peds: assessment (slides 1-50)

Question 1

4 categories of growth (that differ for each age group)

Answer 1

physical, cognitive, emotional and social growth

Question 2

at what age do we generally start to screen BP and BMI

Answer 2

BP after age 3
BMI after age 2
*but BP At least once during infancy – digital doppler method is easiest

Question 3

The best way to conceptualize a single health supervision visit (well visit) is not as one visit but as a visit of multiple encounters encompassing what 4 objectives?

Answer 3

disease detection
disease prevention
health promotion
anticipatory guidance

Question 4

what two phases is infancy divided into?

Answer 4

Neonatal period- first 28 days

Postnatal period- 29 days to 1 year

Question 5

baby: when is the first exam? what is the comprehensive exam?

Answer 5

First exam is at delivery

Comprehensive exam within 24 hours

Question 6

when do kids start having yearly visit?

Answer 6

3yr- middle school

Question 7

when are the doc visits in early childhood?

Answer 7

Early childhood- 12 mth, 15mth, 18 mth, 24 mth, 30 mth, 3 yr, 4yr

Question 8

when are the doc visits in infancy

Answer 8

Infancy- 3-5 days, 1month, 2 mth, 4 mth, 6 mth, 9 mth

Question 9

when is apgar score done? what is included?

Answer 9

1 min and 5 min
Heart rate, respiratory rate, muscle tone, reflex irritability, color
(appearance, pulse, grimace, activity, respiration)

Question 10

what is the scale of apgar score and what does each score mean? (1 min)

Answer 10

8-10 - normal
5-7- some nervous system depression
0-4 - severe depression, immediate resuscitation

Question 11

score of 0-7 on apgar at 5 min means what?

Answer 11

0-7 – high risk for subsequent central nervous system and other organ system dysfunction

Question 12

a baby with a low apgar may need what two things?

Answer 12

Oxygen and clearing out the airway to help with breathing

Physical stimulation to get the heart beating at a healthy rate

Question 13

is apgar meant to predict the future health of the child?

Answer 13

no

Question 14

how off can the ballard score be?

Answer 14

accuracy may be off by 2 weeks

Question 15

what is the ballard score ?

Answer 15

estimate gestational age based on baby height, weight + muscle tone

Question 16

newborn complex behavior: habituation

Answer 16

ability to selectively and progressively shut out negative stimuli

Question 17

newborn complex behavior: attachment

Answer 17

A reciprocal, dynamic process of interacting and bonding with the caregiver

Question 18

newborn complex behavior: state regulation

Answer 18

ability to modulate the level of arousal in response to different degree of stimulation

Question 19

newborn complex behavior: perception

Answer 19

ability to regard faces, turn to voices, quiet in presence of singing, track colorful objects, respond to touch, and recognize familiar scents

Question 20

what ages are early and middle childhood?

Answer 20

Early childhood 1-4 years

Middle childhood 5-10 years

Question 21

late childhood/adolescence is divided into what 3 phases

Answer 21

Early- 10-14 year olds
Middle 15-16 year olds
Late 17 to 20 year olds

Question 22

By 1 year child should _____ birth weight and increase height by ____

Answer 22

triple , 50%

Question 23

Neurologic development progresses from ______ to ________

Answer 23

central, peripheral

Question 24

what are the 3 key stages of language development and what are the 3 ages?

Answer 24

cooing at 2 months
babbling at 6 months
one to three words at 1 year

Question 25

what are the international growth charts for children 0-2 yo

Answer 25

WHO

Question 26

pulse at birth and by 12 months

Answer 26

birth - 140 | 12 months- 115

Question 27

what can the RR be for infant?

Answer 27

< 2 months anything over 60/min 2-12 months anything over 50/min *observe at least 60sec *most reliable when sleeping

Question 28

fever can raise RR in infants up to __ respirations per minute for _____ degree centigrade of fever.

Answer 28

10, EACH

Question 29

high RR + fever in infant?

Answer 29

Get the fever down THEN check RR again. - switch tylenol and Motrin so they get something every 2-3 hrs

Question 30

at what ages do you do rectal temp?

Answer 30

0-2 mo

Question 31

what is acrocyanosis?

Answer 31

blue hands/ feet

Question 32

what is central cyanosis a sign of? where do you look for it?

Answer 32

(sign of congenital heart disease) at tongue and oral mucosa

Question 33

what is lanugo?

Answer 33

fine, downy hair over entire body concentrated more at shoulders and back ( Sheds first few wks)

Question 34

what is miliaria rubra?

Answer 34

scattered vesicles on reallyy red base - face and trunk | - from obstruction of sweat glands

Question 35

what is erythema toxicum?

Answer 35

rash- red macules, w/ central pinpoint vesicles scattered all over body (looks like flea bites)

Question 36

what is pustular melanosis?

Answer 36

more in black infants- small vesicles on brown base

Question 37

what is milia?

Answer 37

pinhead white raised bumps - seen on nose + around. | -in sebaceous glands

Question 38

what is normal "physiologic" jaundice? how do you test it?

Answer 38

2nd or 3rd day, peaks about 5th day, usually gone within a wk - yellowish blanching = jaundice

Question 39

when do the anterior + posterior fontanelles close?

Answer 39

Anterior fontanelle – closes between 4 and 
26 months of age | Posterior fontanelle – closes by 2 months 
of age

Question 40

eyes may be ____ for the first few weeks of life

Answer 40

fixed

Question 41

babies have swelling where from birthing process?

Answer 41

eyes

Question 42

Babies can get intermittent strabismus but should be gone by ___ months

Answer 42

3

Question 43

how do you check visual acuity in newborn?

Answer 43

use visual reflexes to assess vision | - pupil constriction, optic blink reflex, blinking with movement of object toward eye.

Question 44

looking in the eye, red =? black =? white =?

Answer 44

red- normal black- cataract white- retinoblastoma

Question 45

ears: ______ _______ _______ for several months before becomes cone-shaped

Answer 45

Diffuse light reflex

Question 46

how can you look at TM? why might you not be able to see TM in infant?

Answer 46

pull pinna down to look- might be full of “stuff” (vernix caseosa)

Question 47

Palpate _______ _______ _____ after birth to ensure it is intact

Answer 47

upper hard palate

Question 48

how do teeth come in? (with what frequency? what location comes up first? )

Answer 48

1 tooth per month for 6-26 months of age, 
Central and lateral incisors erupt first, molars last

Question 49

if birth extraction was difficult, what should you be sure to check?

Answer 49

crepitus of clavicles (maybe fracture)

Question 50

what part of thorax exam is not helpful to do in infants? why?

Answer 50

percussion: not helpful in infants; hyperresonant* NOTE: thorax is more rounded in infants than in older children and adults

Question 51

what do you palpate thorax for?

Answer 51

tactile fremitus (if making noise/crying)

Question 52

lung sounds upper vs lower airway?

Answer 52

Upper airway: loud, symmetric transmission throughout the chest, loudest as stethoscope is moved upward; coarse during inspiratory phase Lower airway: loudest over site of pathology; asymmetric; often occur during expiration

Question 53

how is auscultation of lungs different for infants than kids/adults?

Answer 53

sounds are louder and harsher generally

Question 54

respiratory problems: what two aspects do we check for infant breathing?

Answer 54

audible breath sounds + work of breathing

Question 55

audible breath sounds that indicates resp. problem (4)

Answer 55

Grunting Wheezing Stridor Obstruction (often right lung)

Question 56

work of breathing that indicates resp. problems (3)

Answer 56

Nasal flaring Grunting Retractions- supraclavicular, intercostal, subcostal

Question 57

what is sinus dysrhythmia? is this normal?

Answer 57

normal in infant - Inc. rate on inspiration and dec. on expiration

Question 58

PMI in infants

Answer 58

located 1 interspace higher than in adults

Question 59

checking pulses in infant- check all 4 extremities for what?

Answer 59

coarctation of aorta

Question 60

central cyanosis is what color?

Answer 60

Raspberry red (desat) vs. strawberry pink (normal)

Question 61

why might breasts be slightly enlarged in newborn?

Answer 61

from estrogen of mother

Question 62

when should umbilical cord fall off by?

Answer 62

2 wks