Well Child Exam

Question 1

What is vernix caseosa? What is it made from?

Answer 1

Cheesy white covering

Made from fetal corneocytes/sebaceous activity

Rich lipid matrix

Question 2

What is milia?

Answer 2

Pinpoint white papules w/out erythema

Question 3

What is milia caused by?

Answer 3

Blocked sebaceous glands

Question 4

What are mongolian spots?

Answer 4

Congenital dermal melanocytosis

Question 5

What population is most often affected by mongolian spots?

Answer 5

Asian, NA, Hispanic, East Indian, African

Question 6

What is erythema toxicum?

Answer 6

Yellow eosinophilic papules on red base

Question 7

What is erythema toxicum caused by?

Answer 7

Unknown but may be due to immaturity of pilosebaceous follicles

Question 8

What are 2 signs of elevated ICP?

Answer 8

Widely split sutures

Bulging fontanelles

Question 9

What is a sign of craniosynostosis?

Answer 9

A raised, bony ridge at a suture line

Question 10

A large fontanelle can be the 1st sign of….

Answer 10

congenital hypothyroidism

Question 11

When does the anterior vs the posterior fontanelle close?

Answer 11

Anterior: 9-18mos

Posterior: 1-2mos

Question 12

What is the size of the anterior vs the posterior fontanelle?

Answer 12

Anterior: 1-4cm

Posterior: < 1cm

Question 13

Which extracranial finding can cross the suture lines?

Answer 13

Caput succedaneums

*Cephalohematomas CANNOT

Question 14

What can ankyloglossia lead to?

Answer 14

Limited movement of tongue

Pain w/ nursing

Speech difficulty or dental problems

Puckering of tongue tip

Question 15

What is the tx of ankyloglossi?

Answer 15

Frenulectomy in neonatal period

Question 16

What causes congenital torticollis (“wry neck”)?

Answer 16

Bleeding into the SCM muscle during birth

Question 17

What is pectus excavatum vs pectus carinatum? Which is MC?

Answer 17

Excavatum: “funnel chest”, sternal depression (MC)

Carinatum: “chicken breast or pigeon chest”

Question 18

Are pectus abnormalities more common in boys or girls?

Answer 18

Boys!

Question 19

Diminished femoral pulses may indicate what?

Answer 19

Coarctation of aorta

Question 20

What are common non-cardiac findings in infants w/ cardiac disease?

Answer 20

Poor feeding, failure to thrive, irritability

Tachy, hepatomegaly, clubbing

Weakness

Question 21

What is a common dysrhythmia seen in infants & children?

Answer 21

HR increasing on inspiration & decreasing on expiration

Question 22

What is the MC dysthymia in infants?

Answer 22

PSVT

Question 23

Undescended testicles are most common in…

Answer 23

Pre term infants

Question 24

Describe 2 variations of urethral openings

Answer 24

Hypospadias: ventral

Epispadias: dorsal

Question 25

What are 3 variants of hypospadias?

Answer 25

Subcoronal Midshaft Penoscrotal

Question 26

What are 2 common scrotal masses in newborns? What side are they MC on?

Answer 26

Hydroceles & inguinal hernias MC on right side

Question 27

Compare & contrast hydroceles vs hernias

Answer 27

Hydrocele: overlie testes & spermatic cord, transilluminate, resolve by 18mos Hernias: separate from testes, reducible

Question 28

What imaging should you perform if you are unable to see the bottom of a sacral dimple?

Answer 28

U/S! Could be a sign of imperforate anus or spina bifida

Question 29

What are RFs for dysplasia of the hips (DDH)?

Answer 29

Breech, caucasian, 1st born female Family hx, prior child born w/ DDH Premature

Question 30

What 2 maneuvers can you use to detect DDH?

Answer 30

Barlow: tests for ability to sublux or dislocate Ortolani: tests for posterior dislocation

Question 31

What are signs of DDH?

Answer 31

Audible "click" Asymmetrical leg creases

Question 32

How do you treat DDH?

Answer 32

Ortho eval & pavlik harness

Question 33

At what age can you perform palmar grasp vs plantar grasp?

Answer 33

Palmar: birth to 3-4mos Plantar: birth to 6-8mos

Question 34

What is the moro reflex?

Answer 34

Hold baby supine & abruptly lower body 2ft Arms should abduct & extend, legs should flex

Question 35

What does an asymmetric moro reflex indicate?

Answer 35

Fx of clavicle or brachial plexus injury

Question 36

What is the asymmetric tonic neck reflex?

Answer 36

"bow & arrow position"

Question 37

What is the positive support reflex?

Answer 37

Baby stands up w/ help, partially bearing weight, & sags after 20-30 secs

Question 38

Lack of a positive support reflex indicates...

Answer 38

Hypotonia & flaccidity

Question 39

What is the rooting reflex?

Answer 39

Skin at corners of mouth are stroked --> mouth opens & head turns toward stimulated side

Question 40

What is trunk incurvation?

Answer 40

Stroke 1 side of back from shoulder to buttocks Spine will curve toward stimulated side

Question 41

Absence of trunk incurvation indicates...

Answer 41

Transverse SC lesion

Question 42

What is the MC cause of childhood blindness?

Answer 42

Amblyopia

Question 43

At what age should you start checking BP?

Answer 43

3yo

Question 44

What RFs warrant earlier BP check?

Answer 44

Kidney disease, prematurity Congenital HD, recurrent UTIs, hematuria or proteinuria

Question 45

At what age should you screen for iron deficiency?

Answer 45

9-12mos

Question 46

At what age should you screen for lead?

Answer 46

1-2yo

Question 47

At what age should you screen for autism?

Answer 47

18-24mos

Question 48

What RFs warrant lipid panel testing in 2-10yo?

Answer 48

FH of: HLD, early CV disease, obesity, overweight, HTN, DM

Question 49

At what age should one's 1st dental exam be performed?

Answer 49

12mos-3yo

Question 50

How long does the car seat remain rear facing? What height requires booster seat?

Answer 50

Until 2yo 4'9" & under

Question 51

At what age, can you sit in the front seat?

Answer 51

13

Question 52

What are milestones at 1 month old?

Answer 52

Head control Responds to sounds/noises Spontaneous smile

Question 53

What are 2 mos milestones?

Answer 53

Responsive smile Coos/vocalizes Lifts head when prone Follows TO midline

Question 54

What are 4 mos milestones?

Answer 54

Rolls from tummy to back Laughs, squeals Follows PAST midline Grasps toys/objects

Question 55

What are 6 mos milestones?

Answer 55

- Sits w/ support - Bears wt on legs - "ba, da-da" - Reaches out for toys - Follows 180 degrees - Stranger danger/ separation anxiety

Question 56

What are 9 mos milestones?

Answer 56

``` Crawls Pulls up on furniture "mama/dada" Pincer grasp Responds to name ```

Question 57

What are 12 mos milestones?

Answer 57

Walks Waves Points Self feeds w/ fingers

Question 58

What are 15 mos milestones?

Answer 58

3-6 words Climbs stairs Imitates actions

Question 59

What are 18 mos milestones?

Answer 59

``` 5-15 words Spoon/fork Scribbles Follows commands Runs, walks backward ```

Question 60

What are 24 mos milestones?

Answer 60

``` 20-50 words 2 word phrases Kicks Builds Speech understandable ```

Question 61

What are ADEs of the Hep B vaccine?

Answer 61

Fever | Pain at injection site

Question 62

What are ADEs of the rotavirus vaccine?

Answer 62

Intussusception V/D, cough, rhinitis

Question 63

What are ADEs of the DTaP vaccine?

Answer 63

Swelling, redness at site | Fever

Question 64

What are ADEs of PCV13?

Answer 64

Fever, local rxn, irritability , changes in sleep Febrile seizures if administered w/ flu vaccine

Question 65

What are ADEs of the IPV vaccine?

Answer 65

Redness, pain at injection site

Question 66

What are ADEs of the MMR vaccine?

Answer 66

Fever Morbilliform rash GBS

Question 67

What are ADEs of the Hep A vaccine?

Answer 67

Pain, swelling, induration at injection site HA Loss of appetite