Clin Assess Flashcards
How often do you see kids for well child visits?
1-2 weeks then @2, 4, 6, 9, 12, 15, 18, 24 months, then annually
what are the 4 principles of child development?
- follows predictable pathway
- wide range of “normal”
- various factors affect development
- childs development level affects how you can conduct hx and PE
What do you want to do in first 24 hours after baby is born and before d/c?
- screen for congenital heart disease using pulse ox
2. circumcision
How soon should baby regain birth weight?
by 2 weeks
What are the 5 components of Apgar score?
- HR
- RR
- Muscle tone
- reflex irritability
- color
When do you calculate apgar score?
1min and 5min
What are normal apgard scores?
8-10
What are milestones at 2 months?
- smiles
- turns head to sounds
- pays attention to faces
What are 4 month milestones?
- likes to play with people
- copies facial movements (smile, frown)
- babbles with expression
- cries in different ways to show hunger, pain, tired
What are 6 month milestones?
- 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!
What are 9 month milestones?
- sitting on own
- pulling up to stand
- some may start walking
- crawls
What are 12 month milestones?
- WALKING! (safety is big emphasis at visit)
- WHOLE milk
- simple gestures (waving)
- says “mama” “dada”
What are 18 month milestones?
- walking on own ( up steps, runs)
- starting to TALK (“no”)
- drinks from cup, eats with spoon
- can follow 1-step commands
What are 2yo milestones?
- start showing independence (reassure parents this is normal!)
- switch to SKIM milk
- toilet readiness
- makes/copies straight lines/circles
What are 3yo milestones?
fine motor skills (holding pen, drawing)
What are 5yo milestones?
- friends
- counts to 10
- can use toilet on own
What are 6-10 milestones?
achievement by trial-and-error, goal-directed
When does puberty start?
girls- 10yo
boys- 11yo
What is the last step of puberty?
growth spurt
When does puberty end?
girls- 14yo
boys- 16yo
When and how often do you measure head circumference?
every visit until 2yo
How often to measure weight/length?
every visit until 2yo (then height?)
How do you define failure to thrive?
- growth under 5th percentile
- drop 2 quartiles in 6 months
- weight for length under 5th percentile
What are breastfeeding guidelines?
- exclusive breastfeeding for 6 months
- followed by continued breastfeeding with other food introduced at 6 months
- continue breastfeeding until 1yo (or longer)
What are benefits of breastfeeding?
Lower rates of: infection, allergies, SID, celiac dz, IBD, obesity, DM, leukemia, neurodevelopment outcomes
When do you transition from baby food?
12 months
When do you switch to WHOLE milk?
12 months
When do children “graze”
12 months
When do you switch to SKIM milk?
2yo
What are car seat guidelines?
- 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
When do you get your primary teeth?
first tooth eruption: 4-15 months
By age 3: 20 teeth
When do you get permanent teeth?
eruption: 5-7yo
ends by: 13-14yo
What is the #1 chronic disease in children?
dental caries
When and how often should children be getting flouride varnish?
children 6months-5yo
q3-6 months
What are guidelines for screen time?
- avoid before age 2
- limited to 2hrs
- monitor content
- “screen free zone”
What can excessive media lead to?
attention problems
school difficulties
sleep/eating d/o
obesity
What is the leading cause of death in children after 1st year of life?
injuries
What are newborn screening tests?
- pulse ox
- H/H
- lead screening
- TB skin test
- visual acuity
- hearing
- cholesterol
- STI/HIV
What is colic?
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
What is tx for colic?
reassurance, learn ways to soothe/comfort
At what age do children have temper tantrums?
1-4yo (usually once a week)
When do breath-holding spells occur?
6 months-6yo
during expiration (falls silent)
often response to anger/injury
rarely LOC
What is enuresis?
repeated urination durin day or night in child over 5yo
must occur at least 2x/week x3 months
What is encopresis?
repeated passage of stool in inappropriate places by child over 4yo
What is the reason behind encopresis usually?
constipation (90% of time)
What is a night terror?
w/n 2 hours of falling asleep, lasts 30 min
doesn’t wake up
What is a nightmare?
child wakes up alert
What is dyssomnias?
trouble initiating sleep and/or waking @night
What is the most common feeding problem?
refusing to eat
What can cause early closure of fontanelles?
- microcephaly
- craniosynostosis
- metabolic abnormalities
What can cause delayed closure of fontanelles?
- normal variant
- hypothyroidism
- megacephaly
- increase intracranial pressure
- ricketts
What does a depressed anterior fontanelle signify?
dehydration
What is caput succedaneum?
soft tissue swelling related to dlivery process
CROSSES suture lines
What is cephalohematoma?
DOES NOT CROSS suture lines
more firm discrete
predisposes to jaundice
What is subgleal hemoragghage?
life-threatening!!
What does an absent or unequal red reflex signify?
congenital catarats (need optho referral)
When is subconjunctival hemorrhage seen?
babies born vaginally
What causes purulent eye discharge?
gonococcal conjunctivitis
What is associated with low set, posterior rotated ears?
- renal anomalies
- hearing loss
What are things you see in babues gums?
Bohns nodules, Epstein pearls
What is micrognathia?
- lower jaw pushed back
- underlying chromosomal abnormality
- feeding difficulty
When should baby pass first meconium?
w/n 72 hours
What is transitional stool?
green/brown
What are sacral dimples?
- no problem if can see base
- If can’t see base, EMERGENCY! want to make sure not connected to spinal canal
What is imperforate anus?
hole not in right place
What is hypospadius?
penis hole underneath
What is epispadias?
penis hole on top
What is chordee?
penis attached to abdomen
What is hydrocele?
transilluminates
What is Barlow test?
dislocating hip
What is ortolani test?
relocating hip
What is Galeazzi test
lay prone with knees bent
What do you do if you hear/feel a click during hip dysplasia tests?
get US!
What is the rooting reflex?
stroke cheek
What is the galant reflex?
stroke side of stomach
what is the moro reflex?
drop baby
What is hypotonia associated with?
Downs syndrome, neurologic deficit
What is erythema toxicum?
Benign, looks like flea bites all over
-if persists longer tahn first week–> make sure not contact dermatitis, flea/scabies bites
What is cutis marmorata
mottling
What is mottling associated with?
premature infants
congenital hypothyroidism
Downs syndrome
What is acrocyanosis?
blue hands/feet
What is linea nigra?
hypopigemented line from belly button to pubic
What is nevus simplex?
salmon patch, stork bite
What are slate grey patches?
Mogolian spots
How do you assess a newborn for jaundice?
apply pressure to skin to press out normal color. Look for yellowish “blanching”
What is normal jaundice?
appears in 48-72 hours and peaks on fifth day. usually disappears w/n a week.
What is a common cause for physiologic jaundice?
breastfeeding
What does jaundice w/n first 24 hours signify?
hemolytic anemia
What does late-appearing jaundice or jaundice that lasts 2-3 weeks signify?
biliary obstruction/liver disease
What are risk factors for jaundice? (5)
- premature
- breastfed
- illness/sepsis
- ABO incompatiblity
- G6PD deficiency
How do you estimate gestation age?
under 35 weeks- premature
35-36 weeks- late preterm
37-42 weeks- term
over 42 weeks- post-term
What classifies SGA and LGA
SGA is under 10th percentile
LGA is over 10th percentile
What are possible indications of abuse in an infant?
- 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)
What are strong indications of sexual abuse?
- 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
What does H. influenza B cause?
periorbital cellulitis
What is important to distinguish between in undescended tests?
undescended testes vs highly tractile testes vs active cremasteric reflex
What is an intrinsic cause of stained teeth?
tetracycline
What is an extrinsic cause of stained teeth?
poor oral hygiene
What lymph nodes are commonly enlarged in children?
cervical lymph nodes
What are brushfield spots?
abnormal speckling spots on iris (suggest Downs)
What is herpetic stomatitis?
tender ulcerations of oral mucosa and surrounded by erythema
What are facial characteristics of fetal alcohol syndrome?
- short palpebral fissures
- wide, flat philtrum
- thin lips
What does fetal alcohol syndrome put kid at risj for?
- growth deficiency
- microcephaly
- mental retardation
What is cretinism?
congenital hypothyroidism
What are features of congenital hypothyroidism?
- coarse facial features
- low-set hairline
- sparse eyebrows
- enlarged tongue
- hoarse cry
- umbilical hernia
- myxedema
- mottled skin
- mental retardation
What can congenital syphilis cause?
- 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)
What can cause facial nerve palsy in infant?
- injury to nerve during delivery
- inflammation of middle ear during AOM
- Bells palsy
What are characteristics of Downs syndrome?
- 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
What are characterists of hyyerpthyroidism in children?
- accelerated growth
- staring eyes (not true exophthalmos)
- enlarged thyroid gland (goiter)
What is craniosynostisos?
premature closure of 1 or more sutures of skull
results in abnormal growth of skull
What are leading causes of morbidity in adolescents?
- unintended PG
- STIs
- substance abuse
- smoking
- dropping out of school
- depression
- homelessness
- physical violence
What is parental consent not needed for?
- substance abuse tx
- STI screening/tx
- PG prevention and care
- sometime abortion
- mental health clinic
- emergency care
What is delayed puberty defined as?
- 12yo for girls (breast development is first sign)
- 14yo for boys (testicular enlargement is first sign)
What is a constitutional delay in puberty?
will eventually progress spontaneously through
What is a pathologic delay in puberty?
hypothalamic, pituitary, gonadal disorders
How do you eval a delay in puberty?
- look at growth velocity (delayed vs stalled)
- Tanner stages
- xray of L hand/wrist to check skeletal maturation
- additional tests: pelvic US, brain MRI, hormone teting, karotyping
Tanner stages for boys?
1: pre puberty
2: enlargement of scrotum/testes
3: enlargement of penis length
4: enlargement of penis girth
5: adult genitalia
Girls tanner stages?
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
Boys and girls tanner stages?
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
“2 minute MSK exam”
- move neck in all directions
- shrug shoulders against resistance
- arm stuff
- make fist, clench, spread fingers
- squat and duck walk 4 steps
- bend forward w/knees straight touching toes
- stand on heels and tip toes
Is an EKG/echo recommended for routine sports physical?
NO!
What is the female athlete triad?
- eating d/o
- menstrual dysfucntion
- low bone density
What are complications of female athlete triad?
- pathologic fractures
- cardiac arrhythmias
- hypoglycemia
- seizures
- resp. failure
What is early findings in both bacterial and viral infections?
leukocytosis with neutrophil reponse
What is seen on CBC in viral infection?
increased lymphocytes (neutrophil response is transient)
What is seen on CBC in bacterial infection?
greater neutrophil counts (left shift with increased immature cells)
When else might you order CBC?
- eosinophilia for allergies
- w/diff for cancer work up
- H/F for preop prep
- Hgb for anemia screening
What does a peripheral blood smear show?
detects abnormalities in form and function
What is a peripheral blood smear confirmatory for?
leukemia, sickle cell disease, anemia
What is lumbar puncture gold standard for?
CSF eval in suspected meningitis and encephalitis?
What LP values do you expect in BACTERIAL meningitis?
- SUPER elevated pressure
- super elevated leukocytes (mostly PMNs)
- elevated protiens
What LP values do you expect in VIRAL meningitis?
- normal pressure
- leukocytes (mostly lymphocytes)
- normal protein
What is gold standard for UTI confirmation?
urine culture
When do you want to get cultures?
Every LP, joint aspiration, I and D, biopsy
What are rapid tests typically testing for?
antigens
What do serologic tests look for?
development of antibodies
When do you use serologic tests?
hepatitis, HIV, lyme, HSV
What do molecular tests look for?
GENETIC diagnostics
looks at DNA sequencing via PCR
When do you use molecular tests?
- to determine genetic carrier status
- CF
- fragile X
- Huntington disease
- Tay Sachs
- Thalassemias
What does steeple sign on xray signify?
croup
what does thumbprint sign on xray signify?
epiglottitis
What is normal pr interval?
under 0.2s
What are benefits of CT?
fast! primary modality for acute/emergent situations
sedation rarely needed
What are bad things of CT?
radiation (small increase in cancer risk)
What are benefits of MRI?
Noninvasive (no radiation)
Test of choice for CNS abnormalities (brain tumor)
What are downsides of MRI?
- time-consuming
- sedation often required
