Well Child Exam Flashcards
What is vernix caseosa? What is it made from?
Cheesy white covering
Made from fetal corneocytes/sebaceous activity
Rich lipid matrix
What is milia?
Pinpoint white papules w/out erythema
What is milia caused by?
Blocked sebaceous glands
What are mongolian spots?
Congenital dermal melanocytosis
What population is most often affected by mongolian spots?
Asian, NA, Hispanic, East Indian, African
What is erythema toxicum?
Yellow eosinophilic papules on red base
What is erythema toxicum caused by?
Unknown but may be due to immaturity of pilosebaceous follicles
What are 2 signs of elevated ICP?
Widely split sutures
Bulging fontanelles
What is a sign of craniosynostosis?
A raised, bony ridge at a suture line
A large fontanelle can be the 1st sign of….
congenital hypothyroidism
When does the anterior vs the posterior fontanelle close?
Anterior: 9-18mos
Posterior: 1-2mos
What is the size of the anterior vs the posterior fontanelle?
Anterior: 1-4cm
Posterior: < 1cm
Which extracranial finding can cross the suture lines?
Caput succedaneums
*Cephalohematomas CANNOT
What can ankyloglossia lead to?
Limited movement of tongue
Pain w/ nursing
Speech difficulty or dental problems
Puckering of tongue tip
What is the tx of ankyloglossi?
Frenulectomy in neonatal period
What causes congenital torticollis (“wry neck”)?
Bleeding into the SCM muscle during birth
What is pectus excavatum vs pectus carinatum? Which is MC?
Excavatum: “funnel chest”, sternal depression (MC)
Carinatum: “chicken breast or pigeon chest”
Are pectus abnormalities more common in boys or girls?
Boys!
Diminished femoral pulses may indicate what?
Coarctation of aorta
What are common non-cardiac findings in infants w/ cardiac disease?
Poor feeding, failure to thrive, irritability
Tachy, hepatomegaly, clubbing
Weakness
What is a common dysrhythmia seen in infants & children?
HR increasing on inspiration & decreasing on expiration
What is the MC dysthymia in infants?
PSVT
Undescended testicles are most common in…
Pre term infants
Describe 2 variations of urethral openings
Hypospadias: ventral
Epispadias: dorsal
What are 3 variants of hypospadias?
Subcoronal
Midshaft
Penoscrotal
What are 2 common scrotal masses in newborns? What side are they MC on?
Hydroceles & inguinal hernias
MC on right side
Compare & contrast hydroceles vs hernias
Hydrocele: overlie testes & spermatic cord, transilluminate, resolve by 18mos
Hernias: separate from testes, reducible
What imaging should you perform if you are unable to see the bottom of a sacral dimple?
U/S!
Could be a sign of imperforate anus or spina bifida
What are RFs for dysplasia of the hips (DDH)?
Breech, caucasian, 1st born female
Family hx, prior child born w/ DDH
Premature
What 2 maneuvers can you use to detect DDH?
Barlow: tests for ability to sublux or dislocate
Ortolani: tests for posterior dislocation
What are signs of DDH?
Audible “click”
Asymmetrical leg creases
How do you treat DDH?
Ortho eval & pavlik harness
At what age can you perform palmar grasp vs plantar grasp?
Palmar: birth to 3-4mos
Plantar: birth to 6-8mos
What is the moro reflex?
Hold baby supine & abruptly lower body 2ft
Arms should abduct & extend, legs should flex
What does an asymmetric moro reflex indicate?
Fx of clavicle or brachial plexus injury
What is the asymmetric tonic neck reflex?
“bow & arrow position”
What is the positive support reflex?
Baby stands up w/ help, partially bearing weight, & sags after 20-30 secs
Lack of a positive support reflex indicates…
Hypotonia & flaccidity
What is the rooting reflex?
Skin at corners of mouth are stroked –> mouth opens & head turns toward stimulated side
What is trunk incurvation?
Stroke 1 side of back from shoulder to buttocks
Spine will curve toward stimulated side
Absence of trunk incurvation indicates…
Transverse SC lesion
What is the MC cause of childhood blindness?
Amblyopia
At what age should you start checking BP?
3yo
What RFs warrant earlier BP check?
Kidney disease, prematurity
Congenital HD, recurrent UTIs, hematuria or proteinuria
At what age should you screen for iron deficiency?
9-12mos
At what age should you screen for lead?
1-2yo
At what age should you screen for autism?
18-24mos
What RFs warrant lipid panel testing in 2-10yo?
FH of: HLD, early CV disease, obesity, overweight, HTN, DM
At what age should one’s 1st dental exam be performed?
12mos-3yo
How long does the car seat remain rear facing? What height requires booster seat?
Until 2yo
4’9” & under
At what age, can you sit in the front seat?
13
What are milestones at 1 month old?
Head control
Responds to sounds/noises
Spontaneous smile
What are 2 mos milestones?
Responsive smile
Coos/vocalizes
Lifts head when prone
Follows TO midline
What are 4 mos milestones?
Rolls from tummy to back
Laughs, squeals
Follows PAST midline
Grasps toys/objects
What are 6 mos milestones?
- Sits w/ support
- Bears wt on legs
- “ba, da-da”
- Reaches out for toys
- Follows 180 degrees
- Stranger danger/ separation anxiety
What are 9 mos milestones?
Crawls Pulls up on furniture "mama/dada" Pincer grasp Responds to name
What are 12 mos milestones?
Walks
Waves
Points
Self feeds w/ fingers
What are 15 mos milestones?
3-6 words
Climbs stairs
Imitates actions
What are 18 mos milestones?
5-15 words Spoon/fork Scribbles Follows commands Runs, walks backward
What are 24 mos milestones?
20-50 words 2 word phrases Kicks Builds Speech understandable
What are ADEs of the Hep B vaccine?
Fever
Pain at injection site
What are ADEs of the rotavirus vaccine?
Intussusception
V/D, cough, rhinitis
What are ADEs of the DTaP vaccine?
Swelling, redness at site
Fever
What are ADEs of PCV13?
Fever, local rxn, irritability , changes in sleep
Febrile seizures if administered w/ flu vaccine
What are ADEs of the IPV vaccine?
Redness, pain at injection site
What are ADEs of the MMR vaccine?
Fever
Morbilliform rash
GBS
What are ADEs of the Hep A vaccine?
Pain, swelling, induration at injection site
HA
Loss of appetite
