Well Child Exam

Question 1

AAP recommended well visit schedule

Answer 1

Birth
1 mo
2 mo
4 mo
6 mo
9 mo
12 mo
15 mo
18 mo
2 yr

Question 2

What is measured in a newborn and pediatric growth curve?

Answer 2

• height
• weight
• head circumference (Tracked until 2-3 years)
• BMI (at 2 years)

Question 3

Growth curve

Answer 3

Overweight =85-95%
Obese = >95%
Underweight =<5%

Microcephaly= <3%
Macrocephaly = >97%

Question 4

When is a baby technically preterm?

Answer 4

<37 weeks

Question 5

What is normal birth weight?

Answer 5

> 2500 grams is normal

Low is <25000gm
Very low is <15000gm

Question 6

What range is appropriate for gestational age?

Answer 6

10-90%ile

Question 7

Neonatal period

Answer 7

1-28 days

Question 8

Post neonatal period

Answer 8

29th day - 1 year

Question 9

Apgar Score

Answer 9

Key assessment off the newborn immediately after birth (minute 1 and minute 5)

—SCORE OUT OF 10—

HR: 0-absent, 1- slow, 2 >100

Respiratory effort: 0- absent, 1-slow, 2-good, crying

Muscle tone: 0-limp, 1-some flexion, 2-active motion

Response to catheter in nostril: 0-none, 1 - grimace, 2 - cough or sneeze

color: 0-blue or pale, 1 - body pink, extremities blue, 2- fully pink

Question 10

When is the genetic newborn screen done?

Answer 10

heel stick before discharge and again at 7-14 days of life

Question 11

Color of baby

Answer 11

Cyanosis- mild is normal at birth but should turn pink soon

Peripheral cyanosis (finger tips) - can be normal for 1-2 days

Question 12

Vernix Caseosa

Answer 12

• cheesy white covering
• made from fetal corneocytes/sebaceous gland activity
• rich lipid matrix

Question 13

Milia

Answer 13

• pinpoint white papules without erythema
• blocked sebaceous glands
• located on nose, chin, forehead & cheeks

Question 14

Mongolian Spot

Answer 14

• aka congenital dermal melanocytosis
• blue patches of pigment
• location: lumbar area, buttocks, or extremities
• fade with time
• seen in asian, native american, hispanic, african

Question 15

Erythema Toxicum

Answer 15

• yellow eosinophillic papules on a red base
• Appear on day 2-4
• Location: trunk
• etiology thought to be due to immaturity of the pilosebaceous follicles
• Timing: usually disappear in the 2nd week of life

Question 16

Craniosynostosis

Answer 16

raised, bony ridge at a suture line (premature ossification of the suture line)

Question 17

What endocrine disorder can be associated with large fontanelles?

Answer 17

hypothyroidism

Question 18

Fontanelle closure

Answer 18

anterior fontanelle: closes by 9-18 months

Posterior fontanelle: closes by 1-2 months

Question 19

Cephalohematoma

Answer 19

swelling/collection of blood over one or both parietal bones
-DOESN’T cross the suture lines

-resolves in weeks to months

Question 20

Caput Succedaneum

Answer 20

• edema of the scalp
• Can cross suture lines
• resolves in days

Question 21

Hypetelorism

Answer 21

abnormally wide eyes

Question 22

During what age are babies nose breathers so you need to be careful about keeping their nose open

Answer 22

<1 month

Question 23

What do you do to the auricle to examin a babies ear?

Answer 23

pull auricle down

Question 24

Epstein’s pearls

Answer 24

small white inclusion cysts

• benign
• on palate
• seen between 2-4 months

Question 25

Ankyloglossia (tongue tie)

Answer 25

- limits movement of tongue - can interfere with nursing - puckering of midline of tongue** Tx: cut it

Question 26

Congenital torticollis "wry neck"

Answer 26

- from bleeding into the sternocleidomastoid during birth - firm fibrous mass within the muscle 2-3 wks after birth - will disappear on its own

Question 27

Upper airway sounds

Answer 27

- harsh and loud - symmetric - louder as stethoscope moves up chest - inspiratory

Question 28

Lower airway sounds

Answer 28

- asymmetric - louder going toward abdomen - expiratory

Question 29

If you find a diminished femoral pulse what might that be from?

Answer 29

coarctation of the aorta

Question 30

MC dysrhythmia in infants

Answer 30

paroxysmal supra ventricular tachycardia (PSVT)

Question 31

How many arteries and veins are in the umbilical cord?

Answer 31

2 - umbilical arteries | 1 - umbilical vein

Question 32

Which side are hydroceles and inguinal hernias more likely to occur on?

Answer 32

Right

Question 33

Hernia vs. Hydrocele

Answer 33

Hernias are reducible, do not transillumiate Hydroceles don't reduce, can be transilluminated, resolve on their own

Question 34

If you can't see the bottom of a sacral dimple, what test needs to be done?

Answer 34

Ultrasound

Question 35

During physical exam what would raise suspicion of a developmental displasia of the hips?

Answer 35

Audible click with Barlow or Ortolani (posterior hip dislocation) -asymmetry of the hips

Question 36

Treatment for developmental hip dysplasia?

Answer 36

- pavlik harness | - ortho eval

Question 37

Palmar grasp

Answer 37

- baby will grasp your thumb | - birth - 3-4 months

Question 38

Plantar grasp (babinski)

Answer 38

- toes will curl when you touch sole of baby's foot | - Birth to 6-8 months

Question 39

Moro Reflex (Startle Reflex)

Answer 39

- Abruptly lower baby while supine - arms should abduct and extend, hands open, legs flex - Birth to 4 months **If they continue to do this beyond this time frame suggests neurologic disease *asymmetric response indicated fracture of clavicle or brachial plexus injury

Question 40

Asymmetric Tonic Neck Reflex

Answer 40

- when you turn the head to one side, the baby will flex the arm and leg on the opposite side - Birth to 2 months

Question 41

Positive Support Reflex

Answer 41

- hold baby upright on its feet - should partially bear weight for 20-30 seconds - 2-6 months

Question 42

Rooting reflex

Answer 42

stroking perioral skin will cause baby to turn head to stimulated side and open mouth. -birth to 3-4 months

Question 43

Trunk incurvation (Galant's Reflex)

Answer 43

- hold baby prone - stroke alongside the spine from the shoulder to buttock - spine will curve to stimulated side -birth to 2 month

Question 44

Placing and Stepping Reflexes

Answer 44

- like the positive support reflex but only one foot touches tabletop - look for other foot to step forward

Question 45

What is the most common cause of childhood blindness?

Answer 45

amblyopia

Question 46

When should you start checking BP?

Answer 46

start at age 3

Question 47

When do you screen for iron deficiency?

Answer 47

9 months or 12 months

Question 48

Rear facing car seat until what age?

Answer 48

2 years

Question 49

Booster seat until how tall?

Answer 49

4'9" | -No front seat until 13 years old

Question 50

1 month old

Answer 50

- follows face - some head control - responds to sounds - spontaneous smile

Question 51

2 month old

Answer 51

- Responsive smile - coos/vocalizes - lifts head when prone - follows to midline

Question 52

4 month

Answer 52

- rolls from tummy to back - good head control - laughs, squeals - follows past midline - grasps toys

Question 53

6 month

Answer 53

- sits with support - bears weight on legs - vocalizes "ba da" - reaches out for toys - follows 180 degrees - stranger danger/separation anxiety

Question 54

9 month

Answer 54

- crawls - pulls up to stand - "mama" "dada" - pincer grasp****

Question 55

12 months

Answer 55

- walks - waves bye-bye - points with index finger - self feeding

Question 56

15 months

Answer 56

- 3 to 6 words - walks well - climbs stairs - imitates actions

Question 57

18 months

Answer 57

- 5-15 words - some 2 word phrases - uses spoon/fork - scribbles - runs, walks backwards

Question 58

24 months

Answer 58

- 20-50 words or more - 2 word phrases - kicks ball - builds 3-4 block tower

Question 59

What is a contraindication to the Hep B vaccine?

Answer 59

severe allergy to yeast

Question 60

What are some contraindications to the rotavirus vaccine?

Answer 60

- Hx of intussusception | - Severe Combined Immunodeficiency

Question 61

DTaP vaccine

Answer 61

- 5 total vaccines | - Diphtheria, Tetanus, Pertussis

Question 62

HIB (Haemophilus influenzae type B)

Answer 62

-4 total vaccines contraindications: - infant under 6 weeks

Question 63

IPV (Poliomyelitis)

Answer 63

NO longer a live vaccine** | contraindicated in pregnancy

Question 64

MMR vaccine

Answer 64

- Measles, Mumps, Rubella - 2 total shots - live vaccine (so pregnant ladies cannot get this)

Question 65

Varicella

Answer 65

- live vaccine | - 2 doses

Question 66

Hepatitis A

Answer 66

-2 doses