Barkley Review: Pediatrics Assessment Day 1 with Answers (50 Solved Questions)

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Barkley Review: Pediatrics Assessment Day 11.Developmentally Delayed 6 mo old s/sxa.Prematureb.Child hasn’t started iron supplementsc.Baby can’t grasp fingerd.Child is 8 lbs at 6 mo old check-up without teeth2.Jogging Again after having babya.Mom can start jogging when baby is 2-3 mo old and has good head control3.Erik Eriksona.Psychosocial theoristb.Viking = verses guy and doesn’t include age range but focuses on stagesc.Stagesi.Infancy (birth to 1 year): trust vs. mistrustii.Toddler (1-3 years): autonomy vs. shame and doubtiii.Pre-school (3-6 y/o): initiative vs. guiltiv.School age (6-12 y/o): industry vs. inferiority1.Accolades are an accomplishmentv.Adolescence (12-18 y/o): identity vs. role confusion4.Jean Piageta.Cognitive theoristb.Primary theoristi.Sensorimotor stage: Birth to 2 yearsii.Pre-operative/pre-conceptual stage: 2-4 yearsiii.Intuitive/pre-operational thinking: 4-7 y/oiv.Concrete thinking: 7-11 y/ov.Formal operational thought: 11-15 y/o1.Ability to abstract2.Utilize algebra type solving5.Sigmund Freud

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a.Psychosexual theorist / psychosocial domainb.Primary theoristsc.Based on personalities are developed or not by experiences in particular sages ofdevelopmenti.ID: Principle of pleasureii.Ego: Principle of reality/self-interestiii.Superego: Principle of morality or conscienced.Psychosexual developmenti.Infancy: oral stage1.Birth-6 mo: orally passive (devel of ID, biologic pleasure principle)2.7-18 mo: orally aggressive (teething); oral satisfaction of needs bymother decreases tensionii.Toddler: 1.5- 3 years= anal stageiii.Pre-school: 3-6 years= phallic stage (ego devel= love of opposite sex)iv.School age: 6-12 years= latency stage (sexual drive repressed, socializationoccurs, super ego and morality development)v.Adolescence: 12-18 years: genital stage6.4 mo-old infants not cooing or making eye-contact. What would be the most appropriate actionto take?a.Ask mother if she has noticed the infant’s behaviors and let her know that you areconcerned, as most infants are making social interactions at this point. Ask to see infantagain in one month for further evaluation7.Red Flags of Pediatricsa.A deficit of sequential measurementsb.Brain tumor= sequential lines on growth chart where head circumference increasessignificant on the growth charti.18 month visit= vital areas1.Measure head circumference, body length, and heightii.BMI is only good after 2 years of age8.Domains of Growth & Development: 3 Domainsa.Physical

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b.Cognitivec.Psychosocial9.Nutritiona.Exclusive breast feeding for the first 6 monthsb.Adequate supplementation of ironi.1mg/kg/day at 6 months of ageii.First primary tooth by 6 months ageiii.Finish getting rest of teeth 24 months of ageiv.Permanent teeth starts at 6 y/o age and complete at 12 y/oc.Caloriesi.Birth -6 mo: 120 kcal/kg/dayii.7 mo- 1 year 100 kcal/kg/dayiii.2-10 years: 70-100 kcal/kg/dayiv.Adolescents: 45 kcal/kg/dayv.Adults: 30 kcal/kg/dayd.Physical growthi.Cephalon (caudal) to proximal = distal10. B-lymphocytesa.Helps the body to make abt’s against vaccine11.DTAPa.Don’t give after 7 y/o ageb.Provides more protection for babies in diptheria12. Tdapa.Booster require every 10 years on birthdayb.Given to children 7 y/o or olderc.Every pregnant woman at every pregnancyd.All HCPs and elderly patients13.HIBa.Do not give after age 5 y/o

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14.Pneumococcala.PCV13b.PCV23i.Pneumovaxii.Given to patients who need it for certain dx1.Spleen issues (need when condition developed or born with conditions=receive around age 2 and only requires 1 dose)15.IPVa.Injectable doseb.Only given in Americac.4 shots16.Influenzaa.Annuallyb.Beginning at 6 mosc.Give in early fall/end of summerd.Pregnant women do get flu shots since baby is unprotectede.Don’t give to immunocompromised patientsf.6-35 months (up to 3 years) ½ dose 0.25 ml (1stflu shot get 0.25mL and comes back in 1month for next dose)g.3 years older= receives a full dose 0.5mLh.Children younger than 9 y/o receive 2 doses 1 mo apart17.MMRa.Series of 2 (1 y/o and by 12 y/o)b.Exposed by traveling or endemic areasc.MMR can be given as early as 6 months of aged.Can be given simultaneously with TB testing with PPD but prefer to post-pone PPD for 4-6 wks to avoid possible suppressive responsiblee.Can vaccinate child as early s 6 months if traveling to outside areas and vaccinate againat 1 year18.Varicella

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a.Live vaccineb.Series of 2 (b/w 12 months and 12 years; minimum 3 years apart)19.Hep Aa.Oral fecalb.Given at 1 y/o (2 injections)c.1 year-2 years and 6 mo apart20.Meningococcal vaccinea.Series of 2b.Age 11-12 y/o and booster at age of 16 yearsc.Adolescents can receive first dose at or after 16 yearsd.No booster necessary21.HPVa.Vaccine protects against cancerb.Gardasil 9 (protection against 9 series of HPVc.Multivariant protects against genital wartsd.Recommended that they sit for 15 mins after vaccination d/t risk of labile syncope,postural hypotension, and vasovagal responsese.Males and females receivef.Most common sexually diseaseg.Series of 2 injectionsi.As early as 9 y/o age but recommended at 11 or 12 y/oii.Second dose given 6-12 mo after 1stdoseh.series of 3 injectionsi.15 or olderii.Second dose given 1-2 moniii.3rddose given at 6 mo22.DiGeorge Syndromea.A phenotypic presentation of short philtrum, aortic arch anomalies, and seizure duringinfancy would raise genetic concerns for this d/o

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23.Down Syndrome Common Phenotypic (physical) findingsa.Microcephaly, upward slanting eyes, hypotonia24.Down syndrome Common Genotypic (Trisomy) findingsa.Requires a micro-array lab drawn25. Which condition would you not necessarily expect to find a cardiac defecta.Klinefelter’s syndrome26. Which conditions would have a cardiac defect associated with ita.Turner’s syndromeb.diGeorge’s syndromec.trisomy 13 (down syndrome)27. a mother who had 2 previous m/c is again pregnant. She wants to know the very earliest testthat can be done to reassure her that her baby doesn’t have a congenital defect. Yourecommenda.chorionic amniocentesis can be done as early as 11 weeks GA (u/s guidance of a sampleb/w the placenta and uterus looking for a certain DNA)i.fetal u/s only gives a review of the body partsii.quad blood test only test for 4 diseases of the most common birth defectsiii.genetic testing on both parents is done before pregnancy1.can still perform this test but it will take 2weeks for results to come backand patients will have to pay out of pocket b/c insurance won’t cover itsince the patient is already pregnant28. least important when taking a prenatally hx of 2-week-old at his or her first PCP visita.baby coos at 2 weeks= isn’t necessary b/c it doesn’t happen this early29. how many points are available for each item on the APGAR scoring system for a NB?a.10 is the maximum scoreb.3 points available for each item (0-1-2)30. 3 w/o infant becomes less interested in breast-feeding over the last day. Has been slightly warmduring last feeding. No vomiting, diarrhea, or rash. V/S temp 97.0, HR 190 bpm. RR 40.Appropriate action.a.After a thorough physical examination you send baby to hospital emergency room forfurther tests and possible admissioni.Baby has s/sx of shock requires NICU

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ii.Giving acetaminophen to a child that is dehydrated causes acute liver failure31. Which of the following reflexes would not be expected to disappear by 4 months of age?a.Babinski (AkA Dancing reflex) goes away in 1 year when child starts to walk(placing/stepping)i.Rooting goes away by 3-4 monthsii.Moro reflex away by 4 monthsiii.Placing/stepping goes away in 2 mo age32. You are examining NB in nursery and with infant lying on back, you flex knees up, then with yourthumb inside knee, abduct the leg and feel femoral head slide into acetabulum. You have justperformed which exam?a.Ortolani’s click for development of hip dysplasia1.Reducing dislocation/will feel and hear a click when placing femoralhead back into locationii.Barlow1.Demonstrates dislocation by adductingiii.Generum varum1.Bow legiv.Genum valgum1.Knot knee33. Which is not a survival reflex?a.Moro reflexi.Survival reflex: temperature, breathing, and sucking34. An appropriate method to assess the visual acuity on an infant isa.Obtain a blink reflex and observe for pupil constriction35. Stranger danger is a normal developmental stage that most infants exhibit at about what age?a.6 months = baby develops a sense of comfortability to one person (this is normal)i.Usually resolves within 2 months36. Appropriate antipyretic drug and dosage for a 4 mo old isa.Acetaminophen 10-15 mg/kg every 6 hours *i.Ibuprofen is only given at 6 mo of age

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ii.Can cause liver failure if acetaminophen is given at 20 mg/kg37. Bright futures program isa.A national health promotion and disease prevention initiative38. Toddlers should be seen for health promotion at the following intervalsa.Every 3 months until 18 months then every 6 months until 3 years of age and thenannually there after39. You’re seeing 18 mo old for a routine exam. Which is the least of importance to complete.a.Determine Body surface indexi.Not an appropriate growth objective evaluation until age 24 months (2 y/o)b.Appropriate exam for routinei.Head circumference until age 21.b/c pt can still develop hydrocephalus due to sutures not fulling beingclosedii.Assessment of dental developmentiii.Language assessment40. Sammy is not using two-words sentences, is rocking himself, and is not interested in pictures ofanimals on wall. These signs are a particular concern at what earliest age?a.2 years of agei.3 years of age to dx autism41. Per Piaget, during school age, a child will begin to learn math operations, parts of a sentence,state capitals, etc.. These are all evidence of which stage of development?a.Concrete stage = piaget stage42. Although growth and development slows during this stage, you would still expect which of thefollowing growth parameters?a.Weight of 6lbs/year and height of 2 inches/year43. Which of the following is true regarding obesity?a.Defined as a BMI > 95thpercentile44. To make the dx of ADHD, the following must be present except?a.Combative behavior when given limitsi.s/sx present before age 7 (dx at school age)

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ii.unable to sit still in class or at dinner table during entire mealiii.noticeably less attentive than peers of same age in same setting45. appropriate mngmt of child with ADHD can include all of the following except?a.CNS depressant: Diphenhydraminei.Anytime you see 2 opposites as your answer choice and the option to tell youexcept in the question then one of those answers are true46. The adolescent period is characterized by all of the following excepta.Need for first cervical cytology test for sexually active femalesi.First pap smear is age 21b.Correct periodsi.Psychosocial stage of identify vs role confusionii.Rapid changes in ht and wt peak velocityiii.Conflict with parents47. The following should be included in a physical exam at age 18 excepta.Testicular volume determination (i.e. Prader Beads)i.Done to estimate volume in testicular if a person is surviving childhood cancer48. You are performing a health exam on Maria who recently turned 18. You note on exam she is asenior in HS active in school drama performance, has a boyfriend but is celibate, and has areasonable respect for her parents. What else do you need to ask her?a.Does she or any of her friend’s smoke, drink, or use recreational drugs?49. During a physical exam for Victor, age 13, you note that his pubic hair is dark and curly and thathis penis elongated. You estimate his sexual maturity rating (tanner stage) is at what stage?a.Stage 3 * is where the most differential occursi.Stage 1ii.Stage 2= some differentiationiii.Stage 3iv.Stage 4= more differentian but less than adult50. Nevaeh is a 12 y/o female with breast enlargement but no differentiation b/w nipple and theareola. She also has curly pubic hair. According to Tanner Staging for Females when should sheexpect her first menses?a.Within the next year

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