NMS Q&A Family Medicine

258 NMS Q&A Family Medicineantigen detection followed by the treatment with erythromycin.11. The answer is C. The timing is head up and controlledat 3 months, sit unsupported at 6 months, crawl at9 months, and walk at 12 months. These are good screeningguidelines and serve the family doctor or pediatricianwell, not only in educating parents, but also in reviewingto establish a database for a new pediatric patient. Manychildren, especially those from families of higher socioeconomicstatus, will walk before 1 year and some as earlyas 6 months. Also, children may take longer than 6 monthsto sit unsupported. If only one of these mile markers is adeparture from the normal rules of thumb, it may beexplained by factors unique to the child’s personality orfamily living status. Nevertheless, such a departure shouldtrigger a more detailed examination for development.Delay in walking may be based on neurological, orthopedic,or cerebral development. Such refinements of developmentalevaluation include grasp progressing fromulnar palm to radial, including the thumb at 3 to 4 months;using the thumb in opposition to pick up objects at7 months.12. The answer is C. The child should double the birthweight by the age of 6 months and increase three times bythe age of 1 year. Choice A is virtually the same rule for achild of average birth weight. Many children will exceedthis rate of growth, which is acceptable as long as the childis not becoming obese (i.e., simply growing bigger andfaster is alright). Obesity should be addressed when itappears and prescribed for by the age of 2.13. The answer is D. The uterus returns to normal sizemore rapidly in mothers who breast feed. Breast-fedbabies also have decreased weights relative to formula-fedbabies during the initial months, but this does not affecttheir final stature or weight. Breast milk supplies secretoryIgA and macrophages but not IgG. One disadvantage ofbreast feeding is that some infants develop jaundice. Theneonatal jaundice produced by breast feeding is felt to bebenign and is not believed to produce kernicterus.14. The answer is D, a 10-month-old who has an allergyto cow’s milk protein. The reaction to the ingested proteincauses inflammation in the intestine and resultant chroniclow-grade gastrointestinal blood loss, which predisposesto iron deficiency. The iron in breast milk, though nothigh in concentration, is very well absorbed because ofthe effect of lactoferrin in breast milk to enhance absorption.Vitamin C increases intestinal iron absorption. Termand postdate babies are not at increased risk, as even“standard” formulas are iron fortified.ReferencesFamily Medicine Board Review 2009. Kansas City, MO ; May3–10, 2009 .Gegas BG . Preventive care and triage of the infant and newborn .In: Rudy DR , Kurowski K , eds. Family Medicine: House OfficerSeries . Baltimore, MD : Williams & Wilkins ; 1997 : 669 – 688 .Thilo EH , Rosenberg AA . The newborn infant . In: Hay W Jr ,Levin MJ , Sondheimer JM , Deterding RR , eds. Current PediatricDiagnosis and Treatment , 19th ed . New York/Chicago/San Francisco: McGraw-Hill ; 2005.