Pedi Well Visit
At which of the following ages in a young child's life is parental anticipatory guidance about infant sleep position most helpful?
A. Birth
B. 2 weeks
C. 2 months
D. 4 months
A. Birth
You palpate a patient's fundal height to be at the level of the umbilicus. Based on this you estimate they are around ___ weeks pregnant.
20 weeks (assuming single gestation, normal pregnancy). IUGR, twin pregnancy and the presence of large fibroids can alter this. You would always want to check an ultrasound if the GA is not known.
During a well neonate visit for a healthy 2 week old born at 41 weeks gestation you expect the baby will have:
A. A visual preference for the human face
B. Hear low pitched voices best
C. Will not react to the cry of other neonates
D. A poorly developed sense of smell
A. A visual preference for the human face.
Neonates hear high-pitched voices best (think of how you raise the pitch of your voice when talking to a baby!).
They do react the the cry of other babies
Smell is one of the best developed senses at birth
Common signs and symptoms of pertussis in a 3 year old child include all of the following except:
A. Uncontrollable cough
B. Vomiting
C. Fatigue
D. Diffuse rash
D. Diffuse rash
What is the correct intervention for candida vulvovaginitis>
A. Clotrimazole cream
B. Oral metronidazole
C. Metronidazole gel
D. Clindamycin cream
A. Clotrimazole cream
Bonus - what do the other options all treat?
When counseling parents about safe sleeping, the NP advises:
A. Position the baby on the side w/ a positioning wedge as he is most comfortable
B. Place the baby in a face-up position in the crib
C. Place a soft bumper in the crib to minimize risk of injury
D. Even when the caregiver is in attendance, the tummy down position is never safe in the first 2 months of life
The duration of therapy of a symptomatic urinary tract infection in pregnancy is:
A. 3 days
B. 5 days
C. 7 days
D. 10 days
C. 7 days
Bonus - Can you name some options for treatment?
A healthy 6-7 month old infant is able to:
A. Roll from back to stomach
B. Confidently self feed a cracker
C. Reach for an object
D. Crawl on abdomen
A. Roll from back to stomach
A 16 year old presents with 3 days of pharyngitis and fatigue. Findings include exudative pharyngitis, minimally tender anterior and posterior cervical LAD and right and left upper quadrant abdominal tenderness. This is most consistent with...
Infectious mononucleosis
The average onset of perimenopause in North American women is between the ages of:
A. 35-40 y/o
B. 40-45 y/o
C. 45-50 y/o
D. 50-55 y/o
B. 40-45 y/o
You see a child who resists being placed in a supine position on the exam stable, cries loudly when her parent is out of view and has visibly erupting lower central incisors. This child is approximately what age?
A. 6-8 weeks
B. 3-4 months
C. 7-8 months
D. 2-3 years
C. 7-8 months. Stranger anxiety setting in! Teething varies child to child but typically we see upper and lower central incisors erupt between 6-10 months.
Symptoms of postpartum depression include all of the following except:
A. Hallucinations
B. Overwhelming fatigue
C. Insomnia
D. Severe mood swings
A. Hallucinations (postpartum psychosis)
The following benchmarks indicate normal development by a healthy child born at term who is now 12 months old (Choose all that apply)
A. Talking in 2 word sentences
B. Pointing to a desired object
C. Reaching for a desired object
D. Walking backward
B and C
A day day old infant presents with multiple raised lesions resembling flea-bites over the trunk and nape of the neck. The infant is nursing well and has no fever or exposure to animals. These lesions likely represent:
A. erythema toxicum neonatorum
B. Milia
C. Acne neonatorum
D. Staphylococcal skin infection
A. Erythema toxicum neonatorum
Irregular bleeding associated w/ Depo Provera can be minimized with the use of all of the following except:
A. Acetaminophen
B. Ibuprofen
C. Naproxen sodium
D. Estrogen supplements
A. Acetaminophen
"Infancy" ends at how many months old?
12 months
A high blood pressure diagnosed after the 20th week of pregnancy diagnosed as:
A. Chronic hypertension
B. Gestational hypertension
C. Preeclampsia
D. HELLP syndrome
B. Gestational hypertension
The pincher grasp is a __ month milestone
9 month
Palmer grasp comes earlier (6 months). Still ok to let babies practice self feeding as early as 6 months though this will be easier once a pincher grasp develops.
Preferred first-line treatment for AOM in children without a PCN allergy includes:
A. Cefdinir 14mg/kg/day in 1 or 2 doses
B. Ceftriaxone 50mg IM
C. Azithromycin 30mg/kg/day
D. Amoxicillin 80-90mg/kg/day in 2 divided doses
D. Amoxicillin 80-90mg/kg/day (not to exceed adult dosing). AKA "High-dose" amoxicillin.
Which of the following is a worrisome finding noted during pelvic examination on a 62 year old woman?
A. Flattening of the vaginal rugae
B. Vaginal PH = 5.6
C. Ovary palpable on bimanual exam
D. Scant white vaginal discharge
C. Ovary palpable on bimanual exam. Post-menopause ovaries should not be palpable. No cysts are forming. Worrisome for ovarian mass/cancer.
AAP recommends that exclusively and partially breastfed infants receive supplements of ___ units/day of Vitamin ___ shortly after birth and that they continue these supplements until they are weaned and consuming >1000 ml/day of fortified formula or whole milk.
400 units of vitamin D.
In the first weeks of a viable intrauterine pregnancy, serum quantitative hCG levels usually double every ___ hours until approximately 10,000-20,000 mIU/ml.
48 hours
"My 15 month old only says 4-6 words!". You counsel this parent that... (select all that apply)
A. Early intervention may be helpful
B. This is considered normal
C. By 24 months we expect children to have up to a 300 word vocabulary
D. Most 15 month olds only have one or two words
B. and C. - parents will notice an explosion of speech between 15 and 24 months. Their child is right on track.
A 6 y/o boy presents w/ a 1 day history of a fiery red, maculopapular facial rash concentrated on the cheeks. He has had a mild headache and myalgia for the past week. The most likely diagnosis is:
A. Erythema infectiosum
B. Roseola
C. Rubella
D. Scarlet fever
A. Erythema infectiosum AKA Fifth's disease caused by Parvovirus B19.
Bonus - treatment for this includes ...
A 32 year old woman is here to review the results of her recent liquid-based pap screening that revealed: atypical squamous cells of unknown significance and high risk HPV positive. She has no known history of previous abnormal cytology. Her last screening was 3 years ago. The most appropriate next step is to:
A. Advise her to return in 6 months for repeat pap and HPV testing.
B. Obtain swabs for GC/chlamydia testing
C. Refer for colposcopy
D. Counsel her that the usual cervical cancer screening guidelines should be followed
C. Refer for colposcopy