Pediatric Exam and Common Medical Problems Flashcards Preview

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Flashcards in Pediatric Exam and Common Medical Problems Deck (58)
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1

Types of Patient Encounters

Health Supervision Well Child Check-up(WCC)
-New or established
-Acute/Illness Care
-Follow-up Care

Health Supervision Visits
-Longitudinal Care:
-Based on “Bright Futures Guidelines” for health supervision from the AAP

2

WCC @ Year 0-­‐1:

Newborn–3-­‐5days–2-­‐4wks–1mo–2mo–4mo–6mo–9mo

3

WCC @ Year 1-­‐2:

12mo–15mo–18mo

4

WCC @ Year 2-­‐3:

24mo–30mo

5

WCC @ Year 3–21:

Yearly

6

Health Supervision Visit: Components

-Current Concerns (CC/HPI)
-Past Medical History (PMHx)
-Growth and Development
-Screening
-Immunizations
-Nutrition/Elimination
-Sleep Patterns/ Habits
-Family History
-Social History
-Physical Exam
-Anticipatory Guidance

7

Basics of Development

Gross Motor, Fine Motor, Communication (Receptive/ Expressive Language), Cognitive Development, Emotional/ Social/ Behavioral.

8

Screening Labs and Procedures

-Newborn Metabolic Screening (PKU)
-Hearing screen – OAE testing
-Hemoglobin Screening
-Lead screening
-Dyslipidemia screening
-Tuberculosis screening
-Sexual health in adolescents
-Fluoride Varnish

9

Hemoglobin Screening

At 12 mo

10

Lead screening

At 6 months- 6 years,
Testing at 1 and 2 years

11

Dyslipidemia screening

All children screened for cholesterol at least once between ages 9 and 11 years, and again between ages 17 and 21 years. (from the NHLBI of the NIH) endorsed by the AAP

12

Tuberculosis screening

-WCC; 2-4 weeks, 6 month, 12 month, 18 month, every WCC from 2 years through 21 years old.;
-Place PPD if at risk

13

Sexual health in adolescents

Routine pelvic exam not needed until age 21 yrs;
Annual STI screen if sexually active,
First fraction void or vaginal swab for GC/Chlamydia,
Blood draw for RPR and HIV

14

Fluoride Varnish

WCC at ages; 12, 18, 24 and 30 months

15

UF Peds Clinic Developmental Screening

Developmental Screening & Autism Screening

16

Developmental Screening:

-Perform at 18 and 30 month WCC.
-(May also screen other ages as needed; 2-60 months)

Tool: ASQ - Ages & Stages Questionnaire
-Communication, Gross Motor, Fine Motor, Problem solving, Personal-social (6 questions in each category)

17

Autism Screening:

-Screen at 24 month WCC visits

Tool: MCHAT – Modified CHecklist for Autism in Toddlers
-(validated for screening toddlers between 16 and 30 months of age)
-[23 questions]

18

THE “HEADS” PSYCHOSOCIAL, INTERVIEW FOR ADOLESCENTS

Home/Health
Education/Employment
Activities/Associations
Drugs/Diet
Stress/Sexuality

19

GOAL OF THE PREPARTICIPATION SPORTS EXAMINATION

-Identify medical problems with risks of life-threatening complications (e.g. past concussions, exercional syncope, family history of sudden death in young individuals)
-Identify pertinent medical conditions (e.g., hypertension, asthma, diabetes, allergies, seizures)
-Identify and rehabilitate old musculoskeletal injuries
-Identify and treat conditions that could interfere with performance (e.g., exercise-induced bronchospasm)
-Remove unnecessary restrictions on participation

20

Sports Physical Setting

-Office Based
-Records available
-Confidentiality
-Quiet
-Follow up
-Can overwhelm a small practice
-Mass Physicals
--Large numbers
--Consistent exams
--Team able to gather information
--Cheap

21

Hypertrophic cardiomyopathy(HCM)

-The leading cause of sudden cardiac death in young athletes
-Physical examination and medical history catch only 3% of cases
-Family history of sudden death (Familial HCM is autosomal dominant)
-0.2% to 0.5% of the general population
-Syncope, dyspnea, palpitations, chest pain
-ECGs detect abnormalities in ~70% of asymptomatic HCM, but cannot determine if it is specifically HCM
-Echocardiograms are used to diagnose HCM (detect 80+%)

22

Acute Care Visits

-Sick children do not act like well children!
-Vital signs as indicated by illness: (Weight, ? Temp, ?BP; ? O2 Sat)
-Pertinent related history (Duration, symptoms, Past Hx, Ill contacts, Travel)
-Pertinent or focused physical exam

23

Follow-up Visits

-Assess management and therapy of previously identified concerns: (Otitis media, Growth, Asthma)
-Vital signs as indicated per problem
-Pertinent related history to identify regression or progression of illness
-Pertinent physical exam

24

COMPONENTS OF THE PHYSICAL EXAM

HEENT
Heart/Lungs
Abdomen/GU
Skin
Musculoskeletal
Neuro

25

Pearls for the Physical Exam

--Use some developmental milestone knowledge!
--Distraction – use toys or books
--Let the child see and touch the exam tools you will be using (Call the otoscope a “flashlight”)
--Demonstrate on self, parent or doll before using tools on child
--Remember to talk to the patient and family during the exam.

26

Pediatric Physical Exam

--Heart and lungs FIRST!
--Work down then up
--Ears and mouth LAST!

27

Tips for Examining the Young Child

-Use a reassuring voice throughout the examination
-Avoid asking permission to examine a body part (the answer may be “No”!); instead, give choices
-Examine the child in the parent’s lap
-If unable to console the child, allow a short break

28

Length, Height, Weight, Head

Length/height: After age 2, kids should grow at least 5 cm/yr

Weight: Failure to thrive is inadequate weight gain for age, Growth 2 quartiles in 6 months, Weight for height 97th percentile or 2 standard deviations above mean

29

Blood Pressure

Elevated blood pressure during exercise, crying, anxiety.
Most frequent “cause” of elevated BP in kids is an improperly performed exam (incorrect cuff size)

Transint HTN can be from meds (prednisone, ritalin);
sustained HTN can be from renal parenchymal or artery disease, coarctation of aorta, and primary hypertension
BP:

Normal 95th percentile

30

Pulse

More sensitive to effects of illness, exercise, emotion. Palpate femoral or brachial, or listen to heart

Higher in infancy.