Well Child 1 Flashcards
(45 cards)
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)
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
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
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
5
Q
Growth charts vary based on what?
A
Gestational age
- premature infants
- syndromes (Down syndrome, fragile X)
6
Q
Give the %
- Overweight
- Obesity
- Underweight
A
- Overweight: 85-95%
- Obesity: >95%
-
Underweight: <5%
*
7
Q
Give the %
- Microcephaly
- Macrocephaly
A
- Micro: <3%
- Macro: >97%
8
Q
How many weeks?
- Preterm
- Term
- Post-term
A
- Pre: <37 weeks
- Term: 37-42 weeks
- Post: >42 weeks
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
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%
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
12
Q
What is the key assessment of the newborn immediately after birth?
A
Apgar
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
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)
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
16
Q
Terminology?
- Cheesy white covering
- Decreases as term approaches
- Made from fetal corneocytes / sebaceous gland activity
- “rich lipid matrix”
A
Vernix Caseosa
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
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
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
**Which Extracranial Finding?**
* Swelling/collecting of blood over one or both parietal bones
* Does NOT cross suture lines
* Resolves in weeks to months
Cephalohematoma
26
**Which Extracranial Finding?**
* Edema of the scalp
* CAN cross suture ines
* Resolved in days
Caput succedaneum
27
Diagnosis?
**Bilateral Cephalohematoma**
* Does NOT cross suture lines
* swelling/collection of blood over one or both parietal bones
* resolves in weeks to months
28
Diagnosis?
**Caput succedaneum**
* CAN cross suture line
* edema of the scalp
* resolves in days
29
**Eyes**
* Term for abnormally wide eyes
* What is common from birth trauma
* Red reflexes should be present/symmetrical
* Hypetelorism
* Subconjunctival hemorrhages
30
**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
* **Nose breathers:** \< 1 month
* **\>2 yrs:** pull upward
* **\<2** yrs: pull down
31
**Mouth: which finding?**
* Small, white, benign, inclusion cysts
* On palate
* No tx needed (resolve spontaneously)
* 2 - 4 months old
Epstein's pearls
32
* Where are Bohn nodules usually seen?
* Where are Epstein's pearls seen?
* **Bohn:** gingival ridge
* **Epstein:** palate
33
Diagnosis?
**Epstein's pearls**
* small, white, benign, inclusion cysts
* Palate
* No tx
* 2 - 4 months old
34
**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
**Ankyloglossia**
"tongue tie"
35
Tx for Ankyloglossia "Tongue Tie"
Frenotomy / Frenulotomy in neonatal period
36
Diagnosis?
**Ankyloglossia (Tongue Tie)**
* congenital short lingual frenulum
* Tx w/ frenotomy/frenulotomy
37
**Neck**
* Position for palpation for infants?
Position for older children?
* **Infants:** supine
* **Older**: sitting upright
38
**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?
* "wry neck"
* sternocleidomastoid
* 2 - 3 weeks after birth
* months
39
**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?
* difficult arm/shoulder extraction
* "funnel chest" - sternal depression / M\>F
* "chicken breast deformity / pigeon chest" / M\>F
40
Diagnosis?
**Pectus Excavatum** (cave)
* "funnel chest" - sternal depression
* M\>F
41
Diagnosis?
Pectus **C**arinatum
* "**c**hicken breast deformity"
* "pigeon chest"
* M\>F
42
Would Pectus Excavatum **or** Pectus Carinatum need referral to cardiology?
Pectus Excavatum
43
**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?
* unilateral lesions (congenital diaphragmatic hernia)
44
**Cardiovascular**
* Diminished femoral pulse may indicate what?
* What are some common noncardiac findings in infants w/ cardiac disease?
* Coarctation of the aorta
* **Non-cardiac:**
* ****poor feeding, failure to thrive, irritability
* tachypnea, hepatomegaly, clubbing
* poor overall appearance, weakness
45
**Cardiovascular: auscultation**
* Infants/children often have normal _____ (HR increasing on inspiration & decreasing on expiration)
* What is the MC dysrhythmia in infants? What age?
* sinus dysrhythmia
* paroxysmal supra ventricular tachycardia (PSVT)
* any age, including in utero
