Preschool

Question 1

Erikson Developmental Stage

Answer 1

Initiative v. Guilt
Initiate activity
Sensitive to criticism
Learn by giving stimuli or copying you

Question 2

Piaget Developmental Stage

Answer 2

Pre conceptual Phase
Egocentrism
Unable to connect the reversible operation
Magical Thinking- little basis in reality

Question 3

Sleep pattern

Answer 3

10-12 hours/night

Question 4

Physical Changes

Answer 4

Protuberant abdomen disappears, pelvis straightens, abdominal muscles develop
All primary teeth have developed
CV system enlarges in proportion to general body growth
Legs grow faster than rest of body

Question 5

Growth Rate

Answer 5

Gain 4 lbs. (2 kilos) of body weight per year
Gains 7cm (2 inches) of height each year
Head reaches 80% of adult size
Refer growth to visualize normal patterns
(height, weight and head circumference)

Question 6

Organ Development

Answer 6

Kidneys reach full maturity- toilet training can only happen after 18 months
Lung capacity increases, RR decreases
Tonsils and adenoids increase in size
Refer for:
- hydrocele (swelling in testes) transillumination & shift
- undescended testes
- UTI (think anatomical problems, hygiene, sex abuse)
- frequent OM- may lead to hearing loss

Question 7

Nutrition

Answer 7

Require: 90 kcal/kg (avg. 1800 calories daily)

• Protein: 13-19g/day
• Total fat intake: 20-30% of intake
• 5 servings of fruits and vegetables daily

Question 8

3 year milestones: motor

Answer 8

Climbs, walks, alternates feet in stair climbing
Opens doors, turns knobs
Builds 9 block tower
Holds pencil, draws circles
Feeds self
Can put on some clothing and shoes
Peddles tricycle

Question 9

4 year milestones: motor

Answer 9

Skipping/hopping on one foot, walks on tiptoes
Catches ball
Uses scissors, can cut and paste
Dresses and Undresses with supervision (no laces/zippers)
Copies squares, some uppercase letters
Brushes own teeth and washes own hands

Question 10

5 year milestones: motor

Answer 10

Stands on one foot for 10 seconds, hops and somersaults
Can print own name
Copies triangle
Jumps rope
Dresses and undresses independently
Uses eating utensils
Ties shoe laces

Question 11

3 year milestones: social, cognitive, emotional

Answer 11

Egocentric
Imitates adults and playmates
Plays make-believe
Tolerates periods of separation from parents
Has nightmares, fears
Parallel and associative play
Sorts objects by shape and color
Follows directional commands
Inquisitive and talkative

Question 12

4 year milestones: social, cognitive, emotional

Answer 12

Better understanding of time
Less egocentric
Associative play
Follows 3-part commands
Correctly names some colors
Understands concept of counting

Question 13

5 year milestones: social, cognitive, emotional

Answer 13

Can count 10 or more objects
Associative play
Has fewer fears
Eager to please

Question 14

3 year milestones: language

Answer 14

Vocabulary about 900 words
Speaks 4-5 word sentences
Speech mostly intelligible
Can say age, name, and sex

Question 15

4 year milestones: language

Answer 15

Vocabulary about 1500 words
Speaks 5-6 word sentences
Tells stories
Follow basic grammatical rules

Question 16

5 year milestones: language

Answer 16

Vocabulary about 2100 words
Speak 6+ word sentences
Can define some words
Knows days of week, and months
Prints some letters of the alphabet
Uses future tense
Knows address

Question 17

3 year old physical: exam

Answer 17

Height, weight, BMI, growth chart
BP starts at age 3
Hearing & Vision Screening
Refer for dental screening (do oral exam: cavities, tooth decay, bottle feeding)

Question 18

3 year old physical: lab work

Answer 18

Urinalysis: 
- pos. protein => kidney problem
- leukocytes => UTI
- blood
- glucose => DM
Hemoglobin/hematocrit (anemia screening)
Lead (based on risk factors, blood test)
Cholesterol screening with risk factors

Question 19

Who mandates TB testing?

Answer 19

Entry to daycare, school, summer camp, college

Question 20

How should TST be placed?

Answer 20

Placed intra-dermally in forearm, 2-4 inches below elbow
Use 0.1mL solution in TB syringe
Record location of TST placement, lot #, expiration date
Follow up: 48-72 hours, measure reaction in millimeters
If positive: must notify the health department

Question 21

Safety Topics

Answer 21

Poisoning: lead, cleaning supplies, imported toys, plants, vitamins, alcohol, medications
Choking: small toys, meds, toxic materials
Traffic and street-crossing
Guns a firearms- locked
Secondhand smoke- esp. with asthma
Safety helmets
Refer for car seats

Question 22

What is the most common neurobehavioral disorder in preschool?

Answer 22

ADHD- 4-12%
Inattention, distractibility, impulsivity and hyperactivity
Diagnosed around 4 years old
MRI- see smaller right side of the brain
Child may have trouble in school: underachievement, behavioral problems, disruptive in class, playground conflicts, aggressive behavior, daydream, short attention span
Symptoms exist in ALL settings: school, home, play

Question 23

What differential diagnosis should be explored with suspected ADHD?

Answer 23

Look at family history and current home life
Mania
Bipolar
Conduct or oppositional defiant disorder
Learning disability
Neurological disorder

Question 24

What history is needed when diagnosing ADHD?

Answer 24

Birth hx- premie, substance use during pregnancy, trauma?
Developmental milestones- was there a delay?
Illnesses- poor vision, ear infection, head trauma?
Family hx- mental illness, substance abuse?
School performance?

Question 25

What should the physical exam include when diagnosing ADHD?

Answer 25

Height, weight, head circumference, growth curve
Hearing
Vision
Exam: neuro, eyes, ears, heart
Lead level
Behavior in our office

Question 26

Referrals and treatments of ADHD

Answer 26

Refer to pediatric psychiatry
May refer back for EKG (b/c stimulant tx) and complete metabolic panel
Med prescribed by psych: maybe you will refill, if discussed
Treatment: stimulant + behavioral therapy

Question 27

Counseling for ADHD

Answer 27

Routine follow-up
Diet
Refer for support networks