Quiz 2: Infant Well Child

Front 1

You are seeing a 36-month-old boy for his well-child visit. His parents are anxious about ensuring that his development is appropriate. He passed a hearing screen at birth and, other than a few colds, has been generally healthy. He has never been hospitalized or had any serious illness. He is able to run well, walk up stairs, and walk slowly down stairs. He uses more words than the parents are able to count, but can use them only in short, two or three-word sentences. His speech is understandable. He can draw a circle, but not a cross. Neurologic examination shows normal cranial nerves, normal sensitivity, normal motor reflexes, and no Babinski sign. Which of the following is the most appropriate next step in the management of this patient?

Back 1

Reassure the parents that the boy's development appears normal

Front 2

Normal milestones for 36 month old child

Back 2

• run well, walk up stairs, walk slowly down stairs
• words in two or three word sentences
• understandable speech
• draw a circle, but not a cross

Front 3

When to perform a BAER? (brain stem auditory evoked potential hearing test)

Back 3

infants failing to meet language milestones if they cannot cooperate with more comprehensive testing

Front 4

Clues for autism

Back 4

• developmental delay
  
• autistic features: lack of symbolic play, repetitive movements, poor sociability
  

Front 5

When to refer to developmental specialist?

Back 5

if concerns on developmental screens

Front 6

Sammy is a healthy male child brought into your office by his mother for a well-child examination. As part of your evaluation you assess his developmental milestones. He is able to run, make a tower of 2 cubes, has 6 words in his vocabulary, and can remove his own garments. What would you estimate Sammy’s age to be based upon his developmental milestones?

Back 6

18 months

Front 7

12 month milestones

Back 7

• gross motor: pulling to stand, standing alone
• fine motor: block in a cup, banging 2 cubes in hands
• language: imitate vocalizations and babble: "mama" and "dada"
• social: Wave bye bye play pat a cake

Front 8

15 month milestones

Back 8

• stoop and recover wand walk well
• say few words
• wave bye bye
• drink from a cup

Front 9

2 1/2 year old

Back 9

• jump up
  
• throw ball overhand
  
• build tower of 6-8 cubes
  
• wash and dry hands
  

Front 10

3 year old milestones

Back 10

• balance on each foot for 1 second
• wiggle thumbs
• name four pictures
• name 1 colour
• name a friend
• brush teeth with help

Front 11

Mark is a 5-month-old male who is brought to the urgent care clinic with a three-day history of rhinorrhea and non-productive cough. When he was born he was large for gestational age, and his exam then was notable for macrocephaly, macroglossia, and hypospadias. On physical exam now his vitals signs are stable. He has copious nasal discharge, but his lungs are clear to auscultation. On abdominal exam, you palpate an abdominal mass on the right side just below the subcostal margin. It is 7 cm in diameter and does not cross the midline. The abdomen is soft and non-tender with active bowel sounds. What is the most likely cause of his mass?

Back 11

Wilm's tumour

Front 12

Wilm's tumour

Back 12

associated with:

• Beckwith Widemann syndrome
• omphalocele
• hemihypertrophy
• hypoglycemia
• LGA
• other dysmorphisms

Front 13

Teratoma features

Back 13

• identified often incidentally
• may be sympatomatic due to mass effect

Front 14

Renal cell carcinoma risk factors

Back 14

• adulthood
• cigarette smoking
• obesity

Front 15

Hepatoblastoma

Back 15

Associated with familial adenomatous polyposis

Front 16

An asymptomatic, healthy 9-month-old female is found to have a palpable RUQ mass on exam. After further imaging and lab studies, the mass is diagnosed as a neuroblastoma that has involvement in the bone marrow as well. The mother is worried about the prognosis. Which of the following is true about the prognosis of neuroblastoma in this child?

Back 16

Non-amplification of the n-myc gene is a favorable prognostic factor.

Front 17

Prognosis of neuroblastoma

Back 17

• still favourable outcome if lymph node involvement
• favourable if young age, and differentiating histology
• favourable if non-amplification of n-myc gene
• poor prognosis if distant metastases

Front 18

A 9-month old baby boy comes to the clinic for a well child visit. The child is at the 50th percentile for weight, length, and head circumference. He is reaching all developmental milestones appropriately. The mother has no concerns at this visit. The child has previously received the following vaccines: 3 doses of DTaP, 3 doses of Hib, 2 doses of HepB, 3 doses of RotaV, 2 doses of IPV and 3 doses of PCV13, and no influenza vaccines. Which vaccines should the child receive at today’s visit?

Back 18

Influenza, Hep B, IPV is correct. The patient needs a third Hep B, a third IPV, and a yearly flu shot starting at 6 months of age.

Front 19

A 10-month-old asymptomatic infant presents with a RUQ mass. Work-up reveals a normocytic anemia, elevated urinary HVA/VMA, and a large heterogeneous mass with scant calcifications on CT. A bone marrow biopsy is performed. Which of the following histologic findings on bone marrow biopsy is most consistent with your suspected diagnosis?

Back 19

Small round blue cells with dense nuclei forming small rosettes