Ambulatory Peds Flashcards

Question

Occular Assessment motility of EOM and nystagmus

Answer 1

Motlity of EOM can be tested the same: use toy instead of pen - abnormal: CN palsay Nystagmus - referr to optho.

Answer 2

Pupillary - assess size, shape and symmetry coloboma: irregular pupil shape = refer can be due to genetic abnorms. Fundoscopic papilledema = increase ICP **Cherry red macula = Tay Sachs disease** **diabetic retinopathy**: screen 5 yeras post T1DM, can pick up undx. T2DM

Answer 3

ENT: do last! most invasive for kids Hearing Exam - done in first month of life for formal testing - parents usually have good index of suspicion - **formal hearing test should be done before neonate leaves hospital** Screen at... - 4, 5, 6, 8, and 10 years (speech!) - 1 x between 11 and 14 - 1 x between 15 - 17 - 1 x between 18 - 21 - anytime parent is concerned - persistnet ear effeusions 0-2 months: clap = theyshould be startled 2-3 change in body movement reponses to sounds or famiai expression with familar sounds 3-4 turn and listen to voices 6-7 can same some thigns ## Footnote screening for hearing is done in schools!

Answer 4

Ears - should draw line from eyes to ears and have top 1/3 of ear above - and 20 degrees rotated ear back Low set ears - trisopy 21 - trisomy 18 - treacher collins - beckwith wideman Ear pits and tags - can beislated, but also associted with genetic consitions - if you seen **ear pits and tags, check for hearing loss and renal anomilies** Microotia - graded I - Iv (most sever) Cup/Lop Ears = normal

Answer 5

Nares patency palate and uvual integrity speech quality dentition!! : CHIP DOES cover dental Teeth - frsit should be between 6-10 months - watch for baby bottle decay of teeth NEck Masses: referral to ENT - thyroglossal: thyroid gland fails to fall to its position Cystic Hydroma 2nd branchical cleft cyst : emryonic remains

Answer 6

Abnroaml breasts nipple distance - turners syndrome gynecomastica - meds induced (dig, INH, cimetidine, antidep.) - breast tumor - adrenal or gonsal lesions - hypethyroid - klinefelters - severe renal/liver disease (estrogen cant clear) Exam of Gynecomastia - **do a testicualr exam!!!: testicaulr CA** - can be benigin and spontaneously regress - refer if they are prepubetal, under virilized, testicular mass, persisant longer than normal sexual maturation stages pectus excavatum (in) and carinatum (out)

Answer 7

upper airway issue: inspiratory finding lower airway issue: expiratory finding *sounds transmit widely through chest in kids, difficult* Upper Airway - nose and stethescope sound will be equal - symmetric shoulds - harsh and loud Lower Airway - variable sounds - asymmetric - louder when in lower chest/abd.

Answer 8

Cardiovascular Infants - dx. before leaving hospital - sweating, cyanotis with feeds = think this - poor weight gain or weight loss toddelrs/kids - simiarl to adult sx. - difficutl to keep up with peers! Exam - smaller scop - palpate brachial and femoral pulses simultaneously Murmurs Still Murmur: musical, **loudest in supine position, early systlic at LL sternal boarder** Physiologic Murmur (thingk high outflow state) **Systolic ejection murmus, heard at 2nd/3rd ICS** Venous Hum : **upper right sternal boared, decreasd with neck pressure or turning to the right**

Answer 9

ABdomen - kids have pot belly but do good exam - liver and spleen margins are often palpable - kindeys easy to feel - bend knees or hand over hand GU - usually on inspection is needed: always exaplin what you are doing and why it sok for doctor and mom to see - sexual maturity rating - palpate testicles for position DRE onl for - rectal bleeding - sevre constipation - sometime for appendicitis - pelvic exam only for gyn compliants or abd.peliv pain

Answer 10

Neurologic Exam Obeserve - moving hands and legs and neck spontaneously - wualitative assessment Examination Period - response to stimuli - strenght/motor test - CN test - Gait testing Primitive reflexes Palmar Grasp: 0-4 months Rooting: 0-4 Trunk incurvation : 0-2 Ventral suspention: 0-4 moro reflex: 0-4 stepping reflex: days-2 months

Answer 11

Barlow - dislocates unstable hip - lay baby on back, hips and knees flex, hips are adducted in and downward pressure - click = + Ortolani - after barlow: see if you can relocate - thigh abducted, pressure on greater trochanters - clunk = + Scolisos - checked in schools - bend over and see from back

Answer 12

Newborn Screen Bilirubin at 12-24 hours CCHD ANemai - 12 months (routine) - 15, 18, 24, 30 = high risk (vegan or poor eater) - annually 3-18 if high risk Lead (defer if low risk) - screen if old home first - if + screen : 12, 24 months BP - age 3+ - early if risk TB - periodicall if at risk lipids - once between 9-11 years - once between 17-21 years - if high risk - more often STIs - adolescne if at risk HIV - **once 15-18** Cervical dysplasia - starting at 21

Answer 13

Family Support - assess and help Healhy Child - early detection of developmental delays - parent encourge tummy time and reading Oral health - intervene and educate early before teeth come up - SES impacts oral health: caviteis = common - use floridein toothpaste and regular brushing - smear of paste for little ones, pea size for a little bigger Flouride - recommendations depend on municapline water supply flouride amounts - **flouride varinsih can be applied 3-6 months** for those at risk

Answer 14

injury is most significant problem of children and teens leadsing cause of death under 19 Traffic Safety - car seats never in front seat Burn Prevention - smoke alarms - hot water < 120 Fall prevention - gates and crib rails - **AVOID USE OF WALKERS: THSES ARE NOT GOOD** Choking - toliet paper tube test - blind cords away Drowning Prevention - no buckets - surpervise baths BAck to sleep and infant CPR

Answer 15

Traffic Safety - back seat care seats: weight height and age recommendations - forward facing only once 60 pounds - then to booster seat - no thick caots FAll PRevention - stair/windo gaurds - prevent furniture falls Posion Prvetion: storage of meds and know number to call Drowning - locks and swim safety lessons age 1-3

Answer 16

Traffic SAfety - booster seats and seat belts - back seat until at least 13 years old swim and spor safety - helments and portective equiptment

Answer 17

Violence Prevention - Bullying: encourgae child to identfy where to get help and help parents - monitor socail media Media use -**Screening: who monitors and how is it mointored** - how much are they using, tv in bedroom? under 18 months: no tech. 18-24 months: only high quality media with parent there 2 yeras: no more than 1 hours no screens at meals or 1 hour beofre sleep

Ambulatory Peds Flashcards

(41 cards)