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Flashcards in Final Exam Deck (117):
1

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

2

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

3

What characteristics do infants have?

Respond to touch, voice, and visual stimulation

4

What characteristics do toddlers have?

Playful
Curious
Clingy
Unsure of unknown people

5

What characteristics do pre-school children have?

Communicates
Understands
Wants to please

6

What characteristics do elementary school children have?

Sensitive
Shy
Modest

7

What characteristics do adolescents have?

Moody
Overreactive
Focused on body image

8

What are the objectives of a newborn exam?

Evaluate infant's transition to extrauterine life

9

What is the Apgar score?

Evaluates newborn neurologic status and immediate adaptation to extrauterine life
Should be over 8 for normal situations

10

What does the apgar score test?

Heart rate
Respiratory rate
Muscle tone
Reflex irritability
Color

11

What are the different classifications for gestational age?

Preterm = <37 weeks
Term 37-42 weeks
Postterm >42 weeks

12

What are the classifications for birth weight?

Extremely low = < 1,000 grams
Very low = < 1,500
Low = < 2,500
Normal > 2,500 grams

13

What is the name of the system used to determine gestational age in weeks?

Ballard scoring system

14

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

15

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

16

What is a normal heart rate for a newborn? RR?

100 - 160 BPM
RR = 40 - 60

17

What are fontanelles?

Soft spots on babies head

18

What is caput succedaneum?

Swelling of scalp brought on from vertex delivery

19

What is cephalohematoma?

Hemorrhage of blood between the skull and the periosteum
Can not cross suture lines

20

What is a subgaleal bleed?

Bleeding into the area between the scalp and the skull

21

What is plagiocephaly?

Asymmetry of cranium
Occurs when infant lays on one side for too long

22

What is craniosynostosis?

Premature closure of cranial sutures causing abnormally shaped skull

23

What are low set ears a sign of?

Down Syndrome

24

What is ankyloglossia?

Tip of tongue is connected to the base of the mouth

25

What is the Ortolani maneuver?

Flex the legs at the knees and hips and abduct until the knees touch the examining table
Tests hips

26

What is Barlow's maneuver?

Adduction and extension of the hip

27

What are the aspects of a neurological exam?

Tone
Alertness
Movement of extremities
Reflexes

28

What are the normal reflexes found on a neurologic exam of a newborn?

Rooting response
Plantar grasp
Palmar grasp
Moro's reflex - drop baby
Galant - look for spinal curvature towards stimulus
Placing and stepping
Tonic neck reflex
Deep tendon reflexes
Babinski reflex

29

What are Mongolian spots?

Blue or blue-gray skin markings near the buttocks and lower lumbar region

30

What is a sign that a baby has been shaken?

Retinal hemorrhages in the back of the eye

31

What is erythema toxicam?

Red macules with central pinpoint vesicles scattered over entire body

32

What are the normal well visits that a newborn should undergo?

First week
1, 2, 4, 6, 9, 12, 15, and 18 months

33

What is the Denver developmental screening test?

Standard for measuring developmental milestones through out infancy

34

What are the developmental milestones at 1 month?

Responsive to calming actions
Able to follow parents eyes
Recognize parents voices
Smiles
Lifts head when on tummy

35

What are the developmental milestones at 2 months?

Attempts to look at parent
Smiles
Able to console and comfort self
Has differentiated crying and coos
Able to hold head up
Symmetrical movements

36

What are the developmental milestones at 4 months?

Smiles spontaneously
Cries in differentiated manner
Responds to affection/displeasure
Has good head control

37

What are the developmental milestones at 6 months?

Begins to move

38

What are the developmental milestones at 9 months?

Apprehension with strangers
Uses repetitive consonants and vowel sounds
Learns interactive games
Expands motor skills

39

What is tachypnea for infants?

Over 60 up to 2 months
Over 50 from 2 -12 months

40

What are the first signs of puberty in a female?

Hymenal changes
Widening at hips
Growth spurt
Breast buds
Pubic hair

41

What is the Tanner staging used for?

Used to evaluate sexual development

42

What is the first sign of sexual development in males?

Testicle enlargement

43

What hormonal changes occur in pregnant patients?

Estradiol
Progesterone
Placental hormones
EPO

44

What are the breast changes that occur during pregnancy?

Increased size and vascularity
Tender
More nodular
Larger nipples
Areolae darken
Colostrum secreted

45

When does the uterus reach the pelvic brim during pregnancy?

12 -14 weeks

46

When does the uterus reach the umbilicus during pregnancy?

20 - 22 weeks

47

What is Chadwick's sign?

Walls of vagina and cervix turn to a blueish color during pregnancy

48

What is Hegar's sign?

Softening of the cervix and the uterus

49

What are the goals of the first prenatal visit?

Confirm pregnancy
Assess health status of mother and identify risk factors
Counsel to assure birth of a healthy baby

50

What is the most accurate way to assess age of fetus?

Ultrasound
Crown-rum length can be measured starting at 5-13 weeks

51

What is Naegele's Rule?

Way to determine delivery date
First day of LMP + 7 days - 3 months + 1 year

52

What does the TPAL after gravida and para stand for?

Term deliveries
Pre-term deliveries
Abortions
Births to living children

53

What is quickening?

Fetal movements that can be felt
Mother - 18 - 20 weeks
Examiner 24 weeks

54

Where can the fetal heart rate be heard?

Half way between the symphysis and top of uterus

55

When is the most effective time for a mother to take folic acid?

Prior to conception

56

What needs to be included in a 10 minute geriatric screener?

Physical
Cognitive
Psychosocial

57

What are ADLs?

Bathing
Dressing
Toileting
Transfering
Continence
Feeding
Managing money

58

What are IADLs?

Using phone
Shopping
Food prep
Housekeeping
Laundry
Transportation
Taking medicine

59

What is delirium?

Decline from previously attained level of cognitive functioning

60

What does DIAPERS stand for when assessing incontinence?

Delirium
Infection
Atrophic urethritis/vaginitis
Pharmaceuticals
Excess urine output
Restricted mobility
Stool impaction

61

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

62

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

63

What are the vital signs?

Blood pressure
Heart rate
Respiration rate
Temperature

64

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

65

What is the most accurate form of taking temperature?
Least?

Most: Rectal
Least: Axillary

66

What is a macule?

Nonpalpable flat lesion smaller than 1 cm
Moles and freckles

67

What is a patch?

Nonpalpable flat lesion greater than 1 cm
Vitilgo and café au lait spots

68

What is a papule?

Palpable solid mass, smaller than 1 cm
Nevus and wart

69

What is a nodule?

Palpable solid mass, between 1-2 cm
Erythema nodosum

70

What is a tumor?

Palpable solid mass, greater than 2 cm
Neoplasm and lipoma

71

What is a plaque?

Palpable solid mass
Flat or elevated papule with surface area greater than height
Psoriasis and seborrheic keratosis

72

What are the ABCDEs of melanoma?

Asymmetry
Borders - irregular and blurring
Color - Anything besides light or medium brown
Diameter - greater than 6mm
Evolving - any change is concerning

73

What are the signs of bell's palsy?

Paralysis of one side of the face

74

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

75

What is a fissure?

Linear crack from the epidermis into the dermis

76

What is onychomycosis?

Fungal infection of the nails
Nails will become thickened, brittle, discolored and crumbly

77

What is a decubitus ulcer?

Pressure ulcer or bedsore
Early sign is erythema that does not blanche with pressure

78

What are stasis ulcers?

Venous ulcers
Ulcers occur when blood backs up in veins and leaks out

79

How does alopecia aereata present?

Sudden hair loss in round patches without scarring or inflammation
Alopecia totalis: whole scalp
Alopecia universalis: whole body

80

What is trichotillomania?

Hair loss resulting from the pulling or plucking of hairs
Hairs of affected areas are of various lengths

81

What is xanthelsama?

Cholesterol deposits around the eyes
Caused by hypercholesterolemia

82

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

83

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

84

What happens in a left homonymous hemianopsia?

Left visual field is lost in both eyes

85

What is pectus excavatum?

Chest dips inward at the sternum

86

What is pectus carinatum?

Anteriorly displaced sternum

87

What is crepitus?

Snap, crackle, or pop when palpating chest
Caused by air bubbles being trapped

88

What do wheezes tell you about lung obstruction?

Monophonic means obstruction in one lung
Polyphonic means obstruction in both lungs

89

How is screening for an AAA done?

Ultrasound

90

What are the six P's of acute limb ischemia?

Pain
Pallor
Pulselessness
Poikilothermia
Parasthesia
Paralysis

91

What produces the first heart sound?

Closing of the mitral valve

92

What produces the second heart sound?

Closing of the aortic valve

93

What causes splitting of S2?

Aortic and pulmonic valves close at separate times

94

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

95

What are the effects of standing and squatting for hypertrophic cardiomyopathy?

Standing - increases murmur intensity
Squatting - decreases murmur intensity

96

What are the effects of standing and squatting for aortic stenosis?

Standing - decreases intensity
Squatting - increases murmur intensity

97

What causes an S3 to be heard?

Vigorous rapid ventricular filling
Pathologic change in ventricular compliance

98

What causes an S4 sound to be heard?

Changes in ventricular compliance
Increased stroke volume from high-output

99

What is the characteristic sign of oral candidiasis?

White plaques that can be easily scraped off

100

What is Acute Necrotizing Ulcerative Gingivitis?

Trench mouth caused by infection
Presents with foul breath, fever, malaise, and ulcerations

101

How should normal lung tissue sound to percussion?

Resonance

102

Where in the lung would you expect to hear vesicular sounds?

More peripheral regions of the lung

103

What is the scale for describing pulse amplitude?

4 - bounding
3 - full, increased
2 - expected
1 - diminished, barely palpable
0 - absent, not palpable

104

What are the risk factors for PAD?

Over 65 years old
Over 50 with history of diabetes or smoking
Leg symptoms with exertion
Non-healing wounds

105

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

106

What does stroke volume depend on?

Preload
Myocardial contractility
Afterload

107

What should JVP measurement be under?

Under 3 cm

108

In what position is an S3 heard best?

Left lateral decubitus with bell at apex
Early diastole

109

In what position is an S4 murmur heard best?

Supine or left lateral decubitus with bell at apex
Late diastole/early systole

110

How does bicuspid aortic valve present?

Often asymptomatic but may have an ejection systolic murmur heard at the apex

111

What can cause an abnormal PMI?

Increased stroke volume
Chronic pressure load
Chronic volume overload

112

What is gastroparesis?

Impaired or delayed gastric emptying in the absence of mechanical obstruction

113

How does gastroparesis present?

Epigastric distention
Epigastric tenderness
Succussion splash
Decreased bowel sounds

114

How does compartment syndrome present?

Pain with passive stretching of muscles
Tense compartment with a firm feeling

115

How do you differentiate between leukoplakia and erythroplakia?

Leukoplakia consists of only white patches
Erythroplakia consists of red lesions

116

How does mono present?

Fever
Pharyngitis
Lymphadenopathy

117

What are the centor criteria for strep?

Fever
Lack of cough
Anterior cervical lymphadenopathy
Tonsilar exudate