Peds Flashcards
(140 cards)
1
Q
what are the 3 areas for well child exams
A
physical development
cognitive development
social and emotional development
2
Q
What is considered newborn stage
A
0-28 days
3
Q
What is considered infancy stage
A
0-12 months, includes neonate
4
Q
what is considered toddler/early childhood stage
A
1-4 years
5
Q
what is considered school-aged/middle childhood
A
5-10 years
6
Q
what is considered adolescence stage
A
11-20 years, early middle and late
7
Q
what type of social and environmental factors can alter childhood development
A
child abuse, chronic illness and low socioeconomic status
8
Q
what type of neonatal resuscitation is needed at birth usually
A
drying and bulb suction
9
Q
What are the 5 components of APGAR scoring
A
Appearance, pulse, grimace, activity and respiratory effort
10
Q
what is the APGAR scoring
A
classify newborns neurologic recovery from birth and immediate adaptation
11
Q
What is the scale for APGAR
A
0-2 want total score above 7
12
Q
When are the APCAR scores taken
A
at 1 and 5 minutes
13
Q
What is conisdered severe depression APGAR
A
score of 0-4 in first minute
score of 0-7 in five minutes
14
Q
When is the hospital evaluation taken for neonate
A
within 24 hours after delivery
15
Q
What is involved in hospital evaluation of neonate
A
maternal Hx, delivery record, full head to toe exam
16
Q
What is included in head to toe hospital evaluation of neonate
A
molding/fontanelles red reflex palate genital hip exam primitive reflexes
17
Q
what is included in the review delivery record for hospital evaluation of neonates
A
gestation, mode of delivery, duration of labor, augmentation/induction, complications (vacuum/forceps, O2), APGAR, blood lgucose
18
Q
What is given in eye to prevent infection after birth
A
erythromycin ointment
19
Q
What is given to neonates shortly after delivery to prevent bleeding
A
Vit K injection
20
Q
What is the scoring system for gestational age in weeks
A
ballard scoring
21
Q
what is the ballard scoring based on
A
neuromuscular sign and physical characterisitcs that change with gestational maturation
22
Q
What are the parts of ballard scoring and what is the scale
A
neuromuscular maturity is 1-5
physical maturity is 1-5
use chart to determine
23
Q
What is the gestational age for preterm, term and posterm
A
preterm is 42 weeks
24
Q
What is a normal birth weight
A
> or = 2,500 grams
25
what percentile is considered small for age
<10th
26
what percentile is considered large for age
>90th
27
Describe neonate feeding
every 3 hours
breastfeeding is initially small volumes, milk comes in after 2-3 days
formula 15-30 mL
28
Describe weight changes in neonates during first week
normally lose 10% then gain back by 10-14 days
29
Describe normal voiding of neonates
3-4 voids in first 1-3 days is normal
| day 4-5 should see 6-8 voids ea 24 hour period
30
Describe the meconium
first stool, within 24 hours of life, dark, black tarry
31
describe stool by 4-5 days of life
breast feeding- yellow seedy
| formula- green yellow
32
How is jaudice accounted for in hospital care of neonate
checked with transcutaneous bilimeter or serum direct/indirect bilirubin levels
compared to nomogram and repeal levels drawn
33
What indicates more than physiologic jaundice in neonate
elevated lecels of bilirubin prior to first 24 hours
34
what are types of non-physiologic jaundice in neonate
```
ABO incompatability/Rh
Cephalohematoma
Infection
Hemoglobinopathies (thalassemia)
Enzyme deficiencies (G-6-PD)
```
35
What is the difference of hospital discharge for vaginal delivery versus caesarean
vaginal 2 days after
| caesarean 3 days after
36
what is done to neonate before discharge
hepatitis B immunization
hearing screen
newborn screening blood test
circumcision done
37
What is the follow up care for neonates, 24-48 hours after discharge
weight loss, hyperbilirubinemia
| prematurity
38
What are main points of wellness visit in infants
continued assessment of growth and development
immunizations
give parental information
answer parent questions
39
What items of HPI are discussed in infant well visit
```
feeding
stooling/voiding
sleeping
development
safety
additional parental concerns
```
40
What is included in PMHx for infants
medical problems. injuries, hospitilizations, surgery
41
What is included for rest of soap for infants
meds, allergies, FMHx, social Hx such as pets/guns/daycare
42
when is the second nerborn screen typically done
week 2
43
What are the intervals for well visits
3-4 days growth
week 2 growth and development (GD)
1 mo, 2 mo, 4 mo, 6 mo, 9 mo, 12 mo (GD)
44
When is the Hb lab usually included in well visit
9 months
45
how much weight does an infant gain in first year of age
triple birth weight
46
What are the factors of the growth chart
weight for age, length for age, head circumference for age, weight for length
47
What are the components used for assessment of developmental milestones
physical(gross motor and fine motor)
language.cognitive
personal/social
48
Describe neurological development of newborn
centrally to peripherally
| head control trunk control arms. legs then hands then fingers
49
describe language progess of infant
2 months- cooing
6 months- babbling
1 year - 1-3 words
50
what are the cognitive skills for a infant
learn cause and effect, object permanence and use of tools
| by 9 mo should recognize strangers, seek comofrot from parent in exam and manipulate objects
51
What are the personal/social milestones for infant
understanding self and family
social tasks like bonding and attachment to caregivers
temperment which can vary, can adapt to new environment and stimuli
predictability in schedules
52
When can physician do entire exam on a table
up to 9 mo, infant is in diaper
53
What is they exam guidline for infant 9 mo and older
on parent lap because stranger anxiety occurs
54
What is the general sequence for newborn exam
heart and lung first
| HEENT last
55
Until when must head circumference be measured in infant
up to 36 months
56
Describe respiratory infant exam
breathing pattern, skin color, signs of distress & use of accessory muscles
auscultate lung fields (ant/post)
57
Describe CV infant exam
compare brachial and femoral pulses b/l
palpate PMI
auscultate with bell&diaphragm
BP no measured until 3 yrs
58
Describe abdominal exam for infant
observe shape, contour, and presnce of hernias, auscultate bowel sounds in all 4 quadrants
percuss
palpate and note size of liver and spleen
59
What do you make sure not to miss on infant lung exam
chest asymmetry
| respiratory distress
60
What are examples of infant respiratory distress
nasal flaring, retractions, accessory muscle use
61
What do you make sure not to miss on infant CV exam
benign murmurs, PDS first 2-3 days of life, Still's murmur, pulmonary glow murmur
brachial/femoral pulses
62
What do make sure not to miss on infant GI exam
liver tip palpable 1-2 cm below costal margin
no spleen palpable
can feel kidneys
anal fissures
63
Describe GI exam in male infant
visual inspection, retract foreskin to see urethral meatus
confirm b/l descended testes
palpate for inguinal or femoral hernias
64
Describe GI exam in female infant
visual inspection of external genitalia
| palpate for inguinal or femoral hernias
65
Describe anal/rectal exam for infants
position, fissures, fistulas
66
describe neuro exam for infant
assess cranial nerves (grossly)
asses strength and muscle tone
attempt to elicit deep tendon reflexes
asses primitive reflexes in young infants
67
What are not to be missed in male and female infant GU exams
female: labial adhesions
male: urethral opening and circumcision
68
What is not to be missed in neuro exam for infants
primitive reflexes
69
What is the palmar grasp reflex and when is it tested for
finger in hand and press against palm-> should grasp finger
| ages birth to 4 months
70
Describe plantar grasp reflex and when it is tested for
touch sole at base of toes--> toes curl
| birth to 9 months
71
describe moro (startle reflex) and when it is tested for
hold supine support head, back and legs then abruptly lower 2 feet and see if arms abduct,extend, hands open and legs flex (+/- cry)
birth to 4 months
72
describe asymmetric tonic neck reflex and when it is tested for
supine, turn head to one side holding jaw over shoulder--> arm/leg on that side should extend and opposite arm and leg should flex
birth to 4 months
73
describe positive support reflex and when it is tested for
hold around trunk and lower till feet touch surface, hips, knees, ankles extend, partially bearing weight (sag after 20 seconds)
birth to 2-6 months
74
What is the rooting reflex and when is it tested for
stroke perioral skin at corner of mouth, mouth should open and turn head toward stimulated side
birth to 3-4 months
75
what is the trunk incurvation or galants reflex and when is it tested for
support prone position, stroke one side of back 1 cm from midline from shoulder to buttocks
spine should curve toward stimulated side
birth to 3 months
76
describe placing/stepping reflex and when is it tested for
hold upright, have one sole touch table
hip and knee of same foot will flex adn the other foot will step forward
birth (day 4) and varies when disappears
77
Describe Landau reflex and when it is tested for
suspended prone-> head lifts up and spine will straighten
| birth to 6 months
78
describe parachute reflex and when it is tested for
suspend prone and slowly lower head toward surface
arms and legs extend in protective fashion
4 and 6 months, does not disappear
79
Describe MSK exam for infant
observe symmetry of extremities/length, deformities, digits
palpate spine for scoliocis, spina bifida occulta
palpate feet for curvature/rotation deformities (un utero)
80
What are the common foot deformities in infants
metatarsus varus and clubfoot
81
What is involved in hip examination of infant
Barlow and Ortolani maneuvers to test for signs of dislocation
effective until 3 months after hip capsuel begins to tighten
82
What signs do you look for in hip exam after hip capsule tightened
Galeazzi
83
What does the Ortolani test for? how is it done
presence of posteriorly dislocated hip
| hold legs in supine then twist knee on one side laterally so hip joint rotates externally
84
What does the Barlow test test for and how is it done
tests for ability to sublux or dislocate intact but unstable hip
internally rotate knee and cause internal rotation of hip joint
85
What tests must you do on an infnat hip exam
ortolani/barlow
| galeazzi
86
When inspecting the head of infant what is not to be missed
```
anterior fontanelle( close later)
posterior fontanelle (close early)
should be flat and soft in consistency
```
87
What must not be missed in eye exam of infant
red reflex, reflection of light on retina, generally red in color, should by symmetrical reflection
88
what does an abnormal red reflex indicate in infant
cataracts, galucoma, retinoblastoma, or other abnormalities of eyes
89
What is not to be missed in oral exam of infant
palate, teeth, mucuc-cysts (epstein pearls), tongue abnormalities like tongue tied or tonsils
90
What is not to be missed in neck palpation of infant
cervical lymph node abnormalities
91
What is not to be missed in ear exam of infant
pits/tags
| TM using insufflator if possible ear infection
92
What do you check for in ROM of neck in infants
Torticollis
93
What is not to be missed in infant exam of skin
```
benign rashes
mongolian spots
nevi
hemangiomas
sacral dimple or hair tufts
```
94
What immunization within 6 years is given in hospital
hepatitis B
95
What immunzations are given up to 6 yrs old in office
```
hep B, rotavirus, diptheria, tetanus, acellular pertussis (DTaP)
haemophilus influenza type B
pneumococcal
inactivated poliovirus
influenza
measles, mumps, rubella, varicella, hepA
```
96
What are the physical and motor developments in a toddler
rate of growth slows after infancy to approximately half
after 2 yrs gain 2-3 Kg& 5 cm per year
walk, jump hop and skip
can draw lines and make circles
97
Describe cognitive developments in toddlers
sensorimotor learning-touching and looking
simple problem solving(imitative play)
2-3 words to sentences, by 4 yrs should be 100% understandable
98
What are the social and emotional developments seen in toddlers
imitate activities to imaginative play
drive for independence
temper tantrums common
99
What are general considerations for toddler eam
```
down to diaper
on parent lap
use toys to distract
can touch equipment
use instrument on parent or toy first
flexible sequence of exam
```
100
What area should be examined last in toddler
the area of complaint
101
In addition to growth chart what other standard of measurement is now used for toddler
BMI
102
What are the physical motor developments for a child 5-10 yr old
growth steady and slow
| strength and coordination imrpove
103
What are the cognitive and language developments ina child 5-10 yrs old
concrete operational limited logic and more complex learning
| self efficacy
104
what are the social and emotional developments in a child 5-10 yrs old
progressivley more independent, development of selft esteem-family and environment contribute greatly
evolving self identity
105
What other items do you begin to discuss with a child 5-10 yrs old
school issues
body changes
asthma symptoms, speech development etc
106
What are general considerations for a PE on child 5-10 yrs old
```
dressed in clothes
examine on table
describe what you are doing (yr4-10)
resepct modesty
flexible on sequence exam
plot Ht Weight and calculate BMI
```
107
What changes in CV exam now in a child 5-10 yrs old
compate RADIAL and femoral pusles b/l
palpate PMI
auscultate with bell & diaphragm
measure BP in both arms in children >3 yrs
108
What is a Still's murmur
Grade II/IV, musical, vibratory midsystolic
109
What is a venous hum
soft continuous, louder in diastole
110
what is a carotid bruit
midsystolic, louder on left, eliminated by carotid compression
111
What is added in male GU exam for ages 5-10
palpate for inguinal or femoral hernias
112
What changes in MSK exam for children 5- 10 yrs old
observe walking and standing barefoot
| Galeazzie test/sign
113
What is genu carum
blowlegged
114
When is intoeing seen and when does it disappear
may increase up to 4 yrs then disappear by 10 yrs old
115
What is different on HEENT exam for child 5-10 yrs old
```
add palpation of all head lymph nodes
palpate thyroid
visual tracking
visual acuity-- formal test
speculum to asses nose mucosa
```
116
What must be done in ear inspection if suspect otitis media
pneumatic otoscopy
117
When do permanent teeth begin
age 6
118
When do you being the hearing test for ears
ages 3-4
119
What age group is early adolescence
10-14
120
When does physical puberty begin for males? females?
males 9-13.5 yrs
| females 8-13 yrs
121
What is the cogniitive development in early adolescence
concrete operational
122
what is the social development for early adolescence
focus is on present
identity if normal, peer influence
independence- ambivalence
123
What ages are middle adolescence
15-16
124
What are the cognitive developments in middle adolescence
transitional (many ideas)
| develop insight, reflect on feeling, though of others
125
what are the social developments of middle adolescence
identity- who am I,
| independence, limit testings, experimental behaviors, dating
126
What ages are late adolescence
17-20 yrs old
127
What are the cognitive developments for late adolescence
formal operational
128
what are the social developments for late adolscence
identity role with respect to others
sexuality, future
independence-separation from family
129
What are general considerations for PE for late adolescence
```
patient gowned, on table, respect privacy, give pt option for parent to leave room
have chaperone for breast and GU exam
describe what you are diong
ask patient to describe pain etc.
plot Ht weight and BMI
```
130
On BMI what percentile is underweight
below 5th
131
What percentile of BMI is at risk of overweight and overweight
at risk is 85th percentile
| overweight is > or equal to 95th percentile
132
What is adrenarche and when does it occur
activation of adrenal medulla for production of androgens
| occurs before onset of puberty
133
What is gonadarche, differences in male vs female?
earliest gonadal changes of puberty (GnRH released) males the LH stimulates testosterone and FSH stimulates sperm maturation
females FSH stimulates estrogen and follicle formation and LH stimulates corpus luteum after ovulation
134
When does thelarch being
beginning of breast development at puberty
135
What is pubarche
beginning of pubic hair
136
What is menarche
occurence of first menstrual bleeding
137
What are the 5 stages of tanner development for breasts
1- preadolescent (elvation of nipple
2- evelation breast/nipple
3- enlargement of breast and areola, no separation of contour
4- projection areola/nipple to form secondary mound
5- mature stage, projection of nipple only
138
What are the order of changes for female puberty
breast buds
pubic hair
growth spurt (peaks age 12)
menarche
usually takes about 4 years
139
What are the tanner stages for men
1- preadolexcent, no pubic hair, penis and testes same size as childhood
2- pubic hair sparse, pigmented, penis is slightly larger, testes and scrotum are larger and lsightly reddened
3- pubic hair darker, penis larger, testes and scrotum larger
4- pubic hair coarse curly, not on thighs, penis larger in length and diameter, testes and scrotum larger and scrotal skin darker
5- pubic hair spread to medial thighs
penis is adult size and same with testes and scrotum
140
What are the order of changes for male puberty
```
testicular growth, pubic hair, penile enlargement
growth spurt (peaks age 14)
```
takes average 3 years
