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D2 E1 Shea > Well Child 1 > Flashcards

Well Child 1 Flashcards

1
Q

What are the 5 types of developmental milestones?

A
  • Physical (maturation, growth, puberty)
  • Motor (gross & fine motor skills)
  • Cognitive (achievement of milestones, language, school performance)
  • Emotional (self efficacy, self esteem, independence, morality)
  • Social (social competence, self responsibility, integration w/ family & community)
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2
Q

AAP recommends well visits at what ages? (10)

A
  • birth
  • 1 month
  • 2 months
  • 4 months
  • 6 months
  • 9 months
  • 12 months
  • 15 months
  • 18 months
  • 2 years
  • Then annually –> adolescence
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3
Q

Newborn & Pediatric Growth Curves

  • Compares what 4 measurements to the population?
  • Measured in percentiles %%%
  • BMI is used starting at approximately what age?
A
  • height, weight, head circ., BMI
  • 2 yrs
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4
Q

Newborn & Pediatric Growth Curves

  • Head circumference is tracked until about __ - ___ y/o
  • Head circumference is important to assess for what?
A
  • 2 - 3 yrs
  • Brain growth
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5
Q

Growth charts vary based on what?

A

Gestational age

  • premature infants
  • syndromes (Down syndrome, fragile X)
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6
Q

Give the %

  • Overweight
  • Obesity
  • Underweight
A
  • Overweight: 85-95%
  • Obesity: >95%
  • Underweight: <5%
    *
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7
Q

Give the %

  • Microcephaly
  • Macrocephaly
A
  • Micro: <3%
  • Macro: >97%
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8
Q

How many weeks?

  • Preterm
  • Term
  • Post-term
A
  • Pre: <37 weeks
  • Term: 37-42 weeks
  • Post: >42 weeks
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9
Q

Classification of Birth Weight (g)

  • Extremely low BW: ___ g
  • Very low BW: ___ g
  • Low BW: ____ g
  • Normal BW: ___ g
A
  • Extreme L: <1000 g
  • Very L: <1500 g
  • Low: <2500 g
  • Normal: >2500 g
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10
Q

Give the %

  • Small for gestational age (SGA)
  • Appropriate for gestational age (AGA)
  • Large for gestational age (LGA)
A
  • SGA: <10%
  • AGA: 10-90%
  • Large: >90%
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11
Q

Give the ages

  • Infancy
  • Neonatal period
  • Postneonatal period
A
  • Infancy: 1st yr of life
  • Neonatal: 1 - 28 days
  • Postneonatal: 29 days - 1 year
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12
Q

What is the key assessment of the newborn immediately after birth?

A

Apgar

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13
Q
  • The apgar is scored how long after birth?
  • What do the scores range from?
  • Scoring may continue at __ minute intervals until the score is what?
A
  • 1 and 5 minutes after birth
  • Range: 0 - 10
  • 5 min intervals until >7
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14
Q

Describe the population wide testing for metabolic & genetic diseases

A

Blood sample from heel stick:

  • before discharge
  • again at 7-14 days

(varies from state to state)

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15
Q

General PE

  • T/F: mild cyanosis can be normal at birth
  • Peripheral cyanosis (finger tips) can be normal for how many days?
  • Jaundice- can be difficult based on what?
A
  • True, but baby should pink soon thereafter
  • Peripheral: 1 - 2 days
  • Baby’s race
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16
Q

Terminology?

  • Cheesy white covering
  • Decreases as term approaches
  • Made from fetal corneocytes / sebaceous gland activity
  • “rich lipid matrix”
A

Vernix Caseosa

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17
Q

Condition?

  • Pinpoint white papules w/o surrounding erythema
  • Caused by what?
  • Commonly on noase, chin, forehead, cheeks
  • Usually appears within the first few weeks & disappears over several weeks
A

Milia

  • blocked sebaceous glands
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18
Q

Condition?

  • aka congenital dermal melanocytes
  • blue patches of pigment
  • commonly seen over lumbar area, buttocks, extremities
  • generally fade w/ time
  • Common which 5 races?
A

Mongolian Spots

  • Asian
  • Native American
  • Hispanic
  • East Indian
  • African Americans
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19
Q

Diagnosis?

A

Mongolian Spots

  • aka: “congenital dermal melanocytes”
  • blue patches
  • fade over time
  • Asian, Native American, Hispanic, East Indian, African descent
20
Q

Condition?

  • yellow eosinophillic papules on red base
  • may appear on 2nd to 4th day of life
  • mostly seen on trunk
  • unknown etiology but thought to be due to what?
  • typically disappear w/in 1 week of birth
A

Erythema Toxicum

  • due to: the immaturity of the pilosebaceous follicles
21
Q

Diagnosis?

A

Erythema Toxicum

  • yellow eosinophilic papules on red base
  • 2nd - 4th day of life
  • trunk
  • d/t immaturity of pilosebaceous follicles
  • disappear within 1 w of birth
22
Q

Sutures

  • Name the 4 sutures
  • Birth process can result in what?
  • What is a sign of elevated ICP (due to meningitis or hydrocephalus)
  • What sign suggests craniosynostosis (which needs neurosurgery)
A
  • 4: sagittal / coronal / lambdoid / frontal
  • Birth process: molding / overriding of sutures
  • Incr ICP: widely split sutures
  • Cranio: raised, bony ridge at a suture line
23
Q

Fontanelles

  • Areas where major sutures intersect
  • ALWAYS palpate (should be soft/flat)
  • Bulging may indicate what?
  • Sunken may indicate what?
  • Large fontanelle can be 1st sign of what?
A
  • Bulging: increased ICP (bleed vs. meningitis)
  • Sunken: dehydration
  • Large: 1st sign of hypothyroidism
24
Q

Fontanelles

  • Anterior is located at the juncture of what 3 sutures?
  • Posterior at juncture of what 2 sutures?
A
  • Anterior: Metopic, sagittal, coronal
  • Posterior: sagittal & lambdoid
25
Q

Which Extracranial Finding?

  • Swelling/collecting of blood over one or both parietal bones
  • Does NOT cross suture lines
  • Resolves in weeks to months
A

Cephalohematoma

26
Q

Which Extracranial Finding?

  • Edema of the scalp
  • CAN cross suture ines
  • Resolved in days
A

Caput succedaneum

27
Q

Diagnosis?

A

Bilateral Cephalohematoma

  • Does NOT cross suture lines
  • swelling/collection of blood over one or both parietal bones
  • resolves in weeks to months
28
Q

Diagnosis?

A

Caput succedaneum

  • CAN cross suture line
  • edema of the scalp
  • resolves in days
29
Q

Eyes

  • Term for abnormally wide eyes
  • What is common from birth trauma
  • Red reflexes should be present/symmetrical
A
  • Hypetelorism
  • Subconjunctival hemorrhages
30
Q

Nose/Ears

  • Infants under what age are nose breathers (ensure no obstructions)
  • Over 2-3 yrs old: pull auricle which way?
  • Under 2-3 yrs old: pull auricle which way?
  • Preauricular pits/tags are common
  • ALWAYS screen for hearing
A
  • Nose breathers: < 1 month
  • >2 yrs: pull upward
  • <2 yrs: pull down
31
Q

Mouth: which finding?

  • Small, white, benign, inclusion cysts
  • On palate
  • No tx needed (resolve spontaneously)
  • 2 - 4 months old
A

Epstein’s pearls

32
Q
  • Where are Bohn nodules usually seen?
  • Where are Epstein’s pearls seen?
A
  • Bohn: gingival ridge
  • Epstein: palate
33
Q

Diagnosis?

A

Epstein’s pearls

  • small, white, benign, inclusion cysts
  • Palate
  • No tx
  • 2 - 4 months old
34
Q

Condition?

  • Congenital short lingual frenulum
  • Can limit tongue movement
  • Can cause pain w/ nursing
  • Usually see puckering of midline tongue tip w/ movement
  • May lead to speech difficulty / dental problems
A

Ankyloglossia

“tongue tie”

35
Q

Tx for Ankyloglossia “Tongue Tie”

A

Frenotomy / Frenulotomy in neonatal period

36
Q

Diagnosis?

A

Ankyloglossia (Tongue Tie)

  • congenital short lingual frenulum
  • Tx w/ frenotomy/frenulotomy
37
Q

Neck

  • Position for palpation for infants?
    Position for older children?
A
  • Infants: supine
  • Older: sitting upright
38
Q

Congenital Torticollis

  • Another name?
  • Results from bleeding into which muscle during the stretching process of birth?
  • Appears as a firm fibrous mass within the muscle how many weeks after birth?
  • Disappears over how long?
A
  • “wry neck”
  • sternocleidomastoid
  • 2 - 3 weeks after birth
  • months
39
Q

Chest:

  • Clavicle fx may occur during birth, particularly during delivery of what?
  • Pectus excavatum, also called what? Greater in M or F?
  • Pectus Carinatum, also called what? Greater in M or F?
A
  • difficult arm/shoulder extraction
  • “funnel chest” - sternal depression / M>F
  • “chicken breast deformity / pigeon chest” / M>F
40
Q

Diagnosis?

A

Pectus Excavatum (cave)

  • “funnel chest” - sternal depression
  • M>F
41
Q

Diagnosis?

A

Pectus Carinatum

  • “chicken breast deformity”
  • “pigeon chest”
  • M>F
42
Q

Would Pectus Excavatum or Pectus Carinatum need referral to cardiology?

A

Pectus Excavatum

43
Q

Lungs

  • Observe first, then use stethoscope
  • Ribs don’t move much w/ quiet breathing
  • Diminished BS in one side of chest of newborn may suggest what?
A
  • unilateral lesions (congenital diaphragmatic hernia)
44
Q

Cardiovascular

  • Diminished femoral pulse may indicate what?
  • What are some common noncardiac findings in infants w/ cardiac disease?
A
  • Coarctation of the aorta
  • Non-cardiac:
    • ​poor feeding, failure to thrive, irritability
    • tachypnea, hepatomegaly, clubbing
    • poor overall appearance, weakness
45
Q

Cardiovascular: auscultation

  • Infants/children often have normal _____ (HR increasing on inspiration & decreasing on expiration)
  • What is the MC dysrhythmia in infants? What age?
A
  • sinus dysrhythmia
  • paroxysmal supra ventricular tachycardia (PSVT)
    • any age, including in utero

D2 E1 Shea (13 decks)

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