CMN 571 final Exam Study Test with
Questions and Verified Answers
Sickle cell disease - ✔✔Essentials of diagnosis and typical features: Predominantly
African, Mediterranean, middle eastern, Indian, or Caribbean ancestry. Anemia, elevated
retic count, usually jaundice. Recurrent episodes of musculoskeletal or abdominal pain.
Often hepatomegaly or splenomegaly that resolves. Increased risk of bacterial sepsis.
Cornerstone of treatment: patient & family education, comprehensive outpatient care,
appropriate treatment of acute complications.
Hypothyroid Congenital & Acquired - ✔✔Essentials of diagnosis and typical features:
Growth retardation, decreased physical activity, weight gain, constipation, dry skin,
cold intolerance, and delayed puberty.
Untreated congenital hypothyroidism: thick tongue, large fontanels, poor muscle tone,
hoarseness, umbilical hernia, jaundice, and intellectual retardation. T4, FT4, and T3 resin
uptake are low; TSH levels are elevated in primary hypothyroidism.
Screening: Newborns are screened, any abnormal should be confirmed with venous T4 and
TSH level.
Treatment: Levothyroxine is the drug of choice.
PKU (phenylketonuria) - ✔✔Essentials of diagnosis and typical features:
,Intellectual disability, hyperactivity, seizures, light complexion, and eczema characterize
untreated patients. Newborn screening for elevated plasma phenylalanine identifies most
infants. Early diagnosis and treatment with restrictive diet prevents intellectual disability.
Lead - ✔✔Children with lead toxicity are typically asymptomatic. High lead levels (>70)
can cause severe health problems such as seizures and coma.
CDC recommends universal lead screening for children at ages 1 and 2 and targeted
screening for older children living in communities with a high percentage of old housing or a
high percentage of children with high lead levels.
A venous blood sample is preferred over a capillary sample.
Chelation of lead is indicated for levels over 45 and is urgently required for levels over 70.
With any level >5 rescreening should be performed at recommended intervals.
Iron deficiency - ✔✔Most common nutritional deficiency in the US
Risk factors are preterm or low birth weight, multiple pregnancy, iron deficiency in the
mother, use of non-fortified or cows milk before age 1, infant diet low in iron containing foods.
Infants and toddler consuming more that 24oz of cows milk are at risk as well as children with
chronic illness, restricted diet, or extensive blood loss.
Universal screening for anemia should occur at 12 months by obtaining a H&H, premature
or low birth weight may need testing before 6 months.
Hypercholesterolemia & Hyperlipidemia - ✔✔Non fasting lipid screen is
recommended universally for children between 9-11.
Fasting is recommended between 2-8 and 12-16 if risk factors are present.
Diet and weight management are primary interventions, for severe dyslipidemia (>190 LDL)
pharmacologic therapy should be considered. (>160 if family hx, >130 depending on level
and risk factors.)
Tuberculosis - ✔✔Risk should be assessed at well child visits and screening should be
based on high risk status.
,High risk defined as: contact with a person with known or suspected TB; symptoms or
radiographic finding of TB; birth/residence/travel to area with high prevalance of TB;
contact with HIV/AIDS person, prisoner, illicit drug user, homeless.
Dental health - ✔✔By six months every child should have a caries-risk assessment.
Streptococcus mutans- key organism in dental caries.
Primary teeth generally erupt at 7 months, but may appear as early as 3-4 months and as
late as 12-15 months.
Complete set of primary teeth present at 30-36 months.
Application of fluoride varnish starting at 6 months with first tooth and at every well child visit.
Circumcision - ✔✔Parents may note a petroleum gauze on the penis; this should remain
for the first 24 hours. After this is removed, instruct to clean area with water and monitor for
infection. Soap is often discouraged as it may irritate the area.
It takes about 5‐6 days to heal.
Newborn Safety - ✔✔Teaching the parents:
Crib slats should be a maximum of 2‐3/8 inches apart.
Car safety seat should be REAR‐FACING in the middle of the back
seat.
Bath water should be lower than 120 F.
Encourage first aid and infant CPR classes for parents/caregivers.
Avoid smoking around newborn.
Umbilical cord care - ✔✔Cord clamp is removed in about 24 hours and then it takes
the stump 10‐12 days to dry up and fall off.
The stump should be cleaned with water and allowed to air dry. Diaper is kept below the stump
to help prevent infection.
Monitor for S/SX of infection‐ purulent drainage, foul odor, redness. If noted, instruct
parents to report to healthcare provider.
, Autism Spectrum Disorder - ✔✔Characterized by
1. persistent deficits in social communication and social interaction across multiple contexts.
2. restricted, repetitive patterns of behavior, interests, and activities.
Autism specific screen recommended at 18 and 24-30 months.
MCHAT - modified checklist for autism in toddlers.
All children with ASD should have formal audiology eval, chromosomal microarray, and DNA for
fragile X.
Hip exam - ✔✔Ortolani Maneuver - flex hips of supine infant to 90 degrees then with
the examiners index finger placing anterior pressure on the greater trochanters, gently and
smoothly abduct legs using the examiners thumbs. Cluck = dislocation
Barlow Maneuver - adduct the hip and push laterally on the upper inner thigh. Clunk = unstable
hip.
What is masked hypertension (MH), what patients are at risk for it and how should patients
be evaluated for it? - ✔✔DEFINITION: When a patient (child) has normal BP in office but
elevated BP on ABPM.
WHO IS AT RISK: Pts with obesity and secondary forms of HTN (such as CKD or repaired
aortic coarctation). It is ESPECIALLY prevalent in pts with CKD and associated with target
organ damage.
HOW TO EVALUATE: Pts with CKD should be monitored with ABPM as part of routine
CKD management.
AAP guidelines, p 22.
A child's brain has reached 90% of its adult weight at age _______. - ✔✔FIVE (5)
Questions and Verified Answers
Sickle cell disease - ✔✔Essentials of diagnosis and typical features: Predominantly
African, Mediterranean, middle eastern, Indian, or Caribbean ancestry. Anemia, elevated
retic count, usually jaundice. Recurrent episodes of musculoskeletal or abdominal pain.
Often hepatomegaly or splenomegaly that resolves. Increased risk of bacterial sepsis.
Cornerstone of treatment: patient & family education, comprehensive outpatient care,
appropriate treatment of acute complications.
Hypothyroid Congenital & Acquired - ✔✔Essentials of diagnosis and typical features:
Growth retardation, decreased physical activity, weight gain, constipation, dry skin,
cold intolerance, and delayed puberty.
Untreated congenital hypothyroidism: thick tongue, large fontanels, poor muscle tone,
hoarseness, umbilical hernia, jaundice, and intellectual retardation. T4, FT4, and T3 resin
uptake are low; TSH levels are elevated in primary hypothyroidism.
Screening: Newborns are screened, any abnormal should be confirmed with venous T4 and
TSH level.
Treatment: Levothyroxine is the drug of choice.
PKU (phenylketonuria) - ✔✔Essentials of diagnosis and typical features:
,Intellectual disability, hyperactivity, seizures, light complexion, and eczema characterize
untreated patients. Newborn screening for elevated plasma phenylalanine identifies most
infants. Early diagnosis and treatment with restrictive diet prevents intellectual disability.
Lead - ✔✔Children with lead toxicity are typically asymptomatic. High lead levels (>70)
can cause severe health problems such as seizures and coma.
CDC recommends universal lead screening for children at ages 1 and 2 and targeted
screening for older children living in communities with a high percentage of old housing or a
high percentage of children with high lead levels.
A venous blood sample is preferred over a capillary sample.
Chelation of lead is indicated for levels over 45 and is urgently required for levels over 70.
With any level >5 rescreening should be performed at recommended intervals.
Iron deficiency - ✔✔Most common nutritional deficiency in the US
Risk factors are preterm or low birth weight, multiple pregnancy, iron deficiency in the
mother, use of non-fortified or cows milk before age 1, infant diet low in iron containing foods.
Infants and toddler consuming more that 24oz of cows milk are at risk as well as children with
chronic illness, restricted diet, or extensive blood loss.
Universal screening for anemia should occur at 12 months by obtaining a H&H, premature
or low birth weight may need testing before 6 months.
Hypercholesterolemia & Hyperlipidemia - ✔✔Non fasting lipid screen is
recommended universally for children between 9-11.
Fasting is recommended between 2-8 and 12-16 if risk factors are present.
Diet and weight management are primary interventions, for severe dyslipidemia (>190 LDL)
pharmacologic therapy should be considered. (>160 if family hx, >130 depending on level
and risk factors.)
Tuberculosis - ✔✔Risk should be assessed at well child visits and screening should be
based on high risk status.
,High risk defined as: contact with a person with known or suspected TB; symptoms or
radiographic finding of TB; birth/residence/travel to area with high prevalance of TB;
contact with HIV/AIDS person, prisoner, illicit drug user, homeless.
Dental health - ✔✔By six months every child should have a caries-risk assessment.
Streptococcus mutans- key organism in dental caries.
Primary teeth generally erupt at 7 months, but may appear as early as 3-4 months and as
late as 12-15 months.
Complete set of primary teeth present at 30-36 months.
Application of fluoride varnish starting at 6 months with first tooth and at every well child visit.
Circumcision - ✔✔Parents may note a petroleum gauze on the penis; this should remain
for the first 24 hours. After this is removed, instruct to clean area with water and monitor for
infection. Soap is often discouraged as it may irritate the area.
It takes about 5‐6 days to heal.
Newborn Safety - ✔✔Teaching the parents:
Crib slats should be a maximum of 2‐3/8 inches apart.
Car safety seat should be REAR‐FACING in the middle of the back
seat.
Bath water should be lower than 120 F.
Encourage first aid and infant CPR classes for parents/caregivers.
Avoid smoking around newborn.
Umbilical cord care - ✔✔Cord clamp is removed in about 24 hours and then it takes
the stump 10‐12 days to dry up and fall off.
The stump should be cleaned with water and allowed to air dry. Diaper is kept below the stump
to help prevent infection.
Monitor for S/SX of infection‐ purulent drainage, foul odor, redness. If noted, instruct
parents to report to healthcare provider.
, Autism Spectrum Disorder - ✔✔Characterized by
1. persistent deficits in social communication and social interaction across multiple contexts.
2. restricted, repetitive patterns of behavior, interests, and activities.
Autism specific screen recommended at 18 and 24-30 months.
MCHAT - modified checklist for autism in toddlers.
All children with ASD should have formal audiology eval, chromosomal microarray, and DNA for
fragile X.
Hip exam - ✔✔Ortolani Maneuver - flex hips of supine infant to 90 degrees then with
the examiners index finger placing anterior pressure on the greater trochanters, gently and
smoothly abduct legs using the examiners thumbs. Cluck = dislocation
Barlow Maneuver - adduct the hip and push laterally on the upper inner thigh. Clunk = unstable
hip.
What is masked hypertension (MH), what patients are at risk for it and how should patients
be evaluated for it? - ✔✔DEFINITION: When a patient (child) has normal BP in office but
elevated BP on ABPM.
WHO IS AT RISK: Pts with obesity and secondary forms of HTN (such as CKD or repaired
aortic coarctation). It is ESPECIALLY prevalent in pts with CKD and associated with target
organ damage.
HOW TO EVALUATE: Pts with CKD should be monitored with ABPM as part of routine
CKD management.
AAP guidelines, p 22.
A child's brain has reached 90% of its adult weight at age _______. - ✔✔FIVE (5)
