Module 2 EB Flashcards
(193 cards)
1
Q
developmental milestones: children can dress themselves
A
middle childhood
2
Q
developmental milestones: can catch a ball using only their hands
A
middle childhood
3
Q
developmental milestones: can tie their shoes
A
middle childhood
4
Q
developmental milestones: having independence from family becomes more important now
A
middle childhood
5
Q
developmental milestones: events such as starting school bring children this age into regular contact with larger world
A
middle childhood
6
Q
developmental milestones: friendships become more and more important
A
middle childhood
7
Q
developmental milestones: physical, social, mental skills develop quickly at this time
A
middle childhood
8
Q
developmental milestones: critical time for children to develop confidence in all areas of life, such as friends, school work, and sports
A
middle childhoodd
9
Q
developmental milestones: behavioral patterns developed during adolescence will comprise the Adolescence health status and the risk of developing future chronic diseases in their adulthood
A
adolescence
10
Q
developmental milestone: puberty and somatic growth are completed during this period
A
adolescence
11
Q
developmental milestone: thinking moves from concrete to abstract
A
adolescence
12
Q
developmental milestone: independent identity and separation from family occur
A
adolescence
13
Q
developmental milestone: preparations made for future careers or vocations
A
adolescence
14
Q
developmental milestone: exposed to cell phones, driving, smoking/drinking etc.
A
adolescence
15
Q
age ranges for adolescence
A
age ranges vary but adolescence typically begins with puberty and ends with adulthood
-since individuality occurs, ranges are usually 10 years to 19 years
16
Q
separation-individuation theme initiated during this time
A
5
17
Q
ready to relate to peers in an interactive manner
A
5
18
Q
brain has reached 90% of its adult weight
A
5
19
Q
sensorimotor coordination has matured (facilitates pencil/paper tasks, sports)
A
5
20
Q
cognitive abilities: at preoperational stage (focus on one variable in a problem at a time)
A
5
21
Q
activities to be observed: can catch ball
A
5-6yrs
22
Q
activities to be observed: skips smoothly
A
5-6yrs
23
Q
activities to be observed: copies a + already drawn
A
5-6yrs
24
Q
activities to be observed: tells age
A
5-6yrs
25
activities to be observed: concept of 10 (eg. counts 10 tongue depressors). May recite to higher number by rote
5-6yrs
26
activities to be observed: knows right and left hand
5-6yrs
27
activities to be observed: draws recognizable person with at least 8 details
5-6yrs
28
activities to be observed: can describe favorite television program in some detail
5-6yrs
29
activities related by parent: does simple chores at home (taking out garbage, drying silverware)
5-6yrs
30
activities related by parent: goes to school unattended or meets school bus
5-6yrs
31
activities related by parent: good motor ability but little awareness of dangers
5-6yrs
32
mastered conservations of length
5 1/2 yrs
33
recognizes numbers, letters, words
6
34
learns to write
6
35
beginning of concrete operations (perform mental operations concerning concrete objects that involve more than one variable)
6
36
can order, number, classify (relate to concrete objects in the environment)
6
37
magical thinking diminishes
6
38
reality of cause-effect relationships is better understood
6
39
fantasy and imagination are still reflected in themes of play
6
40
activities to be observed: copies a triangle
6-7yrs
41
activities to be observed: defines words by use ("what is an orange?" "to eat.")
6-7yrs
42
activities to be observed: knows if morning or afternoon
6-7yrs
43
activities to be observed: draws a person with 12 details
6-7yrs
44
activities to be observed: reads several 1-syllable printed words (my, dog, see, boy)
6-7yrs
45
activities to be observed: language - approximately 2560 words; intelligible 6- or 7-word sentences
6-7yrs
46
what is the age range for middle childhood?
7-10yrs
47
what do children devote most of their time to during middle childhood?
school and peer group interactions
48
major developmental tasts are achievement in school and acceptance by peers
7
49
academic expectations intensify, become more abstract, require child to concentrate on, attend to, and process increasingly complex auditory/visual info
7
50
language is at adult proficiency by what age?
7
51
activities to be observed: counts by 2s and 5s
7-8yrs
52
activities to be observed: ties shoes
7-8yrs
53
activities to be observed: copies a diamond
7-8yrs
54
activities to be observed: knows what day of the week it is (not date or year)
7-8yrs
55
activities to be observed: no evidence of sound substitutions in speech (eg. fr for thr)
7-8yrs
56
activities to be observed: draws a man with 16 details
7-8yrs
57
reads paragraph #1 Durrell
7-8yrs
58
corresponding arithmetic: adds and subtracts 1-digit numbers
7-8yrs
59
Learning disabilities or attention, organization, and impulsivity problems occur
8-9yrs
-may have significant issues with these tasks, receiving negative reinforcement from teachers/parents = poor self-image manifested by behavioral difficulties
--> pediatrician must evaluate potential learning disabilities in any child not developing adequately at this stage or present with emotional/behavioral issues
60
what determines the difference in success at school for 8-9yr olds?
quality of the response, attentional abilities, and child's emotional approach
61
activities to be observed: defines words better than by use ("what is an orange?" "a fruit.")
8-9yrs
62
activities to be observed: can give an appropriate answer to the following: "What is the thing for you to do if..."
-you've broken something that belongs to someone else?
-a playmate hits you without meaning to do so?
8-9yrs
63
reading: reads paragraph #2 Durrell
8-9yrs
64
Corresponding arithmetic: learning borrowing and carrying processes in addition to subtraction
8-9yrs
65
Activities to be observed: knows the month, day, and year
9-10yrs
66
activities to be observed: names the months in order (15 sec, 1 error)
9-10yrs
67
activities to be observed: makes a sentence with these three words in it (1 or 2; can use words orally in proper context --> 1. work, money, men; 2. boy, river, ball)
9-10yrs
68
reading: reads paragraph #3 Durrell (should be able to read and comprehend literature)
9-10yrs
69
Corresponding arithmetic: learning simple multiplication
9-10yrs
70
what is viewed as part of a continuum of responses by the child to a variety of internal/external experiences (biological/environmental)?
behavioral variations
71
definition: temperament
genetically influenced behavioral disposition that is stable over time; "how" of behavior vs the "why" = motivation of the "what" = ability; independent psychological attribute that is expressed as a response to an external stimulus (experiences --> influences temperament --> influences responses of others in child's environment); hard to evaluate in younger ages d/o variety of internal/external experiences
72
how common is it for a child in 1st grade to wet the bed? (%)
20%
73
Enuresis: prevalence
-boys or girls?
-age?
boys, among 7-9yr olds
74
Enuresis: definition
repeated urination into clothing during the day and into the bed at night by child who is chronologically and developmentally OLDER THAN 5 YEARS
-this pattern of urination MUST OCCUR at least TWICE A WEEK for 3 MONTHS
75
Enuresis: two types
1. monosymptomatic (never have been dry at night for >6MO with no daytime accidents)
-reflects a maturational disorders (delay in the maturation of the urologic and neurologic systems) with no underlying organic problem
2. complicated/non-monosymptomatic (involves nocturnal enuresis and daytime incontinence; reflects underlying disorder)
76
Enuresis type 1
-causes
-evaluation
-genetic; children have higher threshold for arousal (don't wake to full bladder sensation); overproduction of urine from dec production of desmopressin or resistance to ADH
-hx and physical exam; every child should have UA including specific gravity; obtain urine culture in girls
77
Enuresis type 1
-first line treatment
-second line treatment
-education and avoidance of being judgmental/shameful towards child; behavioral strategies used for 3 months every night (limit liquids before bed, awaken child at night, bedwetting alarms); parents need to be active participants (most common cause of failure is child does not awaken or parents do not wake child)
-desmopressin acetate (DDAVP) --> decreases urine production; high relapse rate when medications are stopped
78
Enuresis type 2
-evaluation
-treatment
-consider underlying pathology (cystitis, diabetes insipidus, seizure disorders, neurogenic bladder, anatomical abnormalities of urinary tract system, constipation, and psychological stress/child maltreatment. obtain complete hx and physical exam, diary that includes daily record of voiding and fecal elimination
-correct underlying cause; referral to peds specialist
79
Encopresis
-prevalence (ages)
-definition
-1-3% children experience this problem; occurs most between 5-6yrs
-repeated passage of stool into inappropriate places (underpants) by child who is chronologically or developmentally older than 4 years. occurs EACH MONTH for at least 3 MONTHS and is NOT ATTRIBUTABLE to physiologic effects of substance of other medical condition except to mechanisms involving constipation
80
Encopresis - what does it most often result from?
constipation (90%)
81
Encopresis:
-evaluation
-treatment
-complete hx, physical exam, rectal exam; abd XR (to note degree of constipation, appearance of bowel, if obstruction present)
-education, support; behavioral strategies (sit on toilet after meals), do not punish/no guilt; establish regular bowel regimen; encourage BM daily
82
what is the first line treatment for sleep disorders related to pediatric insomnia?
sleep hygiene education and cognitive behavioral therapy = first line treatments
83
how much sleep should a newborn get?
10-19hrss/day in 2-5hr blocks
84
first year of life - what is the sleep length of time?
9-12hr blocks
85
Total # hours of sleep per day: 1-2yrs
11-14
86
Total # hours of sleep per day: 3-5yrs
10-13
87
Total # hours of sleep per day: 6-13
9-11
88
Total # hours of sleep per day: adolescents
9-9.5
89
what percent of children experience sleep disturbance at some point in first 4yrs of life?
20-40%
-% decreases in school aged children
90
most common pediatric sleep disorder
insomnia of difficulty initiating/maintaining sleep
91
sleep is controlled by 2 mechanisms:
1. homeostatic drive (increase in pressure to fall asleep over course of day)
2. circadian rhythm
92
what are our two different biologic clocks (in relation to sleep/wake)?
1. circadian rhythm: daily sleep-wake cycle
2. ultradian rhythm (occurs several times per night) - stages of sleep = stages of sleep cycle every 50-60min (infants) and every 90 in (adolescents)
93
two major sleep stages
1. NREM/non-REM: divided into 3 stages
2. REM: occurs throughout the night but INCREASES DURING LATTER HALF OF NIGHT
94
What stage of sleep?
Light sleep. Reduced body movements, slow eye rolling, sometimes opening/closing of eyelids
N1
Stage 1
95
What stage of sleep?
Slowing eye movements, respirations, HR, and relaxation of muscles. Mature individuals spend 50% of sleep time in this stage.
N2
Stage 2
96
What stage of sleep?
Slow-wave sleep. Body is relaxed, breathing is slow/shallow, HR is slow. Deepest NREM sleep occurs 1-3hrs after going to sleep.
N3
Stage 3
97
What stage of sleep?
Muscle tone relaxed, sleeper may twitched/grimace. Eyes move erratically beneath closed lids.
REM
Stage R
98
Night terrors
-how quickly does this occur after falling asleep?
-what stage of sleep does this occur?
-common ages
-management
-within 2hrs falling asleep
-during deepest NREM sleep (stage 3)
-3-8yrs
-ensuring environment is free of obstacles/lock doors outside, put bell on child's door
99
Night terrors
-what does the child do?
-have memory of event?
-sit-up in bed screaming, thrashing about, exhibiting rapid breathing, tachycardia, sweating; child incoherent and unresponsive to comforting (can last up to 30 min)
-no memory of event next day
100
Sleepwalking
-when does it occur?
-common ages
-management
-slow-wave/deep sleep (stage 3)
-ages 4-8yrs
-ensuring environment is free of obstacles/lock doors outside, put bell on child's door
101
Nightmares
-occur during which stage of sleep?
-how will child act?
-associated with what?
-REM sleep (stage R)
-awakens alert, can describe nightmare, talk about it next day; child seeks and responds to parental reassurance. Difficulty going back to sleep afterward.
-stress, trauma, anxiety, sleep deprivation
102
BEARS mneumonic for sleep disorder management
Bedtime resistance
Excessive daytime sleepiness
Awakening during the night
Regularity and duration of sleep
Sleep-disordered breathing
103
How often are you assessing a child for sleep disorders?
Screen child for quality and quantity of sleep at EVERY well-child visit
104
ABCs of SLEEPING
Age-appropriate Bedtimes and wake times with Consistency
Schedule and routines
Location
Exercise and diet
no Electronics in bedroom or before bed
Positivity (positive home environment)
Independence when falling asleep
Needs of child met during the day =
Great sleep
105
What type of children is melatonin useful for?
children with visual impairment, developmental disability and ASD
106
what is included for every routine middle childhood exam?
height, weight, BMI, BP, vision, hearing
107
what is the most common neurodevelopmental disorder?
ADHD (2-10% of school-aged children)
108
biologic factors that influence development are...?
Genetic!
109
what questionnaire is used for ADHD?
Vanderbilt ADHD Diagnostic parent/teacher rating scales
110
what is the triad of symptoms related to ADHD?
hyperactivity-impulsive, inattentive, combined type
111
common type of ADD/ADHD overall, girls, boys
overall: combined
girls: inattentive subtype
boys: hyperactive subtype
112
ADHD
-what are the diagnostic features
-<17yrs
-must exhibit 6+ sx listen in either domain
-sx must be present PRIOR to age 12 yr
-sx have persisted for at least 6 MO
-must occur in more than one setting
-affects quality of life
-not attributable to another psychiatric condition (mood, anxiety, SA)
113
ADD/ADHD Medications: stimulants
-what schedule? meaning?
-schedule 2; high potential for abuse and dependence
114
monitoring parameters in relation to ADD/ADHD medications - stimulants
-baseline cardiac evaluation in patients with risk factors
-BP, HR at baseline, after dose increase, and periodically
-Height/weight in pediatrics at baseline and periodically
**consider in those with prolonged tx: CBC w/ diff + platelets annually
115
types of drugs that are stimulants for ADD/ADHD (2)
-Methylphenidates (azstarys, concerta, daytrana, focalin/XR, Jornay, QuilliChewER/XR, Ritalin
-amphetamines (Adderall, Adderall XR, Dexedrine, mydayis, Vyvanse)
116
can stimulants and nonstimulant medications for ADD/ADHD be used simultaneously?
YES
-Intuniv, Kapvay, Qelbree, Strattera
117
Off label ADHD meds
Bupropion (Wellbutrin), clonidine ER, guanfacine
118
Features of ASD
"clinically significant impairment" with social communication component impaired in comparison to the individual's "general developmental level"
119
how common is ASD diagnosis?
1 in 54 children, with male overrepresented by about 4:1
120
what screening tool is used to diagnose ASD?
M-CHAT
Administered at 18 and 24-30MO
121
how many hours/week of intensive behavioral intervention for ASD children is recommended?
25hr/week
122
Definition of intellectual disability
-what two items must be present for dx
-IQ
-adaptive function and cognitive standardized testing must be >2 standard deviations BELOW mean to quality for ID
-IQ <70
123
at what age is puberty complete?
16-18yrs
124
what four items demonstrate developmental passage from childhood to adulthood?
1. completing puberty and somatic growth
2. developing socially, emotionally, and cognitively, and moving from concrete thinking to abstract thinking
3. establishing an independent identity and separating from family
4. preparing for a career or vocation
125
three leading causes of mortality in adolescents (15-19yrs)
1. unintentional injury (41%; primary cause MVA, poisoning inc prescription drugs - opioids)
2. suicide (18%, firearms)
3. homicide (15%, firearms)
126
Major casues of morbidity in adolescents
-psychosocial
-related to poverty
127
at what age do you conduct a physician visit with only the adolescent, and then with parent present?
-starting at age 11-12
128
when do you utilize the HEADSS assessment? what does each letter stand for?
-used as a good psychosocial history tool to assess on the questionnaire before an appointment
-home, education/employment, activities, drugs, sexuality, and suicide/depression
129
Early middle adolescence (Male)
-process to create testosterone
-increase in LH/FSH secretion --> stimulates gonads to produce estrogen/testosterone
-LH stimulates interstitial cells of testes --> testosterone
-FSH stimulates production of spermatocytes in presence of testosterone
*circulating testosterone levels increase more than 20-fold during puberty (levels of testosterone correlate with physical stages of puberty and degree of skeletal maturation)
130
Early middle adolescence (female)
-female maturation
-FSH stimulates ovarian maturation, granulosa cell function, estradiol secretion
-LH important in ovulation and involved in corpus luteum formation progesterone secretion
-estradiol levels progressively inc --> maturation of female genital tract/breasts
131
growth spurts in boys vs growth spurts in girls (adolescents)
girls grow 2 years before boys (girls peak 11.5 and 12 years, boys peak 13.5 and 14 years)
132
Sexual Maturity Rating (SMR)
-5 phases
1. SMR 1: pre-puberty
2. SMR 2: pubic hair sparse, fine, nonpigmented and downy; male genitalia development begins
3. pubic hair is pigmented and curly, increases in amount
4. pubic hair is adult in texture but limited in area
5. adult maturity
133
first measurable sign of puberty in girls
height spurt
134
first conspicuous sign of puberty in girls
breast buds between 8-11yrs
135
first sign of puberty in boys (usually 10-12yrs)
scrotal and testicular growth
136
when does axillary hair, deepened voice, and chest hair occur in boys during puberty?
usually 2 years after growth of pubic hair
137
complications associated with marijuana use
tachycardia, HTN, bronchodilation, decreased fertility, learning problems, coordination and memory
138
what are the greatest barriers to screening adolescents for substance abuse in the primary care setting?
-insufficient time
-lack of training
139
screening tools for SA
BSTAD & S2BI
140
CAGE questionnaire
used to assess SA
-Their need to Cut down; Annoyance if asked about it; feeling Guilty about the use; need for an Eye opener
*score of 2 or more is highly suggestive of abuse
141
when must a chaperone be present during an adolescent exam?
during pelvic exam or stressful/painful procedure
142
how often should vision and hearing be assessed by practitioner?
at every health supervision visit
143
what should visual acuity be in 3-5yr olds?
what should visual acuity be in >equal 6hr olds?
-20/40
-20/30
144
how often is hearing screen performed?
ages 4, 5, 6, 8, 10 years of age, and several times during adolescence
145
After age 4, hearing screen
-hz tested
-at what db?
500, 1000, 2000, 4000hz
20dB
146
when is BMI graphed?
starting at age 2yrs
147
at what age are practitioners screening children for obesity?
6yrs old
148
how is BMI measured in relation to sex and age?
it is sex and age specific
149
tests to run when obesity is dx
fasting lipid profile, fasting glucose and/or hemoglobin A1c, ALT
150
when do BP screening begin at well child visits?
by age 3
151
what is HTN frequently caused by in the pediatric population?
renal or obesity
152
how should the width of the BP cuff fit around a child?
40-50% of the circumference of the limb
153
how is HTN dx in pediatric population?
3 separate occasions of elevated BPs
154
stages of HTN (pediatric)
-Elevated BP: 90-95%
-Stage 1 HTN: >than between the 95th and 99th percentile plus 12mmHg
-Stage 2 HTN: >99th percentile plus 12mmHg
155
define scoliosis
lateral curvature of the spine greater than 10 degrees of deviated from straight
156
at what age are children screened for scoliosis? (boys and girls)
-girls: ages 10 and 12 yrs
-boys: ages 13 or 14 yrs (only once)
157
Signs of scoliosis (3)
-uneven shoulders
-curve of spine
-uneven hips
158
how is scoliosis classified?
anatomical location (thoracic or lumbar)
159
what is the most common type of scoliosis?
-other types
idiopathic (80%)
-seen in adolescent girls during growth spurt ages (10-18yrs; 10-12yr most often, but can be seen earlier)
-other types: congenital, neuromuscular, syndromic
160
at what age does scoliosis tend to occur?
ages 8-10yrs, but can occur earlier
-incidence is same in males and females; though, females have 10-fold greater risk of curve progression (seen during growth spurt 10-12yrs)
161
adam's forward bend test
patient stands and bends forward at waist, with the examiner assessing for symmetry of the back from behind and beside the patient
162
at what degree of scoliosis is a Cobb angle required?
10 degrees
163
cobb angle measurement
measurement for quantifying spine curvature of scoliosis (measured on a standing PA XR of spine)
-described maximum distance degree of side-to-side curvature
*needed for official dx of scoliosis
**no pulmonary impairment is usually seen with Cobb angle <35 degrees
164
scoliosis treatment
<20 degrees - observation (unless progression observed)
20-40 degrees - back bracing
>40 degrees - surgery
165
what is the most common cause of severe kyphosis?
scheuermann disease
166
pap smear screenings
-when does it start
-how often is the screening
-age 21
-every 3 years
167
at what age should a provider obtain a lipid panel with nonfasting nonHDL chol or fasting lipid panel?
9-11yrs and 18-21yrs
168
at what age should provider obtain fasting lipid profile if familial HDL newly positive, parent with dyslipidemia, and any other RFs or high-risk conditions
12-17yrs
169
when to start screening for BP in pediatric patient?
3yrs
170
when to start screening for obesity in pediatric patient?
6 years
171
when to start screening for diabetes in pediatric patient?
>equal 10 yrs with >equal 2 RFs; should be screened q2yrs
172
when to start screening for scoliosis in female and male pediatric patients?
-ages 10 and 12 yrs
-ages 13 or 14 yrs
173
when to start screening for anemia in pediatric patients?
annually for RFs
screen those with RFs with Hbg or HCT
174
when to start screening for depression in pediatric patients?
>equal 12 yrs with PHQ2 screening (self-report rating scales that are easily used in primary care to assist in assessment and monitoring response to treatment
175
when to start screening for substance use in pediatric patients?
>equal 11 yrs with CRAFFT screening
176
when to start screening for tobacco use in pediatric patients?
>equal 11 yrs
177
when to screen for chlamydia
sexually active females <25yrs annually; retest >equal 3MO after tx
178
when to screen for gonorrhea
sexually active females <25yrs annually; retest >equal 3MO after tx
-screen at least annually for sexually active MSM at sites of contact regardless of condom use. screen every 3-6MO if increased risk
179
when to screen for HSV
consider HSV serology in men/women coming fro STI evaluation esp if multiple partners
180
when to screen for HIV
screen between 15-18yr, at least once; repeat screening if RFs for infection present
181
when to screen for syphilis
screen sexually active MSM at least annually and q3-6MO if at increased risk for infection
182
percent of children depressed before adolescence, during adolescence
-when does the rate of depression in females approach adult levels?
-1-3% before puberty
-around 8% for adolescents
-age 15
183
What is the HEADSS screening tool used for?
to screen for health concerns from the patient
Home
Education/employment
Activities
Drugs
Sexuality
Suicide/depressions
184
what is the third most chronic illness of adolescent girls in US?
AN
185
contraindications for VAR vaccine
-hx of anaphylactic/anaphylactoid reaction to gelatin, neomycin, or any other component of the vaccine
-blood dyscrasias, leukemia, lymphomas, or malignant neoplasms affecting bone marrow or lymphatic system
-primary or acquired immunodeficiency, inc persons with immunosuppression associated with cellular immunodeficiencies and AIDS or severe immunosuppression associated with HIV infection
-receiving prolonged high-dose immunosuppressive therapy (>equal 2weeks) (steroids, etc.)
-moderate or severe concurrent illenss
-family hx of congenital hereditary immunodeficiency, unless person has been determined to be immunocompetent
-is or may be pregnant
186
vaccinations due at kindergarten
Dtap - 5
MMR - 2
VAR - 2
Flu - annual
IPV - 4
187
vaccinations dur at ages 11-12yrs
Tdap - 1
Flu - annually
HPV - 1-2 doses; given as early as 9yrs; 2 or 3 shot series
MenACWY - 1
188
vaccinations due at 18+ (college)
-MenACWY - 2 total (1 more)
-MenB - 1
189
contraindications of MenB
None
Precautions of mod-severe illness with/without fever; pregnancy; latex sensitivity
190
contraindications of MenACWY
severe allergic rxn to any Dtap containing vaccine and rubber latex
191
contraindications of Tdap
encephalopathy not attributable too another identifiable cause within 7d of administration of previous dose of DTP, Tdap, or DTaP
192
contraindications of HPV
pregnancy
193
