children of this age range. It is important to remember that genetic background, as well as nutrition and exercise, may affect a child’s growth.

A sense of body image begins developing around age 6. Sedentary habits in school-age children are linked to a risk for obesity and heart disease in adults. Children in this age group should get 1 hour of physical activity per day.

There can also be a big difference in the age at which children begin to develop secondary sexual characteristics. For girls, secondary sex characteristics include:

Breast development
Underarm and pubic hair growth
For boys, they include:

Growth of underarm, chest, and pubic hair
Growth of testicles and penis

Answer 387

A

By age 5, most children are ready to start learning in a school setting. The first few years focus on learning the fundamentals.

In 3rd grade, the focus becomes more complex. Reading becomes more about the content than identifying letters and words.

An ability to pay attention is important for success both at school and at home. A 6-year-old should be able to focus on a task for at least 15 minutes. By age 9, a child should be able to focus attention for about an hour.

It is important for the child to learn how to deal with failure or frustration without losing self-esteem. There are many causes of school failure, including:

Learning disabilities, such a reading disability
Stressors, such as bullying
Mental health issues, such as anxiety or depression
If you suspect any of these in your child, talk to your child’s teacher or health care provider.

Answer 388

A

Early school-age children should be able to use simple, but complete, sentences that contain an average of 5 to 7 words. As the child goes through the elementary school years, grammar and pronunciation become normal. Children use more complex sentences as they grow.

Language delays may be due to hearing or intelligence problems. In addition, children who are unable to express themselves well may be more likely to have aggressive behavior or temper tantrums.

A 6-year-old child normally can follow a series of 3 commands in a row. By age 10, most children can follow 5 commands in a row. Children who have a problem in this area may try to cover it up with backtalk or clowning around. They will rarely ask for help because they are afraid of being teased.

Answer 389

A

Frequent physical complaints (such as sore throats, tummy aches, or arm or leg pain) may simply be due to a child’s increased body awareness. Although there is often no physical evidence for such complaints, the complaints should be investigated to rule out possible health conditions. This will also assure the child that the parent is concerned about their well-being.

Peer acceptance becomes more important during the school-age years. Children may take part in certain behaviors to be part of “the group.” Talking about these behaviors with your child will allow the child to feel accepted in the group, without crossing the boundaries of the family’s behavior standards.

Friendships at this age tend to be mainly with members of the same sex. In fact, younger school-age children often talk about members of the opposite sex as being “strange” or “awful.” Children become less negative about the opposite sex as they get closer to adolescence.

Lying, cheating, and stealing are all examples of behaviors that school-age children may “try on” as they learn how to negotiate the expectations and rules placed on them by family, friends, school, and society. Parents should deal with these behaviors in private with their child (so that the child’s friends don’t tease them). Parents should show forgiveness, and punish in a way that is related to the behavior.

It is important for the child to learn how to deal with failure or frustration without losing self-esteem.

Answer 390

A

School-age children are highly active. They need physical activity and peer approval, and want to try more daring and adventurous behaviors.
Children should be taught to play sports in appropriate, safe, supervised areas, with proper equipment and rules. Bicycles, skateboards, in-line skates, and other types of recreational sports equipment should fit the child. They should be used only while following traffic and pedestrian rules, and while using safety equipment such as knee, elbow, and wrist pads or braces, and helmets. Sports equipment should not be used at night or in extreme weather conditions.
Swimming and water safety lessons may help prevent drowning.
Safety instruction regarding matches, lighters, barbecues, stoves, and open fires can prevent major burns.
Wearing seat belts is the most important way to prevent major injury or death from a motor vehicle accident.

Answer 391

A

f your child’s physical development appears to be outside the norm, talk to your health care provider.
If language skills appear to be lagging, request a speech and language evaluation.
Keep close communication with teachers, other school employees, and parents of your child’s friends so you are aware of possible problems.
Encourage children to express themselves openly and talk about concerns without fear of punishment.
While encouraging children to participate in a variety of social and physical experiences, be careful not to over-schedule free time. Free play or simple, quiet time is important so the child does not always feel pushed to perform.
Children today are exposed, through the media and their peers, to many issues dealing with violence, sexuality, and substance abuse. Discuss these issues openly with your children to share concerns or correct misconceptions. You may need to set limits to ensure children will be exposed to certain issues only when they are ready.
Encourage children to participate in constructive activities such as sports, clubs, arts, music, and scouts. Being inactive at this age increases the risk of lifetime obesity. However, it is important not to over-schedule your child. Try to find a balance between family time, school work, free play, and structured activities.
School-age children should participate in family chores such as setting the table and cleaning up.
Limit screen time (television and other media) to 2 hours a day.

Answer 392

A

Understand abstract ideas. These include grasping higher math concepts, and developing moral philosophies, including rights and privileges.
Establish and maintain satisfying relationships. Adolescents will learn to share intimacy without feeling worried or inhibited.
Move toward a more mature sense of themselves and their purpose.
Question old values without losing their identity.

Answer 393

A

Girls may begin to develop breast buds as early as 8 years old. Breasts develop fully between ages 12 and 18.
Pubic hair, armpit and leg hair usually begin to grow at about age 9 or 10, and reach adult patterns at about 13 to 14 years.
Menarche (the beginning of menstrual periods) typically occurs about 2 years after early breast and pubic hair appear. It may occur as early as age 9, or as late as age 16. The average age of menstruation in the United States is about 12 years.
Girls growth spurt peaks around age 11.5 and slows around age 16.

Answer 394

A

Boys may begin to notice that their testicles and scrotum grow as early as age 9. Soon, the penis begins to lengthen. By age 17 or 18, their genitals are usually at their adult size and shape.
Pubic hair growth, as well as armpit, leg, chest, and facial hair, begins in boys at about age 12, and reaches adult patterns at about 17 to 18 years.
Boys do not start puberty with a sudden incident, like the beginning of menstrual periods in girls. Having regular nocturnal emissions (wet dreams) marks the beginning of puberty in boys. Wet dreams typically start between ages 13 and 17. The average age is about 14 and a half years.
Boys’ voices change at the same time as the penis grows. Nocturnal emissions occur with the peak of the height spurt.
Boys’ growth spurt peaks around age 13 and a half and slows around age 18.

Answer 395

A

The sudden and rapid physical changes that adolescents go through make adolescents very self-conscious. They are sensitive, and worried about their own body changes. They may make painful comparisons about themselves with their peers.

Physical changes may not occur in a smooth, regular schedule. Therefore, adolescents may go through awkward stages, both in their appearance and physical coordination. Girls may be anxious if they are not ready for the beginning of their menstrual periods. Boys may worry if they do not know about nocturnal emissions.

During adolescence, it is normal for young people to begin to separate from their parents and make their own identity. In some cases, this may occur without a problem from their parents and other family members. However, this may lead to conflict in some families as the parents try to keep control.

Friends become more important as adolescents pull away from their parents in a search for their own identity.

Their peer group may become a safe haven. This allows the adolescent can test new ideas.
In early adolescence, the peer group most often consists of non-romantic friendships. These often include “cliques,” gangs, or clubs. Members of the peer group often try to act alike, dress alike, have secret codes or rituals, and participate in the same activities.
As the youth moves into mid-adolescence (14 to 16 years) and beyond, the peer group expands to include romantic friendships.
In mid- to late adolescence, young people often feel the need to establish their sexual identity. They need to become comfortable with their body and sexual feelings. Adolescents learn to express and receive intimate or sexual advances. Young people who do not have the chance for such experiences may have a harder time with intimate relationships when they are adults.

Answer 396

A

The first myth is that they are “on stage” and other people’s attention is constantly centered on their appearance or actions. This is normal self-centeredness. However, it may appear (especially to adults) to border on paranoia, self-love (narcissism), or even hysteria.
Another myth of adolescence is the idea that “it will never happen to me, only the other person.” “It” may represent becoming pregnant or catching a sexually-transmitted disease after having unprotected sex, causing a car crash while driving under the influence of alcohol or drugs, or any of the many other negative effects of risk-taking behaviors.

Answer 397

A

Adolescents become stronger and more independent before they have developed good decision-making skills. A strong need for peer approval may tempt a young person to take part in risky behaviors.

Motor vehicle safety should be stressed. It should focus on the role of the driver/passenger/pedestrian, the risks of substance abuse, and the importance of using seat belts. Adolescents should not have the privilege of using motor vehicles unless they can show that they can do so safely.

Other safety issues are:

Adolescents who are involved in sports should learn to use equipment and protective gear or clothing. They should be taught the rules of safe play and how to approach more advanced activities.
Young people need to be very aware of possible dangers including sudden death. These threats can occur with regular substance abuse, and with the experimental use of drugs and alcohol.
Adolescents who are allowed to use or have access to firearms need to learn how to use them properly.
If adolescents need to be evaluated if they appear to be isolated from their peers, uninterested in school or social activities, or doing poorly at school, work, or sports.

Many adolescents are at increased risk for depression and potential suicide attempts. This can be due to pressures and conflicts in their family, school or social organizations, peer groups, and intimate relationships.

Answer 398

A

Adolescents most often need privacy to understand the changes taking place in their bodies. Ideally, they should be allowed to have their own bedroom. If this is not possible, they should have at least some private space.

Teasing an adolescent child about physical changes is inappropriate. It may lead to self-consciousness and embarrassment.

Parents need to remember that it is natural and normal for their adolescent to be interested in body changes and sexual topics. It does not mean that their child is involved in sexual activity.

Adolescents may experiment with a wide range of sexual orientations or behaviors before feeling comfortable with their own sexual identity. Parents must be careful not to call new behaviors “wrong,” “sick,” or “immoral.”

The Oedipal complex (a child’s attraction to the parent of the opposite sex) is common during the adolescent years. Parents can deal with this by acknowledging the child’s physical changes and attractiveness without crossing parent-child boundaries. Parents can also take pride in the youth’s growth into maturity.

It is normal for the parent to find the adolescent attractive. This often happens because the teen often looks very much like the other (same-sex) parent did at a younger age. This attraction may cause the parent to feel awkward. The parent should be careful not to create a distance that may make the adolescent feel responsible. It is inappropriate for a parent’s attraction to a child to be anything more than an attraction as a parent. Attraction that crosses the parent-child boundaries may lead to inappropriately intimate behavior with the adolescent. This is known as incest.

Answer 399

A

The teenager’s quest to become independent is a normal part of development. The parent should not see it as a rejection or loss of control. Parents need to be constant and consistent. They should be available to listen to the child’s ideas without dominating his or her independent identity.

Although adolescents always challenge authority figures, they need or want limits. Limits provide a safe boundary for them to grow and function. Limit-setting means having pre-set rules and regulations about their behavior.

Power struggles begin when authority is at stake or “being right” is the main issue. These situations should be avoided, if possible. One of the parties (typically the teen) will be overpowered. This will cause the youth to lose face. The adolescent may feel embarrassed, inadequate, resentful, and bitter as a result.

Parents should be ready for and recognize common conflicts that may develop while parenting adolescents. The experience may be affected by unresolved issues from the parent’s own childhood, or from the adolescent’s early years.

Parents should know that their adolescents will repeatedly challenge their authority. Keeping open lines of communication and clear, yet negotiable, limits or boundaries may help reduce major conflicts.

Most parents feel like they have more wisdom and self-growth as they rise to the challenges of parenting adolescents.

Answer 400

A

1 DTAP, IPV, HIB=(pentacel), HepB, Prevnar, Rotavirus

Answer 401

A

2 DTAP, IPV, HIB=(pentacel), HepB, Prevnar, Rotavirus (HepB if not at birth)

Answer 402

A

3 DTAP, IPV, HIB=(pentacel), HepB, Prevnar, Rotavirus

Answer 403

A

No Shots - hemoglobin (check iron)

Answer 404

A

4 Prevnar, HepA#1

Answer 405

A

MMR, Varivax (proquad)

Answer 406

A

4 DTAP, IPV, HIB=(pentacel), (HepA optional)

Answer 407

A

DTAP, IPV, MMR (Varivax and HepA if not yet given)

Answer 408

A

Tdap, meningitis, HepB series, HepA series, Varivax if needed, Gardasil

Answer 409

A

Jaundice check

Answer 410

A

PKU#2

Random smile

Answer 411

A

Routine Check

Follows

Answer 412

A

Pentacel (DtAP), IPV, HIB)
Prevnar
HBV
Rotavirus
Goos and Coos

Answer 413

A

Pentacel (DtAP), IPV, HIB)
Prevnar
HBV
Rotavirus
Laughs/Sometimes Rolls

Answer 414

A

Pentacel (DtAP), IPV, HIB)
Prevnar
HBV
Rotavirus
Sits

Answer 415

A

HgB
Pulls to stand
Separation anxiety
stranger anxiety

Answer 416

A

HAV
Prevnar
Walks
2-5 Words

Answer 417

A

Proquad (MMR/Varivax)

Climbs

Answer 418

A

Pentacel (DtAP), IPV, HIB)

Runs

Answer 419

A

HAV

Sentences

Answer 420

A

DtAP
IPV
MMR varivax (proquad)
HgB
UA
vision check

Answer 421

A

Tdap
Meningococcal (menveo)
Gardasil #1 (start series)
Varivax if series not complete

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Pediatrics Flashcards

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