CMN 571 FINAL EXAM UPDATED QUESTIONS AND
ANSWERS GRADED A+
✔✔Varicella vaccine - ✔✔Prevention or decreased severity of Varicella (chickenpox)
Given in two doses - alone or with MMR
Live virus vaccines - contraindicated in children who have acquired treatment related
cellular immunodeficiencies or congenital T cell abnormalities. (can be given to HIV
infected children who are not severely immunosuppresed)
Should not be given to pregnant women, however a pregnant family member is not a
reason to withhold vaccine in a child.
Personal or family Febrile seizure history is a precaution
Adverse effects- minor site reactions.
✔✔Hepatitis A vaccine - ✔✔Two dose schedule between 12 and 23 months, 6 months
apart.
Formulas - Havrix, Vaqta. Combo with Heb B- Twinrix.
Precaution to vaccination include pregnancy and moderate to severe acute illness.
Adverse effects - uncommon and mild. Pain, swelling, and induration at injection site,
headache and loss of appetite.
✔✔Development 1-2 Months - ✔✔Observed:
Holds head erect/lifts head
Turns side to back
Regards faces and follows objects through visual field
Drops toys
Becomes alert in response to voice
Related:
Recognizes parents
Engages in vocalizations
Smiles spontaneously
✔✔Development 3-5 Months - ✔✔Observed:
Grasps cube - first ulnar and later thumb opposition
Reaches for and brings objects to mouth
Raspberry sounds
Sits with support
Related:
Laughs
Anticipates food on sight
Turns back to side.
✔✔Development 6-8 Months - ✔✔Observed:
Sits alone for short period
Reaches with 1 hand
First scoops up a pellet; then grasps with thumb opposition
Imitates bye-bye
,Passes object from hand to hand midline
Babbles
Related:
Rolls back to stomach
Inhibited by the word NO
✔✔Development 9-11 Months - ✔✔Observed:
Stand alone
Pat a cake and peek a boo
Uses thumb and index finger to pick up pellet
Related:
Walks by supporting self on furniture
Follows 1 step verbal commands "come here" "give it to me"
✔✔Development 1 year - ✔✔Observed:
Walk independently
Mama and Dada with meaning
Neat pincer grasp to pick up pellet
Release cube into cup after demonstration
Gives toys on request
Tower of 2 cubes
Related:
Points to desired objects
Says one or two other words
✔✔Development 18 months - ✔✔Observed:
Tower of 3-4 blocks
Throws ball
Seats self in chair
Dumps pellet from bottle
Related:
Walks up and down stairs with help
4-20 words
Understands 2 step command
Carries and hugs doll
Feeds self
✔✔Devleopment 24 Months - ✔✔Observed:
Speaks short phrases - 2 words or more
Kicks ball on request
Tower 6-7 cubes
Points to named objects or pictures
Jumps off floor with two feet
Stands on either foot alone
Uses pronouns
Related:
,Verbalized toilet needs
Pulls on simple garment
Turns pages of book singly
Plays with domestic mimicry
✔✔Development 30 months - ✔✔Observed:
Walks backwards
Hop on 1 foot
Prepositions
Copies crude circle
Points to objects described by use
refers to self as I
Holds crayon in fist
Related:
Helps put things away
Carries on a conversation
✔✔Development 3 years - ✔✔Observed:
Holds crayon with fingers
Tower 9-10 cubes
Imitates 3 cube bridge
Copies circle
Gives first and last name
Related:
Rides tricycle using pedals
Dresses with supervision
✔✔Development 3-5 years - ✔✔Observed:
Climbs stairs with alternating feet
Button and unbutton
"What do you like to do that is fun?" uses plurals, personal pronouns, and verbs
Responds to command to place toy in, on or under table
Draws a circle when asked to draw a person
Knows own sex
Gives full name
Copies a circle already drawn
Related:
Feeds self at mealtime
Takes off shoes and jacket
✔✔Development 4-5 Years - ✔✔Observed:
Runs and turns without losing balance
May stand on 1 leg for 10 seconds
Buttons clothes and laces shoes
Counts to 4 by route
Draws a person
, Knows days of week
What must you do if you are sleepy
Copies + in imitation
Related:
Self care at toilet
Plays outside for at least 30 min
Dresses self except for tying
✔✔Growth Parameters - ✔✔Height, weight and head circumference at each well child
visit.
Naked baby and underpants for older kids
Recumbent length until 2 years then standing
WHO growth charts are recommended
Head circumference can cease at 2 years if it has been steady
Use weight for length chart for up to 2 years then BMI
✔✔Blood pressure - ✔✔Screening starts at 3 years.
Conditions that warrant starting BP screening sooner: Prematurity, CHD, Recurrent UTI,
hematuria, protienuria, renal disease, family hx renal disease, solid organ transplant,
malignancy or bone marrow transplant, treatment with drugs known to raise BP
(steroids, BC), conditions associated with HTN (neurofibromatosis, tuberous sclerosis),
Elevated ICP.
HTN is BP > 95%
Diagnosis of HTN should not be made with automated cuff alone, and should be over 3
visits.
Cuff should be 40-50% circumference of the limb
HTN diagnosed children should have a CBC, serum nitrogen, creatinine, electrolytes,
fasting lipid panel, glucose, urinalysis, urine cx, renal US, Echo, and retinal exam.
First line treatment is lifestyle modification, medications are indicated if: Symptomatic,
secondary HTN, HTN target organ damage, diabetes, persistent HTN despite non-
pharm.
✔✔Vision - ✔✔Inspection of eyes and lids: All ages
Red reflex: Birth until child can read chart (refer any abnormal)
Assessment of fixation and following: starting at 2 Mo (Refer if poor at 3 Mo)
Corneal light reflex (strabismus): 3MO-5yrs (Refer Asymmetry)
Cover test (Strabismus): 6Mo-5Yrs (Refer presence of fixation movement)
Fundoscopic exam: 3 yrs
Preliterate eye chart: 3-4yrs (Refer unable to pass 20/40 @ 3-5 yrs; 20/30 @ 6 and
older; difference of two lines. Credit is given if 50% correct)
✔✔Hearing - ✔✔Hearing loss can lead to substantial impairments in speech, language
and cognitive development.
Informal testing of hearing is unreliable (shaken rattle) Parental concerns are greatest
predictor.
Prior to age 4 patients should be referred to audiologist for concerns
ANSWERS GRADED A+
✔✔Varicella vaccine - ✔✔Prevention or decreased severity of Varicella (chickenpox)
Given in two doses - alone or with MMR
Live virus vaccines - contraindicated in children who have acquired treatment related
cellular immunodeficiencies or congenital T cell abnormalities. (can be given to HIV
infected children who are not severely immunosuppresed)
Should not be given to pregnant women, however a pregnant family member is not a
reason to withhold vaccine in a child.
Personal or family Febrile seizure history is a precaution
Adverse effects- minor site reactions.
✔✔Hepatitis A vaccine - ✔✔Two dose schedule between 12 and 23 months, 6 months
apart.
Formulas - Havrix, Vaqta. Combo with Heb B- Twinrix.
Precaution to vaccination include pregnancy and moderate to severe acute illness.
Adverse effects - uncommon and mild. Pain, swelling, and induration at injection site,
headache and loss of appetite.
✔✔Development 1-2 Months - ✔✔Observed:
Holds head erect/lifts head
Turns side to back
Regards faces and follows objects through visual field
Drops toys
Becomes alert in response to voice
Related:
Recognizes parents
Engages in vocalizations
Smiles spontaneously
✔✔Development 3-5 Months - ✔✔Observed:
Grasps cube - first ulnar and later thumb opposition
Reaches for and brings objects to mouth
Raspberry sounds
Sits with support
Related:
Laughs
Anticipates food on sight
Turns back to side.
✔✔Development 6-8 Months - ✔✔Observed:
Sits alone for short period
Reaches with 1 hand
First scoops up a pellet; then grasps with thumb opposition
Imitates bye-bye
,Passes object from hand to hand midline
Babbles
Related:
Rolls back to stomach
Inhibited by the word NO
✔✔Development 9-11 Months - ✔✔Observed:
Stand alone
Pat a cake and peek a boo
Uses thumb and index finger to pick up pellet
Related:
Walks by supporting self on furniture
Follows 1 step verbal commands "come here" "give it to me"
✔✔Development 1 year - ✔✔Observed:
Walk independently
Mama and Dada with meaning
Neat pincer grasp to pick up pellet
Release cube into cup after demonstration
Gives toys on request
Tower of 2 cubes
Related:
Points to desired objects
Says one or two other words
✔✔Development 18 months - ✔✔Observed:
Tower of 3-4 blocks
Throws ball
Seats self in chair
Dumps pellet from bottle
Related:
Walks up and down stairs with help
4-20 words
Understands 2 step command
Carries and hugs doll
Feeds self
✔✔Devleopment 24 Months - ✔✔Observed:
Speaks short phrases - 2 words or more
Kicks ball on request
Tower 6-7 cubes
Points to named objects or pictures
Jumps off floor with two feet
Stands on either foot alone
Uses pronouns
Related:
,Verbalized toilet needs
Pulls on simple garment
Turns pages of book singly
Plays with domestic mimicry
✔✔Development 30 months - ✔✔Observed:
Walks backwards
Hop on 1 foot
Prepositions
Copies crude circle
Points to objects described by use
refers to self as I
Holds crayon in fist
Related:
Helps put things away
Carries on a conversation
✔✔Development 3 years - ✔✔Observed:
Holds crayon with fingers
Tower 9-10 cubes
Imitates 3 cube bridge
Copies circle
Gives first and last name
Related:
Rides tricycle using pedals
Dresses with supervision
✔✔Development 3-5 years - ✔✔Observed:
Climbs stairs with alternating feet
Button and unbutton
"What do you like to do that is fun?" uses plurals, personal pronouns, and verbs
Responds to command to place toy in, on or under table
Draws a circle when asked to draw a person
Knows own sex
Gives full name
Copies a circle already drawn
Related:
Feeds self at mealtime
Takes off shoes and jacket
✔✔Development 4-5 Years - ✔✔Observed:
Runs and turns without losing balance
May stand on 1 leg for 10 seconds
Buttons clothes and laces shoes
Counts to 4 by route
Draws a person
, Knows days of week
What must you do if you are sleepy
Copies + in imitation
Related:
Self care at toilet
Plays outside for at least 30 min
Dresses self except for tying
✔✔Growth Parameters - ✔✔Height, weight and head circumference at each well child
visit.
Naked baby and underpants for older kids
Recumbent length until 2 years then standing
WHO growth charts are recommended
Head circumference can cease at 2 years if it has been steady
Use weight for length chart for up to 2 years then BMI
✔✔Blood pressure - ✔✔Screening starts at 3 years.
Conditions that warrant starting BP screening sooner: Prematurity, CHD, Recurrent UTI,
hematuria, protienuria, renal disease, family hx renal disease, solid organ transplant,
malignancy or bone marrow transplant, treatment with drugs known to raise BP
(steroids, BC), conditions associated with HTN (neurofibromatosis, tuberous sclerosis),
Elevated ICP.
HTN is BP > 95%
Diagnosis of HTN should not be made with automated cuff alone, and should be over 3
visits.
Cuff should be 40-50% circumference of the limb
HTN diagnosed children should have a CBC, serum nitrogen, creatinine, electrolytes,
fasting lipid panel, glucose, urinalysis, urine cx, renal US, Echo, and retinal exam.
First line treatment is lifestyle modification, medications are indicated if: Symptomatic,
secondary HTN, HTN target organ damage, diabetes, persistent HTN despite non-
pharm.
✔✔Vision - ✔✔Inspection of eyes and lids: All ages
Red reflex: Birth until child can read chart (refer any abnormal)
Assessment of fixation and following: starting at 2 Mo (Refer if poor at 3 Mo)
Corneal light reflex (strabismus): 3MO-5yrs (Refer Asymmetry)
Cover test (Strabismus): 6Mo-5Yrs (Refer presence of fixation movement)
Fundoscopic exam: 3 yrs
Preliterate eye chart: 3-4yrs (Refer unable to pass 20/40 @ 3-5 yrs; 20/30 @ 6 and
older; difference of two lines. Credit is given if 50% correct)
✔✔Hearing - ✔✔Hearing loss can lead to substantial impairments in speech, language
and cognitive development.
Informal testing of hearing is unreliable (shaken rattle) Parental concerns are greatest
predictor.
Prior to age 4 patients should be referred to audiologist for concerns
