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Pediatrics > Clin Assess > Flashcards

Clin Assess Flashcards

1
Q

How often do you see kids for well child visits?

A

1-2 weeks then @2, 4, 6, 9, 12, 15, 18, 24 months, then annually

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2
Q

what are the 4 principles of child development?

A
  1. follows predictable pathway
  2. wide range of “normal”
  3. various factors affect development
  4. childs development level affects how you can conduct hx and PE
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3
Q

What do you want to do in first 24 hours after baby is born and before d/c?

A
  1. screen for congenital heart disease using pulse ox

2. circumcision

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4
Q

How soon should baby regain birth weight?

A

by 2 weeks

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5
Q

What are the 5 components of Apgar score?

A
  1. HR
  2. RR
  3. Muscle tone
  4. reflex irritability
  5. color
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6
Q

When do you calculate apgar score?

A

1min and 5min

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7
Q

What are normal apgard scores?

A

8-10

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8
Q

What are milestones at 2 months?

A
  • smiles
  • turns head to sounds
  • pays attention to faces
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9
Q

What are 4 month milestones?

A
  • likes to play with people
  • copies facial movements (smile, frown)
  • babbles with expression
  • cries in different ways to show hunger, pain, tired
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10
Q

What are 6 month milestones?

A
  • likes to look at self in mirror
  • knows familiar faces
  • brings things to mouth
  • rolls in both directions
  • sits up w/o support
  • ADD FOOD!
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11
Q

What are 9 month milestones?

A
  • sitting on own
  • pulling up to stand
  • some may start walking
  • crawls
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12
Q

What are 12 month milestones?

A
  • WALKING! (safety is big emphasis at visit)
  • WHOLE milk
  • simple gestures (waving)
  • says “mama” “dada”
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13
Q

What are 18 month milestones?

A
  • walking on own ( up steps, runs)
  • starting to TALK (“no”)
  • drinks from cup, eats with spoon
  • can follow 1-step commands
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14
Q

What are 2yo milestones?

A
  • start showing independence (reassure parents this is normal!)
  • switch to SKIM milk
  • toilet readiness
  • makes/copies straight lines/circles
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15
Q

What are 3yo milestones?

A

fine motor skills (holding pen, drawing)

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16
Q

What are 5yo milestones?

A
  • friends
  • counts to 10
  • can use toilet on own
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17
Q

What are 6-10 milestones?

A

achievement by trial-and-error, goal-directed

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18
Q

When does puberty start?

A

girls- 10yo

boys- 11yo

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19
Q

What is the last step of puberty?

A

growth spurt

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20
Q

When does puberty end?

A

girls- 14yo

boys- 16yo

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21
Q

When and how often do you measure head circumference?

A

every visit until 2yo

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22
Q

How often to measure weight/length?

A

every visit until 2yo (then height?)

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23
Q

How do you define failure to thrive?

A
  1. growth under 5th percentile
  2. drop 2 quartiles in 6 months
  3. weight for length under 5th percentile
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24
Q

What are breastfeeding guidelines?

A
  • exclusive breastfeeding for 6 months
  • followed by continued breastfeeding with other food introduced at 6 months
  • continue breastfeeding until 1yo (or longer)
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25
Q

What are benefits of breastfeeding?

A

Lower rates of: infection, allergies, SID, celiac dz, IBD, obesity, DM, leukemia, neurodevelopment outcomes

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26
Q

When do you transition from baby food?

A

12 months

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27
Q

When do you switch to WHOLE milk?

A

12 months

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28
Q

When do children “graze”

A

12 months

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29
Q

When do you switch to SKIM milk?

A

2yo

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30
Q

What are car seat guidelines?

A
  • rear-facing until 2yo
  • forward-facing as as long as possible (until reach max of manufacturer)
  • booster seat until 4’9” and 8-12yo
  • in rear seat until 13yo
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31
Q

When do you get your primary teeth?

A

first tooth eruption: 4-15 months

By age 3: 20 teeth

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32
Q

When do you get permanent teeth?

A

eruption: 5-7yo

ends by: 13-14yo

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33
Q

What is the #1 chronic disease in children?

A

dental caries

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34
Q

When and how often should children be getting flouride varnish?

A

children 6months-5yo

q3-6 months

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35
Q

What are guidelines for screen time?

A
  • avoid before age 2
  • limited to 2hrs
  • monitor content
  • “screen free zone”
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36
Q

What can excessive media lead to?

A

attention problems
school difficulties
sleep/eating d/o
obesity

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37
Q

What is the leading cause of death in children after 1st year of life?

A

injuries

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38
Q

What are newborn screening tests?

A
  • pulse ox
  • H/H
  • lead screening
  • TB skin test
  • visual acuity
  • hearing
  • cholesterol
  • STI/HIV
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39
Q

What is colic?

A

healthy infant cries over 3 hrs/day for 3 days/week for over 3 weeks (rule of 3’s)

peaks at 2-3 months old

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40
Q

What is tx for colic?

A

reassurance, learn ways to soothe/comfort

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41
Q

At what age do children have temper tantrums?

A

1-4yo (usually once a week)

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42
Q

When do breath-holding spells occur?

A

6 months-6yo

during expiration (falls silent)

often response to anger/injury

rarely LOC

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43
Q

What is enuresis?

A

repeated urination durin day or night in child over 5yo

must occur at least 2x/week x3 months

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44
Q

What is encopresis?

A

repeated passage of stool in inappropriate places by child over 4yo

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45
Q

What is the reason behind encopresis usually?

A

constipation (90% of time)

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46
Q

What is a night terror?

A

w/n 2 hours of falling asleep, lasts 30 min

doesn’t wake up

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47
Q

What is a nightmare?

A

child wakes up alert

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48
Q

What is dyssomnias?

A

trouble initiating sleep and/or waking @night

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49
Q

What is the most common feeding problem?

A

refusing to eat

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50
Q

What can cause early closure of fontanelles?

A
  • microcephaly
  • craniosynostosis
  • metabolic abnormalities
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51
Q

What can cause delayed closure of fontanelles?

A
  • normal variant
  • hypothyroidism
  • megacephaly
  • increase intracranial pressure
  • ricketts
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52
Q

What does a depressed anterior fontanelle signify?

A

dehydration

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53
Q

What is caput succedaneum?

A

soft tissue swelling related to dlivery process

CROSSES suture lines

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54
Q

What is cephalohematoma?

A

DOES NOT CROSS suture lines

more firm discrete

predisposes to jaundice

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55
Q

What is subgleal hemoragghage?

A

life-threatening!!

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56
Q

What does an absent or unequal red reflex signify?

A

congenital catarats (need optho referral)

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57
Q

When is subconjunctival hemorrhage seen?

A

babies born vaginally

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58
Q

What causes purulent eye discharge?

A

gonococcal conjunctivitis

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59
Q

What is associated with low set, posterior rotated ears?

A
  • renal anomalies

- hearing loss

60
Q

What are things you see in babues gums?

A

Bohns nodules, Epstein pearls

61
Q

What is micrognathia?

A
  • lower jaw pushed back
  • underlying chromosomal abnormality
  • feeding difficulty
62
Q

When should baby pass first meconium?

A

w/n 72 hours

63
Q

What is transitional stool?

A

green/brown

64
Q

What are sacral dimples?

A
  • no problem if can see base

- If can’t see base, EMERGENCY! want to make sure not connected to spinal canal

65
Q

What is imperforate anus?

A

hole not in right place

66
Q

What is hypospadius?

A

penis hole underneath

67
Q

What is epispadias?

A

penis hole on top

68
Q

What is chordee?

A

penis attached to abdomen

69
Q

What is hydrocele?

A

transilluminates

70
Q

What is Barlow test?

A

dislocating hip

71
Q

What is ortolani test?

A

relocating hip

72
Q

What is Galeazzi test

A

lay prone with knees bent

73
Q

What do you do if you hear/feel a click during hip dysplasia tests?

A

get US!

74
Q

What is the rooting reflex?

A

stroke cheek

75
Q

What is the galant reflex?

A

stroke side of stomach

76
Q

what is the moro reflex?

A

drop baby

77
Q

What is hypotonia associated with?

A

Downs syndrome, neurologic deficit

78
Q

What is erythema toxicum?

A

Benign, looks like flea bites all over

-if persists longer tahn first week–> make sure not contact dermatitis, flea/scabies bites

79
Q

What is cutis marmorata

A

mottling

80
Q

What is mottling associated with?

A

premature infants
congenital hypothyroidism
Downs syndrome

81
Q

What is acrocyanosis?

A

blue hands/feet

82
Q

What is linea nigra?

A

hypopigemented line from belly button to pubic

83
Q

What is nevus simplex?

A

salmon patch, stork bite

84
Q

What are slate grey patches?

A

Mogolian spots

85
Q

How do you assess a newborn for jaundice?

A

apply pressure to skin to press out normal color. Look for yellowish “blanching”

86
Q

What is normal jaundice?

A

appears in 48-72 hours and peaks on fifth day. usually disappears w/n a week.

87
Q

What is a common cause for physiologic jaundice?

A

breastfeeding

88
Q

What does jaundice w/n first 24 hours signify?

A

hemolytic anemia

89
Q

What does late-appearing jaundice or jaundice that lasts 2-3 weeks signify?

A

biliary obstruction/liver disease

90
Q

What are risk factors for jaundice? (5)

A
  • premature
  • breastfed
  • illness/sepsis
  • ABO incompatiblity
  • G6PD deficiency
91
Q

How do you estimate gestation age?

A

under 35 weeks- premature
35-36 weeks- late preterm
37-42 weeks- term
over 42 weeks- post-term

92
Q

What classifies SGA and LGA

A

SGA is under 10th percentile

LGA is over 10th percentile

93
Q

What are possible indications of abuse in an infant?

A
  • dilation of anus
  • hymenal notch extends over 50 percent
  • condyloma acuminate in child over 3yo
  • brusing, abrasion or bite marks on labia
  • purulent, malodorous vaginal d/c (culture to check for STI)
94
Q

What are strong indications of sexual abuse?

A
  • lacerations, ecchymoses, newly healed scars of hymen or posterior fourchette
  • no hymenal tissue from 3-9 oclock
  • healed hymenal transections
  • preianal lacerations extending to external sphincter
95
Q

What does H. influenza B cause?

A

periorbital cellulitis

96
Q

What is important to distinguish between in undescended tests?

A

undescended testes vs highly tractile testes vs active cremasteric reflex

97
Q

What is an intrinsic cause of stained teeth?

A

tetracycline

98
Q

What is an extrinsic cause of stained teeth?

A

poor oral hygiene

99
Q

What lymph nodes are commonly enlarged in children?

A

cervical lymph nodes

100
Q

What are brushfield spots?

A

abnormal speckling spots on iris (suggest Downs)

101
Q

What is herpetic stomatitis?

A

tender ulcerations of oral mucosa and surrounded by erythema

102
Q

What are facial characteristics of fetal alcohol syndrome?

A
  • short palpebral fissures
  • wide, flat philtrum
  • thin lips
103
Q

What does fetal alcohol syndrome put kid at risj for?

A
  • growth deficiency
  • microcephaly
  • mental retardation
104
Q

What is cretinism?

A

congenital hypothyroidism

105
Q

What are features of congenital hypothyroidism?

A
  • coarse facial features
  • low-set hairline
  • sparse eyebrows
  • enlarged tongue
  • hoarse cry
  • umbilical hernia
  • myxedema
  • mottled skin
  • mental retardation
106
Q

What can congenital syphilis cause?

A
  • facial stigmata (saddle nose)
  • rhinitis, weeping nasal mucosal lesions (snuffles)
  • circumoral rash
  • mucocutaneous inflammation and fissuring of mouth (rhagades)
  • Hutshinson teeth (dental dysplasia)
  • craniotabes tibial periostisis (saber shins)
107
Q

What can cause facial nerve palsy in infant?

A
  • injury to nerve during delivery
  • inflammation of middle ear during AOM
  • Bells palsy
108
Q

What are characteristics of Downs syndrome?

A
  • small, rounded head
  • flattened nasal bridge
  • oblique palpebrak fissures
  • prominent epicanthal folds
  • small, low-set, shell-like ears
  • larger tongue
  • hypotonia
  • transverse palmar creases (simian lines)
  • shortening and incurving of fifth fingers (cliodactlyl)
  • brushfield spots
109
Q

What are characterists of hyyerpthyroidism in children?

A
  • accelerated growth
  • staring eyes (not true exophthalmos)
  • enlarged thyroid gland (goiter)
110
Q

What is craniosynostisos?

A

premature closure of 1 or more sutures of skull

results in abnormal growth of skull

111
Q

What are leading causes of morbidity in adolescents?

A
  • unintended PG
  • STIs
  • substance abuse
  • smoking
  • dropping out of school
  • depression
  • homelessness
  • physical violence
112
Q

What is parental consent not needed for?

A
  • substance abuse tx
  • STI screening/tx
  • PG prevention and care
  • sometime abortion
  • mental health clinic
  • emergency care
113
Q

What is delayed puberty defined as?

A
  • 12yo for girls (breast development is first sign)

- 14yo for boys (testicular enlargement is first sign)

114
Q

What is a constitutional delay in puberty?

A

will eventually progress spontaneously through

115
Q

What is a pathologic delay in puberty?

A

hypothalamic, pituitary, gonadal disorders

116
Q

How do you eval a delay in puberty?

A
  1. look at growth velocity (delayed vs stalled)
  2. Tanner stages
  3. xray of L hand/wrist to check skeletal maturation
  4. additional tests: pelvic US, brain MRI, hormone teting, karotyping
117
Q

Tanner stages for boys?

A

1: pre puberty
2: enlargement of scrotum/testes
3: enlargement of penis length
4: enlargement of penis girth
5: adult genitalia

118
Q

Girls tanner stages?

A

1: pre puberty
2: breast buds, enlargement of areola
3: further enlargement
4: areola and papilla form secondary mound above level of breast
5: maure stage

119
Q

Boys and girls tanner stages?

A

1: prepuberty (villous hairs)
2: sparse growth, long dark hairs
3: darker, coarder hairds
4: adult hair, covering smaller area
5: adult hair type and quantitiy with horizontal upper border

120
Q

“2 minute MSK exam”

A
  1. move neck in all directions
  2. shrug shoulders against resistance
  3. arm stuff
  4. make fist, clench, spread fingers
  5. squat and duck walk 4 steps
  6. bend forward w/knees straight touching toes
  7. stand on heels and tip toes
121
Q

Is an EKG/echo recommended for routine sports physical?

A

NO!

122
Q

What is the female athlete triad?

A
  1. eating d/o
  2. menstrual dysfucntion
  3. low bone density
123
Q

What are complications of female athlete triad?

A
  • pathologic fractures
  • cardiac arrhythmias
  • hypoglycemia
  • seizures
  • resp. failure
124
Q

What is early findings in both bacterial and viral infections?

A

leukocytosis with neutrophil reponse

125
Q

What is seen on CBC in viral infection?

A

increased lymphocytes (neutrophil response is transient)

126
Q

What is seen on CBC in bacterial infection?

A

greater neutrophil counts (left shift with increased immature cells)

127
Q

When else might you order CBC?

A
  • eosinophilia for allergies
  • w/diff for cancer work up
  • H/F for preop prep
  • Hgb for anemia screening
128
Q

What does a peripheral blood smear show?

A

detects abnormalities in form and function

129
Q

What is a peripheral blood smear confirmatory for?

A

leukemia, sickle cell disease, anemia

130
Q

What is lumbar puncture gold standard for?

A

CSF eval in suspected meningitis and encephalitis?

131
Q

What LP values do you expect in BACTERIAL meningitis?

A
  • SUPER elevated pressure
  • super elevated leukocytes (mostly PMNs)
  • elevated protiens
132
Q

What LP values do you expect in VIRAL meningitis?

A
  • normal pressure
  • leukocytes (mostly lymphocytes)
  • normal protein
133
Q

What is gold standard for UTI confirmation?

A

urine culture

134
Q

When do you want to get cultures?

A

Every LP, joint aspiration, I and D, biopsy

135
Q

What are rapid tests typically testing for?

A

antigens

136
Q

What do serologic tests look for?

A

development of antibodies

137
Q

When do you use serologic tests?

A

hepatitis, HIV, lyme, HSV

138
Q

What do molecular tests look for?

A

GENETIC diagnostics

looks at DNA sequencing via PCR

139
Q

When do you use molecular tests?

A
  • to determine genetic carrier status
  • CF
  • fragile X
  • Huntington disease
  • Tay Sachs
  • Thalassemias
140
Q

What does steeple sign on xray signify?

A

croup

141
Q

what does thumbprint sign on xray signify?

A

epiglottitis

142
Q

What is normal pr interval?

A

under 0.2s

143
Q

What are benefits of CT?

A

fast! primary modality for acute/emergent situations

sedation rarely needed

144
Q

What are bad things of CT?

A

radiation (small increase in cancer risk)

145
Q

What are benefits of MRI?

A

Noninvasive (no radiation)

Test of choice for CNS abnormalities (brain tumor)

146
Q

What are downsides of MRI?

A
  • time-consuming

- sedation often required

Pediatrics (3 decks)

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