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

Barkley Review: Pediatrics Assessment Day 1 with Answers provides a wealth of real exam questions, helping you prepare thoroughly for the test.

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    Barkley Review: Pediatrics Assessment Day 1 1. Developmentally Delayed 6 mo old s/sx a. Premature b. Child hasn’t started iron supplements c. Baby can’t grasp finger d. Child is 8 lbs at 6 mo old check-up without teeth 2. Jogging Again after having baby a. Mom can start jogging when baby is 2-3 mo old and has good head control 3. Erik Erikson a. Psychosocial theorist b. Viking = verses guy and doesn’t include age range but focuses on stages c. Stages i. Infancy (birth to 1 year): trust vs. mistrust ii. Toddler (1-3 years): autonomy vs. shame and doubt iii. Pre-school (3-6 y/o): initiative vs. guilt iv. School age (6-12 y/o): industry vs. inferiority 1. Accolades are an accomplishment v. Adolescence (12-18 y/o): identity vs. role confusion 4. Jean Piaget a. Cognitive theorist b. Primary theorist i. Sensorimotor stage: Birth to 2 years ii. Pre-operative/pre-conceptual stage: 2-4 years iii. Intuitive/pre-operational thinking: 4-7 y/o iv. Concrete thinking: 7-11 y/o v. Formal operational thought: 11-15 y/o 1. Ability to abstract 2. Utilize algebra type solving 5. Sigmund Freud

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    a. Psychosexual theorist / psychosocial domain b. Primary theorists c. Based on personalities are developed or not by experiences in particular sages of development i. ID: Principle of pleasure ii. Ego: Principle of reality/self-interest iii. Superego: Principle of morality or conscience d. Psychosexual development i. Infancy: oral stage 1. Birth-6 mo: orally passive (devel of ID, biologic pleasure principle) 2. 7-18 mo: orally aggressive (teething); oral satisfaction of needs by mother decreases tension ii. Toddler: 1.5- 3 years= anal stage iii. Pre-school: 3-6 years= phallic stage (ego devel= love of opposite sex) iv. School age: 6-12 years= latency stage (sexual drive repressed, socialization occurs, super ego and morality development) v. Adolescence: 12-18 years: genital stage 6. 4 mo-old infants not cooing or making eye-contact. What would be the most appropriate action to take? a. Ask mother if she has noticed the infant’s behaviors and let her know that you are concerned, as most infants are making social interactions at this point. Ask to see infant again in one month for further evaluation 7. Red Flags of Pediatrics a. A deficit of sequential measurements b. Brain tumor= sequential lines on growth chart where head circumference increases significant on the growth chart i. 18 month visit= vital areas 1. Measure head circumference, body length, and height ii. BMI is only good after 2 years of age 8. Domains of Growth & Development: 3 Domains a. Physical

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    b. Cognitive c. Psychosocial 9. Nutrition a. Exclusive breast feeding for the first 6 months b. Adequate supplementation of iron i. 1mg/kg/day at 6 months of age ii. First primary tooth by 6 months age iii. Finish getting rest of teeth 24 months of age iv. Permanent teeth starts at 6 y/o age and complete at 12 y/o c. Calories i. Birth -6 mo: 120 kcal/kg/day ii. 7 mo- 1 year 100 kcal/kg/day iii. 2-10 years: 70-100 kcal/kg/day iv. Adolescents: 45 kcal/kg/day v. Adults: 30 kcal/kg/day d. Physical growth i. Cephalon (caudal) to proximal = distal 10. B-lymphocytes a. Helps the body to make abt’s against vaccine 11. DTAP a. Don’t give after 7 y/o age b. Provides more protection for babies in diptheria 12. Tdap a. Booster require every 10 years on birthday b. Given to children 7 y/o or older c. Every pregnant woman at every pregnancy d. All HCPs and elderly patients 13. HIB a. Do not give after age 5 y/o

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    14. Pneumococcal a. PCV13 b. PCV23 i. Pneumovax ii. Given to patients who need it for certain dx 1. Spleen issues (need when condition developed or born with conditions= receive around age 2 and only requires 1 dose) 15. IPV a. Injectable dose b. Only given in America c. 4 shots 16. Influenza a. Annually b. Beginning at 6 mos c. Give in early fall/end of summer d. Pregnant women do get flu shots since baby is unprotected e. Don’t give to immunocompromised patients f. 6-35 months (up to 3 years) ½ dose 0.25 ml (1 st flu shot get 0.25mL and comes back in 1 month for next dose) g. 3 years older= receives a full dose 0.5mL h. Children younger than 9 y/o receive 2 doses 1 mo apart 17. MMR a. Series of 2 (1 y/o and by 12 y/o) b. Exposed by traveling or endemic areas c. MMR can be given as early as 6 months of age d. Can be given simultaneously with TB testing with PPD but prefer to post-pone PPD for 4- 6 wks to avoid possible suppressive responsible e. Can vaccinate child as early s 6 months if traveling to outside areas and vaccinate again at 1 year 18. Varicella

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    a. Live vaccine b. Series of 2 (b/w 12 months and 12 years; minimum 3 years apart) 19. Hep A a. Oral fecal b. Given at 1 y/o (2 injections) c. 1 year-2 years and 6 mo apart 20. Meningococcal vaccine a. Series of 2 b. Age 11-12 y/o and booster at age of 16 years c. Adolescents can receive first dose at or after 16 years d. No booster necessary 21. HPV a. Vaccine protects against cancer b. Gardasil 9 (protection against 9 series of HPV c. Multivariant protects against genital warts d. Recommended that they sit for 15 mins after vaccination d/t risk of labile syncope, postural hypotension, and vasovagal responses e. Males and females receive f. Most common sexually disease g. Series of 2 injections i. As early as 9 y/o age but recommended at 11 or 12 y/o ii. Second dose given 6-12 mo after 1 st dose h. series of 3 injections i. 15 or older ii. Second dose given 1-2 mon iii. 3 rd dose given at 6 mo 22. DiGeorge Syndrome a. A phenotypic presentation of short philtrum, aortic arch anomalies, and seizure during infancy would raise genetic concerns for this d/o

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    23. Down Syndrome Common Phenotypic (physical) findings a. Microcephaly, upward slanting eyes, hypotonia 24. Down syndrome Common Genotypic (Trisomy) findings a. Requires a micro-array lab drawn 25. Which condition would you not necessarily expect to find a cardiac defect a. Klinefelter’s syndrome 26. Which conditions would have a cardiac defect associated with it a. Turner’s syndrome b. diGeorge’s syndrome c. trisomy 13 (down syndrome) 27. a mother who had 2 previous m/c is again pregnant. She wants to know the very earliest test that can be done to reassure her that her baby doesn’t have a congenital defect. You recommend a. chorionic amniocentesis can be done as early as 11 weeks GA (u/s guidance of a sample b/w the placenta and uterus looking for a certain DNA) i. fetal u/s only gives a review of the body parts ii. quad blood test only test for 4 diseases of the most common birth defects iii. genetic testing on both parents is done before pregnancy 1. can still perform this test but it will take 2weeks for results to come back and patients will have to pay out of pocket b/c insurance won’t cover it since the patient is already pregnant 28. least important when taking a prenatally hx of 2-week-old at his or her first PCP visit a. baby coos at 2 weeks= isn’t necessary b/c it doesn’t happen this early 29. how many points are available for each item on the APGAR scoring system for a NB? a. 10 is the maximum score b. 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 warm during 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 for further tests and possible admission i. Baby has s/sx of shock requires NICU

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    ii. Giving acetaminophen to a child that is dehydrated causes acute liver failure 31. 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 months ii. Moro reflex away by 4 months iii. Placing/stepping goes away in 2 mo age 32. You are examining NB in nursery and with infant lying on back, you flex knees up, then with your thumb inside knee, abduct the leg and feel femoral head slide into acetabulum. You have just performed which exam? a. Ortolani’s click for development of hip dysplasia 1. Reducing dislocation/will feel and hear a click when placing femoral head back into location ii. Barlow 1. Demonstrates dislocation by adducting iii. Generum varum 1. Bow leg iv. Genum valgum 1. Knot knee 33. Which is not a survival reflex? a. Moro reflex i. Survival reflex: temperature, breathing, and sucking 34. An appropriate method to assess the visual acuity on an infant is a. Obtain a blink reflex and observe for pupil constriction 35. 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 months 36. Appropriate antipyretic drug and dosage for a 4 mo old is a. 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/kg 37. Bright futures program is a. A national health promotion and disease prevention initiative 38. Toddlers should be seen for health promotion at the following intervals a. Every 3 months until 18 months then every 6 months until 3 years of age and then annually there after 39. You’re seeing 18 mo old for a routine exam. Which is the least of importance to complete. a. Determine Body surface index i. Not an appropriate growth objective evaluation until age 24 months (2 y/o) b. Appropriate exam for routine i. Head circumference until age 2 1. b/c pt can still develop hydrocephalus due to sutures not fulling being closed ii. Assessment of dental development iii. Language assessment 40. Sammy is not using two-words sentences, is rocking himself, and is not interested in pictures of animals on wall. These signs are a particular concern at what earliest age? a. 2 years of age i. 3 years of age to dx autism 41. 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 stage 42. Although growth and development slows during this stage, you would still expect which of the following growth parameters? a. Weight of 6lbs/year and height of 2 inches/year 43. Which of the following is true regarding obesity? a. Defined as a BMI > 95 th percentile 44. To make the dx of ADHD, the following must be present except? a. Combative behavior when given limits i. 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 meal iii. noticeably less attentive than peers of same age in same setting 45. appropriate mngmt of child with ADHD can include all of the following except? a. CNS depressant: Diphenhydramine i. Anytime you see 2 opposites as your answer choice and the option to tell you except in the question then one of those answers are true 46. The adolescent period is characterized by all of the following except a. Need for first cervical cytology test for sexually active females i. First pap smear is age 21 b. Correct periods i. Psychosocial stage of identify vs role confusion ii. Rapid changes in ht and wt peak velocity iii. Conflict with parents 47. The following should be included in a physical exam at age 18 except a. Testicular volume determination (i.e. Prader Beads) i. Done to estimate volume in testicular if a person is surviving childhood cancer 48. You are performing a health exam on Maria who recently turned 18. You note on exam she is a senior in HS active in school drama performance, has a boyfriend but is celibate, and has a reasonable 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 that his penis elongated. You estimate his sexual maturity rating (tanner stage) is at what stage? a. Stage 3 * is where the most differential occurs i. Stage 1 ii. Stage 2= some differentiation iii. Stage 3 iv. Stage 4= more differentian but less than adult 50. Nevaeh is a 12 y/o female with breast enlargement but no differentiation b/w nipple and the areola. She also has curly pubic hair. According to Tanner Staging for Females when should she expect her first menses? a. Within the next year

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