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PEDS- Clinical Disciplines Exam 2 > well child visits & gen peds > Flashcards

well child visits & gen peds Flashcards

1
Q

what are key components of ped health promotion

A

age approp. developmental achievement of the child

health supervision visits

integration of PE findings w/healthy lifestyles

immunizations

anticipatory guidance

Partnership btwn health care provider & child, adolescent & family

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2
Q

what are some components of age age appropriate developmental achievement of the child

A

Physical (maturation, growth, puberty)

Motor (gross & fine motor skills)

Cognitive (achievement of milestones, language, school performance)

Emotional (self efficacy, self esteem, independence, morality)

Social (social competence, self responsibility, integration w/ family & community)

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3
Q

what are some examples of anticipatory guidance

A 
healthy habits
nutrition, healthy eating
safety & prevention of injury
sexual development & sexuality
family relationships
emotional & mental health 
oral health
school & vocation
peer relationships
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4
Q

when does AAP recommend well visit schedules?

A

birth, 1mo, 2mo, 4mo, 6mo, 9mo, 12mo, 15mo, 18mo, 2yr, then annually through adolescence

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5
Q

what are some vital signs for 0-3mo old

A

HR 110-180bpm
BP 85/45-55
RR 30-60

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6
Q

what does the pediatric growth curve compare?

A

the pt’s height, weight, head circumference & BMI to population (measured in %tiles)

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7
Q

At what age does BMI start being used?

A

2 yrs

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8
Q

to what age is head circumference tracked?

A

2-3yrs of age

important to assess for brain growth

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9
Q

what are the % tiles for growth curves?

A 
Overweight = 85-95%ile
Obesity = >95 %ile
Underweight = <5 %ile
Microcephaly = <3%ile
Macrocephaly = >97%ile
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10
Q

classification of gestational age:

A 
Preterm = <37wks 
Term = 37-42wks
Post-term = >42wks
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11
Q

Classification of birth wt.

A

Extremely low BW = <1000g (2.2lbs)
Very low BW = <1500g (3.3lbs)
Low BW = <2500g (5.5lbs)
Normal BW = >2500g

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12
Q

what %tiles for small gestational age, appropriate for gestational age, large for gestational age?

A

SGA = < 10th %ile

AGA = 10-90th %ile

LGA = >90th %ile

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13
Q

1st yr of life is called…

A

infancy

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14
Q

neonatal period =

A

day 1-28

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15
Q

postneonatal period =

A

day 29-1yr

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16
Q

what are some tips for a newborn exam

A

swaddle newborn

dim the lights to see the eyes

observe feeding (nursing) if possible

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17
Q

what is apgar?

A

key assessment of the newborn immediately after birth

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18
Q

when is it used?

A

Scored at 1 & 5 minutes after birth

Scores range from 0 to 10

Scoring may continue at 5 min intervals until the score is > 7

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19
Q

what is a newborn screen test?

A

population wide testing for metabolic & genetic diseases

blood samples collected by heel stick before discharge then again at 7-14 days of life

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20
Q

tips for newborn peds exam

A

Support the head

Take what parts of the PE are easily available
listen to heart & lungs while baby is asleep

Look at that red reflex if the baby’s eyes are open

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21
Q

general PE findings

A

Cry:
strong vs. weak, abnormal sounding

Respiratory effort:
nasal flaring, use of accessory muscles (abdomen, intercostal), respiratory rate

Posture/Tone:
Normal = flexion of legs & arms when supine
Abnormal = low tone, floppy

Color:
Cyanosis- mild can be normal at birth, but baby should be pink soon thereafter
Peripheral cyanosis (finger tips)- can be normal for 1-2 days
Jaundice (yellowing of the skin)- sometimes difficult based on the baby’s race

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22
Q

what is vernix caeosa?

A

cheesy white covering

decreases as term approaches

made from fetal
corneocytes/sebaceous gland activity

rich lipid matrix

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23
Q

what is milia?

A

Pinpoint white papules w/out surrounding erythema

caused by blocked sebaceous glands

commonly on nose, chin, forehead & cheeks

usually appears w/in the 1st few weeks & disappears over several weeks

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24
Q

what is mongolian spot?

A

aka congenital dermal melanocytosis

blue patches of pigment

commonly seen over lumbar area, buttocks or extremities

they generally fade w/ time
common in those of Asian, Native American, Hispanic, East Indian & African descent

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25
Q

what is erythema toxicum?

A

yellow eosinophillic papules on red base

may appear on 2nd to 4th day of life

mostly seen on trunk
unknown etiology but thought to be due to the immaturity of the pilosebaceous follicles

typically disappear w/in 1 week of birth

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26
Q

what can be a sign of elevated ICP (meningitis or hydrocephalus)

A

Widely split sutures

bulging fontanelles (bleed vs. meningitis)

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27
Q

what suggests craniosynostosis?

A

A raised, bony ridge at a suture line

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28
Q

what are the areas where major sutures intersect?

A

fontanelles (should be soft, not depressed)

*always palpate

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29
Q

what can be the 1st sign of congenital hypothyroidism?

A

large fontanelle

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30
Q

a sunken fontanelle may indicate…

A

dehydration

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31
Q

characteristics of anterior fontanelle

A

closes by approx. 9-18mo

varies in size- 1 to 4cm

located at the juncture of the metopic, sagittal & coronal sutures

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32
Q

characteristics of posterior fontanelle

A

closes by approx. 1-2mo

should be <1cm

located at juncture of the sagittal & lambdoid suture

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33
Q

what is a cephalohematoma?

A

extracranial finding: swelling/collection of blood over one or both parietal bones

does NOT cross suture lines

resolves in wks to months

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34
Q

what is a caput succedaneum?

A

edema of the scalp,
CAN cross suture lines,
resolves in days

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35
Q

which one crosses suture lines? bilateral cephalohematoma or caput succedaneum?

A

caput succedaneum can cross

B/L cephalohematoma does NOT

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36
Q

what are you looking for on PE for face?

A

facial symmetry – facial palsies from nerve birth injury

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37
Q

what are you looking for on PE for eyes?

A

spacing of eyes: Hypetelorism (abn. wide)

subconjunctival hemorrhages are common from birth trauma

Red reflexes should be present & symmetrical

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38
Q

what are you looking for on PE for nose?

A

infants <1mo are nose breathers- ensure no obstructions

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39
Q

what are you looking for on PE for ears?

A

pull the auricle gently downward for the best view

preauricular pits & tags are common: always screen for hearing loss

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40
Q

what are epstein’s pearls

A

small, white benign, inclusion cysts

typically seen on palate

Bohn nodules are usually seen on gingival ridge

No tx needed, they will resolve spontaneously,
usu. seen between 2-4mo of age

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41
Q

what is ankyloglossia?

A

tongue tie – congenital short lingual frenulum

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42
Q

characteristics of ankyloglossia?

A

can limit movement of tongue

can cause pain w/ nursing

usually see puckering of the midline tongue tip w/ movement

may lead to speech difficulty or dental problems

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43
Q

Tx for ankyloglossia?

A

frenulectomy in neonatal period

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44
Q

What is included in PE for neck?

A

Palpate the neck while infants are lying supine

Sitting upright for older children

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45
Q

what is congenital torticollis?

A

aka “wry neck”

results from bleeding into the sternocleidomastoid m. during the stretching process of birth

appears as a firm fibrous mass within the muscle 2-3 weeks after birth

generally disappears over months

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46
Q

when can you see a clavicle fx?

A

may occur during birth, particularly during delivery of a difficult arm or shoulder extraction

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47
Q

what is pectus excavatum? prevalence?

A

“funnel chest”- sternal depression

1/400-1000 live births
M > F (3x)

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48
Q

what is pectus carinatum? prevalence?

A

“chicken breast deformity or pigeon chest”

1/1500 live births
M > F (4x)

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49
Q

what is important to remember for lung PE?

A

Observe 1st, stethoscope after

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50
Q

peds PE for lungs

A

look at general appearance, RR (30-40bpm is normal for infants), color, nasal component, audible breath sounds & work of breathing

ribs don’t move much during quiet breathing for infants

diminished breath sounds in one side of the chest of a newborn suggest unilateral lesions (ie. congenital diaphragmatic hernia)

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51
Q

upper airway lung PE findings

A

harsh and loud, symmetric, louder as stethoscope moves up chest, usu. inspiratory

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52
Q

lower airway lung PE findings

A

often symmetric, louder lower in chest toward abd., often expiratory

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53
Q

cardiovascular peds PE

A

Femoral pulses: diminished may indicate coarctation of the aorta

Common non cardiac findings in infants w/ cardiac disease:

  • poor feeding, failure to thrive, irritability
  • tachypnea, hepatomegaly, clubbing
  • poor overall appearance, weakness
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54
Q

HR ____ on inspiration & ____ on expiration

A

increases

decreases

often normal to have sinus dysrhythmia

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55
Q

what is the MC dysthymia in infants?

A

paroxysmal supra ventricular tachycardia PSVT (any age, even in utero)

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56
Q

umbilical cord anatomy

A

2 umbilical arteries, 1 umbilical vein

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57
Q

what is an umbilical granuloma

A

develops at the base of the navel

pink granulation tissue formed during the healing process

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58
Q

male GU exam

A

presence of testes, size of penis, appearance of scrotum

btwn 2-5% of full term & 30% pre term male infants are born w/ an undescended testicle

59
Q

what is hypospadias?

A

urethral opening (hypO=“belOw”)- abnormal ventral placement

(check for this BEFORE circumcision

60
Q

what is epispadias?

A

urethral opening (Epi- hits you in the “Eye”)- abnormal dorsal placement- this is uncommon

61
Q

what are 2 common scrotal masses in newborns?

A

hydroceles & inguinal hernias

both frequently coexist, both MC on right side

62
Q

Tx for peds hydrocele?

A

usu. resolves by 18mo- however refer to urology to r/o hernia

63
Q

characteristics of hyroceles?

A

trasilluminated but NOT reducible

64
Q

hernia characteristics and tx?

A

usu. reducible, often do NOT transilluminate but don’t resolve so refer

65
Q

Female GU PE findings

A

Often a milky white discharge present- may be blood tinged (norm. from mom’s estrogen)

Labial adhesions

imperforate hymen may be noted at birth

66
Q

anus/spine peds PE

A

Imperforate anus is not always obvious: cannot assume until baby passes meconium, usually w/in 48hrs

Sacral dimple: need to do ultrasound if you cannot see the bottom!!

67
Q

Extremities peds PE

A

Count fingers & toes

Syndactly

Palmar crease: single palmar crease, aka simian crease- assoc. w/ trisomy 21 (may be normal variant)

68
Q

what is a do not miss on Hip peds PE?

A

do not miss = developmental dysplasia of the hips (DDH)

1/1,000 births

69
Q

risk factors for DDH?

A

breech, caucasian, 1st born female
family hx / prior child born w/ DDH
prematurity

70
Q

DDH eval/PE?

A

an audible “click” heard w/ these maneuvers should prompt further work up

eval leg creases- asymmetry may be related

71
Q

what does Barlow test for?

A

the ability to sublux or dislocate an intact, but unstable hip

72
Q

what is ortolani test for?

A

tests for posteriorly dislocated hip

73
Q

tx for DDH?

A

ortho eval & pavlik harness

can lead to degenerative hip disease if untreated

74
Q

how do you perform the palmar grasp? what age?

A

place your fingers into the baby’s hands & press against the palmar surfaces
baby will flex all fingers to grasp your fingers

tests primitive reflex

Age: Birth to 3-4mo

75
Q

how do you perform the plantar grasp reflex?

A

touch the sole at the baseof the toes, toes will curl

Age: Birth to 6-8mo

76
Q

what is the moro reflex? age?

A

Hold the baby supine while supporting the head, back & legs

Abruptly lower the entire body about 2 feet

Arms should abduct & extend, hands open, & legs flex (baby may cry)

age: birth to 4mo

77
Q

persistence beyond during Moro reflex suggests…

A

neurologic disease ( cerebral palsy, especially beyond 6mo)

78
Q

asymmetric response during Moro reflex suggests…

A

indicates fracture of clavicle or brachial plexus injury

79
Q

Asymmetric tonic neck reflex? age?

A

with baby supine, turn head to one side, holding jaw over shoulder

the arms/legs on side to which head is turned extend (think bow & arrow)

the opposite arm/leg flex

age: birth - 2mo

80
Q

persistence beyond 2 mo’s during asymmetric tonic neck reflex suggests…

A

asymmetric central nervous system development

81
Q

what is the positive support reflex?

A

Hold the baby around the trunk & lower until the feet touch a flat surface

the hips, knees & ankles extend & baby stands up, partially bearing weight, sags after 20-30sec

82
Q

age of positive support reflex? what does a lack of reflux indicate?

A

Age: birth or 2mo to 6mo

lack of reflux = hypotonia or flaccidity

83
Q

what is the rooting reflex? age?

A

stroke the perioral skin at the corners of the mouth

the mouth will open & baby will turn the head toward the stimulated side

Age: birth to 3-4mo

84
Q

What is trunk incurvation (galant’s reflex)?

A

Support the baby prone w/ one hand

stroke one side of the back 1cm from midline, from shoulder to buttocks

the spine will curve TOWARD the stimulated side

85
Q

age and absence of trunk incurvation (galant’s reflex)?

A

Age: birth to 2mo

absence suggests a transverse spinal cord lesion or injury

86
Q

placing and stepping reflexes? age?

A

hold baby upright from behind (as in positive support reflex)

have one sole touch the tabletop

the hip & knee of that foot will flex & the other foot will step forward

alternate stepping will occur

Age: birth (best after 4 days) to variable age to disappear

87
Q

Vision PE: visual acquity?

A

Ages 3-5: 20/40

Ages 6 & up: 20/30

88
Q

Vision PE?

A

always check red reflex!

Toddler/preschool- cover/uncover, Gocheck vision

AAP recommends annual photo screening btwn 1-3yrs old

89
Q

what is the MC cause of childhood blindness?

A

amblyopia

90
Q

hearing recommendation from AAP?

A

universal hearing screen before leaving the hospital

91
Q

when do you start checking a BP?

A

3 yr well but sooner if RF’s

kidney dz, prematurity, congenital heart dz, recurrent UTI’s/hematuria/proteinuria, other assoc. w/HTN (neurofibromatosis)

92
Q

Additional Lab screening

A

Hgb screen for Fe deficiency at 9mo or 12 mo

lead: ages 1-2 or high risk

autism at 18mo & 12mo

STI’s high risk

lipid panel

93
Q

when would you order a lipid panel?

A

fasting lipid screening for children btwn ages 2-10 if certain RF’s: FHx hyperlipidemia, early CV dz, obesity, overweight, HTN, DM

94
Q

dental pt education for peds

A

Wash gums & teeth prior to 1st dental visit
1st dental visit between 12mo-2 or 3yrs of age
brush teeth 2x a day
floss 1x a day
Dental visit every 6mo

95
Q

car safety Pt education

A

Rear facing car seat until 2yrs

Booster seat until 4’9”

No front seat until 13yrs of age

96
Q

1 month old milestones

A

fixes/follows on face
some head control
responds to sounds/noises
spontaneous smile

97
Q

2 month old milestones

A

Responsive smile
coos/vocalizes
lifts head when prone
follows to midline

98
Q

4 month old milestones

A 
rolls from tummy to back 
good head control
laughs, squeals
follows past midline 
grasps toys/objects
99
Q

6 mo old milestones

A 
sits w/ support
bears weight on legs
vocalizes “ba, da-da”
reaches out for toys 
follows 180 degrees
stranger danger/separation anxiety
100
Q

9 mo old milestones

A 
crawls 
pulls up to stand &amp; cruises on furniture 
says mama/dada 
immature pincer grasp 
responds to name
101
Q

12 mo old milestones

A 
walks (however, may be delayed up until 18mo)
waves bye-bye
says mama/dad
points w/ index finger
self feeds w/ fingers
102
Q

15 mo old milestones

A

3-6 words
walks well
climbs stairs
imitates actions

103
Q

18 mo old milestones

A 
5-15 words 
some 2 word phrases
uses spoon/fork
scribbles 
follows simple commands 
runs, walks backward
104
Q

24 mo old milestones

A 
20-50 words or more
2 word phrases
kicks ball
builds 3-4 block tower
50% speech understandable
105
Q

HBV Vaccine: how many doses? when?

A

3 doses given at birth, 1-2mo, & between 6-18mo

106
Q

HBV transmitted? sxs? complications?

A

spread: contact w/ blood or body fluids, birth
sxs: may be asx, jaundice, HA, weakness, V, joint pain
complications: chronic liver infx, liver failure, liver CA

107
Q

contraindication to HBV vaccine?

A

severe allergy to yeast

108
Q

ADE’s from HBV vaccine?

A

fever (1-3%)

pain at injection site (3-29%)

109
Q

Rotavirus: given? transmission, sxs, complications?

A

live, oral vaccine given at 2,4,6 mo’s
transmish: saliva, oral contact

dz sxs: V/D, fever

complications: severe D, dehydration

110
Q

contraindications to Rotavirus vaccine?

A

hx of intussusception

infants w/ SCID (severe combined immunodeficiency)

defer in those w/ acute moderate to severe gastro

111
Q

ADE’s from rotavirus vaccine?

A

slightly increase risk of intussusception

possible vomiting & diarrhea, cough or runny nose

112
Q

DTap doses and age?

A

5 total vaccines given at 2mo, 4mo, ,6mo, 15 or 18mo, then again at 4yrs

113
Q

DTap dz’s spread?

A

Diphtheria = air, direct contact

Tetanus = exposure through cuts in skin

Pertussis = air, direct contact

114
Q

Dz sxs for DTap?

A

Diphtheria = sore throat, fever, weakness, swollen glands in neck

Tetanus = stiffness in neck & abdominal muscles, difficulty swallowing, muscle spasms, fever

Pertussis = severe cough, runny nose, apnea

115
Q

Dz complications for DTap?

A

Diphtheria = pericarditits, heart failure, coma, paralysis, death

Tetanus = broken bones, breathing difficulty, death

Pertussis = pneumonia, death

116
Q

contraindication to DTap vaccine?

A

do not give to children who have developed encephalopathy w/in 7 days of a previous dose of this vaccine

defer for those w/ progressive neurological disorders (infantile spasms, uncontrolled epilepsy) until condition is stabilized

precaution if pt developed high fever, inconsolable crying or shock like state previously w/in 48hrs of vaccine admin

117
Q

ADE’s to DTap?

A

swelling & redness at site, fever

118
Q

Haemophilus influenzae type B vaccine doses and age?

A

4 total vaccines given at 2mo, 4mo, 6mo, 12 or 15mo

119
Q

HIB transmission? sxs? complications?

A

Dz spread by: air, direct contact
Dz sxs: asymptomatic unless bacteria enter blood (sepsis)

Dz complications: meningitis, intellectual disability, epiglottis, pneumonia, death

120
Q

Contraindication to HIB vaccine?

A

infants <6 wks of age

individuals w/ allergic reaction to previous HIB vaccine

121
Q

ADE’s to HIB vaccine

A

very uncommon, redness or pain at site

122
Q

doses and age for PCV 13

A

4 total given at 2mo, 4mo, 6mo, 12 or 15mo

common cause of AOM & sinusitis

123
Q

transmission, sxs, complications for PCV 13

A

Disease spread by: air, direct contact
Disease symptoms: asymptomatic, pneumonia
Disease complications: bacteremia, pneumonia, meningitis, death

124
Q

contraindications to PCV 13 vaccine?

A

severe previous allergic reaction to vaccine

defer for individuals during moderate or severe acute illness w/ or w/o fever

125
Q

ADE’s to PCV 13

A

fever, local reaction, irritability, increased or decreased sleep

possible risk for febrile seizure when administered w/ influenza vaccine

126
Q

IPV age and dose?

A

4 given at 2mo, 4mo, 6-18mo, & 4yrs

no longer a live vaccine

127
Q

transmission? sx? complications?

A

Disease spread by: air, direct contact, through the mouth
Disease symptoms: asymptomatic, sore throat, fever, nausea, headache
Disease complications: paralysis, death

128
Q

contraindications to (poliomyelitis) IPV?

A

allergic reaction to previous IPV vaccine

defer during moderate or severe acute illness

pregnancy

129
Q

ADE’s from IPV vaccine?

A

minor local redness &/or pain at injection site

no serious adverse reactions have been described

130
Q

MMR given and dose?

A

2 given at 12-15mo & 4yrs
live vaccine

does NOT cause autism

131
Q

Dz’s spread MMR

A

air, direct contact

132
Q

Dz sxs for MMR

A

Measles: rash, fever, cough, runny nose, pink eye

Mumps: swollen salivary glands, fever, headache, fatigue, muscle pain

Rubella: rash, fever, swollen lymph nodes

133
Q

complications of MMR

A

Measles: encephalitis, pneumonia, death

Mumps: meningitis, encephalitis, inflammation of testicles or ovaries, deafness

Rubella: very serious in pregnant women- can lead to miscarriage, stillbirth, premature delivery, birth defects

134
Q

contraindications to MMR

A

pregnant women, women intending to become pregnant within 28days

immunocompromised persons

egg or neomycin allergy (anaphylactic)

135
Q

ADE’s to MMR vaccine?

A

fever (5-15%) about 6-12 days following vaccine

transient morbilliform rash

GBS (1 case per 3million)

136
Q

varicella given, dose?

A

2 given at 12-15mo & 4yrs

live vaccine

137
Q

transmission, sxs, complications for varicella?

A

Disease spread by: air, direct contact

Disease symptoms: rash, fatigue, headache, fever

Disease complications: infected blisters, bleeding disorders, encephalitis, pneumonia

138
Q

contraindications to varicella vaccine?

A

allergic reaction after previous Varicella vaccine

pregnant women

139
Q

ADE’s to varicella vaccine?

A

minor injection site reactions (20%)

rash at injection site (3-5%)
sparse varicelliform rash

outside injection site (3-5%)
5-26 days after vaccine

140
Q

HAV dose and given?

A

2 doses given at 12mo & 18mo (must be 6mo from 1st dose)

141
Q

transmission, sxs, complications for HAV?

A

Disease spread by: direct contact, contaminated food or water
Disease symptoms: asymptomatic, fever, stomach pain, loss of appetite, fatigue, vomiting, jaundice, dark urine
Disease complications: liver failure, arthralgia, kidney, pancreatic & blood disorders

142
Q

contraindications to HAV

A

previous allergic reaction

caution w/ pregnancy or illness

143
Q

ADE’s to HAV

A

minor local redness &/or pain at injection site

no serious adverse reactions have been described

PEDS- Clinical Disciplines Exam 2 (5 decks)

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