General Peds Flashcards
What does pediatrics focus on?
primary prevention
What does adult med focus on?
secondary and tertiary prevention
What is primary prevention?
vaccine
prevents things from occuring
What are pediatric normal values?
based on bell curve
normal: 5th-95th%
low: 95%
What is a fever?
100.4F
What is tachycardia in babies?
> 200
What is RR overtime?
30-60 –> 20-40 –> 10-20
What is newborn?
1-2 mo
Infant?
2-24 mo (2yrs)
Child?
24-48mo (toddler)
5-11yo (school)
Adolescent?
12-18yo (teens)
What is important during peds exam?
DEVELOPMENTAL (social, language, intellectual/cognitive/motor)
What is developmental delay?
not reaching milestones
When to do head circumference chart?
0-36mo
Exam -2mo?
primitive reflexes intact look at familiar/parents coos turn head toward sound hold head smooth movements of arms and legs
Exam -2 mo red flags?
no watching no smile no hand to mouth no response to sound no holding head
Exam - 4mo?
no more primitive reflex play w/ people copies movement and sounds babbles smiles, laughs, and cries in diff ways responds to affection reaches toy w/one hand holds unsupported head roll over pushes up to elbows
Exam -4mo red flags?
trouble moving one or both eyes
no smile (2mo)
no steady head (2mo)
no coo (2mo)
Exam - 6mo?
increased tone/strength equilibrium able to tell strangers play w/ others looks happy look at mirror vowels and consonants responds to name look around transfer objects hand to hand rolls over in both direction sit without support rocks back and forth
Exam -6mo red flags?
no affection no vowel no roll over no laugh tight muscles or rag doll
Exam - 9mo?
parachute reflex afraid of strangers favorite toys understands NO mamama and bababa and dadada fingers to point looks for things you hide peek-a-boo picks up cereal (thumb and index) sitting position stand crawls
Exam - 9mo red flags?
no sitting no babbling no games no response to name no looking where you point
Exam - 12mo?
CBC & LEAD TESTING *1st words *1st steps *ONE word *ONE step commands cries w/no mom or dad fear responds to simple request simple gestures (no , bye bye) start to understand words shaking, banging, throwing things finds hidden things easily drinks from cup pokes w/ index finger cruising (walks holding on furniture) first steps stand alone
Exam - 12mo red flag?
loses skills no point no crawl no stand no words
Exam -18 mo ?
tantrums (frustration of no vocab dictionary) pretend play alone explore w/ parents nearby says words (10-12) point what he wants scribbles follow 1 step verbal commands climb stairs pulls toys while walking eat w/ spoon
Exam-18mo red flags?
no care if caregiver leaves
loses skills
Exam - 24 mo?
*sentences 2-3 words
*2 step instruction
*2 for points –> copies lines
*2 for towers –> stack blocks
*strangers understand 2/4
independent
defiant behavior
know body parts
follow simple instruction
repeats words
completes sentences
names items
stands on tiptoe
kicks ball
run
climb down furniture
Exam -24mo red flags?
no 2 words
no follow direction
no walk steadily
loses skills
Exam - 36mo?
SPATIAL *3 words sentences *strangers understand 3/4 *rides TRIcycle *puzzles 3-4 pieces affection for friends emotions separates from mom and dad dresses and undresses says first name, age, sex names friends
Exam -36mo red flags?
no pretend play
no play with other children
no eye contact
Exam -4 yo?
COMPLEX *40lbs *40in *draw 4 sided figures *stranger understand 4/4 100% *draws person w/ 2-4 body parts doing new things pretends mom and dad sings song tells stories says first and last name use scissors plays board/card games hops and stand on one foot catch bounced ball
Exam - 4yo red flag?
no follow 3 part commands
no understand ‘same’ and ‘different’
no use ‘me’ and ‘you’
speaks unclearly
1yo?
NO bottle and binkie
whole milk
dentist appt
3yo?
vision screen
dangers of curiosity! (matches, knives)
4yo?
hearing screen
School age?
5-10yr same sex friendship --> transient somatic complaints emotions math and language desire to be successful master motor skills
Adolescent?
11-18yo
sex roles develop
friendships are more permanent
invincible
understand hypothetical and deductie reasoning
hormonal changes
scoliosis screen - musculoskeletal maturity
Adolescence guidance?
HEEADSSS Home ok? Education ok? Eating ok? Activities- fave? Drugs Safety at home, school? Sexuality Suicide/mental health
Puberty?
hormone induced that cx 2ndry sex characteristics
Puberty age?
girls: 8-12yo
boys: 9-14yo
Tanner/SMR staging?
scale 1-5
Tanner/SMR female?
1- prepubscent 2 - light hair; breast buddying 3 - darker coarse hair; full breast 4 - adult hair; secondary mound (areola) 5-hair to thigh; darkening tissue around breast
Tanner/SMR male?
1- prepubscent
2- hair along penis; enlargement of penis, testes
3- darker coarse hair; phallus longing, scrotal texture changes
4- adult hair; penis bigger in circumference, darkening of scrotal skin
5- hair to medial thigh; adult size
Constitutional delay?
late bloomers family hx (+) NORM PE and labs bone age is delayed 2-3yrs "catch up growing"
Familiar short stature?
family hx (+)
NORMAL puberty, PE, labs (GH)
bone age is chronological age
Pathological short stature?
<5 cm/yr fetal: chromosomal, Turners sx maternal: fetal alcohol sx endocrine: hypothyroidism non-endocrine: renal tubular acidosis, malabsoprtion, celiac
Short and pudgy?
endocrine (hypothyroidism)
Short and scrawny?
nonendocrine (malabsorption, celiac)
Tall stature - normal?
familial
Tall stature - abnormal?
Klinefelter sx
marfan sx
excessive GH
Marfan sx?
acrachnodactyly
subluxation of lens
autosomal dominant
mutant genes
Klinefelter sx?
small testes
developmental delay
low tesosterone
Excessive GH?
epiphysis open - gigantism
epiphysis closed - acromegaly
Screening test vs dx test?
screening: NO sx are present
dx: sx ARE present
Screening test for peds?
anemia lead hearing vision language
Anemia screening-age?
9-12mo
women: every 5-10yrs
Anemia RF?
women have long menses, low iron intake
premature infant
early use of cows (before 12mo)
too much milk
Iron deficiency?
MOST COMMON CX OF ANEMIA IN CHILDHOOD (6mo-2yrs)
Iron deficnecy - microcytic/hypochromic?
low MCV
incr RDW
decr ferritin
Iron def - screening?
hgb
hct
Iron def - prevention?
breast fed infants take iron supplement
start fortified cereal @ 6mo
NON breast fed infants –> fortified formula
Baby has cognitive delay?
plumbism (lead toxicity)
Plubmism - PE?
low -abdominal pain -constipation -hearing loss -osteopenia -decrease bone growth high -spontaneous abortions -renal dz -seizure
Lead screening-age?
9-12mo
24 mo
Lead RF?
language delay
chronic anemia
PICA
NE industrial
Lead tox tx?
admit
Hearing screen - types?
OAE (otoacoustic emissions)
ABR (auditory brainstem response)
Hearing screen -how?
newborn screening –> fail –> try again –> fail –> ENT
Hearing screen - age?
4yrs 5yrs 6yrs 8yrs 10yrs
Hearing screen - RF?
parent concerns
family hx
craniofacial anomalies
hx of recurrent otits media/effusion
Abnormal speech development?
12mo: no babbling
18mo: no single words
24mo: <600 words
Vision screen - infancy?
object tracking
red reflex
Vision screen - toddler?
red reflex
Vision screen - school age and adolescent?
snellen
Strabismus?
cross eye
estropia - inward
exotropia - outward
NOT visual defect
Amblyopia?
lazy eye VISUAL DEFECT (one brain uses one side more than other)
Developmental screening?
objective screening
Developmental screening - age?
9mo
18mo
30mo
MCHAT screening?
18mo
24mo
Autism-age?
2-4yo
rarely <2yo
"baby not talking" "poor eye contact" "in own world" "plays alone, not in groups" "sensitive to sounds, textures, sights" "self injury"
R/O DEAFNESS
AUTISM
BP - age?
3yo
Cholesterol-age?
11-12yo
17-18yo
CG/Chlamydia-age?
sexually active females
