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1

What 3 specific areas should be addressed at each well child exam?

  1. physical development
  2. cognitive development
  3. social and emotional development

2

When are kids called the following?


•Newborn

•Infancy

•Toddler/Early Childhood

•School-aged/Middle Childhood

•Adolescence (11-20 years)

 


•Newborn

  0-28 days

•Infancy

  0-12 months

•Toddler/Early Childhood

  1-4 years

•School-aged/Middle Childhood

5-10 years

•Adolescence (11-20 years)

Early, middle, & late

3

What are the components of the APGAR scoring?

•A: Appearance (color)
•P: Pulse
•G: Grimace (reflex irritability)
•A: Activity (muscle tone)
•R: Respiratory effort
 

4

Most babies start out at what apgar score?

9 - due to aprocynosis (spelling?)

5

In APGAR, what does activitys stand for?

Muscle tone

6

What are three things given shortly after delivery?

  1. –Erythromycin ointment in eyes to prevent infection (prevent STD infection)
  2. –Vitamin K injection to prevent bleeding
  3. –Full bath
     

7

What is the ballard scoring system for?

What are the subranges?

To determine gestational age in weeks.  

Neuromuscular maturity

-1 to 5

 

Physical maturity

-1 to 5

8

what defines a pre-term baby?

less than 37 weeks

9

What is post term baby time fram?

more than 42 weeks

10

How often should neonates feed?

Every three hours

11

In first week of life, what should happen to a childs weight?

Normal to lose up to 10% of birth weight over first week.  

12

Elevated bilirubin prior to first 24 hours of life indicate it is more than physiological jaundice.  

What are common causes of pathological jaundice of the newborn?


•ABO incompatibility/Rh
•Cephalohematoma
•Infection
•Hemoglobinopathies
–ex: thalassemia
•Enzyme deficiencies
–ex: G-6-PD
 

13

What is a cephalohematoma?

Large bruise that doesn't cross suture lines

14

What is done prior to discrharge from the hospital?


–Hepatitis B immunization
–Hearing screen
–Newborn Screening blood test
 

15

When should there be PCP follow up after discharge?

24-48 hours

16

What components are used for assessment of developmental milestone?


•Physical
      –Gross Motor
      –Fine Motor
•Language/Cognitive
•Personal/Social
 

17

How does neurologic development progress?

Centrally to peripherally

 

  1. –Head control
  2. –Trunk control
  3. –Use of arms
  4. –Use of legs
  5. –Use of hands then fingers
     

18

What are the normal language milestones up to 1 yr?


–2 months-cooing
–6 months-babbling
–1 year-1-3 words
 

19

At 9 months and older, how should you examine the child?

On parent's lap

20

Until when should you measure head circumference?

At each visit until 36 months

21

At what age would you begin checking BP at a well child exam?

3 years

22

What are the primitive reflexes to test?

  1. Palmar grasp
  2. Plantar grasp
  3. Moro (startle reflex)
  4. Asymmetric Tonic Neck
  5. Positive support
  6. Rooting

 

23

How do you test the palmar grasp

finger in hand and press against palmar surface --> grasps finger

24

How do you check plantar grasp?

Touch sole at base toes -->  toes curl

25

How do you test the Moro reflex?

Hold supine support head, back, legs; abruptly lower 2 feet  -->  arms abduct& extend, hands open, & legs flex, +/-cry 

26

What do you use Barlow and Ortolani maneuvers to test for?

Signs of hip dislocation

 

Can indicated developmental hip dysplasia (DHD)

 

If positive, imaging

27

What does ortolani test look for?

presence of posteriorly dislocated hip

28

What does the barlow test reveal?

ability to sublux or dislocate intact but unstable hip

29

When does the anterior fontanelle close?

4-26 months

30

When does posterior fontanelle close?

2 months

31

At what age should a toddler be understandable to all?

By 4 years of age

32

Where should you examine a toddler?

On parents lap

33

Where should you examine a school age child?

On table

34

What are new topics to discuss for school age children?


•School issues
–Performance, bullying, special ed, behavioral issues?
–Does your child have a place to do homework?
•Start talking about body changes of puberty/age appropriate
•Remember that health and development is heavily influenced by physical, social, environmental factors and disease (child abuse, chronic illness, socioeconomic status)
 

35

When does puberty begin for females?

8-13 years

36

When does puberty begin for males?

9-13.5

37

What is adrenarche?


–Activation of adrenal medulla for production of adrenal androgens
–Occurs before the onset of puberty
 

38

What is gonadarche?

What are the hormonal changes for boys and girls respectively?


–Earliest gonadal changes of puberty-GnRH released
•Boys-LH stimulates testosterone production and FSH stimulates sperm maturation
•Girls-FSH stimulates estrogen & follicle formation and LH stimulates corpus luteum after ovulation
 

39

What is Thelarche?

Beginning of breast development at puberty

40

What is pubarche?

beginning of pubic hair

41

What is Tanner 1 for breasts?

elevation of nipple only, preadolescent

42

What is tanner 2 for breasts?

2-elevation breast/nipple as small mound (breast buds)

43

What is tanner 3 for breasts?

further enlargement breast/areola, no separation of contour

44

What is tanner 4 for breast development?

Projection areola/nipple to form secondary mound

45

What is tanner 5 for breasts?

mature stage, projection of nipple only

46

What is tanner 1 for boys?

preadolescent-no pubic hair (fine body hair only); penis/testes same size as childhood

47

What is tanner 2 for boys?

Pubic hair-sparse slightly pigmented, straight. Penis-slight or no enlargement. Testes/scrotum-larger, slightly reddened

48

What is tanner 3 for male?

Pubic hair-darker, coarser, curlier, sparsely over pubic sym; Penis-larger in length. Testes/scrotum-further enlargement

49

Tanner 4 for boys?

Coarse/curly greater than stg 3 but not as great as adult; not on thighs. Penis-further enlargement length/breadth w/ dev. of glans. Testes/scrotum-further enlarged, scrotal skin darkened

50

What is tanner 5 for males?

Pubic hair-adult quantity & quality, spread to medial thighs. Penis-adult size &shape. Testes/scrotum-adult size & shape.

51

What is the acronym for how to approach topics with teens?

HEADS

H- Home how are things?

E - Education, how is school?

A - Alcohol, are your friends drinking?

D - Drugs - do your friends try drugs?

S - Sex: Do you have a boyfriend/girlfriend?  Sexually active?

52

When do you kick parents out of the room?

When a child ilooks mature enough that someone might mistake them for an adult.  

53

What is the typical order of changes in males during puberty?

-Testicular growth

-Pubic hair

-Penile enlargement

-Growth spurt  peaks (age 14)

54

What is the typical order of changes in females during puberty?

-Breast buds

-Pubic hair

-Growth spurt peaks (age 12)

-Menarche (T4)