Peds Flashcards
(122 cards)
1
Q
How long is a neonatal period
A
1-28 days
2
Q
how long is infancy
A
29 days to 1 year
3
Q
What does a newborns skin feel like?
A
soft, smooth and thin
4
Q
for a newborn how will their skin change in the first 10 minutes after birth?
A
cyanosis -> pink
5
Q
Define Acrocyanosis
A
blue cast to hands an feet when exposed to cold
6
Q
What are skin signs of congenital heart disease?
A
if acrocyanosis does not disappear after 8 hours or with warming.
if pt has central cyanosis (tongue, oral mucosa)
7
Q
What is the typical timeline for jaundice in a newborn?
A
appears 2-3 days after birth and peaks day 5, resolves about 1 week
Reason- the baby’s liver is not fully developed yet
8
Q
If see jaundice in <24hrs what do you suspect?
what if jaundice lasts >2-3 weeks?
A
<24 hrs suspect hemolytic disease
> 2-3 weeks suspect liver disease
9
Q
Describe erythema toxicum
A
appears 2-3 days after birth, red macules with central pinpoint vesicles scattered over body – disappears within a wk
COMMON (appears first few weeks and resolve few weeks later)
10
Q
Pustular melanosis
A
small vesiculopustules over brown base – may last several mos, more common in black infants
COMMON (appears first few weeks and resolve few weeks later)
11
Q
Milia
A
pinhead-sized smooth white raised area without erythema on nose, chin, forehead – due to retention of sebum in openings of sebaceous glands
COMMON (appears first few weeks and resolve few weeks later)
12
Q
How do you examine for jaundice in a baby?
A
stretch the skin apart and push to blanch the skin.
If not jaundice then have white blanching , if jaundice then have yellowish blanching
13
Q
How can you tx jaundice?
A
Phototherapy. Can determine if pt needs by using a calculator online
14
Q
How big is the anterior fontanelle and when does it close?
A
4-6cm at birth, closes in 4-26 mos
15
Q
How big is the posterior fontanelle and when does it close?
A
fontanelle 1-2cm at birth, closes in 2 mos.
16
Q
What does fullness or bulging of fontanelles indicate?
A
suspect ↑ intracranial pressure (e.g. due to CNS infection)
17
Q
What does depression of fontanelles indicate?
A
dehydration
18
Q
Up to what age should you still primarily depend on the parent to give a hx?
A
12 y.o
can begin to give hx around 4 but still need clarification from parent
19
Q
At what age can you begin to ask pt’s parent or caregiver to leave the room FOR A PORTION of the visit?
A
10-11 yo
20
Q
What maneuvers do you do first in the PE and last?
A
non disturbing first & ones that need cooperation (heart lungs neuro)
distressing/painful last (ear throat abd)
21
Q
When can you begin head to toe exams?
A
5 yo, but still painful areas last
22
Q
What is the overall goal of peds exam?
A
- Promoting health
- Detecting disease & abuse
- counsel to prevent injury or future health problems
23
Q
What is important info for your hx section?
A
- Prenatal hx (preg complications, infection, smoke, tobacco)
- birth hx (vag or C-section, premature etc)
- development hx so far
- preventitive care (vaccination)
24
Q
What does no eye contact between caregiver and child possibly indicate?
A
neglect
25
What is considered tachypnea in a peds pt older than 1 yo?
>40 breaths/minute
26
How can you take a childs pulse?
auscultation, or palpation of heart, brachial or radial pulse
27
What do you do if your peds pt is in sinus arrhythmia?
NOTHING. it is common in peds. go with insp and expiratory
28
How do you count peds respirations?
rise and fall of abd
29
What is considered respiratory effort in a peds pt?
- retractions (ribs, supraclavicular notch)
- contraction of SCM
- flaring of nostrils
- paradoxical breathing
- stridor
- tachypnea
30
When do you begin routine measurement of BP?
3 yo
31
How can you measure the appropriate size of BP cuff?
What happens if too big or too small?
width should be 2/3 of the pt's upper arm
BIG: underestimated BP
SMALL: artificial high BP
32
If BP is consistently >95th percentile what could the DDx be?
Kidney disease
(incl. renal artery ds)
Coarctation of the aorta
33
Where should you get your temp measurement in an infant or young child?
Rectal
or
axillary
34
How do you measure height for 24-36 mo?
lay on the table paper mark top of head and dorsiflex foot
35
How do you measure height when standing?
Heels, buttocks & shoulders against the wall
| Looking straight ahead (corner of eyes at level of auditory canal)
36
What is considered a fever?
100.4 F or greater
37
What age can you start collecting a BMI?
2 yo
38
Why do you measure the peds pt in lbs?
YOU DONT!
| measure in g or kg bc of med dosing!!!!
39
Up to what age do you measure the head circumference?
How do you measure it?
2 yo
-Measure the largest circumference with the tape snug
from Occipital protuberance to the supraorbital prominence
40
What is infancy growth pattern?
- Growth of trunk predominates
| - Fat increases until 9 months of age
41
What is childhood growth pattern?
- Legs are fastest growing body part
- Weight is gained at a steady rate
- Fat increases slowly until 7 yrs of age when a prepubertal fat spurt occurs before the true growth spurt
42
What is adolescence growth pattern?
Trunk and legs elongate
About 50% of the ideal weight is gained
Skeletal mass and organ systems double in size
43
What does a single line that runs across the palm of the hand indicate?
possible abnormal medical conditions: Down syndrome, fetal alcohol syndrome
44
Allergic rash can be from...
contact dermatitis, meds, supplements, food sensitivity
45
young children get eczema on ...
| and the older they get it goes to...
face, extensors (elbow, knees)
hands, neck, flexor surfaces
46
How do you check dehydration or malnutrition on a child?
check turgor on abd skin that is tented which indicates dehydration& malnutrition
47
What are you inspecting on a head and face exam?
```
Spacing of features (abn. facies)
Symmetry
Skin color (cyanotic, pale)
Sunken eyes (Dehydration, severe illness, malnutrition)
Fontanelles
```
48
What are findings for fetal alcohol syndrome?
```
Smooth philtrum
Widespread eyes (Inner epicanthal folds, Mild ptosis)
Hirsute forehead
Short nose/up turned nose
Thin upper lip
railroad track ears
```
49
Lymphadenopathy in peds is...
common and benign or due to viral or bacterial infection
50
What are shotty lymphnodes?
Small, palpable mobile lymph nodes that represent benign change
– usu. response to viral illness
51
When are postauricular & occipital lymphadenopathy common?
under the age of 2 yo
52
When are cervicle and submandibilar lymphadenopathy common?
over the age of 2
53
When is supraclavicular lymphadenopathy normal?
NEVER
54
describe benign lymphnodes
< 2cm
Firm / soft, freely mobile
Tender
Resolve in 4-6 weeks
55
How do you check an infants visual acuity?
observe infants preference for looking at certain objects AKA TRACKING
56
How do you check a young childs visual acuity?
observe and play with toys, stacking, building, placing inside one another.
If performed well then vision is most likely intact
57
What age can you start using Sellens Chart?
Usually use around age 3 & recommended at 5,6, 8, 10, 12
58
What does redness, hemorrhage, discharge, granular appearance indicate?
Infection, allergy, or trauma
59
What does opacity of the lens mean when looking at the red reflex?
Congenital cataracts
60
What does a white reflex indicate?
Retinoblastoma (< 2 y/o)
61
Audiometry screening for hearing loss is done at schools for ages....
5,6,8 &10
62
What are low or poorly shaped auricles associated with?
renal disorders & congenital abnormalities
63
What is mastoiditis, how does it occur and how is it resolved?
infection that extends to the air cells of the skulls behind the ear
usu. results from untreated otitis media
Requires IV Abx treatment
64
Red tympanic membrane can give a false positive because...
It can occur if the child is crying or has recently cried vigorously… dilation of blood vessels in the tympanic membrane can cause redness
65
How can you differentiate red TM from crying or infection?
crying= red and moveable
| infection red and NOT moveable
66
These signs and sxs are for: History of moist environment
Itching in the ear canal
Intense pain with movement of pinna; chewing
Discharge may be watery at first, then purulent & thick mixed with pus & epithelial cells
Musty, foul-smelling
Conductive hearing loss (exudate and swelling)
Canal is red, edematous; tympanic membrane obscure
Infection of auditory canal (otitis externa)
67
What is the most common infection in childhood?
otitis media
68
Otitis media often accompanies or is followed by...
URI
69
Why are children more susceptible for otitis media than adults?
- The eustachian tubes are shorter, more horizontal, & straighter, making it easier for bacteria to enter
- The tube is floppier, with a tinier opening that's easy to block
- Young children get more colds because it takes time for the immune system to be able to recognize and ward off cold viruses
70
Fever, feeling of blockage, tugging earlobe, anorexia, irritability, dizziness, vomiting & diarrhea
Deep-seated earache
Discharge if tympanic membrane ruptures or through tympanostomy tubes; foul-smelling
Conductive hearing loss (fills with pus)
Tympanic membrane may be red, thickened, bulging; full, limited, or no movement
These signs and sxs are associated with?
Otitis media
71
What can cause effusion in the ear?
allergies
| obstructed or dysfunctional Eustachian tube
72
-Sticking or cracking sound on yawning or swallowing
-no signs of acute infection
-Pain is uncommon; feeling of fullness
-Discharge is uncommon
-Conductive hearing loss as middle ear fills with fluid
If chronic, may delay speech development temporarily – common reason for “tubes”
-Tympanic membrane is retracted, yellowish, air fluid level/or bubbles, dull; impaired mobility
These sxs are associated with..?
Otitis media with effusion
73
What does a saddle-shaped nose with a low bridge and broad base associated with?
congenital abnormalities
74
What is allergic salute?
Transverse crease at the juncture between the cartilage and the bone of the nose
occurs with repeated wiping of nose with hand
75
What do you do if a child refuses to open their mouth when you need to check their throat?
1. Insert a tongue blade through the lips to the back molars
2. Gently but firmly insert the tongue blade between the back molars
3.press the blade to the tongue
(This should stimulate the gag reflex)
Gives you a brief view of the mouth and oropharynx
76
At what age can misalignment of teeth from thumb sucking be reversed?
by 6 or 7 yo
77
Strawberry tongue is associated with...
Scarlet fever
78
How can you tell the difference between milk deposits or candidiasis (thrush)
scrape the tongue blade over area.
If non-adherent- milk deposit
if adherent- thrush
79
What are the grades to describe tonsils and what does each grade mean?
1+ Visible
2+ Halfway between tonsillar pillars & the uvula
3+ Nearly touching the uvula
4+ Touching each other
80
What is tonsillitis (inflammation or infection of the tonsils) usually caused by?
Streptococci
81
What are sxs of tonsillitis?
Sore throat, referred pain to the ears, dysphagia, fever, fetid breath, and malaise
Tonsils appear red and swollen; purulent exudate
82
What specific sxs are associated with Strep throat?
-Yellow or white exudates
Need throat culture to confirm Strep. – may see identical clinical picture with viral infection
-Anterior cervical lymph nodes enlarged
83
What is infectious mononucleosis caused by?
Epstein-Barr Virus
84
What are sxs of mono?
Pharyngitis, fever, fatigue, malaise
| Looks like Strep.
85
What are the exam findings for mono?
Enlarged anterior and posterior cervical chains
| Splenomegaly, hepatomegaly, and/or a rash may be noted
86
What are the sxs for epiglottitis?
```
Sudden high fever
Drooling
Croupy cough
Sore throat
Apprehension & focus on breathing
Tripod position, neck extended
```
87
Do you use a tongue blade to examine epiglottis?
HELL NAHHHH youll cause respiratory distress and obstruct the airway
88
Why is it easy to miss the dullness of underlying consolidation (percussion)
because peds pt's are COMMONLY hyperresonant because their chest wall is thinner
89
What are influenza sxs?
```
Cough
Fever
Malaise
Headache
Mild sore throat
Coryza (cold symptoms incl. runny nose)
```
90
These exam findings indicate....
```
Tachypnea
Shallow breathing
Flaring of nostrils
Occasional cyanosis
Limited movement; splinting
Increased fremitus (consolidation)
Dullness (consolidation)
Variety of crackles
Occasional rhochi
Bronchial breath sounds
+ Egophony, bronchophony, whispered pectoriloquy
```
PNA
91
these exam findings indicate....
```
Occasional tachypnea
Occasional shallow breathing
Often no deviation from expected findings
Tactile fremitus undiminished
Resonance
Breath sounds may be prolonged
Occasional crackles
Occasional expiratory wheezes
```
Bronchitis
92
These exam findings indicate...
```
Tachypnea
Dyspnea
Tachycardia
Diminished fremitus
Hyper-resonance
Limited diaphragmatic descent; lower diaphragmatic level
Prolonged expiration
Wheezes
Diminished lung sounds
```
asthma
93
Where do you find the apical impulse on a peds pt? why?
4th - 5th left intercostal space
| Apex of the heart is higher, heart lies more horizontal
94
What are the most common benign murmurs?
Still's murmurs
95
What does a Still's murmur sound like and how do you listen for it ?
Grade 1-2/6; musical, early-mid-systolic
Best heard mid or lower LSB with pt SUPINE (diminishes from supine->standing)
– may be heard in carotid arteries
-May be accentuated by fever, exercise
96
Venous hum is ...
Caused by turbulence of blood flow in the internal jugular vein
97
Is venous hum common in peds pts?
YAAASSSS
98
What does venous hum sound like and how can it be heard?
Continuous low-pitched sound
Louder during diastole
Best heard in supraclavicular space
99
During inspiration should the abd be soft or hard?
soft
100
If the abd is hard during inspiration and expiration what should you suspect?
peritoneal irritation
101
If see pulsation of the abd what does that mean?
nothing... it is nl in peds
102
If see distended veins of the abd what does that mean?
vascular obstruction, abdominal distension or abdominal obstruction
103
If see spider nevi of the abd what does that mean?
may indicate liver disease
104
What does a nl toddlers abd look like?
Abdomen protrudes slightly “pot-bellied”
105
What does a nl child above age 5 abd look like?
Abdomen may become concave when laying supine
106
up to what age are abd respirations seen
6-7 yo
107
Diastasis recti
what doe it look like ?
what do you do ?
```
Midline separation (1-4 cm) of the rectus abdominus
Between the xiphoid and umbilicusa
```
No need to repair in most cases
Usually resolves by 6 years of age
108
splenomegaly can indicate..
Infection (e.g. mono)
| Blood disorder
109
What is Wilms tumor?
nephroblastoma
110
What is the most commonintraabdominal tumor of childhood (2-3 years of age)
nephroblastoma
111
What does Wilms tumor feel or look like?
Firm, non-tender mass deep within the flank
Only slightly moveable
Does not usually cross midline; sometimes bilateral
112
Tympanic abd is more common in children than adults, why?
gas
113
what would a Sausage-shaped mass in left lower quadrant be?
Feces in the sigmoid colon
| Constipation
114
what would a Sausage-shaped mass in the left or right upper quadrant be?
-Intussusception
(Telescoping of one segment of intestine into another resulting in intestinal obstruction)
Most common abdominal emergency in children < 2 y/o
115
What is the cause of instussusception?
unknown
116
What are the signs and sxs for instussusception?
```
A bdominal “sausage”
B lood from the rectum
C olic: babies draw up their legs
D istention, dehydration, & shock
E mesis
F ace pale
```
117
What is this description associated with?
Traction issue resulting from repetitive quadriceps contraction through the patellar tendon at its insertion upon the skeletally immature tibial tubercle
Most common theory is that this traction issue leads to leads to multiple subacute fractures or tendon inflammation
Most common ages 9-14 who: participate in athletics & have recently undergone a rapid growth spurt
Osgood-Schlatter disease (osteochondritis of the tibial tubercle)
118
What are the sxs of Osgood-Schlatter disease ?
Knee pain with activity
Pain & swelling at tibial tubercle –
point of insertion of patellar tendon
Can be bilateral
119
What would be the PE findings for Osgood-Schlatter disease ?
Swelling/tenderness at proximal tibial tuberosity
Full ROM (may be painful)
Negative ant. drawer
Neurovascular exam is normal
120
How do you manage Osgood-Schlatter disease ?
ICE, rest, possible anti-inflammatory medication
121
What is the most common cause of sudden cardiac death in athletes
hypertrophic cardiomyopathy
122
What do providers counsel school aged kids about?
- healthy lifestyle (diet, exercise, tv time, sleep, hygiene)
- safety precautions for sports
- STD prevention
- other (alcohol, drugs etc)
