Flashcards in Final Exam Deck (117):
What are the four key principles of pediatric examination?
Child development proceeds along a predictable pathway
Range of normal development is wide
Various factors can affect child development and health
The child's developmental level affects how you conduct the history and physical examination
What are the age ranges for pediatrics?
Infant - birth to 18 months
Toddler - 18 months to 3 years
Pre-school child - 3 to 6 years
Elementary school child - age 6 to puberty
Adolescent - puberty to late teens
What characteristics do infants have?
Respond to touch, voice, and visual stimulation
What characteristics do toddlers have?
Unsure of unknown people
What characteristics do pre-school children have?
Wants to please
What characteristics do elementary school children have?
What characteristics do adolescents have?
Focused on body image
What are the objectives of a newborn exam?
Evaluate infant's transition to extrauterine life
What is the Apgar score?
Evaluates newborn neurologic status and immediate adaptation to extrauterine life
Should be over 8 for normal situations
What does the apgar score test?
What are the different classifications for gestational age?
Preterm = <37 weeks
Term 37-42 weeks
Postterm >42 weeks
What are the classifications for birth weight?
Extremely low = < 1,000 grams
Very low = < 1,500
Low = < 2,500
Normal > 2,500 grams
What is the name of the system used to determine gestational age in weeks?
Ballard scoring system
What is neo - natal abstinent problems?
Issues newborns have when they are removed from drugs their mother was taking
Can have tremendous tremors and high pitched cries
What are complex newborn behaviors?
Habituation - shut out neg stimuli
Attachment - bond to caregiver
State regulation - control level of arousal based on stimulation
Perception - ability to respond to environment
What is a normal heart rate for a newborn? RR?
100 - 160 BPM
RR = 40 - 60
What are fontanelles?
Soft spots on babies head
What is caput succedaneum?
Swelling of scalp brought on from vertex delivery
What is cephalohematoma?
Hemorrhage of blood between the skull and the periosteum
Can not cross suture lines
What is a subgaleal bleed?
Bleeding into the area between the scalp and the skull
What is plagiocephaly?
Asymmetry of cranium
Occurs when infant lays on one side for too long
What is craniosynostosis?
Premature closure of cranial sutures causing abnormally shaped skull
What are low set ears a sign of?
What is ankyloglossia?
Tip of tongue is connected to the base of the mouth
What is the Ortolani maneuver?
Flex the legs at the knees and hips and abduct until the knees touch the examining table
What is Barlow's maneuver?
Adduction and extension of the hip
What are the aspects of a neurological exam?
Movement of extremities
What are the normal reflexes found on a neurologic exam of a newborn?
Moro's reflex - drop baby
Galant - look for spinal curvature towards stimulus
Placing and stepping
Tonic neck reflex
Deep tendon reflexes
What are Mongolian spots?
Blue or blue-gray skin markings near the buttocks and lower lumbar region
What is a sign that a baby has been shaken?
Retinal hemorrhages in the back of the eye
What is erythema toxicam?
Red macules with central pinpoint vesicles scattered over entire body
What are the normal well visits that a newborn should undergo?
1, 2, 4, 6, 9, 12, 15, and 18 months
What is the Denver developmental screening test?
Standard for measuring developmental milestones through out infancy
What are the developmental milestones at 1 month?
Responsive to calming actions
Able to follow parents eyes
Recognize parents voices
Lifts head when on tummy
What are the developmental milestones at 2 months?
Attempts to look at parent
Able to console and comfort self
Has differentiated crying and coos
Able to hold head up
What are the developmental milestones at 4 months?
Cries in differentiated manner
Responds to affection/displeasure
Has good head control
What are the developmental milestones at 6 months?
Begins to move
What are the developmental milestones at 9 months?
Apprehension with strangers
Uses repetitive consonants and vowel sounds
Learns interactive games
Expands motor skills
What is tachypnea for infants?
Over 60 up to 2 months
Over 50 from 2 -12 months
What are the first signs of puberty in a female?
Widening at hips
What is the Tanner staging used for?
Used to evaluate sexual development
What is the first sign of sexual development in males?
What hormonal changes occur in pregnant patients?
What are the breast changes that occur during pregnancy?
Increased size and vascularity
When does the uterus reach the pelvic brim during pregnancy?
12 -14 weeks
When does the uterus reach the umbilicus during pregnancy?
20 - 22 weeks
What is Chadwick's sign?
Walls of vagina and cervix turn to a blueish color during pregnancy
What is Hegar's sign?
Softening of the cervix and the uterus
What are the goals of the first prenatal visit?
Assess health status of mother and identify risk factors
Counsel to assure birth of a healthy baby
What is the most accurate way to assess age of fetus?
Crown-rum length can be measured starting at 5-13 weeks
What is Naegele's Rule?
Way to determine delivery date
First day of LMP + 7 days - 3 months + 1 year
What does the TPAL after gravida and para stand for?
Births to living children
What is quickening?
Fetal movements that can be felt
Mother - 18 - 20 weeks
Examiner 24 weeks
Where can the fetal heart rate be heard?
Half way between the symphysis and top of uterus
When is the most effective time for a mother to take folic acid?
Prior to conception
What needs to be included in a 10 minute geriatric screener?
What are ADLs?
What are IADLs?
What is delirium?
Decline from previously attained level of cognitive functioning
What does DIAPERS stand for when assessing incontinence?
Excess urine output
Why are physical exams conducted?
Screening for occult disease
Assure good health
Develop relationship with patients
Identify cause of symptoms
Track known disease
Power of mystique and touch
What are the three goals of performing a systemic physical exam properly?
Maximize the patient's comfort
Avoid unnecessary changes in position
Enhance clinical efficiency
What are the vital signs?
What is a set of orthostatic BPs?
Measurement of heart rate and blood pressure when the patient is supine, sitting, and finally standing
Looking for 20 or greater drop from supine to standing or 10 or greater drop in diastolic
What is the most accurate form of taking temperature?
What is a macule?
Nonpalpable flat lesion smaller than 1 cm
Moles and freckles
What is a patch?
Nonpalpable flat lesion greater than 1 cm
Vitilgo and café au lait spots
What is a papule?
Palpable solid mass, smaller than 1 cm
Nevus and wart
What is a nodule?
Palpable solid mass, between 1-2 cm
What is a tumor?
Palpable solid mass, greater than 2 cm
Neoplasm and lipoma
What is a plaque?
Palpable solid mass
Flat or elevated papule with surface area greater than height
Psoriasis and seborrheic keratosis
What are the ABCDEs of melanoma?
Borders - irregular and blurring
Color - Anything besides light or medium brown
Diameter - greater than 6mm
Evolving - any change is concerning
What are the signs of bell's palsy?
Paralysis of one side of the face
What are the cranial nerves?
1 - olfactory
2 - optic
3 - oculomotor
4 - trochlear
5 - trigeminal
6 - abducens
7 - facial
8 - vestibulocochlear
9 - glossopharyngeal
10 - vagus
11 - accessory
12 - hypoglossal
What is a fissure?
Linear crack from the epidermis into the dermis
What is onychomycosis?
Fungal infection of the nails
Nails will become thickened, brittle, discolored and crumbly
What is a decubitus ulcer?
Pressure ulcer or bedsore
Early sign is erythema that does not blanche with pressure
What are stasis ulcers?
Ulcers occur when blood backs up in veins and leaks out
How does alopecia aereata present?
Sudden hair loss in round patches without scarring or inflammation
Alopecia totalis: whole scalp
Alopecia universalis: whole body
What is trichotillomania?
Hair loss resulting from the pulling or plucking of hairs
Hairs of affected areas are of various lengths
What is xanthelsama?
Cholesterol deposits around the eyes
Caused by hypercholesterolemia
What would cause a horizontal defect in the visual field?
Occlusion of a branch of the central retinal artery
Either the bottom or top half of one eye would lose vision
What would cause a bitemporal hemianopsia in the visual field?
A lesion at the optic chasm
Vision loss occurs in the lateral half of each eye
What happens in a left homonymous hemianopsia?
Left visual field is lost in both eyes
What is pectus excavatum?
Chest dips inward at the sternum
What is pectus carinatum?
Anteriorly displaced sternum
What is crepitus?
Snap, crackle, or pop when palpating chest
Caused by air bubbles being trapped
What do wheezes tell you about lung obstruction?
Monophonic means obstruction in one lung
Polyphonic means obstruction in both lungs
How is screening for an AAA done?
What are the six P's of acute limb ischemia?
What produces the first heart sound?
Closing of the mitral valve
What produces the second heart sound?
Closing of the aortic valve
What causes splitting of S2?
Aortic and pulmonic valves close at separate times
What are the effects of standing and squatting for mitral valve prolapse?
Standing - click moves earlier in systole and murmur lengthens
Squatting - click is delayed and murmur shortens
What are the effects of standing and squatting for hypertrophic cardiomyopathy?
Standing - increases murmur intensity
Squatting - decreases murmur intensity
What are the effects of standing and squatting for aortic stenosis?
Standing - decreases intensity
Squatting - increases murmur intensity
What causes an S3 to be heard?
Vigorous rapid ventricular filling
Pathologic change in ventricular compliance
What causes an S4 sound to be heard?
Changes in ventricular compliance
Increased stroke volume from high-output
What is the characteristic sign of oral candidiasis?
White plaques that can be easily scraped off
What is Acute Necrotizing Ulcerative Gingivitis?
Trench mouth caused by infection
Presents with foul breath, fever, malaise, and ulcerations
How should normal lung tissue sound to percussion?
Where in the lung would you expect to hear vesicular sounds?
More peripheral regions of the lung
What is the scale for describing pulse amplitude?
4 - bounding
3 - full, increased
2 - expected
1 - diminished, barely palpable
0 - absent, not palpable
What are the risk factors for PAD?
Over 65 years old
Over 50 with history of diabetes or smoking
Leg symptoms with exertion
How does atelectasis present on physical exam?
Diminished tactile fremitus
Delayed or diminished chest wall movement
Dullness to percussion
Diminished breath sounds in lower long
What does stroke volume depend on?
What should JVP measurement be under?
Under 3 cm
In what position is an S3 heard best?
Left lateral decubitus with bell at apex
In what position is an S4 murmur heard best?
Supine or left lateral decubitus with bell at apex
Late diastole/early systole
How does bicuspid aortic valve present?
Often asymptomatic but may have an ejection systolic murmur heard at the apex
What can cause an abnormal PMI?
Increased stroke volume
Chronic pressure load
Chronic volume overload
What is gastroparesis?
Impaired or delayed gastric emptying in the absence of mechanical obstruction
How does gastroparesis present?
Decreased bowel sounds
How does compartment syndrome present?
Pain with passive stretching of muscles
Tense compartment with a firm feeling
How do you differentiate between leukoplakia and erythroplakia?
Leukoplakia consists of only white patches
Erythroplakia consists of red lesions
How does mono present?