week 3 content

Question 1

AAP periocity table of timing of well child visits

Answer 1

• 3-5 days of age (when home from hospital)
• 1 month
• 2,4,6,9,12,15,18,24, and 30 months
• annually beginning age 3

Question 2

start the visit: 3 things

Answer 2

• review VS and anthropometrics before you enter the room
• greet the family and patient
• ask about concerns

Question 3

first step of the data collection

Answer 3

history

Question 4

when does the head to toe PE start?

Answer 4

preschool

Question 5

interval history

Answer 5

allergies, ER visits, illnesses, injuries, hospitlaizations

Question 6

other components of the history

Answer 6

• medications
• nutritional history
• physical activity hisotry
• elimination
• safety
• sleep
• social history
• developmental history
• mental health assessment

Question 7

temp taking regulations

Answer 7

• no axillary temps (except for newborn)
• no typmanic temps less than 6 mo
• oral temp at age 4-5 years

Question 8

apicle pulse should be taken when

Answer 8

ages 6 years and younger

Question 9

bp should be taken when

Answer 9

ages 3 years and older

Question 10

length measured until when

Answer 10

2 years, then the height is started

when switching over, there can be a change in length becuase when they are laying down they can be “stretched” a bit

Question 11

head circ is measured when

Answer 11

3 years and younger

Question 12

BMI calculated at age

Answer 12

2 and older

Question 13

notes about wt measuring

Answer 13

• infant weighed naked, no diaper
• toddlers weighed in diaper only
• preschool and older weight with no shoes or jacket

Question 14

absent red reflex

Answer 14

indicative of a retinoblastoma

Question 15

weak or absent femoral pulses

Answer 15

coarc of the aorta

Question 16

undecended testes

Answer 16

need to have happened and if not, should be refered to urology by 6 mo of age

Question 17

hip click

Answer 17

look for it in every exam for the first whole YOL (ortolani and barlow)

Question 18

strabismus

Answer 18

• intermittment si normal for first 4 mo
• finding can be cover uncover test OR unequal light reflexes
• if not fixed, what can happen: amblyopia

Question 19

umbilical hernia

Answer 19

can resolve on own

Question 20

scoliosis

Answer 20

assessed via forward bending beginning at age 9-10 for girls and 11-12 for boys. refer if >25 degrees

Question 21

aap recommendations for PPD screening

Answer 21

1,2,4,6 mo visits
use Edinburg of PHQ9
if depression is found, sent to therapy, provider or ER if self harm is evident

Question 22

CCHD screening

Answer 22

pulse ox on R arm, and R or L lower extremity
pass : difference between them is less than 3% and both are between 95-100%

Question 23

school hearing tests ages

Answer 23

4,5,6,8,10 and then 1 time between ages 11-14, and another time between 15 and 17

Question 24

iron deficincy

Answer 24

• risk assessment: 4 mo
• preemie: higher risk for iron deficiency
• risk assessment measure H and H at 12,15,18,24, and 30 mo

Question 25

dental screening and oral health

Answer 25

- 6 months: screening starts - 1 year: refer to dental home - first semi-annual cleaning starts at 3 years

Question 26

latent TB

Answer 26

1,6,12 and 24 mo risk assessment

Question 27

reasons to check blood pressure before age 3

Answer 27

- SGA - birth weight <1500g - born at < 32 weeks - neonatal complications that require intensive care or umbilical artery catheterization -CHD

Question 28

screening for dyslipidemia

Answer 28

kids with risk factors: begins after the age of two kids without risk factors: screen 2x during childhood, once between age 9-11, one between 17-21

Question 29

screening for alcohol, nicotine and substance abuse starts when

Answer 29

age 11. start the conversation of dangers at age 9

Question 30

depression screen

Answer 30

annual 12-21

Question 31

girls reach full height when?

Answer 31

1-2 years after menarche

Question 32

first female sign of puberty, then what follows?

Answer 32

breast development or thelarchy, 6 months later then there is pubic hair

Question 33

average age of menarche

Answer 33

12.5 years (usually 1.5-2.5 years after breast bud development, takes 18-24 mo to establish reg. cycles

Question 34

primary amenorrhea

Answer 34

- no menarche by 16 years - no breast buds by 14 years

Question 35

earlist puberty change for males is? what happens 6 months later?

Answer 35

growth of the testes, grow pubic hair (adrenarche), then elongation/widening of the penis.

Question 36

which teste hangs lower

Answer 36

L

Question 37

3 causes of death in adolecents

Answer 37

1) unintentional injuries (MVA) 2) suicide (last 15 years) 3) homicide

Question 38

situations to breech confidentiality

Answer 38

danger to self danger to others child abuse resportable STI's gunshot/knife wound billing 3rd party payers

Question 39

sensitive questions to ask with parents out of the room

Answer 39

BI-HEADSS Bi- body image do you ever feel bad about your weight? does anyone else make you feel bad about your weight? H-home situation Do you feel safe at home? E-education/employment do you have a job? how are things going at school? A- activities are you in sports? D- dating/drugs have you ever tried any frugs? marijuana? pills? have you tried alcohol? S-sexuality do you have a girlfriend/boyfriend or both? are you sexually active? what types of sexual acitvity are you engaed in? do you use protection? have you ever been made to do seomthing you are uncomfortable with doing? S- suicide

Question 40

testing/screening for STI's

Answer 40

sexually active: screen annually for chlamidia and gonorrea HIV: once between ages 15-18 per periocidity table

Question 41

difference between PE and WCC

Answer 41

- does not replace a WCC

Question 42

stats on sports physical

Answer 42

65-75% detection rate of conditions

Question 43

history that is connected to CHD

Answer 43

- alcohol exposure in utero - fam h/o - maternal diabetes - h/o rhumatic fever or Kawasaki -genetic

Question 43

timing of sports physical

Answer 43

4-6 weeks before the season starts

Question 45

s1 sound

Answer 45

closure of the mitral and tricuspud valve inaudible: VSD< atrioventricular valve regurgitation, PDA, and occasionally Pulm valve stensosis

Question 46

pathological murmurs

Answer 46

higher than a grade 3- when a thrill is present

Question 47

venous hum

Answer 47

not pathalogical- no referral

Question 48

functional murmur identifier

Answer 48

stills murmur decreases in intensity when the child stands up

Question 49

what are we worried about when the murmur increases when the patient stands up?

Answer 49

hypertrophic cardiomyopathy- associated with sudden death in athletes

Question 50

thrills are felt with what

Answer 50

blood flow from high to low pressure

Question 51

innocent murmur VS ASD

Answer 51

- precordial activity is increased in ASD - S2 splits and moves with respiration in an innocent murmur wharas it is "fixed" and non effected by inspiration in an ASD - patient stands up- innocent increases in intensity, ASD does not