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PCM 2.2 > Peds > Flashcards

Peds Flashcards

1
Q

3 specific areas of well child exams

A
  1. physical development - walking
  2. cognitive development - talking
  3. social and emotional development - thinking
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2
Q

before 2 months, what must be done if neonates get fever?

A

check for sepsis in case of meningitis

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3
Q

define neonate

A

first 28 days of life

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4
Q

define infant

A

neonatal period until 12 months

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5
Q

what is APGAR score

A

5 components that classify newborn’s neurologic recovery from birth and immediate adaptation

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6
Q

what does APGAR stand for?

A 
A = appearance (color)
P = pulse
G = grimace (reflex irritability)
A = activity (mm tone)
R = respiratory effort
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7
Q

most baby starts at what APGAR score and why?

A

starts at 9 cus have bad peripheral circulation

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8
Q

when is hospital eval done and what is included in it?

A
  • done within 24 hours of delivery

- includes review of maternal hx (esp GBS), delivery record, and full head to toe PE

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9
Q

hospital care of newborn includes?

A

shortly after delivery, give:

  1. erythromycin ointment in eyes to prevent infection
  2. Vitamin K injection to prevent bleeding
  3. full bath
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10
Q

how is gestational age estimated?

A

Ballard Scoring System

- based on neuromuscular sign and physical characteristics that change with gestational maturation

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11
Q

neonate feeding

A
  • done every 3 hours
  • breastfeeding: initially small volumes of colostrum, milk come in after 2-3 days (can be longer in first time mothers)
  • formula 15-30 mL
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12
Q

weight change in newborns

A
  • normal to lose up to 10% of birth weight over 1st week

- should be regained by 10-14 days of life

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13
Q

number of voiding per day

A
  • 3-4 voids in day 1-3

- 6-8 voids by day 4-5

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14
Q

color of stools

A
  • initial stools are meconium (dar, black, tarry) and should stool within first 24hrs
  • day 4-5, stools depend on type of feeding (breast - yellow, seedy, formula - green-yellow)
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15
Q

jaundice in newborns

A

elevated levels esp prior to first 24 hours of life indicate more than physiologic jaundice

  1. ABO incompatibility/Rh
  2. cephalohematoma
  3. infection
  4. hemoglobinopathies (thalassemia)
  5. enzyme deficiencies (G6PD)
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16
Q

prior to discharge, what must be done?

A
  1. hep B immunization
  2. hearing screen
  3. newborn screening blood test
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17
Q

what does infant well child visits include?

A
  • assessment of growth and development

- provide parent with info/advice on multitude of subjects concerning infant

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18
Q

what labs should be done at 2 week? and 12 months?

A
  1. newborn screen #2

2. hemoglobin

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19
Q

components used for assessment of development milestones

A
  1. physical - gross and fine motor
  2. language/cognitive
  3. personal/social
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20
Q

how does neurologic development progresses in infant?

A

centrally to peripherally (gross –> fine motor)

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21
Q

language development of infants

A

2 months - cooing
6 months - babbling
1 year - 1-3 words

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22
Q

by 9 months, what cognitive process should the infant possess?

A
  • recognize strangers
  • seek comfort from parents during exam
  • actively manipulates objects
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23
Q

at 9 months, where should the exam be done?

A

9 months and older infants should be examine on parents lap due to stranger anxiety

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24
Q

infant GU exam

A
  • female: labial adhesions
  • male: urethral opening (gently retract foreskin to visualize urethral meatus but do not force foreskin back) and circumcision
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25
Q

infant neurological exam

A

primitive reflexes

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26
Q

infant lungs exam

A
  • chest symmetry

- respiratory distress (nasal flaring, retractions, accessory mm use)

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27
Q

infant CV exam

A
  • benign murmurs
  • brachial/femoral pulses
  • BP not done in child < 3 yrs
28
Q

infant GI exam

A
  • liver tip palpable 1-2 cm below costal margin
  • no spleen palpable
  • can feel kidneys
  • anal fissures
29
Q

primitive reflexes

A
  1. palmar grasp
  2. plantar grasp
  3. moro (startle reflex)
  4. rooting
  5. stepping
30
Q

palmar grasp primitive reflex

A

place finger in hand and press against palmar surface –> grasp finger

31
Q

plantar grasp primitive reflex

A

touch sole at base of toes –> toes curl

32
Q

moro (startle reflex) primitive reflex

A

hold supine and support head, back, legs; abruptly lower 2 feet –> arms abduct and extend, hands open, and legs flex, +/- cry

33
Q

rooting primitive reflex

A

stroke perioral skin at corner mouth –> mouth opens and turns head toward side stimulated

34
Q

place/stepping primitive reflexes

A

hold upright, have one sole touch table –> hip and knee of that foot will flex and other foot will step forward

35
Q

infant MSK exam

A
  • observe: symmetry, deformities, digits (syndactyly, polydactyly)
  • palpate: spine (scoliosis, spina bifida occulta), feet (curvature/rotation deformities)
36
Q

infant hip exam

A

Barlow and Ortolani maneuvers to test for dislocation

  • can indicate development hip dysplasia (DHD)
  • test effective until 3 months, when hip capsule begins to tighten
37
Q

ortolani test

A

tests for presence of posteriorly dislocated hip

38
Q

barlow test

A

tests for ability to sublux or dislocate intact but unstable hip

39
Q

infant HEENT exam: head

A

fontanelles

  • ant closes be/w 4-26 mos
  • post closes by 2 mos
  • both should be flat and soft in consistency
40
Q

infant HEENT exam: eyes

A

red reflex

- abnormal = cataracts, glaucoma, retinoblastoma, or other abnormalities of eye

41
Q

infant HEENT exam: oral

A
  1. palate
  2. teeth
  3. mucus-cysts (Epstein pearls)
  4. tongue abnormalities (tongue-tied)
  5. tonsils
42
Q

infant HEENT exam: cervical lymph nodes

A
  1. enlargement
  2. size
  3. shape
  4. mobility
43
Q

infant HEENT exam: ears

A
  1. pits/tags

2. TM using insufflator if possible ear infection

44
Q

infant skin exam

A
  1. newborn benign rashes
  2. mongolian spots
  3. nevi
  4. hemangiomas
  5. sacral dimple/hair tufts
45
Q

infant anticipatory guidance

A
  1. healthy habits/ behaviors: injury prevention, nutrition, oral health
  2. parent-infant interaction: promote development
  3. family relationship: time for self
  4. community interaction: resources
46
Q

benign heart murmurs in children

A
  1. Still’s murmur
  2. Venous hum
  3. carotid bruit
47
Q

Still’s murmur

A

grade II/VI, musical, vibratory midsystolic

48
Q

venous hum

A

soft, continuous, louder in diastole

49
Q

carotid bruit

A

midsystolic, usually louder on L, eliminated by carotid compression

50
Q

toddler PE

A
  • similar to adult PE

- CV - cont to compare radial/femoral pulses b/l

51
Q

toddler anticipatory guidance

A
  1. healthy habits and behaviors: injury and illness prevention, nutrition and oral health
  2. parent-child interaction: reading, fun time, TV
  3. family relationships: activities, babysitters
  4. community interaction: childcare, resources
52
Q

early adolescence (10-14 y/o): components used to assess development milestone

A
  1. physical - puberty
  2. cognitive - concrete operational
  3. social - identity, peers increasing importance
53
Q

middle adolescence (15-16 y/o): components used to assess development milestone

A
  1. physical - females more comfortable, males awkward
  2. cognitive - develop insight
  3. social - identity, independence
54
Q

late adolescence (17-20 y/o): components used to assess development milestone

A
  1. physical - adult appearance
  2. cognitive - formal operational
  3. social - independence (sep from family, real indep)
55
Q

adolescence PE

A

similar to adult PE

  • when doing GU exam, have chaperon present
  • visualize external genitalia to confirm Tanner staging
  • female pelvic/breast exams - not performed until pt reaches 21 y/o or 3 yrs after onset of sexual activity
56
Q

adrenarche

A
  • activation of adrenal medulla for production of adrenal androgens
  • occurs before onset of puberty
57
Q

gonadarche

A

earliest gonadal changes of puberty GnRH released

  • boys: LH stimulates testosterone production and FSH stimulates sperm maturation
  • girls: FSH stimulates estrogen and follicle formation and LH stimulates corpus luteum ovulation
58
Q

thelarche

A

beginning of breast development at puberty

59
Q

pubarche

A

beginning of pubic hair

60
Q

menarche

A

occurrence of 1st menstrual bleeding

61
Q

tanner staging - breast

A
  1. preadolescent; elevation of nipple only
  2. elevation breast/nipple as small mound (breast buds); entering puberty
  3. further enlargement breast/areola, no separation
  4. projection areola/nipple to form secondary mound
  5. mature stage, projection of nipple only
62
Q

tanner stage - pubic hair (same in both female and male)

A
  1. preadolescent; no pubic hair except for fine body hair
  2. sparse growth of long, slightly pigmented, downy hair along labia
  3. darker, coarser, curlier hair spreading sparsely over pubic symphysis
  4. coarse and curly hair as in adults; hair has not spread to thigh
  5. hair adult in quantity and quality; spread over medial surfaces of thigh but not up abdomen
63
Q

order of female puberty changes

A
  1. breast buds
  2. pubic hair
  3. growth spurts peaks (age 12)
  4. menarche
64
Q

tanner stagning - penis/testes

A
  1. preadolescent; penis/testes same size as childhood
  2. penis - slight or no enlargement; testes/scrotum - larger, slightly reddened
  3. penis - larger in length; testes - further enlargement
  4. penis - further enlargement and dev of glans; testes - further enlarged, scrotal skin darkened
  5. penis/testes - adult in size and shape
65
Q

order of male puberty changes

A
  1. testicular growth
  2. pubic hair
  3. penile enlargement
  4. growth spurt peaks (age 14)
66
Q

adolescent anticipatory guidance

A 
HEADS
H - home
E- Education
A - alcohol
D - drugs
S - sexuality

PCM 2.2 (4 decks)

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