Answer to Question 1
ANS: B
The head circumference should be measured at all well visits up to 2 years of age to assess for macro- or microcephaly. Assess the head symmetry and look for plagiocephaly. For the fontanel to be accurately assessed, the child should be sitting upright and not crying. Some variants that might be noted in newborns include the following:
Caput succedaneumSeen at birth, usually following a traumatic vaginal delivery or vacuum-assisted delivery; edema of the soft tissue of the scalp that usually crosses the suture lines; no specific treatment; should resolve in a few days.
CephalohematomaOfte n appears several hours after birth and may increase for the first 24 hours; subperiosteal collection of blood that does not cross the suture lines; may take weeks to months to resolve; watch for hyperbilirubinemia.
Red Flags for the Head Examination
No growth in head circumference between well visits.
Enlarged head size or excessive growth between well visits.
Answer to Question 2
ANS: D
Adolescents are at the height of trying to fit in and be normal. They worry about how they stack alongside their peers and may have concerns about their physical appearance, including their height, weight, or the presence of acne. They are striving to be independent and fear the loss of control and possibly even death. Privacy is very important at this age, so offer to examine the child without the parent unless the child prefers it otherwise. Remember to keep body parts covered when you are not examining them. Explain each step of your examination, and give the child a chance to ask questions or make choices as you progress. Be very nonjudgmental, and talk professionally but casually with them. Teach adolescents about their bodies, and stress the normalcy of their features and appearance.