Midterm flashcards
What is the leading cause of sudden death in young athletes during exertion? Think of systems endocrine, respiratory etc
Cardiovascular disorders ( cardiovascular system)
What are the examples of pathological murmurs?
Hint: 10 different examples from the the cardiac refresher
> Grade 3 intensity
Holosystolic timing
Maximum intensity at the left upper sternal border
Harsh or blowing quality
Abnormal S2
Systolic click
Diastolic murmur
Increased intensity with upright position
Gallop rhythm (S3 or S4)
Friction rub
What are the characteristics of murmurs?
There are 5 different characteristics
Pneumonic to remember
ITLRQ
(IT loves right quality) my husband is IT and he loves quality of all he does that is where the pneumonic came from
Intensity
Timing
Location
Radiation
Quality
What is one question you want to ask when taking history and suspecting that your patient has Marfan syndrome?
Does anyone in your family have Marfan syndrome? There is a 50 percent chance that a person with Marfan syndrome will pass along the genetic mutation each time they have a child
What kind of cardiovascular problems can happen with Marfan syndrome? Think of aorta and try to answer in order with aortic enlargement and leading to….
Aortic enlargement
Aortic tear or rupture
Mitral valve prolapse
Aortic regurgitation
What is the most common cause of chest pain in anyone who do heavy lifting, weights,
coastal condritis
Peak flow meter is based on what parameters
Height
age
gender
Tibial tuberosity is diagnostic of Osgood-Schlatter disease is when the bump below knee is there and kind of sore and tender. What would be your education for a child and parent? A lot of adolescents complaint of knee pain, like overuse syndrome, dancers would get it but it is not reason to disqualify from sports physical
Reassure parents and students , goal is to exercise quads, demonstrate how to do proper squats, put note so coach and trainer knows, it is very common
Three key systems that we need to pay attention to while doing sports physical are…..
Cardiovascular
Respiratory
Musculoskeletal
When doing cardiac exam on a child or adolescent
you will listen to the heart in 3 different positions
what are they?
First standing, then supine and then you can ask them do valsalva maneuver
What is the indication of doing valsalva maneuver while listening to the heart?
This maneuver by them bearing down can prompt the murmur that was not there
The pneumonic CRAFFT stand for
car-relax-alcohol- forget- family =friends-trouble
What questions will you ask using those above key words?
driving car using alcohol?
C. Have you ever ridden in a Car driven by someone (including yourself) who was high or had been using alcohol or drugs?
R. Do you ever use alcohol or drugs to Relax, feel better about yourself, or fit in?
A. Do you ever use alcohol or drugs while you are by yourself Alone?
F. Do you ever Forget things you did while using alcohol or drugs?
F. Do your Family or Friends ever tell you that you should cut down on your drinking or drug use?
T. Have you ever gotten into Trouble while you were using alcohol or drugs?
As a provider when will you use WHO growth chart for what age group?
WHO growth charts to monitor growth in infants and children ages 0 to 2 years of age
When will you use CDC growth charts
Ages 2 and older
Bright Futures guidelines identify adolescence as 11 to 21 years . what are the stages of adolescence and what age group?
ealry. 11-14
middle 15-17
late 18-21
What do we measure in infants birth to 36 months?
Length for age and weight for age
head circumference for age and weight for length
What do we measure for children and adolescents, 2 to 20?
Stature- for -age weight -for -age
BMI for age
Most common chromosomal disorder continues to be is
Down syndrome
As a provider you should know patterns of growth and you recognize that there are 4 characteristic stages of growth
Rapid growth in infancy and early childhood
slow steady growth in middle school
rapid growth during puberty
gradual slowing down of growth in adolescence until height is reached
BMI for age under 5th percentile is considered
Underweight
BMI 85th to 94th percentile is considered
Overweight
BMI greater than or equal than 95 th percentile is considered
Obese
You are a provider and you do not the app for BMI calculator handy, how would you calculate BMI?
Person weight in kilograms divided by the square of height in meters.
Recommendations by American Academy of Pediatrics to limit to have many hours of screen time a day?
TWO
What 5210 stand for?
5 or more servings of fruits and vegetables
2 hours or less recreation screen time
1 hour or more of physical activity
0 sugary beverages drink more water
What is BRIGHT FUTURES?
It is a national health promotion and prevention initiative led by AAP
What is Bright Futures known for?
They provide theory-based and evidence-driven guidance for all preventive care screenings and well-child visits
What are the ways will you use BRIGHT FUTURES?
Observation
Physical exam
Screening
Immunization
Anticipatory guidance
What are the two parts of observation according to BRIGHT FUTURES?
It is surveillance and and screening
When you as a provider perform developmental surveillance?
Developmental surveillance is performed at every health supervision visit
When will you perform developmental screening?
At age 9-, 18-, 30- visits developmental screenings
At what age will you perform autism screening which is part of developmental screening?
At the 18- and 24-month visits autism screening should be performed
A baby needs to achieve developmental milestones during maturation and they are categorized into 5 domains. What are those domains?
Gross motor
Fine motor
Language
Cognitive
Social-emotional
Behavioral
What is important to be aware of while doing physical exam?
Potential short. answer q
- Head to toe sequence is not always appropriate
- Understand the child’s perception of painful procedures
3 Use non-threatening approach
3 Cooperation is increased with parental presence ( except teens) - Examine invasive and sensitive areas last
Assessing child’s head what are the things you will be looking for?
Note size and shape of the head, look for microcephaly and plagiocephaly
check anterior and posterior fontanels
head control should be reached by 4 months
When will posterior fontanel close?
It should close by 2 months
When will anterior fontanel close?
Anterior fontanel should close by 9-18 months.
My nephew’s anterior fontanel should still be open
He is 16 months now I wonder if it is still open
Babies are obligate nose breathers until about what age?
6 months of age
Important to assess the nose is it is patent, occluded
Normal puberty for girls begin at what age?
Between ages 8 and 13
Normal puberty for boys begin when?
Between ages 9 and 14
PMI is at 4th ICS until about what age ?
Until age 7 then it is found in 5th ICS
What are some characteristics of innocent murmurs?
Grade < or equal 2 intensity—– flow murmurs, innocent still murmurs are usually grade 1or 2 in intensity
Softer intensity when the patient is sitting compared when the patient is supine
Short systolic duration( not holosystolic, not diastolic)
Minimal radiation —– the murmur is located in a limited region of precordium
Musical or vibratory quality
Which heart sound is produced by the closure of Mitral and Tricuspid valves and corresponds to the end of diastole and beginning of systole
S1
Which heart sound is produced by the closure of aortic and pulmonic valves and corresponds to the end of systole?
S2
Which murmurs require further evaluation?
all diastolic murmurs and any systolic murmur above grade 2 in severity requires further evaluation with echocardiography
Why do we ask to do Valsalva maneuver when evaluating for murmurs?
Most heart murmurs decrease in intensity with Valsalva, except those of HOCM( hyperthrophic obstructive cardiomyopathy) and MVP, which become more prominent.
Can you describe tonsils grading?
Tonsils are larger in children
Tonsil Grading:
Tonsil 1+: Tonsils <25% of space between pillars
Tonsil 2+: Tonsils <50% of space between pillars
Tonsil 3+: Tonsils <75% of space between pillars
Tonsil 4+: Tonsils >75% of space between pillars - “Kissing Tonsils”
When you assess 7 year old tonsils for school physical you see the that less than 75% of space between pillars how would you document these tonsils?
Tonsil +3