A&P2 Midterm Flashcards
What is the normal heart rate for a Neonate (<28 d) when awake?
100-165 bpm
What is the normal heart rate for a Neonate (<28 d) when sleeping?
90-160 bpm
What is the normal heart rate for a Infant (1 mo-1 y) when awake?
100-150 bpm
What is the normal heart rate for a Infant (1 mo-1 y) when sleeping?
90-160 bpm
What is the normal heart rate for a Toddler (1-2 y) when awake?
70-110 bpm
What is the normal heart rate for a Toddler (1-2 y) when sleeping?
80-120 bpm
What is the normal heart rate for a Preschool (3-5 y) when awake?
65-110 bpm
What is the normal heart rate for a Preschool (3-5 y) when sleeping?
65-100 bpm
What is the normal heart rate for a School-age child (6-11 y) when awake?
60-95 bpm
What is the normal heart rate for a School-age child (6-11 y) when sleeping?
58-90 bpm
What is the normal heart rate for a Adolescent (12-15 y) when awake?
55-85 bpm
What is the normal heart rate for a Adolescent (12-15 y) when sleeping?
50-90 bpm
What is the normal respiratory rate for a Infant (1 mo-1 y)?
30-55 breaths/minute
What is the normal respiratory rate for a Toddler (1-2 y)?
20- 30 breaths/minute
What is the normal respiratory rate for a Preschooler (3-5 y) ?
20-25 breaths/minute
What is the normal respiratory rate for a School-age child (6-11 y)?
14-22 breaths/minute
What is the normal respiratory rate for a Adolescent (12-15 y)?
12-18 breaths/minute
Normal blood pressure range at Birth (12 h).
60-85 systolic
45-55 diastolic
Normal blood pressure range for a Neonate (96 h).
67-84 systolic
35-53 diastolic
Normal blood pressure range for a Infant (1-12 mo.).
80-100 systolic
55-65 diastolic
Normal blood pressure range for a Toddler (1-2 y).
90-105 systolic
55-70 diastolic
Normal blood pressure range for a Preschooler (3-5 y).
95-107 systolic
60-71 diastolic
Normal blood pressure range for a School-age child (6-9 y).
95-110 systolic
60-73 diastolic
Normal blood pressure range for a Preadolescent (10-11 y).
100-119 systolic
65-76 diastolic
Normal blood pressure range for a Adolescent (12-15 y).
110-124 systolic
70-79 diastolic
Produced by closure of the AV valves and corresponds to the QRS complex on the electrocardiogram (ECG).
First Heart Sound S1
Produced by closure of the semilunar valves and is best heard at the left upper sternal border.
Second Heart Sound S2
Occurs in early diastole during the rapid filling phase and is best heard with the bell of the stethoscope.
Third Heart Sound S3
Produced by turbulence as blood enters a stiff ventricle and occurs with myocardial dysfunction or ventricular hypertrophy, semilunar valve stenosis, hypertrophic cardiomyopathy, and tachycardia-induced cardiomyopathy.
Heard best with the bell of the stethoscope and is always a pathologic finding.
Fourth Heart Sound S4
What type of murmur has a characteristic vibratory or musical quality and is typically louder when the patient is supine or if there is a hyperdynamic state associated with fever or anxiety. This is heard best in the left lower sternal border.
Innocent murmur (Still’s murmur)
What is Genu Varum?
Bow leg
What is Genu Valgum?
Knock kneed
What are the 2 growth charts used for pediatrics?
0-2 years WHO
2-21 CDC
What are the three parameters measured for 0-3 years?
Weight
Length
Head Circumference
What are the three parameters measured for 2-20 years?
Weight
Height
BMI
If your patient has a fall out of 2 of the 3 measurements for growth what would this be considered?
Failure to thrive
What are the 4 characteristic stages of growth?
Rapid growth in infancy and early childhood
Slow steady growth in middle childhood
Rapid growth during puberty
Gradual slowing down of growth in adolescence until adult height is reached
How is underweight defined in the pediatric population?
BMI for age under 5%
How is overweight defined in the pediatric population?
BMI for age 85%-94%
How is obese defined in the pediatric population?
BMI > or = to 95%
What does 5210 stand for?
5 - Five or more servings of fruits and vegetables
2 - 2 hours or less of recreational screen time
1 - 1 hour or more of physical activity
0 - 0 sugary beverages, drink more water
At what age in pediatrics are the following milestones met?
Stranger anxiety; Rolls over; begins to say consonants while babbling; brings things to mouth.
6 months
At what age in pediatrics are the following milestones met?
Puts out arm or leg when dressed, cries when familiar people leave; stands well; responds to simple
commands, makes gestures, puts things in a cup and removes them, bangs things together.
12 months
At what age in pediatrics are the following milestones met?
Dresses/undresses self, copies others, takes turns; walks up and downstairs with one foot per stair, runs easily; strangers can understand 75% of language; stacks six or more blocks, turns pages in a book, pushes buttons and turns knobs
3 years
At what age in pediatrics are the following milestones met?
Separation anxiety; ‘stands’ on hands and feet, sits without support, crawls, pincer grasp; understands “no,” points with a finger, says “mama” or “baba;” plays “peek-a-boo.”
9 months
At what age in pediatrics are the following milestones met?
Begins playing with other children, parallel play; stands on tiptoes, kicks a ball, throws a ball overhand; two to four-word sentences, points to things in a book, strangers can understand 50% of language; stacks four
or more blocks, follows two-step instructions.
2 years
At what age in pediatrics are the following milestones met?
Differentiates between real and pretend, wants to be like friends; can stand on one foot for 10 seconds, can somersault; easily understood by others, tells stories, uses future tense; counts to 10, draws a person with
six body parts, prints some letters and numbers
5 years
At what age in pediatrics are the following milestones met?
Engages in pretend play, kisses/hugs familiar people, walks alone, walks up steps, eats with utensils, says several individual words, points to one body part, scribbles with crayon, marker, or pen.
18 months
At what age in pediatrics are the following milestones met?
Likes to play with others, more imaginative play; hops on one foot, can stand on one foot for two seconds, cuts with scissors; can recite a poem or sing songs, understands basic grammar; identifies some colors and numbers, draws a person with two to four body parts.
4 years
What are the names of the 3 behavioral screening tools?
Ages and Stages
(social and emotional)
Pediatric Symptom Checklist (Emotional and Behavioral)
Conners
(ADHD, Learning problems, Executive functioning, Defiance/Aggression, Peer/family relations)
What is a/are (conditions in a recipient that increases the risk for a serious adverse reaction) to vaccination are conditions under which vaccines should not be administered is?
Contraindication
What is a condition in a recipient that might increase the risk for a serious adverse reaction, might cause diagnostic confusion, or might compromise the ability of the vaccine to produce immunity is?
Precaution
What are the 7 rights of vaccine administration?
Right patient
Right time
Right vaccine & diluent
Right dosage
Right route, needle, technique
Right injection site
Right documentation
CRAFFT Pneumonic
C - Car
R - Relax
A - Alone
F - Forget
F - Family or Friends
T - Trouble
What is the question for C in the CRAFFT pneumonic?
Have you ever ridden in a CAR by someone (including yourself) who was “high” or had been using alcohol or drugs?
What is the question for R in the CRAFFT pneumonic?
Do you ever use alcohol or drugs to RELAX, feel better about yourself or fit in?
What is the question for A in the CRAFFT pneumonic?
Do you ever use alcohol or drugs while you are by yourself or ALONE?
What is the question for F in the CRAFFT pneumonic?
Do you ever FORGET things you did while using alcohol or drugs?
What is the question for F in the CRAFFT pneumonic?
Do your FAMILY or FRIENDS ever tell you that you should cut down on your drinking or drug use?
What is the question for T in the CRAFFT pneumonic?
Have you ever gotten into TROUBLE while you were using alcohol or drugs?
What age range does puberty begin for girls?
8-13 years old
What age range does puberty begin for boys?
9-14 years old
Which vaccines are live vaccines and if not given together need to be given 4 weeks apart?
MMR
Varicella
Rotavirus (oral)
Smallpox
Yellow fever
Oral typhoid
Flu Mist
My - MMR
Yellow and - yellow fever
Orange - oral typhoid
Frog - flu mist
Runs - rotavirus (oral)
Very - varicella
Slow - smallpox
What is the most common chromosome abnormality among newborn infants?
Down Syndrome
What is Atlantoaxial instability?
A condition that affects the bones in the upper spine or neck under the base of the skull
What are the 5 goals of the Preparticipation Physical Evaluation (PPE)?
-Determine general physical and psychological health.
-Evaluate for conditions that may be life threatening or disabling.
-Evaluate for conditions that may predispose to injury or illness.
-Provide an opportunity for discussion of health and lifestyle issues.
-Serve as an entry point into the health care system for adolescents without a health care home or medical home.
At what age should a PPE be performed?
Anyone over the age of 6.
Can a PPE be performed without parental consent?
No
If the parent has signed the consent form for the PPE do they need to be present in order to perform the PPE?
No, as long as they have signed the consent the physical can be done. The parent would need to be called for anything abnormal.
How often does the PPE need to be done?
Yearly
What are the 4 levels of clearance for the PPE?
Unconditional clearance: cleared for all sports and levels of participation.
Cleared with recommendation for follow-up.
Not cleared with clearance status to be determined after further evaluation, treatment or rehabilitation.
Not cleared for any sport or level of competition.
Goal is to avoid unnecessary restriction
What are the physical features of Marfan syndrome?
A long narrow face
Tall and thin body build
Arms, legs, fingers and toes that may seem too long for the rest of the body.
Curved spine
Joints that are weak and easily dislocated
Flat feet
Crowded teeth
Narrow and higher arched palate
What is Marfan syndrome?
A genetic condition that affects connective tissue, which provides support for the body and organs.
The major cause of morbidity and mortality in patients with Marfan syndrome are?
Cardiovascular complications:
Aortic enlargement
Aortic tear or rupture
Mitral valve prolapse
Aortic regurgitation
What grade murmur is a soft murmur that is readily detectable?
Grade 2 Non-pathological
What grade murmur is a easily detected murmur associated with a palpable thrill?
requires the presence of a precordial thrill. A thrill located only in the suprasternal notch or neck and not on the precordium does not fulfill this criterion.
Grade 4 Pathological
What grade murmur has the faintest sound that can be detected; often detected by a cardiologist but not by general clinicians?
Grade 1 Non-pathological
What grade murmur is a very loud murmur audible with the stethoscope placed lightly on the chest?
Grade 5 Pathological
What grade murmur is louder than grade 2 but not associated with a palpable thrill?
Grade 3 Pathological
What grade murmur is extremely loud murmur that is audible with the stethoscope off of the chest?
Grade 6
What vaccine/vaccines are given at birth?
Hep B #1
What vaccine/vaccines are given at 1 month?
Hep B #2
What vaccine/vaccines are given at 2 months, 4 months, and 6 months?
Hib
Inactivated Polio (IPV)
DTap
Prevnar
Rotovirus
What vaccine/vaccines are given at 9 months?
Hep B #3
What vaccine/vaccines are given at 12 months?
MMR #1
Varicella #1
What vaccine/vaccines are given at 15 months?
Prevnar #4
Hib #4
What vaccine/vaccines are given at 18 months?
DTap #4
Hep A #1
What vaccine/vaccines are given at 24 months?
Hep A #2
What vaccine/vaccines are given at 4 years?
DTap #5
Polio #4
MMR #2
Varicella #2
What vaccine/vaccines are given at 11 years?
HPV
TDap
What vaccines are required before a child can start school pre-k or kindergarten?
DTap - 5
Polio - 4
Prevnar - 4
Hib - 4
MMR - 2
Varicella - 2
Hep B - 3
What are the 5 components of the bright futures guidelines?
Observation
Physical exam
Screening
Immunization
Anticipatory guidance
At what age do you perform developmental screenings?
9, 18, & 30 months for developmental
18 & 24 months for autism
What is the most common cause of sudden cardiac death in young athletes?
Cardiomyopathies
Is a BP of 130/90 high for a 10 year old?
Yes
Is a BP of 90/60 low for a 17 year old?
Yes
What are the contraindications when giving vaccines?
-Anaphylaxis (Severe allergic reaction).
-Encephalopathy (ie- coma, decreased consciousness, prolonged seizures).
-Known severe immunodeficiency (ie- from hematologic or solid tumors, receipt of chemo, + HIV and severely immunocompromised, congenital immunosufficency).
What groups should not get live vaccines?
Pregnant women
Severely Immunocompromised
What is M-CHAT and when do you do it?
A screening tool for autism
18 and 24 months
At what age do you start checking blood pressure routinely in kids?
3 years old
Tanner Stage 1 in females involves?
Breasts: Elevation of papilla only
Pubic Hair: Villus hair only
Growth: 2-2.4 inches per year
Other: Adrenarche and ovarian growth
Tanner Stage 2 in females involves?
Breasts: Breast bud under the areola, areola enlargement
Pubic Hair: Sparse hair along the labia
Growth: 2.8-3.2 inches per year
Other: Clitoral enlargement, labia pigmentation, growth of uterus
Tanner Stage 3 in females involves?
Breasts: Breast tissue grows but has no contour or separation
Pubic Hair: Coarser hair curled pigmented covers the pubes
Growth: 3.2 inches per year
Other: Axillary hair, acne
Tanner Stage 4 in females involves?
Breasts: Projection of areola and papilla, secondary mound formation
Pubic Hair: Adult hair, does not spread to the thigh
Growth: 2.8 inches per year
Other: Menarche and development of menses
Tanner Stage 5 in females involves?
Breasts: Adult type contour, projection of papilla only
Pubic Hair: Adult hair, spreads to the medial thigh
Growth: Cessation of linear growth
Other: Adult genitalia
Tanner Stage 1 in males involves?
Genitalia: Testes <2.5 cm
Pubic Hair: Villus hair only
Growth: 2.0-2.4 inches per year
Other: Adrenarche
Tanner Stage 2 in males involves?
Genitalia: Testes 2.5-3.2 cm, thinning and reddening of the scrotum
Pubic Hair: Sparse hair at the penis base
Growth: 2.0-2.4 inches per year
Other: Decreases in body fat
Tanner Stage 3 in males involves?
Genitalia: Testes 3.3-4.0 cm, increase of penis length
Pubic Hair: thicker curly hair spreads to the pubis
Growth: 2.8-3.2 inches per year
Other: Gynecomastia, voice break, increased muscle mass
Tanner Stage 4 in males involves?
Genitalia: Testes 4.1-4.5 cm, penis growth darkening of scrotum
Pubic Hair: Adult hair does not spread to thighs
Growth: 4.0 inches per year
Other: Axillary hair, voice change, acne
Tanner Stage 5 in males involves?
Genitalia: Testes >4.5 cm, adult genitalia
Pubic Hair: Adult hair spreads to medial thigh
Growth: Deceleration, cessation
Other: Facial hair, muscle mass increases
At what age do we universally screen for anemia (Hgb) and lead?
1 year old
What are some signs of lead toxicity?
developmental delays
abdominal pain
neurologic changes
irritability
What is the protocol for lead poisoning?
Chelation therapy
What is a normal hemoglobin for a 1 year old?
11-12.5 g/dL pg 724 in Berkowitz
What is the recommended iron replacement amount in children?
Iron replacement 3-6 mg/kg a day based on elemental iron
What should you limit in a child that has anemia or to prevent anemia? Why?
Cows milk - 2 cups per day max
Causes GI bleeding & common cause of iron-deficiency anemia in babies & young children
When should you recheck hemoglobin levels in an anemic child?
In 6 months
When should you use motivational interviewing, what type of subjects?
Sex
Weight
What is motivational interviewing?
A collaborative approach that relies on eliciting the patient’s ideas about change.
It addresses the ambivalence and discrepancies between a person’s current values and behaviors and the person’s future goals.
What are the 4 principles of motivational interviewing?
-Express empathy.
-Identify discrepancies between patient’s current behavior and treatment goals.
-Decrease the likelihood of evoking patient resistance.
-Support the patient’s self efficacy.
What are important tools of motivational interviewing?
-Operationally, open ended questions (How do you feel about smoking?)
-Affirmations (You are tired of having to monitor your blood sugar every day and stick to your diet.)
-Reflective listening (You are worried about your daughters behavior and are concerned that if it persist she may be expelled from school.)
What are the Best Practice recommendations for CV PPE assessment
-Palpate femoral arterial pulses simultaneously with radial pulses
(also assess pulses for intensity)
-Examine for edema
-Assess capillary refill
-Auscultate supine, sitting, then standing… for AT LEAST 20 seconds
-Auscultate with Valsalva maneuver to assess for HCM
-Auscultate while patient is squatting
PPE clearance concerns
-cardiology
-Marfans
-High BP
-single paired organ
-vision
-musculoskeletal injuries
PPE sport specific testing
-baseball players: shoulder exam to assess for internal and external rotation deficits
-hockey players & ballet: FADIR to assess for femoracetabular impingement
PPE common concerns/Best Practice recommendations Marfans
Hypertrophic cardiomyopathy-palpate femoral arterial pulses simultaneously with radial pulses to exclude coarctation of the aorta
PPE “normal” cardiac findings
-systolic ejection murmur
-begins after first heart sound
-ends before the second heart sound
-crescendo-decrescendo
-normal inspiratory S2 split
PPE concerning cardiac findings (reasons to get an echo)
-diastolic, holosystolic, or continuous
-greater than or equal to grade III
-abnormal S2 split
PPE some common rules for contact sports re: skin
-bacterial: need to have been on treatment for 72 hours & no new lesions in the last 48 hours
-tinea corporis: 72 hours of treatment
-herpes: 120 hours of treatment & no new lesions in 72 hours
-tinea capitus: 2 weeks oral treatment & no new lesions
Main anatomic areas to focus on when examining the heart sounds
-cardiac apex
-the aortic area (second intercostal space [ICS] just to the right of the sternum or the third ICS just to the left of sternum)
-the pulmonary area (second ICS just to the left of sternum)
-the tricuspid area (fourth and fifth ICS just to the left of sternum)
-In addition, auscultation of the left axilla, base of the heart, carotid arteries, and interscapular area should be performed to assess for radiation of heart sounds and murmurs
S1
-first heart sound
-produced by vibrations generated by closure of the mitral and tricuspid valves
-corresponds to the end of diastole and beginning of ventricular systole
-precedes the upstroke of carotid pulsation
-is a high-pitched sound
-best heard with the diaphragm of the stethoscope
-influenced by ventricular contractility
PR interval
governs the time that atria have to empty their contents into the ventricle
S2
-second heart sound
-produced by the closure of the aortic and the pulmonary valves at the end of systole
-best heard at the aortic area
-is a high-pitched sound heard best with the diaphragm of the stethoscope
-S2 splitting results from the aortic valve closing slightly before the pulmonary valve (and this is more prominent with inspiration)
S3
-a low-pitched, early diastolic sound
-audible during the rapid entry of blood from the atrium to the ventricle
-best audible at the apex with the patient in left lateral decubitus position with breath held at end expiration
-best heard with the bell of the stethoscope
S4
-late diastolic sound that corresponds to late ventricular filling through active atrial contraction
-low-intensity sound heard best with the bell of the stethoscope
-best heard at the apex with the patient in the left lateral decubitus position at end expiration
Splitting heart sounds vs S3/S4
-split heart sounds are high pitched and best audible with the diaphragm
-S3 or S4 are low-pitched sounds best audible with the bell of the stethoscope
A common benign heart murmur in the newborn that is characterized by transmission to the right side and back.
Peripheral pulmonic stenosis
Common benign physical findings in newborns skin (8).
Milia
Erythema toxicum
Salmon patch
Nevus flammeus
Hemangiomas
Dermal melanosis
Lanugo (body hair)
Vernix
Common benign physical findings in newborns head (3)
Cephalohematoma
Caput succedaneum
Molding
Common benign physical findings in newborns face (2).
Swollen overall appearance
Subconjunctival hemorrhages
Common benign physical findings in newborns eyes (2).
Swollen eyelids,
Subconjunctival hemorrhages
Common benign physical findings in newborns ears (2).
Preauricular appendages/pits
Folded pinnae
Common benign physical findings in newborns nose (2)
Flattened nose
Milia over bridge
Common benign physical findings in newborns mouth and throat (4).
Epstein pearls
Epithelial pearls
Needle teeth
Shortened frenulum
Common benign physical findings in newborns chest (4).
Supernumerary nipples
Breast beds
Galactorrhea
Pectus excavatum or carinatum
Common benign physical findings in newborns genitalia.
Females: swollen labia, hymenal tags, vaginal discharge
Males: hydrocele, undescended testicle (palpated in the inguinal canal)
Common benign physical findings in newborns hips.
Click or clunk sound.
Common benign physical findings in newborns extremities.
Feet turned up, in, or out, but malleable
Common benign physical findings in newborns neurological examination.
Primitive reflexes: Moro, grasp, rooting, stepping
What can you find in the diaper of a child that is dehydrated?
Brick dust
All of the following describe normal behavior for a 3-year-old child, except:
A. Speaks in three- to five-word sentences that are understood by most strangers
B. Can draw a cross
C. Can draw a circle
D. Can ride a tricycle
B. Can draw a cross
Developmental stages in children include the following: 1 year—walk; 2 years—walks up steps with the same foot; 3 years—pedals a tricycle and copies a circle; 4 years—copies a cross and draws a person with three parts
One of the developmental milestones for this age group is the ability to draw a stick figure “person” with six separate body parts. What is the age group that this finding is associated with?
5-year-olds
By 5 years of age, a child can draw a stick person with six body parts, copy a square, print some letters and numbers, and count to 10 or more.
A concerned new mother reports to you that her son, who is 3 years of age, is not toilet trained yet. Which of the following is an appropriate reply?
A. Recommend a referral to a pediatric urologist
B. Advise the mother that her child is developing normally
C. Recommend a bed-wetting alarm
D. Recommend a voiding cystogram
Solution: B
Advise the mother that her child is developing normally
Toilet training begins at approximately 2 years of age and may take 1 to 2 years to complete. Boys who are not toilet trained by 3 years of age may still be developing normally.
Can an infant with a cold be immunized as long as his temperature is below 100.4 F?
Yes. A child can be vaccinated even if they have a low-grade fever, a cold, runny nose, cough, otitis media, or mild diarrhea.
A 14 month old
Should developmentally be able to say “mama” and “dada,” know their own name, and know at least two to five words
A 2 year old
Is able to understand simple commands
A 2 month old
coos and smiles
A 20 month old
Can walk without support
A 3 year old
Can speak in 3 to 5 word sentences
A 6 month old
Is starting to babble, should be able to grasp objects, reach for objects and toys, pass items from one hand to the other, sit up without support, roll over, and bring things to their mouth
A 12 month old
Is learning to “cruise” or hold onto furniture while walking
What signifies a positive Ortolani maneuver?
“clunk” sound during the Ortolani maneuver is a positive finding and signifies a possible hip abnormality (hip dysplasia) in infants. Refer the infant to a pediatric orthopedist.
What are flat pink patches found on the forehead, eyelids, and the nape of the neck of infants called?
Salmon patches, which typically fade by 18 months
CDC HPV vaccine recommendations
The HPV vaccine is recommended for both males and females. First dose at age 11 or 12. If it is given before age 14 years, only two doses are required. If the child is older than 14 years, three doses are required. The vaccine can be given until the age of 26 years, especially if the individual is at high risk. Do not use the vaccine in children younger than 9 years.
When is the MMR vaccine given?
The MMR vaccine because it is not given until 12 months of age
A 4 year old
A 4-year-old child should be able to trace simple objects, run, climb steps, throw a ball, stack objects, and perform several activities of daily living with little or no assistance. The child might not be able to catch a ball but should be able to throw a ball.
Which diagnosis is most likely of an infant is born with microcephaly, narrow eyes, a flat nasal bridge, a thin upper lip, and underdeveloped ears?
Fetal alcohol syndrome
Which diagnosis causes a flat, round face; low-set ears; macroglossia; and hypotonia and what should parents be educated on?
Down Syndrome and parents should be educated about high-risk sports and potential spinal cord injuries.
Which diagnosis is most likely diagnosed in the first few months of life when there is a weight decrease over two or more major percentile lines (90th, 75th, 50th, 25th, and 5th)?
Failure to Thrive; can be caused by inadequate nutritional intake, neglect, or poor maternal bonding.
What is congenital adrenal hyperplasia?
Congenital adrenal hyperplasia is an endocrine disorder that is on the recommended uniform screening panel (RUSP) for newborns.
A 5 year old
should be able to draw a person with up to four parts
A 6 year old advanced fine motor skills
tying shoes and copying a triangle
An adolescent female’s areola, nipple, and breast tissue develop and become elevated as one mound. Which of the following is the correct Tanner stage for this phase of breast development?
Tanner stage III.
During Tanner stage III, the areola, nipple, and breast grow together in one mound. There is no separation yet.
What happens in Tanner Stage IV phase of breast development?
At Tanner stage IV, the areola and the nipple separate to form a distinct mound.
What are some behaviors a 2 year old might show that would be associated with autism or other genetic disorders?
mute and not showing any interest in other children
Some points about the tetanus and diptheria vaccine
-Side effects of the Td vaccine include induration at the injection site
-fever may occur
-Td or Tdap is given in adults every 10 years
-The DPT and DT should not be given beyond 7 years of age
What vitamin supplement is recommended by the American Academy of Pediatrics (APA) during the first few days of life for a breastfed infant?
Vitamin D drops.
According to the American Academy of Pediatrics (APA), all infants should be given vitamin D supplementation within the first few days of life. Mothers who plan to breastfeed their infants should be taught how to use vitamin D drops. Infant formula is supplemented with vitamin D (and many other vitamins, minerals, and omega-3 oil), so there is no need to give it separately.
Fetal TORCH infections can cause microcephaly, mental retardation, hepatosplenomegaly, and intrauterine growth retardation. The acronym TORCH stands for:
Toxoplasma gondii, other infections, rubella, cytomegalovirus, and herpes
When does an infant triple its birth weight?
12 months
When does an infant double its birth weight?
6 months
When does an infant regain their birth weight?
Birth weight is regained by the second week of life (14 days)
Which is the most common type of cancer in young children?
Acute lymphoblastic leukemia
What component of the DTap vaccine is most likely to cause a fever?
The pertussis component
1st week checkup list (3 - 5 days old) / Newborn screening
Immunizations: Hep B #1 (HBV) (if didn’t receive in the hospital)
Screenings: hearing, cardiac, & blood
Safety: where is baby sleeping? Mom having postpardum issues?
1 month checkup
Immunizations: Hep B #2 (HBV)
Screenings: maternal depression
Safety: Sleep, car seat
Growth & development
What is “surveillance” defined as?
the ongoing process of monitoring a child’s development at each health supervision visit and recognizing those who may be at risk for developmental delay
What “screening” referring to?
the universal use of validated, standardized tests at recommended ages & to identify children at risk whose parents or health care provider have no current identified concerns OR whose HCP is refining a concern identified through surveillance
What tool is used to calculate the growth of preterm infants?
The Fenton Preterm Growth Chart (2013)
Uses gender, gestational age, weight, head circ, length, LMP, due date, date of birth, gestation at birth, age in days on date of measurement, and day of life on date of measurement
Categories of developmental milestones (5)
gross motor, fine motor, language, cognitive and social-emotional, and behavioral
When should screening for motor delay be done?
at the 9 month, 18 month, 30 month, and 48 month visits
In pediatrics, where is the PMI found?
4th ICS until about 7 years old, then 5th ICS
What is something special you would do for a breech baby?
US at 6 weeks to check for hip dislocation
What are the 5 domains of social determinants of health?
- Economic stability
- Education access and quality
- Health care access and quality
- Neighborhood and built environment
- Social and community context
12 month checkup
hgb & lead screening, start live vaccines (MMR & varicella)
18 & 24 month checkup
Autism screening (MCHAT)
2 years checkup
start BMI
3 years checkup
BP, vision, hearing
11 years checkup (and every year thereafter)
PHQ-9 & CRAFFT
PDA is more common in…
infants born prematurely
A murmur that is classified as “ functional, ” “ innocent, ” or “ physiologic. ” It is not a structural defect of the heart and may be a result of noise flowing through a normal heart. There is no known cause.
Still murmur
True or False
PDA and VSD are position dependent (heard louder in the supine position)
False
What are the components of the PPE
History
PHQ4
Physical Exam (vital signs, visual acuity, BMI, cardiovascular, musculoskeletal, respiratory, dermatological)
How is peak flow recorded and what physical elements is it based on?
L/min and is based on sex, age, height
When are developmental Surveillance performed?
At every health supervision visit.
Tanner Stages (pubic hair)
Stage 1: No hair
Stage 2: Downy hair
Stage 3: Scant terminal hair
Stage 4: Terminal hair that fills the entire triangle overlying the pubic region
Stage 5: Terminal hair that extends beyond the inguinal crease onto the thigh
Tanner Stages (male genitalia)
Stage 1: scrotum, testes, and penis of a child
Stage 2: enlargement of scrotum and testes and change in texture and reddening of scrotal skin
Stage 3: growth of penis (initially in length then in girth)
Stage 4: further growth of penis (length and girth), growth in scrotum and testes, distinct darkening of scrotum
Stage 5: adult in size and shape
Tanner Stages (boobies)
Stage 1: Only the papilla are elevated above the chest wall
Stage 2: breast budding- elevation of breasts and papilla and increased diameter in areolae
Stage 3: breasts and areolae continue to enlarge showing no separation of contour
Stage 4: areolae and papillae elevate above the level of the breasts
Stage 5: BOOBS
