AANP FNP CERTIFICATION
Tanner Stage 2 - ANSWER Increased rugae of scrotum, testes enlarge. Breast bud.
Straight sparse hair.
Tanner Stage 3 - ANSWER Penis elongates. Pencil penis. Scrotal color darkens.
Breast tissue and areola are one mound. Darkened hair, starts to curl.
Tanner 4 - ANSWER Penis thickens and increases in size. Areola/nipple separate
for secondary mound. Curly hair, not on medial thigh.
When does menarche begin? - ANSWER After Tanner stage 2, within 1-2 years.
Delayed puberty if no secondary sexual characteristics by 12-13 in girls and 14 in
boys.
Trisomy 21 - ANSWER Down Syndrome. Risk with advanced maternal age.
Microcephaly, flat nose, hypotonia, simian crease.
Marfan's Syndrome - ANSWER Pectus excavatum. Tall, wide arm span. Risk of
MVP, aneurysm, aortic regurgitation. Do not clear for sports.
Turner's Syndrome - ANSWER FEMALE. Lymphedema in utero, webbed neck, LD,
widely spaced nipples, HTN coarctation of aorta.
Klienfelter's Syndrome - ANSWER Extra X in males. More feminine. Will see in
puberty. Infertile, hypogonadism, low testosterone. Tall, lanky, underdeveloped
sexually.
Caput succadeum - ANSWER Sutures cross midline, spreads.
Caphalohematoma - ANSWER Sutures do not cross midline, more significant.
When does anterior fontanelle close? - ANSWER 18 months
When does posterior fontanelle close? - ANSWER 2-3 months
Abrnomal red reflex - ANSWER Black or white. Retinoblastoma, cataracts,
osteogenesis perfecta. White specks in down syndrome.
Edward's Syndrome - ANSWER Trisomy 18. Small mouth. High pitched cry.
Newborn screening tests - ANSWER PKU (phenylalanine), can lead to hyperactivity
and mental retardation. Hypothyroid. If not treated, mental retardation. Sickle cell.
Galactessemia, maple smell to urine, septic.
Hordeolum - ANSWER Stye. Pain, edema. Bacitracin ophthalmic ointment.
STD conjunctivitis. - ANSWER Emergency. Rocephin for gonorrhea.
,Gonococcola Ophthamlia Neonatorum - ANSWER 2-4 days after birth. Red eye,
purulent discharge, swollen eyelids. GC culture, Thayer Martin, ROCEPHIN.
Chalmydial Ophthalmia Trachoma - ANSWER 4-10 days after birth. Edematous,
red, profuse WATERY discharge that becomes purulent. Azithromycin,
erythmocycin.
Otitis externa - ANSWER Fungal. Odor, black specks. Clotramizole. Pain with
tragus/pinna. Corticosporin
Sensorineuro hearing loss in PEDS - ANSWER Syphilis, acoustic neuroma,
aminoglycoside (gentamycin)
Epiglottitis - ANSWER Bacterial. Thumb sign on x-ray.
Croup - ANSWER Viral. Steeple sign on x-ray.
Bronchioloitis - ANSWER RSV, adenovirus. Under 3. Lower respi. URI, fever, nasal
flaring, stridor.If a preemie, synegis.
Intermittent Asthma peds - ANSWER SABA, 2 puffs q 4-6 hours. Peak 30 min-2
hours, lasts 4-6.
S. pneumonia (CAP) peds - ANSWER Lobar consolidation. Tx with penicillin.
H. influenza pneumonia peds - ANSWER Lobar consolidation. Amoxicillin or
cephalosporin.
M. cataralis or mycoplasma - ANSWER Linear. Azithromycin.
Neurofibromatosis - ANSWER Cafe au lait spots. Neurofibromas. Eye nodules.
Freckling.
Peds IDA - ANSWER Slow GI loss, too much whole milk. PICA. Flat shaped nails.
Ferritin low. 6-9 month treatments. 3-6 mg/kg day of iron
Thalassemia peds - ANSWER Asymptomatic. Enlarged spleen, tachypnea,
tachycardia, prominence in facial bones. TIBC not increased . Electrophoresis.
Sickle Cell Peds - ANSWER Vasocclusive crisis. Symptoms in stress, heat,
overexerting. Howel Jolly Bodies. Reticulocytosis. Hydrate, oxygenate, pain
managemnet.
Hemophilia - ANSWER Factor VIII. Mother/daughter carry gene but presents in
males. Bleed into joints.
Lead Poisoning - ANSWER Over 10 refer. IDA. Butonion line, gingival border.
Kelation therapy.
,Leukemia peds - ANSWER Chronically tired, pale, resp. infections. Blast cells,
peripheral smear, WBC
HIV testing - ANSWER ELISA in older child. PCR in infant. Western blot confirms.
More than 800 CD4 count normal, viral load less than 5000 or 0/undetectable.
Cause of fever in less than 2 month old - ANSWER Group B strep, e coli
common cause of fever in 2 months and up - ANSWER Strep. pneumoniae, and h.
influenza
Preoperational phase, preconceptual - ANSWER 2-4 years old
Causation, intuitive - ANSWER 4-7 years old
When is vision 20/20? - ANSWER Age 6
Concrete thinking, cognitive tasks, capable - ANSWER School age
What can be confused as child abuse in younger children? - ANSWER
Osteogenesis imperfecta or Mongolian spot
VSD - ANSWER Thrill sometimes felt at LL sternal border. Most common heart
defect in babies. Opening between septum. Holosystolic murmur.
Transposition of great arteries - ANSWER RVH. L. lower sternal border. Egg on a
string on x-ray.
Tetralogy of fallot - ANSWER VSD. Pulmonary stenosis. Overriding aorta. R. sided
hypertrophy. Systolic ejection murmur and thrill. Squat to slow return of blood to
heart.
Aortic stenosis - ANSWER Systolic thrill. R. upper sternal border. Ejection click
heard at apex. LVH. X-ray, severe HF. More common in boys than girls, common to
see mild exercise intolerance
Coarctation of aorta - ANSWER Ejection murmur heard best at LUSB and L
interscapular area. RVH to LVH. Rib notching. Pressures different in upper and lower
extremities.
OFten seen with mitral regurgitation and Aortic stenosis
Still's Murmur - ANSWER 1-3/6, early systolic ejection murmur. Musical / vibratory
(buzz). Left lower sternal border. Turbulence in left ventricle. Innocents. Softens with
standing, Valsalva, sitting. Age 2-6 years
Hemic murmur - ANSWER Mild systolic ejection murmur, high-pitched, pulmonic &
aortic areas.
Only heard in increased cardiac output.
, Venous hum - ANSWER Heard best while sitting, disappears while supine. R and L
upper sternal border, continuous humming murmur. innocent. Disappears in supine
position or when jugular vein compressed. > 3yo
PDA (patent ductus arteriosus) - ANSWER 2-4/6 continuous heard best over LUSB.
Full pulses. Most common congenital heart defect. More common in girls
MVP - ANSWER 1-3/6 mid-systolic click w/ late systolic murmur. Heard best at
apex. Louder with standing/squatting. Often seen with pectus excavatum
Pulmonic valve stenosis - ANSWER 2-5/6 best at LUSB, ejection click @ 2nd L ICS.
Radiates to back.
May involve wide S2. Usually d/t fusion of valves
HTN in peds - ANSWER Organ problem or aldosterone. Cushings. Refer to cards
Rheumatic heart disease - ANSWER Joints, CNS, post infectious group a strep.
affects mitral valve. Jones criteria (carditis, chorea, erythema marginatum, esr
elevated, arthralgia, fever, prolonged PR interval)
Kawasaki's - ANSWER Toxic vasculitis. Fever several days, rash, swelling, peeling,
strawberry tongue, prolonged PR or QT. ASA, refer.
Intusucception - ANSWER Surgical emergency. Lethargy, vomiting, jelly stool, mass
in RUQ. Can be from rotavirus ?
Neuroblastoma - ANSWER Adrenal gland tumor, before age 5. Mass in abdomen.
Catecholamines elevated. Painful, fixed, crosses midline.
Fetal alcohol syndrome - ANSWER Small head, shortened palpebral fissures
(narrow eyes), flat nasal bridge. Thin upper lip.
Port wine stain - ANSWER Trigeminal nerve, refer to opthlamology to rule out
congeital glaucoma. Can be a sign of Sturge-Weber syndrome.
Hirschberg Test - ANSWER Corneal light reflex, tests for strabismus.
Anal wink - ANSWER Absence is indicitave of spina bifida
Tonic neck - ANSWER Fencing
When do you get MMR? - ANSWER 12 months and 4-6 years ol.d
2 month development - ANSWER Follows objects past midline, coos, lifts head,
smiles
6 month development - ANSWER Palmar grasp, reaches, bring things to mouth,
pass things from one hand to another, sits up on own, turns belly-back-belly
Tanner Stage 2 - ANSWER Increased rugae of scrotum, testes enlarge. Breast bud.
Straight sparse hair.
Tanner Stage 3 - ANSWER Penis elongates. Pencil penis. Scrotal color darkens.
Breast tissue and areola are one mound. Darkened hair, starts to curl.
Tanner 4 - ANSWER Penis thickens and increases in size. Areola/nipple separate
for secondary mound. Curly hair, not on medial thigh.
When does menarche begin? - ANSWER After Tanner stage 2, within 1-2 years.
Delayed puberty if no secondary sexual characteristics by 12-13 in girls and 14 in
boys.
Trisomy 21 - ANSWER Down Syndrome. Risk with advanced maternal age.
Microcephaly, flat nose, hypotonia, simian crease.
Marfan's Syndrome - ANSWER Pectus excavatum. Tall, wide arm span. Risk of
MVP, aneurysm, aortic regurgitation. Do not clear for sports.
Turner's Syndrome - ANSWER FEMALE. Lymphedema in utero, webbed neck, LD,
widely spaced nipples, HTN coarctation of aorta.
Klienfelter's Syndrome - ANSWER Extra X in males. More feminine. Will see in
puberty. Infertile, hypogonadism, low testosterone. Tall, lanky, underdeveloped
sexually.
Caput succadeum - ANSWER Sutures cross midline, spreads.
Caphalohematoma - ANSWER Sutures do not cross midline, more significant.
When does anterior fontanelle close? - ANSWER 18 months
When does posterior fontanelle close? - ANSWER 2-3 months
Abrnomal red reflex - ANSWER Black or white. Retinoblastoma, cataracts,
osteogenesis perfecta. White specks in down syndrome.
Edward's Syndrome - ANSWER Trisomy 18. Small mouth. High pitched cry.
Newborn screening tests - ANSWER PKU (phenylalanine), can lead to hyperactivity
and mental retardation. Hypothyroid. If not treated, mental retardation. Sickle cell.
Galactessemia, maple smell to urine, septic.
Hordeolum - ANSWER Stye. Pain, edema. Bacitracin ophthalmic ointment.
STD conjunctivitis. - ANSWER Emergency. Rocephin for gonorrhea.
,Gonococcola Ophthamlia Neonatorum - ANSWER 2-4 days after birth. Red eye,
purulent discharge, swollen eyelids. GC culture, Thayer Martin, ROCEPHIN.
Chalmydial Ophthalmia Trachoma - ANSWER 4-10 days after birth. Edematous,
red, profuse WATERY discharge that becomes purulent. Azithromycin,
erythmocycin.
Otitis externa - ANSWER Fungal. Odor, black specks. Clotramizole. Pain with
tragus/pinna. Corticosporin
Sensorineuro hearing loss in PEDS - ANSWER Syphilis, acoustic neuroma,
aminoglycoside (gentamycin)
Epiglottitis - ANSWER Bacterial. Thumb sign on x-ray.
Croup - ANSWER Viral. Steeple sign on x-ray.
Bronchioloitis - ANSWER RSV, adenovirus. Under 3. Lower respi. URI, fever, nasal
flaring, stridor.If a preemie, synegis.
Intermittent Asthma peds - ANSWER SABA, 2 puffs q 4-6 hours. Peak 30 min-2
hours, lasts 4-6.
S. pneumonia (CAP) peds - ANSWER Lobar consolidation. Tx with penicillin.
H. influenza pneumonia peds - ANSWER Lobar consolidation. Amoxicillin or
cephalosporin.
M. cataralis or mycoplasma - ANSWER Linear. Azithromycin.
Neurofibromatosis - ANSWER Cafe au lait spots. Neurofibromas. Eye nodules.
Freckling.
Peds IDA - ANSWER Slow GI loss, too much whole milk. PICA. Flat shaped nails.
Ferritin low. 6-9 month treatments. 3-6 mg/kg day of iron
Thalassemia peds - ANSWER Asymptomatic. Enlarged spleen, tachypnea,
tachycardia, prominence in facial bones. TIBC not increased . Electrophoresis.
Sickle Cell Peds - ANSWER Vasocclusive crisis. Symptoms in stress, heat,
overexerting. Howel Jolly Bodies. Reticulocytosis. Hydrate, oxygenate, pain
managemnet.
Hemophilia - ANSWER Factor VIII. Mother/daughter carry gene but presents in
males. Bleed into joints.
Lead Poisoning - ANSWER Over 10 refer. IDA. Butonion line, gingival border.
Kelation therapy.
,Leukemia peds - ANSWER Chronically tired, pale, resp. infections. Blast cells,
peripheral smear, WBC
HIV testing - ANSWER ELISA in older child. PCR in infant. Western blot confirms.
More than 800 CD4 count normal, viral load less than 5000 or 0/undetectable.
Cause of fever in less than 2 month old - ANSWER Group B strep, e coli
common cause of fever in 2 months and up - ANSWER Strep. pneumoniae, and h.
influenza
Preoperational phase, preconceptual - ANSWER 2-4 years old
Causation, intuitive - ANSWER 4-7 years old
When is vision 20/20? - ANSWER Age 6
Concrete thinking, cognitive tasks, capable - ANSWER School age
What can be confused as child abuse in younger children? - ANSWER
Osteogenesis imperfecta or Mongolian spot
VSD - ANSWER Thrill sometimes felt at LL sternal border. Most common heart
defect in babies. Opening between septum. Holosystolic murmur.
Transposition of great arteries - ANSWER RVH. L. lower sternal border. Egg on a
string on x-ray.
Tetralogy of fallot - ANSWER VSD. Pulmonary stenosis. Overriding aorta. R. sided
hypertrophy. Systolic ejection murmur and thrill. Squat to slow return of blood to
heart.
Aortic stenosis - ANSWER Systolic thrill. R. upper sternal border. Ejection click
heard at apex. LVH. X-ray, severe HF. More common in boys than girls, common to
see mild exercise intolerance
Coarctation of aorta - ANSWER Ejection murmur heard best at LUSB and L
interscapular area. RVH to LVH. Rib notching. Pressures different in upper and lower
extremities.
OFten seen with mitral regurgitation and Aortic stenosis
Still's Murmur - ANSWER 1-3/6, early systolic ejection murmur. Musical / vibratory
(buzz). Left lower sternal border. Turbulence in left ventricle. Innocents. Softens with
standing, Valsalva, sitting. Age 2-6 years
Hemic murmur - ANSWER Mild systolic ejection murmur, high-pitched, pulmonic &
aortic areas.
Only heard in increased cardiac output.
, Venous hum - ANSWER Heard best while sitting, disappears while supine. R and L
upper sternal border, continuous humming murmur. innocent. Disappears in supine
position or when jugular vein compressed. > 3yo
PDA (patent ductus arteriosus) - ANSWER 2-4/6 continuous heard best over LUSB.
Full pulses. Most common congenital heart defect. More common in girls
MVP - ANSWER 1-3/6 mid-systolic click w/ late systolic murmur. Heard best at
apex. Louder with standing/squatting. Often seen with pectus excavatum
Pulmonic valve stenosis - ANSWER 2-5/6 best at LUSB, ejection click @ 2nd L ICS.
Radiates to back.
May involve wide S2. Usually d/t fusion of valves
HTN in peds - ANSWER Organ problem or aldosterone. Cushings. Refer to cards
Rheumatic heart disease - ANSWER Joints, CNS, post infectious group a strep.
affects mitral valve. Jones criteria (carditis, chorea, erythema marginatum, esr
elevated, arthralgia, fever, prolonged PR interval)
Kawasaki's - ANSWER Toxic vasculitis. Fever several days, rash, swelling, peeling,
strawberry tongue, prolonged PR or QT. ASA, refer.
Intusucception - ANSWER Surgical emergency. Lethargy, vomiting, jelly stool, mass
in RUQ. Can be from rotavirus ?
Neuroblastoma - ANSWER Adrenal gland tumor, before age 5. Mass in abdomen.
Catecholamines elevated. Painful, fixed, crosses midline.
Fetal alcohol syndrome - ANSWER Small head, shortened palpebral fissures
(narrow eyes), flat nasal bridge. Thin upper lip.
Port wine stain - ANSWER Trigeminal nerve, refer to opthlamology to rule out
congeital glaucoma. Can be a sign of Sturge-Weber syndrome.
Hirschberg Test - ANSWER Corneal light reflex, tests for strabismus.
Anal wink - ANSWER Absence is indicitave of spina bifida
Tonic neck - ANSWER Fencing
When do you get MMR? - ANSWER 12 months and 4-6 years ol.d
2 month development - ANSWER Follows objects past midline, coos, lifts head,
smiles
6 month development - ANSWER Palmar grasp, reaches, bring things to mouth,
pass things from one hand to another, sits up on own, turns belly-back-belly
