Peds Physical Exam

Question 1

principles of development?

Answer 1

1. predictable path
2. range of normal development is wide
3. various factors affect child development & health
4. development levels determines how you conduct the HPI/PE

Question 2

when to perform physical exams?

Answer 2

every few months until 4 yo, then annually through middle childhood & adolescence until adulthood

Question 3

newborn

Answer 3

0-28 days

Question 4

infant

Answer 4

0-12 months

Question 5

toddler/early childhood

Answer 5

1-4 yrs

Question 6

school-aged / middle childhood

Answer 6

5-10 years

Question 7

adolescence (11-20)

Answer 7

early, middle, late

Question 8

what is neonatal resuscitation?

Answer 8

warm, dry, suction

Question 9

APGAR

Answer 9

appearance (color)
pulse
grimace (reflex irritability)
activity (muscle tone)
respiratory (effort)
*you want 2s in all categories / assign at 1 min & 5 min

Question 10

what is given immediately after birth?

Answer 10

-erythromycin ointment in eyes
-Vit K to prevent bleeding
-full bath

Question 11

ballard scoring system

Answer 11

neuromuscular activity (square window, scarf sign) + physical maturity (skin, lanugo, plantar surface, ear recoil)

Question 12

neonatal intake

Answer 12

• q2-3 hours
• breastfeeding w/ some colostrum
• formula 15-30 ml
  *normal to lose 7-10% weight first few days of life

Question 13

neonatal output

Answer 13

-6-8 voids per day by day 4-5
-initial stools = meconium (should stool within first 24 hrs of life)
-breast fed = yellow, seedy
- formula = green-yellow

Question 14

physiologic jaundice

Answer 14

“normal”
-in 1/2 all newborns
-appears on 2nd & peaks on 5th day
-disappears within a week

Question 15

pathologic jaundice

Answer 15

*risk of kernicterus
any jaundice within first 24 hrs = pathologic
-breastfeeding jaundice
-ABO incompatibility/Rh
-cephalohematoma
-infection
-enzyme deficiencies

Question 16

hospital discharge after birth?

Answer 16

• 2 days after vaginal delivery
  -3 days after C section

Question 17

what needs to be done prior to discharge?

Answer 17

• Hep B immunization
  -hearing screen
  -1st newborn screening blood test
  -circumcision

Question 18

what is the expected weight gain?

Answer 18

1 ounce per day
-should be back to birthweight by 10-14 days

Question 19

common issues in early infancy?

Answer 19

-congestion
-constipation
-colic (fussy, crying, usually in evenings - use white noise, car rides / resolves by 3-4 months)

Question 20

infant developmental milestones?

Answer 20

• babbling @ 6 months, 1-3 words @ 1 yr
  -6 mos recognize strangers
  -9 mos stranger anxiety, object permanance

Question 21

infant developmental milestones?

Answer 21

• babbling @ 6 months, 1-3 words @ 1 yr
  -6 mos recognize strangers
  -9 mos stranger anxiety, object permanancet

Question 22

toddler milestones

Answer 22

-after 2 yrs gain 2-3 kg & 5 cm per year
-2 yr old = 2 word sentence
-3 yr old = 3 words sentences
-by 4 yrs speech is 100% understandable to all
-temper tantrums are common

Question 23

head injury in neonate

Answer 23

• caput succedaneum crosses suture lines
  -cephalohematoma does not

Question 24

plagiocephaly

Answer 24

positional deformity of skull

Question 25

craniosynostosis

Answer 25

early fusion of sutures

Question 26

fontanelle closure?

Answer 26

-anterior: larger and 18m-2 yr
-posterior: smaller & 1-2 mos

Question 27

infant seborrheic dermatitis

Answer 27

“cradle cap”
-scaling of scalp or eyebrows

Question 28

eyes exam

Answer 28

-cover/uncover test 9 mo-3 yo
-formally assess visual acuity starting at 3 yrs

Question 29

ear exam

Answer 29

-otitis externa
-otitis media (kids have wider, shorts tubes compared to adults which predisposes them to infection)

Question 30

mouth/throat exam

Answer 30

observe philtrum, vermillion border, tongue, cleft pallate
-usually 1 tooth for each month b/n 6-26 mos

Question 31

neck exam

Answer 31

thyromegaly, lymph nodes, torticollis

Question 32

CV exam

Answer 32

-brachial & femoral pulses b/l, PMI, murmurs
-BP not measured in kid under 3 yo

Question 33

neonate HR & RR

Answer 33

40-60 breaths
120-160 beats

Question 34

lung exam

Answer 34

-periodic breathing in infants
-apneic = <15-20 sec pause
-skin color, retractions, grunting, nasal flaring, ascultation

Question 35

abdominal exam

Answer 35

auscultate, percuss, palpate
-spleen should not be palpable

Question 36

GU exam

Answer 36

labial adhesions or discharge
descended testicles, hydroceles, urethra position
*do not forcible retract foreskin in uncircumcised infants
-rectal exam using pinky

Question 37

MSK exam

Answer 37

-obvious deformities, edema, muscle wasting, calluses, ROM, scoliosis
-* normal to have increased lumbar concavity & decreased thoracic convexity, protuberant abdomen, bowlegged/knock kneed

Question 38

hip exam

Answer 38

-ortolani test: for post dislocated hip that you attempt to reduce
-barlow test: ability to sublux or dislocate intact but unstable hip

Question 39

neuro exam

Answer 39

gross assessment unless concerned otherwise
-primitive reflexes
-gross CNs
-strength & muscle tone

Question 40

primitive reflexes

Answer 40

-palmar grasp: place finger in hand and they grasp finger (B-4 mo)
-moro (startle): hold supine support head, quickl lower feet & move arms (cry or not) (B-4 mo)
-rooting: stroke perioral skin, mouth opens & turns head toward side stimulated (B-4 mo)
-parachute: suspend prone & lower head to surface, extrems then extend (4 mo, doesn’t disappear)

Question 41

skin exam

Answer 41

-rashes = atopic dermatitis
-color = pink vs cyanotic
-lesions = mongolian spots, nevi, hemangiomas

Question 42

impetigo

Answer 42

honey crusted lesions, commonly from staph
-tx with abx cream

Question 43

ringworm

Answer 43

tinea infection
-elevated red rings with central depression

Question 44

school aged children

Answer 44

-consider bullies, school performance, special ed, behavioral issues
-puberty / body changes

Question 45

adolescent

Answer 45

-pt gowned & on table -give pt option of asking parent to leave room during HPI & most PE
-need chaperone for breast & GU exam

Question 46

early adolescent

Answer 46

10-14 yo
-puberty begins
-concrete operational cognition
-social identity is important

Question 47

middle adolescence

Answer 47

15-16 yo
-females more comfortable than males
-insight developed
-independence-limit testing, experimentation, dating

Question 48

late adolescence

Answer 48

17-20 yo
-adult appearance
-formal operational cognition
future oriented

Question 49

HEADSS approach for teens

Answer 49

H - how are things going at home?
E - how is school going?
A - do you or your friends drink etoh?
D - do you or your friend do drugs?
S - sexual activity
S - suicidal thoughts (depression screening)

Question 50

tanner stages of sexual maturity ratings (SMR)

Answer 50

-description of development of secondary sex characteristics

Question 51

Tanner Female

Answer 51

1. preadolescent, nipple elevation only, no pubic hair
2. elevation breast/nipple as small mound, sparse pubic hair growth
3. further enlargement, darker, coarse pubic hair
4. projection areola/nipple, coarse & curly pubic hair as in adults
5. projection of nipple only, hair adult in quantity & quality

Question 52

Tanner Male

Answer 52

1. preadolescent
2. sparse pubic hair, no penis enlargement, larger testes
3. darker pubic hair, longer penis, enlarged tests/scrotum
4. coarse & curly pubic hair, enlarged penis, further enlarged testes/scrotum
5. adult quant/quality of hair, adult penis & testes