Red flags!!!
What are the red flags at 2 months of age?
Does not alert to voice.
Cannot raise head when prone.
Lack of looking at faces/lack of fixation.
A 7-year-old girl comes into your office to get her flu vaccine but is allergic to eggs.
Can you still give her a flu vaccine, or do you have to refer her to an allergist? Which vaccine is contraindicated?
You can still give her a flu vaccine. Yellow fever vaccine is contraindicated.
The inactivated trivalent and quadrivalent influenza vaccine (IIV) is produced in eggs, but data have shown that IIV can be safely given to people with egg allergy. According to the Joint Task Force on Practice Parameters (representing the American Academy of Allergy, Asthma, and Immunology and the American College of Allergy, Asthma, and Immunology), the special precautions regarding medical setting and waiting periods after the administration of IIV to egg-allergic recipients beyond those recommended for any vaccine (i.e., 15 minutes so as to avoid hurting themselves if they faint) are no longer warranted.
Evaluate the APGAR score for this newborn at 1 minute:
APGAR score of 8
The infant gets 2 points each for the heart rate, respiration, and muscle tone; 1 point each for reflex irritability and color. Therefore, the total score is 8. Exam questions may still ask you to calculate Apgar scores, so be familiar with the system.
At what age are most children able to sit without support?
7 months
When does a child has to visit a dentist for the first time?
By the time a child is 12 months old or after first tooth erupts.
If patient is not using at least 6 words or has inability to walk independently, this becomes a red flag at what age?
18 months
What vaccines are given to a 4 year old?
MMR (2nd dose)
Varicella (2nd dose)
IPV (4th dose)
DTaP (5th dose)
Influenza (annual dose)
An infant is found to have microcolon, also known as neonatal small left colon syndrome.
What diagnosis does the mother likely have?
Diabetes Mellitus
Congenital anomalies occur 2–4 times more frequently in infants of diabetic mothers. Neonatal small left colon syndrome is one congenital anomaly that is associated with maternal DM. The increased risk of these anomalies in infants of diabetic mothers is likely due to poor diabetes control before conception and during early pregnancy, when fetal organogenesis is occurring.
A mother brings her 18-month-old in for his well-child exam. This is her 1st child and she is very concerned about his development and is always comparing him to other children. You ask her several questions and assure her that he is doing just fine.
He should be able to do all of the following, except:
A. Identify 1 or more body parts
B. Use 2 or 3 word sentences
C. Scribble
D. Run stiffly
E. Feed self
Use 2 or 3 word sentences
The purpose and/or benefits of having a toddler in a rear facing car-seat?
Prevent neck injury.
What is the red flag for language development at 1 year old?
Child does not respond to name.
Does not understand "no".
What vaccines do pregnant women receive and when (WGA)?
Tdap and Influenza; 27-36 WGA
At a newborn's examination, you note edema and blood over the parietal bones, and it does not appear to cross suture lines. You can palpate an "edge" that is finely demarcated.
What is the most likely diagnosis?
Cephalohematoma
Cephalohematoma is a collection of blood under the periosteum of the outer surface of the skull. It most commonly occurs over the parietal bones and does not cross suture lines because it is below the periosteum. Most slowly resolve over a period of weeks or months and do not require x-ray evaluation.
A mother brings her 9-month-old to see you for his well-child visit. She wants to know if he is on target developmentally.
He should be able to do all the following, except:
A. Pull to standing position
B. Creep or crawl
C. Use pincer grasp
D. Walk independently
E. Use repetitive sounds (Mama, Dada)
Walk independently
What would you teach parents about storing cleaning chemicals, home improvements and home maintenance products?
Store in locked cabinets, out of reach.
Have poison control center's phone number near the phone/on the fridge. (1-800-222-1222)
What are the read flags for language, motor and social development for a 6m old infant?
Lack of turning towards voices.
Does not pass objects from one hand to another.
No smiling, laughing or expression.
When is rotavirus vaccine given? How is it given? What specifications does it have?
Given at 2, 4 and 6 months, orally.
First dose should not be given after 15 weeks.
Can not be given after 8 months and if history of intusuception.
A 1-week-old infant currently in the NICU with a history of being born at 28-weeks-gestation presents with:
What is the diagnosis?
Necrotizing Enterocolitis (NEC)
NEC is an inflammatory lesion of the bowel that is mainly seen in preterm infants. (It is the most common intestinal emergency seen in this age group.) The listed symptoms can progress to erythema and cellulitis of the abdominal wall, intestinal gangrene with perforation, and/or peritonitis. Bloody stools are seen in ~ 25% of cases. Most commonly, the distal ileum and proximal colon are affected.
What percent of the birth weight can an infant loose in his first week of life? How soon does an infant regain BW?
7%; 10-14 days of life
What prevention and safety measures should parents use to prevent drowning in bathrooms or pools?
Supervision.
Not leaving standing water in tubs or sinks.
Closing the lid of the toilet.
Fences/gates.
Pool covers.
If a patient does not imitate actions or words of caregivers and has poor eye contact, this becomes a red flag by what age?
2 years
A 4-month old had a prolonged seizure 6 days after his 2-month well child visit. He received the standard 2-month vaccinations. He now returns for his 4-month visit. Which of the following statements is true regarding DTaP?
A. The child should no longer receive DTaP or any component of it ever again.
B. The child should no longer receive DTaP, but may receive the aP component at this visit.
C. The child should no longer receive DTaP, but may receive one of the components at 1-year of age.
D. The child may receive DTaP at this visit.
E. The child should undergo allergy testing with the individual components.
The child should no longer receive DTaP, but may receive one of the components at 1-year of age.
A term infant in the delivery room presents with:
What is the most likely diagnosis?
Persistent Pulmonary Hypertension of the Newborn (PPHN)
PPHN occurs when pulmonary vascular resistance remains elevated after birth, causing pulmonary-to-systemic (right-to-left) shunting of blood via fetal circulatory pathways, leading to severe hypoxia. It is not a specific disease but a syndrome that can be idiopathic or due to a number of causes, including meconium aspiration, sepsis, pulmonary hypoplasia, and others. Differential cyanosis is classic, due to the right-to-left ductus arteriosus shunting.
Name 5 primitive reflexes present at birth that typically disappear at 3–4 months of age.
Rooting, Stepping, Sucking, Hand Grasp, and Moro Reflexes
What foods are chocking hazards and should be avoided?
Hot dogs
Fruits with pits
Hard candy
Nuts
Grapes
Marshmallows