pediatric exam

Question 1

height/length

Answer 1

length: cannot walk or stand; done supine between birth and 24 months (make sure to plot growth curve)
- height: when can walk (2 years)

Question 2

head circumference

Answer 2

measured at every well child check ups until age 2-3

Question 3

BP

Answer 3

can be measured, but more important to measure growth vitals (over 2-3 years of age)

Question 4

vision screening

Answer 4

use senile charge starting at 3 years of age

• point direction of E
• infants, try for red reflex

Question 5

hearing screening

Answer 5

• infants: bell, whisper, rub fingers
• toddler: observe response to whispered voice/noisemakers (stay positioned behind child) -> expect child to respond to sound consistently (development indicates hearing acuity)

Question 6

nutritional assessment

Answer 6

• breast vs bottle fed (frequency, duration)
• note additional intake of vitamins/minerals
• adol: preoccupation with weight and concern about developing muscle mass and losing body fat
• monitor protein intake, calories, vits and mins

Question 7

assessment of developmental milestones

Answer 7

smile (3 months), say 1-2 words (1 y/o)

Question 8

common difficulties associated with meds hx and physical exam

Answer 8

●Preschool aged children will take time to warm up to you
●Start on the other side of the room and let them get comfortable with you before approaching
●Allow children to explore and check out equipment before using it
●Do least stressful tests first and progress to most anxiety producing last (heart and lungs)
●Be prepared for a wiggling child when doing an exam (finger strut!!)
●Most information will come from the adult present with them but if the child is old enough, engage them in the history taking

Question 9

prenatal hx/birth hx

Answer 9

• How did the pregnancy go? (general sense of how it went)
• Did mother take any prenatal meds besides vitamins and iron?
• Plans for baby: breast vs bottle; labor/delivery plans (does OB know what you want?); circumcision; safety issues (car seat, furniture, electrical outlet plugs, etc)
• How long did labor last? Any difficulties/complications with labor?
• Any infections or other conditions -How long were mom and baby together in the nursery? (usu 48 hr max, more if baby was
• What was birth weight? (and discharge weight, which will be less than birth weight)

Question 10

social hx

Answer 10

• Who lives in the home?
• Are siblings prepared?
• Smoking/alcohol?
• Support: friends? Mother-in-law moving in?
• Work, maternity/paternity leave
• Pets
• Diet – eg are parents vegan, and will they be raising baby vegan?

Question 11

past medical history

Answer 11

• Previous pregnancies? How’d they go?
• Assisted pregnancies (in vitro, etc)
• Hx of post-partum depression, gestational diabetes, pre-eclampsia, etc
• Hx of miscarriages? GU surgeries?
• Infections/treated conditions during pregnancy/labor (eg active herpes outbreak)?

Question 12

review of systems

Answer 12

Vomiting, pelvic/abd pain, vaginal bleeding, abnormal vaginal discharge?

• Psych – depression, SI, HI
• HA, other HTN symptoms
• infectious symptoms? sore throat, cough, UTI sxs, etc.

Question 13

5 things to look at during well child visit

Answer 13

Nutrition, Elimination, Sleep, Immune, Development

Question 14

components of well child visit

Answer 14

a. Developmental assessment: meeting growth parameters e.g. head circumference , observing milestones (reflexes should be going away when they should)
b. Physical: skin, umbilicus, fontanels, ears, mouth, palate, mucous membranes
c. Supine: heart, lungs, abdomen, femoral pulses, hips, genitalia, eyes
d. Prone: spine, anus, head raise
e. Neuro: DTR, Babinski, clonus, rooting, suck, palmar grasp, plantar grasp, Moro (startle reflex birth -6mo) , placing, stepping, Galant’s (truncal incurvation), tonic neck,
f. Behavioral assessment/ interaction
g. The parent/ child: model behavior
h. Anticipatory guidance: patient education
close visit ad reassure

Question 15

18 months

Answer 15

when they can be more fussy and scared

Question 16

when should primitive reflexes be gone?

Answer 16

12 months for sure

Question 17

posterior fontanelles close?

Answer 17

2 months of age should be closed

Question 18

anterior fontanelles close?

Answer 18

9-18 months should be closed

Question 19

check femoral pulse

Answer 19

diminished = coarctation of aorta

Question 20

palmar grasp

Answer 20

grasp hand

Question 21

placing response

Answer 21

hold infant up, looks like they are trying to take a step

Question 22

rooting reflex

Answer 22

touch corner of mouth (suckling stimulation), they will turn toward side stimulated

Question 23

tonic neck reflex

Answer 23

“fencing”, turn to left and have is lateral extension of left arm and leg (with contralateral flexion of arm and leg)

Question 24

startle reflex (moro reflex)

Answer 24

abruptly lower and they get scared! arms adduct and flex, legs make similar motions

Question 25

cephalohetoma

Answer 25

significant brusing/hemorrhage (or odd shape) along one of the cranial bonés, generally associated with birth-related trauma (i.e. vacuum assisted); doesn’t cross the suture line, not symmetric (blood under bones)

Question 26

hip dysplasia/ congential dislocation

Answer 26

Ortolani: evaluate with external rotation and pulling; Barlow: knees and hips flexed, push down; perform bilat, will normally here clicks, “thunk” is abnormal sign; trying to force femoral head out of acetabulum, can cause fêmur to dislocate if acetabulum formed inappropriately; key exam until 2 months of age

Question 27

caput succedaneum

Answer 27

edema of the scalp, associated with compression during vaginal delivery; looks like a cone or cap on top of the skull

Question 28

milia

Answer 28

small, whitish papules on face ; plugged sebaceous glands ; common at 2 to 3 months of age (looks like white heads or pustules)

Question 29

port wine stain

Answer 29

swollen blood vessels great darkly colored/red patch or splotches (nevus flammeus) ; vascular abnormaility ; in infants often start out light pink and darken with age ; generally harmless, but if the opthalmic division of the trigeminal nerve is involved, may have associated ocular defects ; if trunk or limb involvement, may have associated neuromuscular problems ; skin biospy or MRI to diagnose

Question 30

hemangioma/"stork bites"

Answer 30

benign red marks

Question 31

mongolian spots

Answer 31

irregular areas of deep blue pigmentation in sacral/gluteal areas; primarily in African, Asian, Latin American, Native American populations

Question 32

failure to thrive

Answer 32

below 5th percentile for height/weight; one or more standard deviation off growth curve pattern

Question 33

strabisumus

Answer 33

eyes; not properly aligned; point penlight at eyes, observe for symmetric reflection from both eyes