Case 2: Newborn

Front 1

Components of well child interview

Back 1

• interval history
• development
• growth
• diet history
• social history
• PE: anticipatory guidance
• immunization

Front 2

Development screening tests

Back 2

• Parents' Evaluation of Developmental Status
• Ages and Stages questionnaire (ASQ)
• Denver II Developmental screening test

Front 3

When to do developmental screens?

Back 3

• 9 months
  
• 18 months
  
• 30 months
  

Front 4

Available formulas for babies?

Back 4

• Cow's milk protein
• Soya protein
• Hydrolyzed cow's milk protein

Front 5

When to transition baby to regular cow's milk?

Back 5

• Never give regular cow's milk until 12 months of age
  
• may lead to colitis, causing microscopic bleeds and gradually worsening anemia
  

Front 6

Caloric requirements of preterm infants?

Back 6

115 to 130 cal/kg/day

Front 7

Caloric requirement for term infant?

Back 7

100 to 120 cal/kg/day

Front 8

Average daily weight gain of term infant?

Back 8

20 to 30 g

Front 9

When are babies expect to have regained birth weight by?

Back 9

2 weeks og age

Front 10

What is the moro reflex?

Back 10

Symmetric abduction

extension of arms followed by adduction of arms, sometimes with a cry

Front 11

When does moro reflex disappear?

Back 11

4 months

Front 12

Moro reflex is an indicator of what peripheral problems?

Back 12

• congenital MSK abnormalities
  
• neural plexus injuries
  

Front 13

When to do developmental screen?

Back 13

• routinely during well child visit
  
• any patient encounter where there are concerns, whether at a sick visit or during hospitilization
  

Front 14

What is developmental surveillance?

Back 14

comparing a child to expected behaviours by age

Front 15

When to start baby on solid food?

Back 15

start on rice cereal with spoon at 4 months

Front 16

Who to supplement with vit D?

Back 16

Infants and children who are exclusively or mostly breastfed

Infants and children drinking less than a quart per day of formula or cows milk

Front 17

When do babies start to sleep through the night?

Back 17

Age 4-6 months

Front 18

How to prevents SIDS?

Back 18

infant placed on back to go to sleep

Front 19

Newborn safety?

Back 19

• quit or avoid smoking around the infant
  
• keep small objects and plastic bags away from baby
  
• don't drink hot liquids while holding baby
  
• don't leave baby alone
  

Front 20

Most effective car seat restraint

Back 20

five point harness with two shoulder straps, lap belt, and a crotch strap

Front 21

T/F: until age 2 years children should face rearward

Back 21

True

Front 22

Doses or DTaP?

Back 22

5

Front 23

Doses of IPV, Hib, PCV13?

Back 23

4

Front 24

Doses of MMR, varicella, rotavirus, hep A, hep B?

Back 24

2 (hep b is three)

Front 25

What is pedarix?

Back 25

combine immunizations for DTaP, HepB and IPV

Front 26

Vaccine adverse events

Back 26

"knots" in skin at injection site

fussiness and fever for 24 hours

*problem if lasts 24 or more hours or more serious side effects such as seizures or inconsolability

Front 27

Early childhood growth patterns?

Back 27

• double birth weight by 4 to 5 months
  
• triple by 1 year
  
• double birth length by 4 years
  

Front 28

Absence of red reflex may indicate what abnormalities?

Back 28

• cataracts
  
• glaucoma
  
• retinoblastoma
  
• chorioretinitisa
  

Front 29

When to refer to ophtho?

Back 29

• shaken baby
  
• suspected retinal tear (e.g. infant with retinopathy or prematurity at an advanced stage)
  

Front 30

6 month dev. milestones

Back 30

Rolls overSits unsupportedNo head lag when pulled to sit from supineReaches for objectsLooks for dropped itemsTurns toward voiceBabbles (i.e., use of repetitive consonants: ba-ba-ba or da-da-da) (When the child says dada-da,the family reinforces the sounds by praising the infant; then the infant makes theconnection of the sound to the father.)Feeds selfDemonstrates stranger recognition, the prelude to stranger anxiety

Front 31

Toddler proofing the home?

Back 31

• install outlet covers
  
• put in cabinet locks
  
• set up stair barriers
  
• make sure cleaning supplies and meds are safely stored
  
• keep number for poison control near phone
  

Front 32

Anticipatory guidance at 6 months

Back 32

• car seat placement: faces rear
  
• do not use walkers
  
• dietary changes: new foods every 5 to 7 days
  
• development: "stranger anxiety" normal, start reading book to infant, two naps per day and sleep through night
  

Front 33

Why use acetaminophen cautiously if baby given vaccine?

Back 33

• may lower antibody response
  
• administer only if necessary
  

Front 34

Prognosis of Stage 4S neuroblastoma?

Back 34

in infants less than one year, normally regress

Front 35

Genetics of neuroblastoma?

Back 35

• familial: 1% of cases, autosomal dominant, low penetrance
  
• nonfamilial: most cases due to somatic mutations, not passed to next generation
  

Front 36

Rectal exam in infant

Back 36

not routine

done if intra-abdominal, pelvic, or perirectal process suspected

Front 37

How to perform rectal exam?

Back 37

lay infant supine

with one hand, hold feet and flex knees and hips on abdomen

insert glove and lubricated index finger into rectum

palpate for hard stool and/or a mass

Front 38

DDx for RUQ mass and pallor in 9 month old infant?

Back 38

hepatic neoplasm

hydronephrosis

neuroblastoma

teratoma

Wilm's tumour

Front 39

Hepatic neoplasm

Back 39

• rare
  
• jaundice may be a feature
  
• asymptomatic abdominal tumour
  

Front 40

Hydronephrosis

Back 40

• obstruction at utero-pelvic junction
  
• hydronephorosis, palpable kidney, flank mass
  
• may have multicystic kidney
  
• UTI
  

Front 41

Neuroblastoma

Back 41

• most frequently diagnosed neoplasm in infants
  
• painless mass in neck, chest, abdomen
  
• asymptomatic or chronically ill and have bone pain
  
• fever, pallor, weight loss
  
• infant younger than a year with asymptomatic RUQ mass, pallor, no jaundice
  

Front 42

Teratoma

Back 42

• painless abdo mass without symptoms
  
• mass effect
  
• rare
  

Front 43

Wilm's tumour (nephroblastoma)

Back 43

• asymptomatic RUQ w/o lymphadenopathy or jaundice
  
• growing and developing normally
  
• incidental
  
• abdo pain and/or vomiting, hypertension
  
• median age: 3
  

Front 44

Initial testing of asymptomatic abdo mass

Back 44

• CBC with diff
  
• catecholamine metabolites (VMA and HVA)
  
• CXR
  
• Skeletal survey
  
• abdo ultrasound
  
• abdo xray
  
• abdo CT
  

Front 45

CBC and diff

Back 45

anemia

cyopenia (bone marrow infiltration)

not specific

Front 46

catecholamine metabolites (VMA and HVA)

Back 46

catecholamines elevated in neuroblastoma

highly specific

Front 47

CXR

Back 47

• bone mets to chest
  
• chest CT or MRI only used if mets not seen on xray
  

Front 48

Skeletal survey

Back 48

id mets to bone

Front 49

abdo us

Back 49

identify mass, determine if solid, cystic or combined. best choice for a first imaging study

Front 50

abdo XR

Back 50

• calcifications, bowel obstruction, not best imaging study for initial eval
  

Front 51

abdo CT

Back 51

• calcifications, consistency of tumour, imaging of lungs
  
• if purely cystic, not needed, which is why US done first