Well Child

Question 1

Lead Screening

Answer 1

Risk assess at 6 mo, 9 mo, 18 mo, 3, 4, 5, 6 yr.

If in high risk area or Medicaid, lead test at 1 and 2 yrs

Question 2

TB test

Answer 2

Risk assess: by 1 mo, 6 mo annually 1-21 y

Question 3

dyslipidemia

Answer 3

Risk assess at 2,4,6,8, 12-17 annually

Screen at 10, 20

Question 4

STI/HIV

Answer 4

If sexually active 11-21, chlamydia screen.

Screen once between 16-18

Question 5

cervical dysplasia

Answer 5

once at 21

Question 6

Oral health

Answer 6

Risk assess or screen at 12 mo, 18 mo, 24 mo, 30 mos.

Screen at 3 yr, 6 yr.

Question 7

Rh incompatibility

Answer 7

When mom is Rh neg and fetus is Rh pos, fetal RBC enter mom’s blood and she forms antibodies. This can attack the fetus during birth or during a subsequent pregnancy –> hemolytic anemia

Question 8

Tx for Rh incompatibility

Answer 8

Screen initially, repeat again at 28 weeks. If Rh-, give RhoGAM between 28-30 weeks, and again w/in 72 hrs of delivery. RhoGAM prevents mom from developing anti Rh antibodies.

Question 9

Aplastic Anemia

Answer 9

Congeintal (Fanconi) or Acquired (NSAIDs, meds, vial infections)
SSx: Thrombocytopenia, Neutropenia, macrocytic Anemia
Dx: CBC, bone marrow bx
Tx: HSCT –> 80% survival, increased CA risk

Question 10

Thalassemia

Answer 10

Eti: African, Middle E, Asia. Abnormal Hgb –> RBC destruction. Alpha or Beta.
SSx: trait: mild microcytic anemia. mild B: homozygous chronic hemolytic anemia. major: develops transfusion, folic acid, splenectomy, HSCT.
Dx: Hgb electrophoresis, blood smear

Question 11

Sickle Cell

Answer 11

Eti: AA
SSx: bone pain, chest pain, tibial ulcers, poor healing
Dx: howell-jolly bodies, target cells
Tx: Folic acid, hydroxyurea

Question 12

Iron Def Anemia

Answer 12

Eti: Microcytic,
Sx: pallor, fatigue, Pica,
Tx: give Iron supplements

Question 13

G6PD

Answer 13

Eti: hemolysis –> heinz bodies during stress
Dx: Bite cells, blister cells

Question 14

Idiopathic Thrombocytopenic Purpura

Answer 14

Eti: Age 2-5, most common childhood bleeding disorder; post infection
Sx: acute, petechiae, ecchymoses, epistaxis
Dx: low platelets, increased megakaryocytes, normal PT and PTT
Tx: self-limiting. Transfusion if severe

Question 15

Hemophilia

Answer 15

Eti: missing either Factor VIII or IX. (8 or 9). X-link recessive - seen in boys.
Sx: hemarthrosis, bleeding
Dx: prolonged PTT, low factors
Tx: give factors

Question 16

VWD

Answer 16

Eti: inherited, caucasian
Sx: menorrhagia, prolonged bleeding
Dx: VWF assay; possible prolonged PTT
Tx: Desmopressin; VWF replacement

Question 17

Salmon patches

Answer 17

Nevus simplex, “stork bite”, angel kiss;

dilated capillaries; fade w/in 1 yr

Question 18

Erythema Toxicum

Answer 18

full term, begin 24-48 hrs from birth; blotchy red macules 2-3 cm w/ central vesicle/pustule.
Chest, back, face, proximal extremities (spares palms, soles).
Eosinophils in lesions.
Lasts 1 week.

Question 19

Acne Neonatorum

Answer 19

2-4 weeks old
Tx: topical erythromycin or benzoyl peroxide.
Resolves 6 mo-1 yr spontaneously.