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Flashcards in Clinical Medicine Deck (55):
1

CAGE

Alcohol dependency assessment: Cut, Annoyed, Guilty, Eye Opener

2

Five steps of the "Evidence Cycle"

1. ask foreground questions, 2. access the best evidence, 3. appraise the evidence critically, 4. apply the evidence to the patient/situation, 5. assess the performance of your plan

3

The four parts of a 'foreground' question (a question answerable by EBM) are?

patient population, intervention, comparison/control, outcome

4

Three questions to ask when appraising a study

1. is it valid?, 2. what are the results?, 3. how can it be applied to your situation

5

criteria for the validity of a diagnostic study

1. diagnostic uncertainty? 2 blind comparison btw the test and an independent gold standard, 3. the results of the test must not influence the decision to use the gold standard (verification bias)

6

hand grasp reflex

after birth to 3 months, grasp increases as the finger is withdrawn

7

head righting

one month lag, 2-3 month no lag, 5-6 month anticipation

8

asymmetric toni neck reflex

2-3 weeks to 6 months, fencer's position

9

moro reflex

birth till 4 months, startle reflex (pick me up)

10

parachute response

9 months till death, superman stance

11

protective equilibrium response

6 months till death, when pushed laterally stakes hand on opposite side

12

rooting reflex

lowered lip and tongue movement towards the stimulated part

13

differences of a pediatric history

birth history, nutrition, growth assessment, developmental history, immunizations, social history in an adolescent BDINGS

14

diet: birth to two years

formula/fruit juice/solids/vitamins

15

HEADSS

Social history: Home, Education/Employment, Activity, Drugs/Drinking, Sexuality, Suicide/Depression/Self Image

16

growth vs. development

growth is the process of growing larger, development is the gradual progression towards potential as a mature adult

17

development

proceeds from cephalic to caudal and proximal to distal. from generalized reflexes to discrete voluntary actions

18

a child's developmental stage impacts

how you approach the history and physical exam

19

gross motor

goal is to gain independent movement, is not predictive of intelligence

20

fine motor

use of upper extremities to engage with and manipulate the environment

21

receptive vs. expressive language

receptive: hearing/seeing, understanding, and responding appropriately; expressive: speech development (audible/oral expressions of language)

22

cognitive development

ability to respond to changes in environment

23

social and emotional development

understanding of self, bonding, attachment, and trust in caregivers, adaptability, temperament, and response to new stimuli

24

term gestation

37-42 weeks

25

three of the most often evaluated signs of postnatal growth

length/height, weight, and head circumference

26

genetic channel for growth

child enters this from 3-18 months

27

primary short stature

intrinsic disorder present at birth, normal bone age

28

normal variants in height

include genetic short stature and constitutional delay (delayed bone age)

29

examples of primary sort stature

turners, noonan, down's, achondroplasia, IUGR

30

secondary short stature

delayed bone age, results from factors outside the skeletal system that effect growth

31

secondary short stature examples

major organ disease, nutritional deficiency, endocrine abnormalities (cushing's, hypothyroidism), poorly controlled diabetes, metabolic disorders, meds (steroids)

32

failure to thrive

defined as weight below the third percentile for age or inadequate weight gain resulting in crossing of percentile lines

33

three broad causes of FTT

inadequate caloric intake, malabsorption, inappropriate utilization

34

most brain growth

occurs during the first year of life

35

macro/microcephaly, FOC (head circumference)

>97th percentile, <3rd percentile, macro due to hydrocephalus, micro due to primary and secondary reasons

36

Fetal Alcohol Syndrome (FAS)

facial anomalies, growth retardation, CNS neurodevelopmental, unexplained behavioral abnormalities

37

requirements to diagnose FAS

1. confirmed maternal alcohol exposure, 2. facial anomalies, 3. growth retardation, 4. CNS neuro-developmental findings

38

normal age of puberty

precocious is before 7yrs in females, 9yrs in males; early is before 9(f), 10(m), late is after 12 (m/f)

39

secondary sexual development

development as a result of androgen secretion -- tanner stages

40

earliest signs of secondary sexual development

breast budding in females and testicular enlargements in males

41

adrenarche

1. none, 2. light, 3. thick, 4. full genital, 5. some on thighs

42

know tanner stages!!

do it

43

newborn

R:30-60, P:120-160, BP:60-80

44

6mo-1yr

R:30-40, P:120-140, BP:70-80

45

2-4yrs

R:20-30, P:100-110, BP:80-95

46

5-8yrs

R:14-20, P:90-100, BP:90-100

47

8-12yrs

R:12-20, P:80-100, BP:100-110

48

>12yrs

R:12-20, P:60-90, BP:100-120

49

proper BP cuff

is wide enough to cover 2/3 of the upper arm

50

coarctation of the aorta

higher BP in upper vs. lower extremities

51

stranger anxiety

at 9 months of age

52

PMI

located just left of the sterna border at the 4th intercostal space

53

at 11 years of age you can

ask parents to leave the room for a personal history

54

peds exam

is no different than adult exam

55

scoliosis screening at

10 & 12 in girls, once at 13/14 in boys