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Pediatrics > Exam 2 General > Flashcards

Exam 2 General Flashcards

1
Q

“…a flexible, continuous process in which knowledgeable professionals perform skilled observations of children during child health care.”

A

Developmental Surveillance

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2
Q

Components of developmental surveillance

A

Eliciting and attending to parents’ concerns

Obtaining relevant developmental history

Skillfully observing children’s development

Sharing opinions with other professionals

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3
Q

Define Developmental Screening

A

Brief test to “sort out those who probably have problems from those who probably do not”

A part of surveillancwe

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4
Q

American Academy of Pediatrics Guidelines for developmental surveillance

A

Perform developmental surveillance at each health supervision visit → if concerns, administer screening test

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5
Q

When should you perform structured developmental screening?

A

at 9, 18 and 30 months

may need to do at 24 months instead of 30 months due to insurance

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6
Q

Benefits of parent-report screening tools

A

less time, same or better psychometrics

administer so complete by the time provider enters the room

foundation for counseling and anticipatory guidance

brings concerns to attention of parents and reassures others

reduces “oh by the way..”

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7
Q

Define global developmental delay

A

delay in 3 or more areas

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8
Q

Define isolated developmental delay

A

delay in 1 area most often speech and language

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9
Q

Define atypical developmental delay

A

Asynchronous, or “out
of order”
uneven development, advanced in some areas, behind in others “splintering”

Think ASD

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10
Q

What may a parent be trying to convey when they say “It seems like my child can’t hear. I call his name, but he just ignores me.”

A

“My child has poor joint attention”

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11
Q

What are the 4 components of joint attention?

A

Oriented and attending to a social partner

Coordinating attention between people and objects

Sharing affect and emotional states with people

Being able to draw others’ attention to objects or events to indicate need or to share experiences

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12
Q

What age should a child develop affective reciprocity (back and fourth baby talk)?

A

3-6 mo

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13
Q

What age does a child develop joint attention (shared experience brining someone in to share)?

A

12-18 mo

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14
Q

What age does a child develop theory of mind (not everyone thinks like me)?

A

30 mo

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15
Q

What age does a child develop intuitive psych (feed baby doll because recognize it may be hungry)?

A

4-5 yrs

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16
Q

How much speech is intelligible at 2 yrs?
3 yrs?
4 yrs?

A

2 yrs - 50%
3 yrs- 75%
4 yrs - 100%

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17
Q

When do you expect a child to be able to turn head towards sound by?

A

6 mo

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18
Q

Possible causes of failure to thrive

A 
Not enough food offered
Child not taking enough food
Emesis
Malabsorption
Increased metabolic demand
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19
Q

What are sentinel injuries?

A

Warning signs for potential abuse

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20
Q

What bruising sites cause concern for abuse?

A 
face/head
chest/abd
back
buttocks
arms
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21
Q

What age children have the highest rate of maltreatment?

A

<1 yo

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22
Q

child abuse FRAMER

A

F: Give parents a listing of the FACTS that have led to your concern

R: Explain that you are REQUIRED TO REPORT on behalf of the child (not against the parents)

A: State that a formal ASSESSMENT is needed to determine the exact nature of the problem and need for treatment

M: Present a MENU of alternatives for evaluation and treatment services (Team Approach)

E: EMPATHY. Acknowledge how difficult a process this is for everyone

R: Insist that you receive a REPORT BACK from the assessment and have open communication with the child protection worker

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23
Q

no pubic hair

pre-pubertal breast

A

SMR 1

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24
Q

sparse pubic hair, vellus

bud under areola

A

SMR 2

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25
Q

Dark, curly, lateral spread pubic hair

Mound beyond areola, single contour

A

SMR 3

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26
Q

Adult pubic hair, no thigh extension

Secondary areolar mound

A

SMR 4

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27
Q

Adult pubic hair, extends to thighs

Adult size, single contour breast

A

SMR 5

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28
Q

No pubic hair
<4 mL testicular vol
Pre-pubertal penis

A

SMR 1

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29
Q

Sparse, vellus pubic hair
>4 mL testicular vol
Slight increase in penis size

A

SMR 2

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30
Q

Dark, curly, lateral spread pubic hair
>8 mL testicular vol
Increase in penis length

A

SMR 3

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31
Q

Adult pubic hair, no thigh extension
>12 mL testicular vol
Increase in penis width

A

SMR 4

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32
Q

Adult pubic hair, extends to thighs
>16-20 mL testicular vol
Adult size penis

A

SMR 5

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33
Q

Precocious Puberty in females

A

SMR 2 prior to age 8

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34
Q

Delayed Puberty in females

A

No thelarche by age 13 years
No pubic hair by age 14 years
No menarche by age 16 years
More than 3-5 years between thelarche to menarche

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35
Q

Precocious Puberty in males

A

SMR 2 prior to age 9 years

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36
Q

Delayed puberty in males

A

No testicular growth by age 14 years

No pubic hair by age 15 years

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37
Q

W/u for precocious puberty

A

Ultrasensitive LH

AM 17 hydroxyprogesterone

Estradiol, testosterone (ultrasensitive)

Pelvic/Testicular ultrasound

Bone Age

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38
Q

Premature Thelarche (Female)

A

Early development of breast tissue typically in toddler most cases will regress in 18 mo

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39
Q

Premature Adrenarche (Female & Male)

A

Early development pubic hair (<8 girls, <9 boys)
MC in girls

No thelarche or other pubertal signs

40
Q

What would cause concern when working uo precocious puberty?

A

Advanced bone ages

↑ gonadotropins

↑ sex-steroid levels

Contra-sexual puberty suggests tumor (diff then pts sex)

41
Q

Central precocious puberty

A

Sex steroid and gonadotropins will be ↑

Always evaluate CNS with MRI in boys; most girls do not have a CNS lesion, but check if CNS symptoms

42
Q

Peripheral precocious puberty

A

McCune-Albright—Café au lait spots that don’t cross midline, jagged boarder

Typically gonadotropins are ↓

43
Q

Bone growth at early to mid adolescence

A

Limbs accelerate before trunk with distal limbs accelerating before proximal

“All hands and feet”

44
Q

Bone growth at mid to late adolescence

A

Primarily truncal growth

45
Q

What percentage of height growth is complete by SMR 4?

A

95%

probably wont get any taller at this point

46
Q

When do males hit peak height velocity?

A
  1. 5 years

10. 3 cm/year

47
Q

When do females hit peak height velocity?

A

11.5 years

9cm/year and 6-8 cm after menarche

48
Q

What happens to Alk phos during adolescent bone growth?

A

increases

49
Q

Cholesterol in males in adolescence

A

HDL ↓

LDL ↑

50
Q

Cholesterol in females in adolescence

A

HDL ↑

LDL ↓

51
Q

Serum creatinine changes in adolescence

A

increases to adult level

52
Q

Neurocog changes in adolescence

A

Limbic System (emotional reg)- very active in early teens, HIGH # of gonadal hormone receptors

Prefrontal Cortex—Executive functioning, reasoning

Neuronal pruning between these two areas is not complete until mid/late 20’s

53
Q

Is cognition and psychosocial development related to age or SMR?

A

age

54
Q

Early adolescence age range

A

10-14 years

55
Q

Middle adolescence age range

A

15-17 years

56
Q

Late adolescence age range

A

18-21 years

57
Q

Emerging adulthood age range

A

to 24-26 years

58
Q

What changes occur in early adolescence?

A

Quest for Autonomy

less interest in fam activities, look to peers, self aware and self consciousness, sexual attraction and risk behavior with more interest than actual action

59
Q

What changes occur in middle adolescence?

A

Exploring Identity

Sep from family, greatest teen/parent conflict, unique self within group, dating and sexual orientation, action more equal to interest now in terms of sex and risk behaviors, decision making impaired in “hot” situations

60
Q

What changes occur in late adolescence?

A

Realization of Self

renegotiate relationship frmo child-parent to adult-adult, more positive interactions, individual values>peer group values, longer romantic involvement with future plans, goals

61
Q

oxic Stress

A

extreme, frequent, or extended activation of the body’s stress response in absence of supportive caregiving

62
Q

coitarche

A

1st intercourse

63
Q

When should you start sex ed conversation?

A

5th and 6th grade

64
Q

Teen pregnancy risks

A

Increased risk for medical and psychosocial problems

Poor maternal weight gain, HTN, anemia

Poverty, lower educational attainment

Violence during/after pregnancy

Risk of death by homicide is 2.6x greater in pregnant and post-partum teens

Poor mental health—higher rates of post-partum depression

65
Q

What are the 2 leading causes of death in 15-19 yo?

A

injury
homicide
suicide

66
Q

MALPRACTICE

A 
M= Mental Health
A= Attempts
L= Lethality
P= Plans
R = Risk taking
A= Alcohol and Drugs
C= Conflict
T= Trauma
I= Impulsivity
C= Community Resources E= Exposure
67
Q

CRAFT

A

Car- Have you ever gotten in a car with someone drunk/high?

Relax/Fit in—Have you used alcohol or drugs to relax or fit in?

Alone—Have you used alcohol/drugs when you are alone?

Family/Friends—Has anyone talked to you about cutting down?

Forget things—Have you forgotten something you’ve done when you were drunk/high?

Trouble—Have you ever gotten in trouble or done something you regretted when you were drunk/high?

68
Q

Age of peak height velocity

A
  1. 5 years in males

11. 5 years in females

69
Q

When should arm span be less than height for boys?

girls?

A

boys before 11 yo

girls before 11-14 yo

70
Q

What can discordant arm span and heights indicate?

A

skeletal dysplasias rather than hormone deficiencies

71
Q

What are benign causes of short stature?

A

Constitutional Growth Delay Familial Short Stature Idiopathic Short Stature

72
Q

What are pathologic causes of short stature?

A

Endocrine

Genetic Syndromes Nutritional Disorders Chronic Illnesses/Drugs

73
Q

BMI >85-95th percentile

A

“Overweight”

74
Q

BMI >95th percentile

A

“Obese”

75
Q

What is Broselow Tape?

A

Color coded tape
Each color corresponds to estimated weight class
Often paired with pediatric color coded crash cart

76
Q

What is AMPLE?

A

2nd trauma eval

A - Allergies
M - Medications
P – Past medical hx/pregnancy
L – Last meal
E – Events/environment leading to the injury
77
Q

What is concern if asystole persists after IV epinephrine x 2 OR after 25min of CPR

A

Death or neurologically poor survival

78
Q

What can untreated hypoxemia or untreated shock lead to

A

prolonged MI

79
Q

What is the most common cause of death due to traumatic injury?

A

MVA

80
Q

Define afterdrop

A

Initial drop in temp during initial warming

81
Q

Irreversible CNS injury occurs after how many mins of hypoxemia

A

3-5 min

82
Q

MC ingested in children

A

coins

83
Q

2kg weight loss = how much fluid loss

A

2 L

84
Q

mc cause of death <1 yo

A

suffocation

85
Q

mc cause of death 1-4 yo

A

drowning

86
Q

mc cause of death 4-18 yo

A

MVA

87
Q

2nd leading cause of childhood mortality

A

cancer

88
Q

leading cause of cancer- related death in children

A

brain and CNS tumors

89
Q

In newborns, MCV is (high/low) and gradually (inc/dec) over first few months of life

A

High

decreases

90
Q

lower limit of nrml MCV for children >1

A

70 + age

91
Q

Reciprocal smiling

A

2 mo

92
Q

Joyous smiling, known caregiver

A

6 mo

93
Q

Gaze monitoring, follow caregivers gaze

A

8 mo

94
Q

Follows a point

A

10 mo

95
Q

Porto-imperative pointing

“I want that”

A

12 mo

96
Q

Porto-declarative pointing

Bring to attention not for help

A

14 mo

Pediatrics (7 decks)

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