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5430: Ped's and Women's Health > Exam 1: Lectures > Flashcards

Exam 1: Lectures Flashcards

1
Q

What is the high quality recommendation screening for perinatal and postpartum depression?

A

1, 2, 4, 6, and 9 month well-child visits

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2
Q

When should screening for developmental delays be conducted based on high-quality practice recommendations?

A

6, 9, 12, 18, 24, and 36 months

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3
Q

Based on high-quality recommendations, when would you screen for social-emotional problems?

A

4-months, 15 months, 24 or 30 months, and 36 months

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4
Q

When does autism spectrum disorder screening happen according to high-quality recommendations?

A

18 months and then 24 or 30 months

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5
Q

You have a newborn baby coming to you for this first visit to the practice. What is an important screening to complete?

A

Domestic violence screening

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6
Q

High-quality recommendations suggest screening for domestic violence at which visits?

A

1st encounter to the practice, 6 month visit, 18 month visit, 24 or 30 month, 36 months

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7
Q

Is juice recommended for children under the age of 6 months old?

A

No, it can lead to poor dental health outcomes

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8
Q

Your patient comes in for their 18 month well child visit. They have a few teeth and their mother is concerned about cavity prevention. She would like to know if she should be using toothpaste when brushing the child’s teeth. What do you recommend?

A

Toothpaste is not recommended for use until 24 month (2 y/o). Continue to brush the child’s teeth twice a day with a soft toothbrush.

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9
Q

How much toothpaste does a child 2-6 y/o need?

A

A pea-sized amount

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10
Q

When should BP monitoring begin in children?

A

3 y/o

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11
Q

Vision screenings should occur in children at what ages?

A

5, 6, 8, 10 and 12 y/o

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12
Q

You have a patient who is 6 y/o in office for their well child exam. Their 5 y/o vision screen was 20/30 and you suggested to repeat it in a year knowing that some children will not reach 20/20 vision until age 6. Today, their vision screening is 20/40. What would you do next?

A

Refer to ophthalmology

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13
Q

When should you repeat a hemoglobin level on an infant?

A

9-12 months

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14
Q

When should lead levels be checked?

A

9-12 months and then 18-24 months

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15
Q

According to the AAP, when do you screen lipid panels?

A

6 y/o, 8 y/o, annually at 10 y/o

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16
Q

According to USPSTF, when do you screen lipid panels in children?

A

It is not recommended to screen lipid panels in children according to USPSTF

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17
Q

What are the components of the newborn visit?

A

A thorough history including prenatal, birth, and current history
Complete physical and vital signs
Anticipatory guidance for the parents
Wrap-up

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18
Q

Height, weight, head circumference, pulse, RR, temp, newborn screening testing, growth chart beginning at birth are components of:

A

Newborn assessment

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19
Q

Skin texture, plantar creases, breast, eyes, ears, genitals, posture, square window, arm recoil, popliteal angle, scarf sign, heel to ear help determine:

A

Gestational age

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20
Q

General appearance/temperament
Growth from birth
Skin integrity
Response to environment including muscle tone and symmetry of movement
Hearing/vision screening
Cardiac/Respiratory
Hip dysplasia or bone fractures
Cord healing and circumcision healing
Neurological defects
Abuse/neglect

A

Newborn physical assessment key aspects

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21
Q

Multiple, firm, pearly, opalescent white papules that exfoliate spontaneously

A

Milia

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22
Q

Yellow-white papultes generally over the nose, forehead, upper lip and cheeks

A

Sebaceous hyperplasia

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23
Q

Firm, yellow-white, 1-2 cm papule or pustules with surrounding erythematous flare that developed around 24-48 hours old

A

Erythema toxicum

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24
Q

Vesicopustules that rupture easily and leave a halo of white scales around a central macule of hyperpigmentation on the trunk, limbs, palms, and soles

A

Transient neonatal pustular melanosis

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25
Q

Scattered superficial bullae on the upper arms and lips

A

Sucking blister

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26
Q

Lacy, reticulated, red or blue vascular pattern

A

Cutis mermorata

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27
Q

Half of the baby’s coloring is red and the other half is pale

A

Harlequin color change

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28
Q

Yellow, hairless smooth plaque on the head or trunk

A

Nevus sebaceous

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29
Q

You have a patient that you diagnosis with nevus sebaceous. What would be your next step in the treatment plan for this patient?

A

Refer to pediatric dermatology as these lesions can develop into a secondary malignancy

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30
Q

If you see a preauricular skin tag or pit what are you concerned for?

A

Genetic disorders, especially those involving the kidneys

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31
Q

The child you are assessing has a loud diastolic murmur, what is your concern?

A

For a pathologic disorder

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32
Q

The child has a flow systolic murmur. What is the concern?

A

No concern, this is normal in infants

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33
Q

Moro, walking/stepping, rooting/sucking, tonic neck, palmar grasp, galant, seimming, and babinski’s are all:

A

Primitive reflexes seen in the newborn

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34
Q

What are management considerations for the preterm infant?

A

Additional vision and hearing screenings
Adjusted growth expectations
Supportive services for parent and baby based off of medical needs
Close medical surveillance

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35
Q

MISFITS acronym:

A

Metabolic disturbances
Inborn errors of metabolism
Sepsis
Formula dilution or over concentration
Intestinal catastrophes
Toxins
Seizures

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36
Q

MISFITS helps with DDx for which population?

A

Critically ill newborns

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37
Q

Newborns should have how many wet diapers/day?

A

6-8

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38
Q

G6PD deficiency, isoimmunization, extrvascular blood, polycythemia, sepsis, drugs, hypothyroidism, and bowel obstruction are all causes of what?

A

Pathologic etiology of hyperbilirubinemia seen with jaundice

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39
Q

The Rule of ‘3’ is helpful for remembering:

A

Colic
Onset by 3 weeks, gone by 3 months

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40
Q

Poor feeding/appetite or sucking
Fever >100.4
Inconsolable crying >3 hrs
Skin rash, red eyes, jaundice
Irritability, lethargy
Umbilical cord odor, drainage, or redness
Cough, vomiting (not spit-up), diarrhea, abdominal distention
Parents should:

A

Call the office immediately

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41
Q

Physical/Motor skills:
-Posterior fontanelle closure
-Step and grasp reflex begin to disappear
-Able to lift head to 45 degrees

A

2 month

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42
Q

Sensory/Cognitive markers:
-Looks at close objects
-Cry differentiates
-Coos, smiles
-Vocal response to familiar voices

A

2 months

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43
Q

Red flags:
-No startle
-Doll eyes
-Quiet
-Asymmetric movement
-Excessive irritability

A

2 months

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44
Q

Physical/Motor markers:
-Moro, tonic neck, and rooting reflexes fade
-Little to no head lag
-Able to sit straight if propped
-Raise head to 90 degrees on stomach
-Roll from front to back
-Reaches for objects with hands, can grasp with both hands, loves putting objects in mouth

A

4 months

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45
Q

Sensory/cognitive markers:
-Well-established close vision
-Starting hand-eye coordination
-Babbles, coos, laughs
-Anticipates feeding by visual cues
-Showing signs of memory development
-Attention seeking via fussing
-Recognize familiar voices and parental touch

A

4 months

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46
Q

Red flags:
-Lack of social smile
-Doesn’t track or turn to a voice
-No hand/mouth activity
-No attempt to raise head when prone
-Persistent fisting

A

4 months

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47
Q

Physical/Developmental markers:
-Doubled birth weight
-Vision 20/60
-Imitating sounds
-Enjoys hearing own voice, loves mirrors and toys
-Able to lift chest and head on stomach, bears weight on hands
-Rolls from back to stomach
-Able to grasp and pick up objects

A

6 months

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48
Q

Sensory/cognitive markers
-Vision 20/60
-Increasing complexity of sound stimulation
-Fear of strangers, recognizes parents
-All primitive reflexes except Babinski is gone

A

6 months

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49
Q

Red flags:
-No smiling or response to play
-No tracking, reaching, or looking for parents
-No grasping or babbling
-Head lag, no attempt to sit with support
-Persistent primitive reflexes

A

6 months

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50
Q

Physical/developmental markers:
-More regular elimination patterns
-Able to crawl, sit for prolonged periods of time, pulls self to standing
-Pincer grasp develops, can help feed self
-Throws and shakes objects

A

9 months

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51
Q

Sensory/cognitive markers:
-Developing depth perception and object permanence
-Responds to simple commands
-Knows their name
-Understands “no”
-May be afraid if left alone
-More interactive with play

A

9 months

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52
Q

Red flags:
-No eye contact or interactive play
-Does not sit in tripod
-No grasp, no visual/oral response to toys
-Asymmetric crawl
-No response to name

A

9 months

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53
Q

Physical/developmental markers:
-Triple birth weight, double birth length
-Head circumference = chest circumference
-6-8 teeth present
-Babinski reflex is gone
-Pulls to stand, may start cruising and walking with hand holding, attempting to walk independently
-Sits independently
-Turns pages, has a more precise pincer grasp

A

12 months (1 y/o)

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54
Q

Sensory/cognitive markers:
-Comprehends several words/simple commands
-“mama”, “dada”, a few other short words
-Imitates sounds and animal noises
-Can develop attachment to objects/toys
-Points to things, waves ‘bye’
-Separation anxiety, clingy to parents

A

12 months (1 y/o)

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55
Q

Emotional development for the toddler stage

A

Autonomy v. Shame/doubt

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56
Q

Cognitive development for the toddler stage

A

Piaget’s object permanence, visual displacement

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57
Q

Red flags/Health watch:
-Cannot walk by 18 month
-Fails to develop heel-toe walking pattern after several months of walking
-Less then 15 words by 18 months
-No two-word sentences
-No imitation of actions or words
-Cannot stack at least 6 blocks
-Doesn’t feed self
-Cannot follow simple instructions

A

2 y/o concerns

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58
Q

Emotional development: 3 y/o

A

Initiative v. Guilt

59
Q

Intellectual development: 3 y/o

A

Egocentric

60
Q

Health watch/red flags:
-Cannot throw ball, jump in place, ride a tricycle
-Cannot grasp crayon with thumb/fingers
-Difficulty scribbling
-Cannot stack 4 blocks
-Cries/clings to parents when they leave
-No interest in interactive play/ignores others
-Doesn’t engage with people outside family or fantasy play
-Resists dressing, sleeping, toileting
-Lashes out, angry outbursts, no self-control
-Cannot copy a circle
-Sentences <3 words, doesn’t use “me”/”you” correctly

A

3-4 y/o concerns, early intervention is key

61
Q

Early childhood

A

5-7 y/o

62
Q

Middle childhood

A

7-10 y/o

63
Q

Late childhood

A

10-12 y/o

64
Q

Developmental characteristics:
-Attached to opposite sex parent
-Sexual identity develops
-Growing social circle
-Learning to modulate behavior
-Development of consciousness
-Intuitive problem solving
-Magical thinking, egocentric

A

Early childhood

65
Q

Developmental characteristics:
-Superego/conscious is internalized
-Acquiring cultural/social skills and incorporating family values/beliefs
-Appreciated individuals interests/skills
-Desire to be successful part of the group
-Logic becomes more apparent, more objective with problem solving
-Motivation to achieve and learn

A

Middle childhood

66
Q

What is a key social developmental piece of information to assess in middle childhood?

A

Loss of learning motivation

67
Q

Developmental characteristics:
-Reemergence of sexual impulses
-Socialization with others with development of hobbies and interests outside of school
-Concrete and formal operational levels develop for problem solving

A

Late childhood

68
Q

Abstract thought process to conceptualized physical properties
Used to organized into a hierarchical system

A

Concerte operational

69
Q

Abstract thinking, complex reasoning, flexibility, hypothesis

A

Formal operational

70
Q

When does AAP recommend beginning screening for scoliosis?

A

8 y/o

71
Q

When should children start to have privacy and time separate from their parents at their well child visits?

A

Adolescents (11/12+

72
Q

SMR Pubic Hair (Males and females):
Absent hair

A

Stage 1

73
Q

SMR Pubic Hair (Males and females):
Downy hair present

A

Stage 2

74
Q

SMR Pubic Hair (Males and females):
Scant terminal hair present

A

Stage 3

75
Q

SMR Pubic Hair (Males and females):
Terminal hair fills the whole triangle overlaying the pubic area

A

Stage 4

76
Q

SMR Pubic Hair (Males and females):
Terminal hair extending beyond the inguinal crease onto the thigh area

A

Stage 5

77
Q

SMR Breast Development:
No glandular breast tissue palpable

A

Stage 1

78
Q

SMR Breast Development:
Breast bud palpable under the areola

A

Stage 2

79
Q

SMR Breast Development:
Breast tissue palpable outside areola
No development of the areola

A

Stage 3

80
Q

SMR Breast Development:
Areola elevated above the contour of the breast, forming a “double scoop” appearance

A

Stage 4

81
Q

SMR Breast Development:
Areolar mound recedes into single breast contour along with hyperpigmentation of the areola, papillae development, and nipple protrusion

A

Stage 5

82
Q

SMR External Genitalia (Male):
Testicular volume less than 4mL or long axis less than 2.5cm

A

Stage 1

83
Q

SMR External Genitalia (Male):
4mL to 8mL or 2.5 to 3.3 cm long

A

Stage 2

84
Q

SMR External Genitalia (Male):
9mL to 12 mL or 3.4 to 4.0cm long

A

Stage 3

85
Q

SMR External Genitalia (Male):
15 mL to 20 mL or 4.1 to 4.5 cm long

A

Stage 4

86
Q

SMR External Genitalia (Male):
> 20 mL or > 4.5 cm

A

Stage 5

87
Q

When is the ideal time to complete a sports participation physical and why?

A

4-6 weeks prior to the start of the season to allow for ample time to condition prior to the season thus preventing injury

88
Q

Dancing, running, strength training, swimming, tennis

A

Non-contact sports

89
Q

Baseball, cheerleading, fencing, figure skating, gymnastics, skiing, softball

A

Limited contact sports

90
Q

Basketball, field hockey, football, ice hockey, lacrosse, rugby, soccer, wrestling

A

High impact sports

91
Q

You have a patient that is diagnosed today in office with mono. She plays field hockey for her high school. She wants to know when she will be able to return to play.

A

Minimum: 1 month d/t high risk for splenic rupture

92
Q

Stress fractures and tendonitis are considered what type of injury?

A

Overuse

93
Q

Ligamentous injuries and fractures are considered what type of injury?

A

Macrotrauma

94
Q

You have a patient with Down Syndrome. They participate in Special Olympics events regularly. They are here today for their updated sports physical. What aspect is mandatory for assessment according the Special Olympics association for this athlete?

A

Cervical evaluation as atlantoaxial instability is associated with Down Syndrome.

95
Q

What is always on the differentials for children with back pain as a CC?

A

Neoplasms

96
Q

When do you treat pharyngitis/tonsillitis with antibiotics?

A

Group A Strep +

97
Q

Age (5-17 y/o)
Season (late fall, winter, early spring)
Evidence of acute pharyngitis (erythema, edema, exudates)
Tender, enlarged anterior cervical lymph nodes
Middle grade fever (101-104)
Absence of S/S of viral URI

A

Six points to consider Group A Strep

98
Q

Can GAS spontaneously resolve?

A

Yes, it generally spontaneously resolves in 3-5 days

99
Q

You have an 8 y/o M with confirmed GAS + pharyngitis. He has NKA. What are you going to prescribe for his treatment?

A

Amoxicillin or PNC

100
Q

Your patient comes in with sore throat and fever of 101.2 x2 days. She is 9 y/o and is diagnosed with GAS + tonsillitis. She is allergic to PNC with a reaction of severe hives. What do you prescribe to treat her?

A

Cephalexin
If concurrent allergy to cephalosporins: azithromycin or clindamycin

101
Q

Your patient comes in with conjunctivitis x1 day with a fever of 103. You note on exam they also have mucositis, peripheral edema, a truncal rash and cervical adenopathy. What’s the lead on your differentials at this time.

A

Kawasaki disease

102
Q

What is the most common cause of pharyngitis?

A

Viruses

103
Q

What is the causative agent of enterovirus?

A

Coxsackie A

104
Q

Small vesicles in the posterior pharynx
Usually seen in children 1-10 with mean age of 4 y/o

A

Enterovirus

105
Q

Hand/foot/mouth disease is formally known as:

A

Adenovirus

106
Q

Fever
Severe pharyngitis
Posterior AND anterior cervical lymphadenopathy
Can have hepatosplenomegaly
Commonly seen in adolescence

A

Mono

107
Q

Order from shortest duration to longest:
Mononucleosis
Viral pharyngitis
Bacterial pharyngitis

A

Viral, bacterial, mono

108
Q

What is the most common cause of sick visits for children?

A

Acute otitis media

109
Q

What are the 3 most common bacteria that cause AOM?

A

Strep pneumoniae
H. influenzae
Moraxella catarrhalis

110
Q

Which 2 vaccines given in infancy can help with protection against the bacteria that can cause AOM?

A

Hib and PCV13

111
Q

Acute history of onset
S/S middle ear inflammation, bulging TM AND middle ear effusion

A

AOM diagnostic criteria per AAP

112
Q

< 6 weeks old
Immunocompromised
Failure of antibiotics after 2-3 rounds
Fluid in middle ear > 12 weeks
Recurrent infections (>3 in 6 month period)
Hearing loss > 3 months

A

Reasons to refer for tympanocentesis

113
Q

You are seeing a 3 y/o F for a sick visit. She has a mild fever, ear pain, and has been more irritable for the past 2 days. Mom reports she has noticed she a poor response when called from other rooms as well. She has NKA. When assessed, you note a bulging TM with moderate effusion and inflammation of the middle ear. You diagnose her with AOM. What will you prescribe for this patient?

A

Amoxicillin for 7 days

114
Q

You have a 4 y/o M presenting for sick visit with mom. He has had increasing fatigue, low grade fever. He keeps asking his parents to repeat what they are saying and keeps pulling on his L ear saying it hurts. On exam you see middle ear inflammation, mild effusion, and a bulging TM. He is allergic to PNC. What do you treat him with?

A

Erythromycin/sulfasoxazole for 7 days

115
Q

You prescribed 2 patients treatment for AOM on the same day. When would you like them to return for a follow up?

A

48 hours after initiation of medication

116
Q

At the 48 hour mark, both your patients are improving with their AOM. When would you like to see them back?

A

10-14 days

117
Q

Is testing necessary when diagnosing otitis externa?

A

No. You can culture the fluid if there is drainage or run labs if the patient is toxic appearing

118
Q

What do you use to treat otitis externa?

A

Astringents
Acetic acid solutions
Ear wick
Ear drops

119
Q

Most acute rhinosinusitis occurs in the:

A

Maxillary sinuses

120
Q

When do the maxillary sinuses present

A

At birth with the ethmoid sinuses

121
Q

When do the sphenoid sinuses pneumatize?

A

5 y/o

122
Q

When can you begin assessing the frontal sinuses?

A

7 y/o, but don’t fully develop until adolescence

123
Q

What are the 2 most common predisposing factors of sinusitis?

A

URI, allergic rhinitis

124
Q

What is a common condition associated with asthma?

A

Chronic rhinitis (80% of people with asthma)

125
Q

What is the treatment course length for acute rhinosinusitis?

A

14 days

126
Q

What is your 1st line treatment for acute rhinosinusitis?

A

Amoxicillin
If PNC allergy: macrolide (Clarithromycin is best)

127
Q

When can the fundoscopic exam begin?

A

5 y/o

128
Q

Defective development of visual pathways needed to attain central vision, generally unilateral

A

Amblyopia

129
Q

Deprivational ambylopia

A

Ptosis, cataract, nystagmus

130
Q

Refractive amblyopia

A

Myopia, hyperopia, astigmatism, anisometropia

131
Q

Treatment for amblyopia:

A

Corrective lenses by an ophthalmologist

132
Q

Strabismus treatment:

A

Eye patching the “good eye”
Corrective lenses
Surgical intervention (not a 1st line)

133
Q

Is nystagmus ever a normal finding?

A

Yes in the first few weeks of life, if persists the patient should be referred

134
Q

Strabismus, decrease visual acuity, white pupil, abnormal red reflex, nystagmus, glaucoma, cellulitis, and photophobia are signs of:

A

Retinoblastoma

135
Q

Insufficient breakdown of membrane that covers the nasolacrimal duct
Begins 2-6 weeks old and generally resolves spontaneously

A

Nasolacrimal duct obstruction

136
Q

When should nasolacrimal duct obstructions be treated with eye drops?

A

When there is excessive mucuopurulent exudate

137
Q

What is the recommended ages for audiometry testing?

A

3, 4, 5, 10, 12, 15, and 18 y/o

138
Q

Permanent hearing loss most commonly associated w/ dysfunction of the inner ear

A

Sensorinerual hearing loss (SNHL)

139
Q

Blocked transmission of sound waves from the external auditory canal to the inner ear

A

Conductive hearing loss

140
Q

Abnormalities of the outer, middle, and inner ear

A

Mixed hearing loss

141
Q

Nerves or nuclei of the CNS are impaired

A

Central hearing loss

142
Q

Birth weight < 1500g
Apgar 0-3 in first 5 minutes, hypotonia up to 2 hr old
NICU admission > 2 days
Prolonged mechanical ventilation (>10 days)
Metabolic disorders
Hyperbilirubinemia with kernicterus or needing transfusion
Ototoxic drug use

A

RF for SNHL in newborns

143
Q

Recurrent OME for > 3 months
Head trauma with LOC or skull fx
Bacterial meningitis
Ototoxic medications
DM
Kidney malformation
FH childhood hearing loss
Neurodegenerative disorders
Syndromes associated with progressive HL
Neurofibromatosis
Parental concern of delays

A

RF for SNHL in children 1 month-3 y/o

144
Q

If there is cause for concern with vision, hearing, eye/ear abnormalities, what should the NP do?

A

Refer to the specialist

5430: Ped's and Women's Health (6 decks)

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