PPS COMPILED SAMPLEX [PART 2 OF 5] - 652 items total with Rationale Flashcards
"Treatment of retentive encopresis A. Laxative B. Contrast enema C. Clearance of impacted fecal material followed by the short-term use of mineral oil or laxatives D. None of the above"
C
“Nelson 21st p1961
If an impaction is present on the initial physical examination, an enema is usually required to clear the impaction while stool softeners are started as maintenance medications. Typical regimens include the use of polyethylene glycol preparations, lactulose, or mineral oil. Prolonged use of stimulants such as senna or bisacodyl should be avoided. “
“Patient with diarrhea. Does not stop with fasting. What is the mechanism?
a. Decreased absorption, increased secretion, electrolyte transport
b. Defect in neuromuscular unit/stasis
c. Decreased functional capacity
d. Maldigestion, transport defects, ingestion of unabsorbable substances”
A
“Nelson 21st p1907. Table 332.10 Mechanisms of Diarrhea
Secretory
- decreased absorption, increased secretion, electrolyte transport
- watery stool, normal osmolality with ion gap <100mOsm/kg
- e.g. Cholera, ETEC, C. difficile
- Persists during fasting, bile salt malabsorption can also increase intestinal water secretion, no stool leukocytes
Osmotic
- maldigestion, transport defects, ingestion of unabsorbable substances
- watry stool, acidic with reducing substances, increased osmolality with ion gap >100 mOsm/kg
- e.g. Lactase deficiency, galactose malabsorption
- Stops with fasting, increased breath hydrogen with carbohydrate malabsorption, no stool leukocytes
Increased motility
- decreased transit time
- loose to normal appearing stool, stimulated by gastrocolic reflex
- e.g. irritable bowel syndrome, thyrotoxicosis
- Infection can also contribute to increased motility
Decreased motility
- defect in neuromuscular units/stasis
- loose to normal appearing stool
- e.g. pseudo-obstruction, blind loop
- Possible bacterial overgrowth due to stasis
Decreased surface area (osmotic/motility)
- decreased functional capacity
- watery stool
- e.g. short bowel syndrome, rotavirus, celiac disease
- Might require parenteral alimentation
Mucosal invasion
- inflammation, decreased colonic reabsorption, increased motility
- blood and increased WBC in stool
- e.g. Salmonella, shigella, amebiasis, Campylobacter”
"A child with repeated bouts of vomiting suddenly developed hematemesis. What mechanism will explain this? A. Blunt trauma B. Tear on esophageal mucosa C. Rupture of esophageal varices D. Upper GI bleeding"
B
“Nelson 21st p1941
The majority of esophageal perforations in children are from blunt trauma (automobile injury, gunshot wounds, child abuse) or are iatrogenic (cardiac massage, NGT placement, traumatic intubation). Esophageal rupture has followed forceful vomiting and patients with anorexia and has followed esophageal injury due to caustic ingestion and foreign body ingestion.
Spontaneous esophageal rupture (Boerhaave syndrome) is less common and is associated with sudden increases in intraesophageal pressure wrought by situations such as vomiting, coughing or straining in stool.
Symptoms of esophageal perforation include pain, neck tenderness, dysphagia, subcutaneous crepitus, fever, tachycardia, bleeding, and cold water polydipsia.
“
"Diarrhea with gaseous abdominal distention stool with >2+ reducing substance, predominant nutrient malabsorbed A. Carbohydrates B. Fat C. Protein D. Amino acid"
A
Nelson 21st 1989 - The measurement of carbohydrate in the stool for pH and the amount of
reducing substances is a simple screening test when available. An acidic
stool with >2+ reducing substance suggests carbohydrate malabsorption.
Sucrose or starch in the stool is not recognized as a reducing sugar
until after hydrolysis with hydrochloric acid, which converts them to
reducing sugars.
"A patient has abdominal pain accompanied by straining efforts with legs and knees flexed. Presented at ER in a shock- like state. Has sausage-shaped mass on abdominal PE. Diagnostic test with high specificity A. CT scan B. Contrast Enema C. Abdominal UTZ D. Plain Xray"
C
“Nelsons 21st p1966 Intussussception
The classic triad of pain, a palpable sausage-shaped abdominal mass, and bloody or currant-jelly stool is seen in <30% of patients with intussussception. The combination of paroxysmal pain, vomiting, and a palpable abdominal mass has a positive predictive value of >90%; the presence of rectal bleeding increases this to approximately 100%
Palpation of the abdomen usually reveals a slightly tender sausage-shaped mass, slightly ill-defined, which might increase in size and firmness during a paroxysm of pain and is most often in the right upper abbdomen, with its long axis cephalocaudal. If it is felt in the epigastrisum, the long axis is transverse. Approximately 30% of patients do not have a palpable mass.
Ultrasound has a sensitivity of approximately 98-100% and a specificity of approximately 98% in diagnosing intussussception. The diagnostic findings of intusussception on ultrasound include a tubular mass in longitudinal views and a doughnut or target appearance in transverse images. “
"Patient 3 months after liver transplant came in for Hep A vaccination prior to travel in 2 months time. A. Hepatitis A vaccine B. Hepatitis A lg C. Hepatitis A vaccine and IG D. None"
C
“Nelsons 21st p2109
Hepatitis A Ig is recommended for preexposure prophylaxis for susceptible travelers to countries where HAV is endemic, and it provides effective protection for up to 2 mo. HAV vaccine given anytime before travel is preferred for preexposure prophylaxis in healthy persons, but Ig ensures an appropriate prophylaxis in children younger than 12 mo, patients allergic to a vaccine component, or those who elect not to recieve the vaccine. If travel is planned in <2wk, older patients, immunocompromised hosts, and those with chronic liver disease or other medical conditions should recieve both Ig AND HAV vaccine “
"Patient presented at ER with RUQ pain, lying on his side with hips and knees flexed. On PE, patient is uncomfortable and the abdomen is distended and tender. Which diagnostic test is highly specific and should be done immediately? A. Serum lipase B. Abdominal UTZ C. Abdominal CT D. Serum amylase"
A
“Nelsons 21st p2076
- Mild acute pancreatitis - AP that is not associated with organ failure, local or systemic complications, and usually resolved within the 1st wk after presentation. This is the most common form of AP
- Moderately severe acute pancreatitis - AP with either transient organ failure/dysfunction (lasting <48hr) or development of local or systemic complications, such as exacerbation of previously diagnosed comorbid disease
- Severe acute pancreatitis - AP with development of organ dysfunction that persists longer than 48hr. Persistent organ failure may be single or multiple. Severe AP is uncommon in children
The patient with AP has moderate to severe abdominal pain, persistent vomiting, and possibly fever. The pain is epigsatric or in either upper quadrant, stead, often resulting in the child’s assuming an antalgic position with hips and knees flexed, sitting upright, or luying to the side. The child is uncomfortable, irritable, and appears acutely ill. The abdomen may be distended and tender and a mass may be palpable.
AP is usually diagnosed by measurement of serum lipase and amylase activities. Serum lipase is considered the test of choice for AP, as it is more specific than amylase for acute inflammatory pancreatic disease and should be determined when pancreatitis is suspected. “
An infant has history of vomiting and regurgitation 3-4x after feeding. What will you do
NORMALIZATION OF ABNORMAL FEEDING TECHNIQUES
“A patient with characteristics of marasmus. What deficiency?
a. Carbohydrates
b. Fats
c. Protein
d. Micronutrients”
C
”"”Nelson 21st p336
Severe acute malnutrition is defined as severe wasting and/or bilateral edema. Other terms are marasmus (severe wasting), kwashiorkor (characterized by edema), and marasmic-kwashiorkor (severe wasting and edema).
Severe wasting is most visible on the thighs, buttocks, and upper arms, as well as over the ribs and scapulae, where loss of fat and skeletal muscle is greatest. Wasting is preceded by failure to gain weight and then by weight loss. The skin loses turgor and becomes loose as subcutaneous tissues are broken down to provide energy. The face may retain a relatively normal appearance, but eventually becomes wasted and wizened. The eyes may be sunken from loss of retroorbital fat, and lacrimal and salivary glands may atrophy, leading to lack of tears and a dry mouth. Weakened abdominal muscles and gas from bacterial overgrowth of the upper gut may lead to a distended abdomen. Severely wasted children are often fretful and irritable.”””
“Preventive measures for GERD
a. Elevate head of bed 3inches
b. No food or drinks 1 hr before bedtime
c. Avoid caffeinated drinks
d. All of the above”
D
“Nelson 21st p1937
Dietary measures for infants include normalization of any abnormal feeding techniques, volumes, and frequencies. Thickening of feeds or use ot commercially prethickened formulas increases the percentage of infants with nor regurgitation, decreases the frequency of daily regurgitation and emesis, and increases the infant’s weight gain.
Older children should be counseled to avoid acidic or reflux-inducing foods (tomatoes, chocolate, mint) and beverages (juices, carbonated and caffeinated drinks, alcohol). Weight reduction for obese patients and elimination of smoke exposure are crucial measures for all ages.
Positioning measures are particularly important for infants, who cannot control their positions independently. Seated position worsens infant reflux and should be avoided in infants with GERD. When the infant is awake and observed, prone position and upright carried position can be used to minimize reflux. Lying in the flat supine position and semi-seated positions (e.g. car seats, infant carriers) in the postprandial period are considered provocative positions for GER and therefore should be avoided.
The efficacy of positioning for older children is unclear, but some evidence suggests a benefit to left side position and elevation during sleep. The head should be elevated by elevating the head of the bed, rather than using excess pillows, to avoid abdominal flexion and compression that might worsen reflux. “
"A 3-week old male had intermittent vomiting. On examination, a firm, movable, olive-shaped hard mass was palpable in the mid-epigastric region. What imaging study can best help confirm the diagnosis? A. Scout film of the abdomen B. Abdominal ultrasound C. Manometry D. Abdominal CT scan"
B
“Nelsons 21st p1947 Pyloric stenosis
The diagnosis has traditionally been established by palpating the pyloric mass. The mass is firm, movable, approximately 2cm in length, olive-shaped, hard, best palpated from the left side, and located above and to the right of the umbilicus in the mid-epigastrium beneath the liver edge.
Two imaging studies are commonly used to establish the diagnosis. Ultrasound examination confirms the diagnosis in the majority of cases. Criteria for diagnosis include pyloric thickness 3-4mm, an overall pyloric length 15-19mm, and a pyloric diameter of 10-14mm. Ultrasonography has a sensitivity of approximately 95%. When contrast studies are performed, they demonstrate an elongated pyloric channel (string sign), a bulge of pyloric muscle into the antrum (shoulder sign) and parallel streaks of barium seen in the narrowed channel, producing a double tract sign. “
"Which of the following features best distinguishes Hirschsprung's disease from functional constipation? A. Failure to thrive B. Encopresis C. Enterocolitis D. Onset after 2 years of age"
C
“Nelson 21st p1962 Table 358.9 Distinguishing features of Hirschsprung disease and functional constipation
FUNCTIONAL CONSTIPATION
Onset after 2 yrs Encopresis common Failure to thrive uncommmon Enterocolitis none Forced bowel traning usual
Abdominal distension uncommon Poor weight gain rare Rectum filled with stool Rectal examination: stool in rectum No malnutrition
Anorectal manometry reveals relaxation of internal anal sphincter
Rectal biopsy is normal
Barium enema shows massive amounts of stool with no transition zone
HIRSCHSPRUNG DISEASE
Onset at birth Encopresis very rare Failure to thrive possible Enterocolitis possible Forced bowel training: none
Abdominal distension common Poor weight gain common Rectum empty Rectal examination: explosive passage of stool Malnutrition: possible
Anorectal manometry reveals failure of internal anal sphincter relaxation
Rectal biopsy shows no ganglion cells
Barium enema shows transition zone with delayed evacuation of barium”
“3 year old takes 8 months old sister’s rattle
a. Slap
b. Scold
c. Time out
d. Take away toys”
C
“Nelson 21st p146
Although some cultures condone the use of corporal punshment for discliplining of young children, it is not a consistently effective means of behavioral control. As children habituate to repeated spanking, parents have to spank ever harder to achieve the desired response, increasing the risk of serious injury.
Sufficiently harsh punishment may inhibit undesired behaviors, but at great psychologic cost. Children mimic the corporal punishment that they recieve; children who are spanked will have more aggressive behaviors later.
Whereas spanking is the use of force, externally applied, to produce behavioral change, discipline is the process that allows the child to internalize controls on behavior. Alternative discipline strategies should be offered, such as the ““countdown”” for transitions along with consistent limit setting, ““time outs”” or ““time ins”” (breaks from play with caregiver present and interacting), clear communication of rules, and frequent approcal with positive reinforcement of productive play and behavior. Punishment should be immediate, specific to the behavior, and time-limited. Time-out for approximately 1min/yr of age is very effective. “
“A child raised in an environment of violence is linked to:
a. Violence
b. Stealing
c. Runaway
d. Depression/ anxiety”
D
“Nelson 21st p86
All types of violence have a profound impact on health and development both psychologically and behaviorally. Children can come to see the world as a dangerous and unpredictable place. This fear may thrwart their exploration of the environment, which is essential to learning in childhood. Children may experience overwhelming terror, helplessness, and fear, even if they are not immediately in danger.
High exposure to violence in older children correlates with poor performance in school, symptoms of anxiety and depression, and lower self esteem. Violence, particularly intimate partner violence, can also teach children especially powerful early lessons about the role of violence in relationships. Violence can change the way that children view their future; they may believe that they could die at an early age and thus take more risks.
Some children exposed to severe and/or chronic violence may suffer from PTSD, exhibiting constricted emotions, difficulty in concentrating, autonomic disturbances, and reenactment of the trauma through play or action. “
"Which is not part of the HEEADSSS? a. Home b. Education C. Abuse d. Spirituality"
C
“Prev Ped 2018 p16
Complete history-taking to screen for risks and protective factor using the tool HEEADSSS which means Home, Education/Employment, Eating, Drugs, Sexuality, Suicidality/depression, Safety, Strength/spirituality “
“Modifiable factor, associated with timing for adolescent growth?
a. Genetic
b. Environmental
c. Hormonal”
B
Environmental facotrs are the only modifiable factor among the choices
“True of gender dysphoria in children EXCEPT
a. Strong desire of gender of the opposite sex
b. A strong desire to be rid of one’s primary and/or secondary
sex characteristics
c. Prefers playmates of opposite sex
d. Dislike of one’s sexual anatomy”
B
“Nelsons 21st p1023 Table 133.2 Summary of DSM-5 diagnostic criteria for gender dysphoria
Gender dysphoria in children
A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6mo duration, as manifested by at least 6 of the following (1 of which must be criteria A1)
- A strong desire to be of the other gender or an insistence that one is the other gender (or some aternative gender different from one’s associated gender)
- In boys (assigned gender), a strong preference for dressing or simulating female attire; or in girls (assigned gender), a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing
- A strong preference for cross-gender roles in make-believe play or fantasy play
- A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender
- A strong preference for playmates of the other gender
- In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities, and a strong avoidance of rough-and-tumble play; or in girls (assigned gender), a strong rejection of typically female toys, games, and activities
- A strong dislike of one’s sexual anatomy
- A strong desire for the primary and/or secondary sex characteristics that match one’s experience gender
B. The condition is associated with clinically significant distress or impairment in social, school, or other important areas of functioning”
“True of Asperger syndrome EXCEPT
a. Persistent deficits in social communication and social interaction
b. Restricted, repetitive patterns of behaviour, interests, or activities
c. Delay in language and cognitive development
d. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning”
C
“Nelsons 21st p295 Table 54.1 DSM-5 diagnostic criteria for autism spectrum disorder
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following currently or in history:
- Deficits in social-emotional reciprocity
- Deficits in nonverbal communicative behaviors used for social interaction
- Deficits in developing, maintaining, and understanding relationships
B. Restricted, retptitive patterns of behavior, interests, and activites as manifested by at least 2 of the following, currently or by history
- Stereotyped or repetitive motor movements, use of objects, or speech
- Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
- Highly restricted, fixated interests that are abnormal in intensity or focus
- Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment
C. Symptoms mye be present in the early developmental period (may not become fully manifest until social demands exceed limited capabilities, or may be masked by learned strategies in later life)
D. Symptoms cause clinically significant impairment in social, occupational, and other important areas or current functioning
E. These disturbances are not better explained by intellectual disability or global developmental delay”
"Parents brought their infant to the clinic. Her birthweight is 3kg. Now she weighs 6kg, laughs out loud, lifts head, able to roll to prone but cannot roll back to supine. At least how old is she? A. 3 mos B. 4 mos C. 5 mos D. 6 mos"
B
“Nelson 21st p134
Between 3 and 4 mo of age, the rate of growth slow to approximately 20g/day. By age 4mo, birthweight has doubled.
Nelson 21st p133 Table 22.2 Emerging patterns of behavior during the first year of life
3mo
Prone: Lifts head and chest with arms extended, head below the plane of body on ventral suspension
Supine: Tonic head posture predominates, reaches forward and misses objects; waves at toy
Sitting: Head lag partially compensated when pulled to a sitting position, early head control with bobbing motion, back rounded
Reflex: Typical moro reponse has not persistence, makes defensive movements or selective withdrawal reactions
4mo
Prone: Lifts head and chest, with head in approximately vertical axis, legs extended
Supine: Symmetric posture predominates, hands at midline, reaches and grasps objects and brings them to mouth
Sitting: No head lag when pulled to sitting position, head stedy, tipped forward, enjoys sitting with full truncal support
Standing: When held erect, pushes with feet
Adaptive: Sees raisin, but makes no more to reach for it
Social: Laughs out loud, may show displeasure when social contact is broken, excited at sight of food
7mo
Prone: Rolls over, pivots, crawls or creep-crawls
Supine: Lifts head, rolls over, squirms
Sitting: Sits briefly, with support of pelvis, leans forward on hands, back rounded
Standing: May support most of weight, bounces actively
Adaptive: Reaches out for and grasps large object, transfers object from hand to hand, grasp uses radial palm, rakes at raisin
Language: Forms polysyllabic vowel sounds
Social: Prefers mother, babbles, enjoys mirror, responds sto changes in emotional content of social contact “
"When is the earliest to have dental check up for carries. A.12 mos B. 15 mos C. 18 mos D. 24 mos"
A
“Prev Ped 2018 p11
The first dental visit is recommended to be done at the time of eruption of the first tooth and no later than 12 months of age.
During the first dental visit, the dentist will assess
- The child’s general health, growth, and behavior
- The child’s oral hygiene and periodontal health
- The risk for developing oral disease
The dentist will likewise provide education on infant oral health and evaluate and optimize flouride exposure. “
"Most common cause of death in all ages including children, adol, and even less than 1 yr old A. Fires and burns B. Drowning C. Vehicular accidents D. Suicide"
C
”"”Leading causes of pediatric death (US, 2016)
- Motor vehicle crashes
- Firearm-related injuries
- Malignant neoplasms
- Suffocation
Leading causes of pediatric death, Philippines (DOH, 2010)
Infant
- Bacterial sepsis
- Pneumonia
- Respiratory distress of newborn
Age 1-4
- Pneumonia
- Gastroenteritis
- Congenital anomalies
Age 5-9
- Pneumonia
- Dengue
- Drowning
Age 10-14
- Pneumonia
- Drowning
- Diseases of nervous system”””
“How many months should exclusive breastfeeding be recommended?
a) 4 months
b) 6 months
c) 8 months
d) 10 months”
B
“Nelson 21st p321
The AAP and WHO recommend that infants should be exclusively breastfed or given breast milk for 6mo. Breastfeeding should be continued with the introduction of complementary foods for 1 yr or longer, as mutually desired by mother and infant. “
“Introduction of lumpy foods should be done during this critical month. If it’s done beyond this month, there’s an increased risk for feeding difficulties.
a) 6 months
b) 8 months
c) 10 months
d) 12 months”
C
“Growth velocity of 6 year old boy is:
a) 6 cm/yr
b) 5 cm/yr
c) 4 cm/yr
d) 3 cm/yr”
A
“Growth milestones
0-2 months (Nelson 21st p132)
A newborn’s weight may initially decrease 10% (vaginal delivery) to 12% (caesarian section) below birthweight in the 1st wk as a result of excretion of excess extravascular fluid and limited nutritional intake.
Infants regain or exceed birthweight by 2wk of age and should grow at approximately 30g per day during the 1st mo.
2-6 months (Nelson 21st p134)
Between 3 and 4mo of age, the rate of growth slows to approximately 20g/day. By age 4mo, the birthweight is doubled
6-12 months (Nelsons 21st p135)
By the 1st birthday, birthweight has tripled, length has increased by 50%, and head circumference has increased by 10%.
12-18 months (Nelsons 21st p137)
Increase in head circumference of 2cm in 2nd year of life
18-24 months (Nelsons 21st p142)
Height and weight increase at a stead rate during this year, with a gain of 5in and 5lb. By 24mo, children are about half their ultimate adult height. Head growth slows slightly, with 85% of adult head circumference achieved by age 2yr, leaving only an additional 5cm gain over the next 2 years.
2-5 yr (Nelsons 21st p143)
Somatic and brain growth slows by the end of the 2nd year of life, with corresponding decreases in nutritional requirements and appetite, and the emergence of ““picky”” eating habits. Increases of approximately 2kg in weight and 7-8cm in height per year are expected.
Birthweight quadruples by 2.5 year of age. An average 4 year old weighs 40lb and is 40in tall. The head will only grow an additional 5-6cm between ages 3 and 18yr.
6-11 yr (Nelsons 21st p146)
Growth occurs discontinuously in 3-6 irregularly timed spurts per year, but varies both within and among individuals. Growth during the period average 3-3.5kg and 6-7cm per year. The head grows only 2cm in circumference throughout the entire period, reflecting a slowing of brain growth.
Nelsons 21st p151 Table 27.1 Growth velocity and other growth chracteristics by age
Infancy
- Birth-12mo: 24cm/yr
- 12-24mo: 10cm/yr
- 24-36mo: 8cm/yr
Childhood
- 6cm/yr
- slowly decelerates before pubertal onset
- height typically does not cross percentile lines
Adolescence
- signoid shaped growth curve
- adolescent growth spurt accounts for about 15% of adult height
- peak height velocity for girls: 8cm/yr
- peak height velocity for boys: 10cm/yr “
“This is the effortless regurgitation of food, with no nausea and retching.
a) Rumination
b) Regurgitation
c) Retching
d) Restitution”
B
“Nelson 21st p1904-1905
Regurgitation is the effortless movement of stomach contents into the esophagus and mouth. It is not associated with distress, and infants with regurgitation are often hungry immediately after an episode.
Regurgitation is a result of gastroesophageal reflux through an incompetent, or, in infants, immature lower esophageal sphincter. This is often a developmental process, and regurgitation, or ““spitting”” resolves with maturity. Regurgitation should be differentiated from vomiting, which denotes an active reflex process with an extensive differential diagnosis. “
“What is the most culturally sensitive developmental parameter?
a) Gross Motor
b) Fine motor
c) Language
d) Personal/Social”
D
“cultural sensitive - personal social
intelligence - language
combine motor and sensory - self help/adaptive”
“3yo with soiling of pants. What would you advise?
a) Observe, since it’s part of normal development
b) Refer to GI
c) Work up for chronic constipation
d) None of the above”
A
“Nelson 21st p1959
Encopresis is defined as voluntary or involuntary passage of feces into inappropriate places at least once a month for 3 consecutive months once a chronologic or developmental age of 4yr has been reached. Encopresis is not diagnosed when the behavior is exclusively the result of direct effects of a substance (e.g. laxatives) or a general medical condition (except through a mechanism involving constipation). “
“A child rolls over, utters polysyllabic vowel sounds, and sits with support.
a) 3 months
b) 4 months
c) 5 months
d) 6 months”
D
”"”Nelson 21st p134
Between 3 and 4 mo of age, the rate of growth slow to approximately 20g/day. By age 4mo, birthweight has doubled.
Nelson 21st p133 Table 22.2 Emerging patterns of behavior during the first year of life
3mo
Prone: Lifts head and chest with arms extended, head below the plane of body on ventral suspension
Supine: Tonic head posture predominates, reaches forward and misses objects; waves at toy
Sitting: Head lag partially compensated when pulled to a sitting position, early head control with bobbing motion, back rounded
Reflex: Typical moro reponse has not persistence, makes defensive movements or selective withdrawal reactions
4mo
Prone: Lifts head and chest, with head in approximately vertical axis, legs extended
Supine: Symmetric posture predominates, hands at midline, reaches and grasps objects and brings them to mouth
Sitting: No head lag when pulled to sitting position, head stedy, tipped forward, enjoys sitting with full truncal support
Standing: When held erect, pushes with feet
Adaptive: Sees raisin, but makes no more to reach for it
Social: Laughs out loud, may show displeasure when social contact is broken, excited at sight of food
7mo
Prone: Rolls over, pivots, crawls or creep-crawls
Supine: Lifts head, rolls over, squirms
Sitting: Sits briefly, with support of pelvis, leans forward on hands, back rounded
Standing: May support most of weight, bounces actively
Adaptive: Reaches out for and grasps large object, transfers object from hand to hand, grasp uses radial palm, rakes at raisin
Language: Forms polysyllabic vowel sounds
Social: Prefers mother, babbles, enjoys mirror, responds sto changes in emotional content of social contact “””
“In the multidisciplinary approach to ADHD, what is the 1st step?
a) Parental counseling
b) Undergo behavioral therapy
c) Refer to other subspecialties
d) None of the above”
A
“Nelson 21st p265
Once the diagnosis of ADHD has been established, the parents and child should be educated with regard to the ways ADHD can affect learning, behavior, self-esteem, social skills, and family function. The clinician should set goals for the family to help improve the child’s interpersonal relationships, develop study skills, and decreased disruptive behaviors. Parent support groups with appropriate professional consultation to such groups can be very helpful. “
“What is the most developed sense at birth?
a) Sight
b) Smell
c) Taste
d) Hearing”
D
“Nelson 21st p130
Soon after birth, neonates are alert and ready to interact and nurse. Neonates are nearsighted, having a fixed focal length of 8-12 inches, approximately the distance from the breast to the mother’s face, as well as an inborn visual preference for faces. Hearing is well-developed, and infants preferentially turn toward a female voice. “
“Mother consults in your clinic with 2 wk old baby. Can the baby recognize her?
a) can see and recognize
b) can’t see
c) can see to at least 20-30cm but can’t recognize
d) None of the above”
C
“Nelson 21st p130
Soon after birth, neonates are alert and ready to interact and nurse. Neonates are nearsighted, having a fixed focal length of 8-12 inches, approximately the distance from the breast to the mother’s face, as well as an inborn visual preference for faces. Hearing is well-developed, and infants preferentially turn toward a female voice. “
“After 2 years old, head circumference is less than chest circumference due to:
a) Closing of sutures and fontanelles
b) Faster growth of thoracic organs
c) Both of the above
d) None of the above”
B
“boy knows his name, age, sex. He says he will wash hands when given a cookie.
a) 2
b) 3
c) 5
d) 7”
B
“Nelson 21st p142 Table 23.1 Emerging patterns of behavior from 1-5yr of age
24 months / 2 years
Motor: Runs well, walks up and down stairs 1 step at atime, opens doors, climbs on furniture, jumps
Adaptive: Makes tower of 7 cubes (6 at 21mo), scribbles in circular pattern, imitates horizontal strokes, folds paper once imitatively
Language: Puts 3 words together (subject, verb, object)
Social: Handles spoon well, often tells about immediate experiences, helps to undress, listens to stories when shown pictures
30 months
Motor: Goes up stairs alternating feet
Adaptive: Makes tower of 9 cubes, makes vertical and horizontal strokes, but generally will not join them to make cross, imitates circular stroke, forming closed figure
Language: Refers to self by pronoun ““I””, knowns full name
Social: Helps put things away, pretends in play
36 months / 3 years
Motor: Rides tricycle, stands momentarily on 1 foot
Adaptive: Makes tower of 10 cubes, imitates construction of ““bridge”” of 3 cubes, copies circle, imitates cross
Language: Knows age and sex, counts 3 objects correctly; repeats 3 numbers or a sentence of 6 syllables, most of speech intelligible to strangers
Social: Plays simple games in parallel with other children, helps in dressing (unbuttons clothing and puts on shoes), washes hands
48 months / 4 years
Motor: Hops on 1 foot, throws ball overhand, uses scissors to cut out pictures, climbs well
Adaptive: Copies bridge from model, imitates construction of ““gate”” of 5 cybes, copies cross and square, draws man with 2-4 parts besides head, identifies longer of 2 lines
Language: Counts 4 pennies accurately, tells story
Social: Plays with several children, with beginning of social interaction and role playing, goes to toilet alone
60 months / 5 years
Motor: Skips
Adaptive: Draws triangle from copy, names heavier of 2 weights
Language: Names 4 colors, repeats sentence of 10 syllables, counts 10 pennies correctly
Social: Dresses and undresses, asks questions about meaning of words, engages in domestic roleplaying “
“Mechanism of heat loss in neonates except
a) convection of heat energy to the cooler surrounding air
b) conduction of heat to the colder materials touching the infant
c) cold radiation from the infant to other nearby cooler objects
d) evaporation from skin and lungs”
C
“Nelson 21st p872
The estimated rate of heat loss in a newborn is approximately 4 times that of an adult. Under normal delivery room conditions (20-25C), these rates generally result in a cumulative loss of 2-3C in deep body temperature (corresponding to a heat loss of approximately 200kcal/kg).
The heat loss occurs by 4 mechanisms
- Convection of heat energy to the cooler surrounding air
- Conduction of heat to the colder materials touching the infant
- Heat radiation from the infant to nearby cooler objects
- Evaporation from skin and lungs”
“A boy skips, hops, draws a triangle, dresses and undresses self. How old is he?
a) 3 years old
b) 4 years old
c) 5 years old
d) 6 years old”
C
”"”Nelson 21st p142 Table 23.1 Emerging patterns of behavior from 1-5yr of age
24 months / 2 years
Motor: Runs well, walks up and down stairs 1 step at atime, opens doors, climbs on furniture, jumps
Adaptive: Makes tower of 7 cubes (6 at 21mo), scribbles in circular pattern, imitates horizontal strokes, folds paper once imitatively
Language: Puts 3 words together (subject, verb, object)
Social: Handles spoon well, often tells about immediate experiences, helps to undress, listens to stories when shown pictures
30 months
Motor: Goes up stairs alternating feet
Adaptive: Makes tower of 9 cubes, makes vertical and horizontal strokes, but generally will not join them to make cross, imitates circular stroke, forming closed figure
Language: Refers to self by pronoun “”"”I””””, knowns full name
Social: Helps put things away, pretends in play
36 months / 3 years
Motor: Rides tricycle, stands momentarily on 1 foot
Adaptive: Makes tower of 10 cubes, imitates construction of “”"”bridge”””” of 3 cubes, copies circle, imitates cross
Language: Knows age and sex, counts 3 objects correctly; repeats 3 numbers or a sentence of 6 syllables, most of speech intelligible to strangers
Social: Plays simple games in parallel with other children, helps in dressing (unbuttons clothing and puts on shoes), washes hands
48 months / 4 years
Motor: Hops on 1 foot, throws ball overhand, uses scissors to cut out pictures, climbs well
Adaptive: Copies bridge from model, imitates construction of “”"”gate”””” of 5 cybes, copies cross and square, draws man with 2-4 parts besides head, identifies longer of 2 lines
Language: Counts 4 pennies accurately, tells story
Social: Plays with several children, with beginning of social interaction and role playing, goes to toilet alone
60 months / 5 years
Motor: Skips
Adaptive: Draws triangle from copy, names heavier of 2 weights
Language: Names 4 colors, repeats sentence of 10 syllables, counts 10 pennies correctly
Social: Dresses and undresses, asks questions about meaning of words, engages in domestic roleplaying “””
“Breastmilk storage period
a) Room temp of 30°c for 3hrs
b) Airconditioned room temp of 25°c for 6hrs
c) Refrigerator temp of 4°c for 8days
d) 2 door freezer for 6mos”
C
“Prev Ped 2018 p26
Breastmilk storage period
- Room temperature (<25C) - 4 hours
- Room temperature (>25C) - 1 hour
- Referigerator (4C) - 8 days
- Freezer compartment of a 1 door refrigerator - 2 weeks
- Freezer compartment of a 2 door refrigerator - 3 months
- Deep freezer with a constant temperature -20C - 6 months”
“Aside from weight for length, what is an accurate growth indicator?
a) BMI for age
b) weight for age
c) Length for age
d) Head circumference”
A
“Interpretation of z score above 3 for BMI for age?
a) Normal
b) at risk for overweight
c) Overweight
d) Obese”
D
“Prev Ped 2016 p33 Figure 3. Z score interpretation
Length/Height for age
- Below -2: Stunted
- Below -3: Severely stunted
Weight for age
- Below -2: Underweight
- Below -3: Severely underweight
Weight for length/height
- Above 3: Obese
- Above 2: Overweight
- Above 1: Possible risk for overweight
- Below -2: Wasted
- Below -3: Severely wasted
BMI for age - Above 3: Obese
- Above 2: Overweight
- Above 1: Possible risk for overweight
- Below -2: Wasted
- Below -3: Severely wasted”
“Brain enlargement in the later years is due to:
a) Development of the sinuses
b) Increase in amount of cerebrospinal fluid
c) Brain myelinization
d) Increased mass of parietal and occipital bones”
C
“Nelson 21st p1017
Both structrual and functional brain development continue throughout adolescence. Cortical gray matter volume peaks in preadolescence then decreases because of selective pruning of rarely used synaptic connections. Cortical white matter volume increases until mid-late adolescence, reflecting increasing myelination and subsequent facilitation of integrated brain activity and more efficient transmission of information between different regions of the brain, enhancing the ““signal-to-noise”” ratio. “
“Brain growth is until what age?
a) 3 yo
b) 7 yo
c) 12 yo
d) 18yo”
D
”"”Nelson 21st p1017
Both structrual and functional brain development continue throughout adolescence. Cortical gray matter volume peaks in preadolescence then decreases because of selective pruning of rarely used synaptic connections. Cortical white matter volume increases until mid-late adolescence, reflecting increasing myelination and subsequent facilitation of integrated brain activity and more efficient transmission of information between different regions of the brain, enhancing the “”"”signal-to-noise”””” ratio. “””
“SMR3 pubic hair, SMR4 penis, with intense peer group involvement
a) Early Adolescence
b) Middle adolescence
c) Late adolescent
d) Late adulthood”
B
“Nelson 21st p1015 Table 132.1 Milestones in early, middle, and late adolescents
Physical
Early adolescents
- Females: secondary sex characteristics (breast, pubic, axillary hair), start of growth spurt
- Males: testicular enlargement, start of genital growth
Middle adolescents
- Females: peak growth velocity, menarche
- Males: growth spurt, secondary sex characteristics, nocturnal emissions, facial and body hair, voice changes
- Changes in body composition, acne
Late adolescents
- Physical maturation slows
- Increased lean muscle mass in males
Peers
Early adolescents - same sex peer affiliations
Middle adolescents - Intense peer group involvement, preoccupation with peer culture, conformity
Late adolescents - peer group and values recede in importance “
"Infant that sits without support, babbles, crawls, prefers mother? a. 5 months b. 7 months C. 10 months d. 12 months"
C
“Nelson 21st p133 Table 22.2 Emerging patterns of behavior during the first year of life
7mo
Prone: Rolls over, pivots, crawls or creep-crawls
Supine: Lifts head, rolls over, squirms
Sitting: Sits briefly, with support of pelvis, leans forward on hands, back rounded
Standing: May support most of weight, bounces actively
Adaptive: Reaches out for and grasps large object, transfers object from hand to hand, grasp uses radial palm, rakes at raisin
Language: Forms polysyllabic vowel sounds
Social: Prefers mother, babbles, enjoys mirror, responds sto changes in emotional content of social contact
10mo
Sitting: Sits up alone and indefinitly without support
Standing: Pulls to sttanding position, cruises or walks holding on to furniture
Motor: Creeps or crawls
Adaptive: Graps objects with thumb and forefinger, pokes at things with forefinger, picks up pellet with assisted pincer movement, uncovers hidden toy, attempts to retrieve dropped object, releases object grasped by another person
Language: Repetitive consonant sounds (mama, dada)
Social: Responds to the sound of name, plays peek-a-boo or pat-a-cake, waves bye bye
1 yr
Motor: Walks with one hand held, rises independently, takes several steps
Adaptive: Picks up rasin with unassisted pincer movement of forefinger and thumb, releases object to other person on request or gesture
Language: Says a few words besides mama and dada
Social: Plays simple ball game, makes postural adjustment to dressing”
“What can a 4 year old do?
a. Dresses and undress
b. Tell a story
c. Stand on 1 foot moment arily
d. Copies a triangle”
B
”””””"”Nelson 21st p142 Table 23.1 Emerging patterns of behavior from 1-5yr of age
24 months / 2 years
Motor: Runs well, walks up and down stairs 1 step at atime, opens doors, climbs on furniture, jumps
Adaptive: Makes tower of 7 cubes (6 at 21mo), scribbles in circular pattern, imitates horizontal strokes, folds paper once imitatively
Language: Puts 3 words together (subject, verb, object)
Social: Handles spoon well, often tells about immediate experiences, helps to undress, listens to stories when shown pictures
30 months
Motor: Goes up stairs alternating feet
Adaptive: Makes tower of 9 cubes, makes vertical and horizontal strokes, but generally will not join them to make cross, imitates circular stroke, forming closed figure
Language: Refers to self by pronoun “”””””"”I””””””””, knowns full name
Social: Helps put things away, pretends in play
36 months / 3 years
Motor: Rides tricycle, stands momentarily on 1 foot
Adaptive: Makes tower of 10 cubes, imitates construction of “”””””"”bridge”””””””” of 3 cubes, copies circle, imitates cross
Language: Knows age and sex, counts 3 objects correctly; repeats 3 numbers or a sentence of 6 syllables, most of speech intelligible to strangers
Social: Plays simple games in parallel with other children, helps in dressing (unbuttons clothing and puts on shoes), washes hands
48 months / 4 years
Motor: Hops on 1 foot, throws ball overhand, uses scissors to cut out pictures, climbs well
Adaptive: Copies bridge from model, imitates construction of “”””””"”gate”””””””” of 5 cybes, copies cross and square, draws man with 2-4 parts besides head, identifies longer of 2 lines
Language: Counts 4 pennies accurately, tells story
Social: Plays with several children, with beginning of social interaction and role playing, goes to toilet alone
60 months / 5 years
Motor: Skips
Adaptive: Draws triangle from copy, names heavier of 2 weights
Language: Names 4 colors, repeats sentence of 10 syllables, counts 10 pennies correctly
Social: Dresses and undresses, asks questions about meaning of words, engages in domestic roleplaying “””””””
“What is the benefit of breastfeeding to the mother?
a. Decrease risk of endometrial and breast cancer
b. Decreases incidence of SIDS
c. Decrease incidence of cervical cancer
d. None of the above”
A
“Fundamentals of Pediatrics vol 1 p273-274 Table 14-2 Benefits of breastfeeding for the mother and the family
- Breastfeeding improves postpartum health - prevents prolonged bleeding from placental stimulation, prevents further anemia
- Breastfeeding hastens postpartum weight loss - larger reductions in weight and hip circumference in mothers who breastfeed compared to those who bottle feed
- Breastfeeding helps optimum child spacing - lactation amenorrhea
- Breastfeeding is affordable and convenient
- Breastfeeding prevents mothers from developing cancer - women who breastfeed have lower risks for breast and ovarian cancer
- Breastfeeing protects against bone and rheumatologic problems - protective against osteoporosis and rheumatoid arthritis “
“When is the best time to repair an undescended testes?
a. 3-6 months
b. 9- 12 months
c. 9-15 months
d. Before 24 months”
C
“Nelson 21st p2828
The congenital undescended testis should be treated surgically by 9-15 mo of age. With anesthesia by a pediatric anesthesiologist, surgical correction at 6 mo is appropriate, because spontaneous descent of the testis will not occur after 4 mo of age. Most testes can be brought down to the scrotum with an orchiopexy, which involves an inguinal incision, mobilization of the testis and spermatic cord, and correction of an indirect inguinal hernia.”
“True regarding adolescence?
a. Males enter puberty before females
b. Menarche is SMR 2
c. Boys will have 2 -3 years increase in length after females have stopped
d. None of the above”
C
“Nelson 21st p1014
In males the first visible sign of puberty and the hallmark of SMR 2 is testicular enlargement, beginning as early as 9.5yr, followed by the development of pubic hair. This is followed by penile growth during SMR 3. Peak growth occurs when testes volumes reach approximately 9-10cm3 during SMR 4.
In females, typically the first visible sign of puberty and the hallmark of SMR 2 is the appearance of breast buds (thelarche) between 7 and 12 yr of age. A significant minority of females develops pubic hair (pubarche) prior to thelarche. Menses typically begin within 3 yr of thelarche during SMR 3-4 (average age 12.5yr, normal range 9-15yr).
Females attain a peak height velocity of 8-9cm/yr at SMR 2-3, approximately 6mo before menarche. Males typically begin their growth acceleration at a later SMR stage, achieve a peak height velocity of 9-10cm later in the course of puberty (SMR 3-4), and continue their linear growth for approximately 2-3yr after females have stopped growing. “
What is the role of the parents regarding obesity in children
Parents should not use food as a reward …. increase physical activity with children, parents should be involved
“Nelson 21st p357 Table 60.8 Proposed suggestions for preventing obesity
Family
- Eat meals aas a family in a fixed place and time
- Do not skip meals, especially breakfast
- Do not allow television during meals
- Use small plates, keep serving dishes away from the table
- Avoid unnecessary sweet or fatty foods and sugar-sweetened drinks
- Remove televisions from children’s bedrooms, restrict times for TV viewing and video games
- Do not use food as a reward”
“What is true regarding intellectual disability?
a. IQ of less than 80
b. Diagnosed before the age of 18
c. Able to take a bath and other stuff”
B
“Nelson 21st p283
Intellectual disability refers to a group of disorders that all include significant impairment in general intellectual function (reasoning, learning, problem solving), social skills, and adaptive behavior. Consistent among these definitions is onset of symptoms before age 18yr or adulthood
Significant impairment in general intellectual function refers to performance on an individually administered test of intelligence that is approximately 2 SD below the mean. Intelligence quotient (IQ) scores <70 would meet these criteria.
Significant impairment in adaptive behavior reflects the degree that the cognitive dysfunction impairs daily function. Adaptive behavior refers to the skills required for people to function in their everyday lives, addressing three broad sets of skills: conceptual, social, and practical. “
True regarding ADHD?
> 50% are achievers
“Nelson 21st p262
ADHD is the most common neurobehavioral disorder of childhood and among the most prevalent chronic health conditions affecting school-aged children.
ADHD is characterized by inattention, including increased distractability and difficulty sustaining attention; poor impulse control and decreased self-inhibitory capability; and motor overactivity and motor restlessness.
Affected children usually experience academic underachievement, problems with interpersonal relationships with family members and peers, and low self-esteem. “
“In a child with stuttering. Which is true?
a. Refer to therapist before preschool years for better outcome
b. Place the child in stress free environment
c. No need for special school
d. None of the above”
A
“Nelson 21st p281-282
Developmental stuttering is a childhood speech disorder that is not associated with stroke, traumatic brain injury, or other possible medical conditions and that interrupts the normal flow of speech through repeated or prolonged sounds, syllables, or single syllable words.
DSM-5 refers to this disorder as childhood onset fluency disorder, and impact on functional behavior is a component of the psychiatric diagnosis of this condition.
If there is a positive family history for stuttering, if symptoms are present for >4wk, and if the dysfluencies are impacting a child’s social, behavioral, and emotional functioning, referral is warranted. Although there is no cure for stuttering, behavioral therapies are available that are developed and implemented by speech and language pathologists.
Treatment in preschool age-children has been shown to improve stuttering. For school-age children, treatment includes not only improving fluency but also concommittants of the condition. This includes recognizing and accepting stuttering and appreciating others’ reaction to the child when stuttering, managing secondary behaviors, and addressing avoidance behaviors. “
“Interpret Weight for age - less than 3?
a. Severe stunting
b. Severe wasting
c. Severely underweight
d. Stunting”
C
“Prev Ped 2016 p33 Figure 3. Z score interpretation
Length/Height for age
- Below -2: Stunted
- Below -3: Severely stunted
Weight for age
- Below -2: Underweight
- Below -3: Severely underweight
Weight for length/height
- Above 3: Obese
- Above 2: Overweight
- Above 1: Possible risk for overweight
- Below -2: Wasted
- Below -3: Severely wasted
BMI for age - Above 3: Obese
- Above 2: Overweight
- Above 1: Possible risk for overweight
- Below -2: Wasted
- Below -3: Severely wasted”
“Normal intelligence etc. but has a hard time reading.
a. Dyslexia
b. Dysarrthria
c. Dysphoria
d. Dysgraphia”
A
“Nelson 21st p267
The term dyslexia means an unexpected difficulty in reading for an individual who has the intelligence to be a much better reader, most commonly caused by a difficulty in the phonological processing (the appreciation of individual sounds of spoken language), which affects the ability of an individual to speak, read, and spell. “
“Mom frustrated because 2 year old child keeps using the left hand. She keeps telling him to use his right hand. What will you advise the mom?
a. Handedness is not established at this age
b. Train the child to use the right hand
c. Do not interfere with handedness
d. None of the above”
A
“Nelson 21st p143
Handedness is usually established by the 3rd yr. Fustration may result from attempts to change childrens’s hand preference. Variations in fine motor development reflect both individual proclivities and different opportunities for learning. Children who are restricted from drawing with crayons, for example, develop a mature pencil grasp later. “
“What to do with a 3 year old throwing temper tantrums in a toy store?
a. Ignore the child
b. Talk to the child and tell its wrong
c. Take child outside the store
d. Give the child a spanking”
A
“Nelson 21st p145
Control is a central issue. They are also prone to lose internal control, that is, to have temper tantrums. Fear, overtiredness, hunger, inconsistent expectations, or physical discomfort can also evoke tantrums. Tantrums normally appear toward the end of the 1st year of life and peak in prevalence between 2 and 4yr of age. Tantrums lasting more than 15min or regularly occuring more than 3x/day may reflect underlying medical, emotional, developmental, or social problems
Nelson 21st p241
The first key to office management of temper tantrums and breath holding spells is to help parents intervene before the child is highly distressed. The parent can be instructed to calmly remind the child of the expected behavior and the potential consequence if the expected behavior does not occur. If the child does not comply, he or she should be placed in time-out for a period approximating 1min for each year of age. Time out can be effectively used in children up to age 10 yr. Parents should also be advised to be mindful of their own reactions to the child’s tantrum behavior, to avoid an escalation of the child’s behavior caused by an angry parental response. “
“6 weeks old brought in the ER due to increased crying not previously noted. Good suck, Normal PE. What will you do/advise?
a. Colic, give spasmodic
b. Prone position
c. Normal for age
d. None of the above”
C
“Nelson 21st p136
Colic is characterized by the rule of 3. It occurs in a healthy, thriving infant beginning in the 2nd or 3rd week of life, lasts about 3 hr/day, occurs 3 days/wk, lasts more than 3wk, and resolved by 3 or 4 mo of age.
There is no specific treatment for colic, but practitioners should provide advice and reassurance to parents. Parents must be counseled about the problem, the importance of implementing a series of calm, systematic steps to soothe the infant, and having a plan for stress relief, such as time-out for parents and substitute caregivers. Parents can be advised that colic is self-limited and has no adverse effects on the child. The cause of colic is not known, and no medical intervention has been consistently effeective. “
“Adolescent came in with abnormal vaginal bleeding? Work up?
a. PT/PTT
b. Hgb/Hct
c. Liver function
d. Vaginal smear”
D
“Answer should be all of the above
Nelson p1060 Table 142.4 Laboratory tests to evaluate patients with abnormal uterine bleeding
- Total and free testosterone (if with s/sx suggestive of PCOS)
- Liver, kidney, and thyroid function studies
- Complete blood count with platelet count
- Urine pregnancy test
- NAAT for Chlamydia, Gonorrhea, Trichomonas
- PT/PTT
- Ferritin level
- VWB factor antigen, ristocetin cofactor, factor VIII activity
- Pelvic UTZ (if bleeding persists despite treatment) “
“Red flag of gross motor development?
a. 3 months with headlag
b. 7 months unable to sit
c. 18 months cannot walk
d. None of the above”
B
“Prev Ped 2018 p19
Gross motor red flags
4 1/2 months - does not pull up to sit
5 months - does not roll over
7-8 months - does not sit without support
9-10 months - does not stand while holding on
15 months - not walking
2 years - not climbing up or down the stairs
2 1/2 years - not jumping with both feet
3 years - unable to stand on 1 foot momentarily
4 years - not hopping
5 years - unable to walk in a straight line back and forth or balance on 1 foot for 5-10 seconds “
“To prevent child abuse?
a. Screening of the family during check ups for risk factors
b. Pediatrician should limit developmental history during check ups
c. Both of the above
d. None of the above”
A
“Nelson 21st p106
Prevention of child abuse and neglect
1. Parent and child education regarding medical conditions helps to ensure the implementation of a the treatment plan and prevent neglect
2. Screening for major psychosocial risk factors for maltreatment (depression, substance abuse, intimate partner violence, major stress) and helping address identified problems, often through referrals, may help prevent maltreatment.
3. Child healthcare professionals should also need to recognize their limitations and facilitate referrals to other community resources.
4. The problems underpinning child maltreatment, such as poverty, parental stress, substance abuse, and limited child-rearing resources, require policies and programs that enhance families’ abilities to care for their children adequately”
BW of 3000g. BL of 49cm. HC of 34cm. Expected anthropometrics at 4 months
Weight of 5400g, length of 58cm, head circumference of 42cm.
“Fundamentals of pediatrics p122 Table 8-1 Useful mnemonic for common growth standards
Weight
0-6 months: age in months x 600 + birth weight (g)
6-12 months: 3600 + (age in months after 6 months x 500) + birth weight (g)
1-6 years: age in years x 2 + 8 (kg)
7-12 years: 1/2 [(age in years x 7) - 5)] (in kg)
Length
0-3 months: birth length + 9cm
4-6 months: birth length + 9cm + 8cm
7-9 months: birth length + 9cm + 8cm + 5cm
10-12 months: birth length + 9cm +8cm + 5cm + 3cm
Length/height
2-12 years: age in years x 6 + 77 (cm)
Mid-parental height
All ages, boys: 1/2 [(paternal + maternal height) + 13] (in cm)
All ages, girls: 1/2 [(paternal + maternal height) - 13)] (in cm) “
“Z score above 2 weight for height
a. Normal
b. Overweight
c. Obese”
B
“Prev Ped 2016 p33 Figure 3. Z score interpretation
Length/Height for age
- Below -2: Stunted
- Below -3: Severely stunted
Weight for age
- Below -2: Underweight
- Below -3: Severely underweight
Weight for length/height
- Above 3: Obese
- Above 2: Overweight
- Above 1: Possible risk for overweight
- Below -2: Wasted
- Below -3: Severely wasted
BMI for age - Above 3: Obese
- Above 2: Overweight
- Above 1: Possible risk for overweight
- Below -2: Wasted
- Below -3: Severely wasted”
