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
Your assessment reveals that space between tonsils less than 25%, how would you document?
tonsils +1
You recognize while assessing young female that puberty starts at what age? what is the range
Per ppt 8-13 y.o
For boys puberty starts at what age? what is the range?
9-14 y.o
What is the first sign of puberty in men?
Testicular size average 11.6 y.o
How many Tanner stages?
How long does it take in years development in years from stage 2 to 5?
5 stages
Development from 2-5 stage takes from 2-4 years
What is a term fro bow leg and when is it considered normal?
Genu varum and considered normal from infancy through 3 years of age
What is the term for knock-knee?
Genu valgum
What is one of the 5 anticipatory guidance priorities?
Social determinants of health
What are examples of anticipatory guidance ?
Wearing seat belts, helmets, sun screen, brush teeth
What are 5 domains of social determinants of health you will address with your patient?
Economic stability
Education access and quality
Health care access and quality
Neighborhood and built environment
Social and community context
The Bright Futures/AAP periodicity schedule is for screening and assessments, what is the schedule?
The first week visit (3 to 5 days old)
1 month old
2 months old
4 months old
6 months old
9 months old
12 months old
15 months old
18 months old
2 years old (24 months)
2 ½ years old (30 months)
3 years old
4 years old
What are some characteristic features you see in down syndrome children?
Upslanting palpebral fissures
epicanthic fold( upper eyelid skin fold covers the inner corner of the eye)
flattened nasal bridge
folded or dysplastic ears
low-set small ears
brachycephaly ( lower than normal ratio of skull length to width, short head)
brushfield spots (spots on iris)
open mouth
protruding tongue
furrowed tongue ( fissured tongue)
short neck
excessive skin at nape of the neck
narrow palate
abnormal teeth
What is atlantoaxial instability and why is it important?
10-30% down syndrome children have this problem and it is when joint between the upper spine and base of the skull is unstable can damage the skull
What are some symptoms of atlantoaxial instability?
Change int he way your daughter/son walks
- gets tired easily when walking
- pain, numbness or tinging in the neck shoulder arms and legs
- head tilting to one side
trouble moving the neck or holding up - weakness in the arms or legs
5.loss of bladder control (having accidents)
You recognize that since children with DS have OSA
What tests should be performed by age 4?
Sleep study— polysomnography
What you need to know before ordering a vaccine?
Know the schedule
know how to access the catch-up schedule
know the contraindications for vaccines
know the requirements for school/ daycare system
know 7 rights of vaccine administration
When can you start flu vaccine?
At 6 months
Foe what age group do we need a booster 30 days later from the first dose of flu vaccine?
Fo children under age 9 we need a booster 30 days later if it is their first ever flu vaccine
When can we give Hep A #1 vaccine?
12-15 months
When can you give second dose of Hepatitis A vaccine?
Can be given 6 months after first dose
How many HPV vaccines do we need to give for patients under age 15?
2 doses 6-12 months apart
How many HPV vaccines do we need to give for ages 15 and up?
3 doses of HPV vaccine, 2nd dose 1-2 months later, 3rd dose 6 months after 1st dose
By age 4 how many DTaP the children should have?
5 doses of DTaP, DTaP #1 at 2 months, DTaP # 2 at 2 months, DTaP # 3 at 6 months, DTaP # 4 AT 15-18 months, DTaP # 5 at 4 years of age
By age 4 how many Polio vaccines should kids have?
4 doses of Polio
Polio #1 #2 #3 at 2, 4, 6 months
Polio # 4 4 years of age
By age 4 how many Prevnar vaccines should children have?
4 doses
Prevnar #1, #2, #3 at 2, 4, 6 months
Prevnar #4 at 12-15 months
By age 4 how many Hib should a child have?
4 doses
Hib #1, #2, #3 at 2, 4 , 6 months
Hib# 4 at 12-15 months
By age 4 how many doses of MMR should a child have
2 doses MMR ( first at 12-15 months, second at 4 years)
By age 4 how many varicella vaccines should a child have?
2 doses of varicella vaccine, Varicella#1 at 12-15 months, varicella # 2 at 4 years of age
By age 3 how many Rotavirus vaccines should a child have?
3 doses of Rotavirus, Rotavirus #1, 2, 3 at 2, 4, 6 months
What medical conditions associated with DS in infancy?
Ocular anomalies (cataracts, glaucoma, strabismus, nystagmus)
Hirschsprung disease ( last part of lg intestine does not work due to lack of nerve cells)
duodenal atresia ( small intestinal blockage)
congenital hypothyroidism
leukemoid reactions
congenital heart disease
What are your live vaccines?
Think MYOFRVS
mY
ORNAGE
YELOOW
FROG
RUNS VERY SLOW
Measles, mumps, rubella
rotavirus
smallpox
chickenpox-varicella
yellow fever
oral typhoid
FlUMIST
What is important about to know while giving live vaccines
Give them 4 weeks apart
What is important to know about contraindications to vaccines?
Understand that majority of contraindications are temporary, when the condition leading to a contraindication is not there vaccine can later be administered
Who should not receive the MMR or another live vaccine?
Immunocompromised patients
Women to be known pregnant
Patients who experienced encephalopathy within 7 days after administration of a previous dose of pertussis-containing vaccine should not receive additional doses of a vaccine that contains pertussis
What are the contraindications to receiving rotovirus vaccines?
SCID- severe combined immunodeficiency and a history of intussusception
What are the difference between contraindication and precaution to receiving a vaccine?
Contraindication—- conditions in a recipient that increases the risk for a serious adverse reaction to a vaccination and under these conditions vaccines should not be administered.
What is a precaution to a vaccine?
Condition in a patient that might increase the risk for a serious adverse reaction, might cause diagnostic confusion, might compromise the ability to produce immunity
Would you defer the vaccine if you suspect precaution to a vaccine?
Yes, however a vaccination might be indicated in the presence of a precaution if the benefit of protection from the vaccine outweighs the risk of adverse reaction
Know 7 rights of vaccine administration
What are they?
The right patient
2. The right time
3. The right vaccine and diluent
4. The right dosage
5. The right route, needle, and technique
6. The right injection site
7. The right documentation
Aaron, a 5 year-old-boy, comes in for his kindergarden examination. Which of the following should be included in his examination?
ROS, complete PE, evaluation of immunizations, anticipatory guidance
The five areas of anticipatory guidance you should cover at each well-child visit include:
Safety, parenting, dental care, nutrition, growth and development
Techniques to achieve cooperation of the toddler
allow child to move around the room and explore
techniques to achieve cooperation of the infant are
place pacifier, gloved finger in mouth
techniques to achieve cooperation of the infant are
place pacifier, gloved finger in mouth
techniques to achieve cooperation of the school-aged child are
teach about the body as you go along
techniques to achieve cooperation of the adolescent are
create accepting atmosphere
To determine the exact location of abdominal pain in a 2-year-old boy
palpate the abdomen and watch the child’s face
Infants gain control of bodily function in a cephalocaudal and proximodistal sequence. This is seen as development in which order?
Head, neck, trunk, extremities
Deep tendon reflexes measure all the following except
primitive reflexes
A transient finding in the newborn is the harlequin sign. It is due to:
circulatory adaptation
Tanginika, a new born African-American girl, appears jaundiced. You know that:
Upon examination of a 5-month-old Cara you find that the anterior and posterior fontanels are closed
You are concerned because:
The internal structure may not be ables to develop properly
To visualize Cara’s who is 5 month old tympanic membrane and ear canal, which technique is correct?
Pull pinna down and back, and touch the child’s head with the hand and holding the otoscope
A child should be evaluated by a dentist if deciduous teeth have not erupted by age:
15 months
Macroglossia is an indication of
congenital problems
Tommy’s tonsils touch the uvula on the left and are barely visible on the right. You grade the tonsils as
L -3+ R -1+
Which of the following eye movement would be considered normal?
slight horizontal nystagmus
Palpebral fissures are usually:
straight across
To test visual acuity in the newborn infant you should
put a black-white chart at arm’s length and move the chart
Complete abdominal or diaphragmatic breathing usually occurs by age:
6 years
Abnormal breathing pattern for the newborn includes
paradoxical breathing
The chest circumference is usually equal to the head circumference by age
6 months and 24 months
after 2 years chest size larger than head
How many doses of Rotavirus should be given by age of 8 months?
3
Testicular volume less than 3 ml, change in texture to scrotal skin, breast bud stage, sparse growth of hair chiefly along the labia/ base of penis. What is the tanner stage for this description?
Tanner stage 2
Elevation of papilla only, no pubic hair, testicular volume less than 3 ml, what tanner stage?
tanner stage 1
Enlargement of breast and areola, increase in size of penis with further testicular enlargement, darker coarser more curled hair, what tanner stage?
tanner stage 3
further enlargement of penis, testicles, with development of glans penis, adult type hair over a small area, projection of the areola and papilla, what stage of tanner?
stage 4
adult size and shape of penis, hair spread to the medial surface of thighs, recession of the areola to the contour of the breast, projection of the papilla only
Stage 5
Systolic murmurs sound like
swish-dupp
common murmur heard in toddler and school-aged children
low-pitched musical systolic ejection murmur between left sternal border and apex
sally, 23 month old should be able to do all the following except
imitate, use symbols, find hidden object w/o watching it being hidden
except generalize and make deductions
by 1 year old head circumference should be
one-third larger than the birth circumference
head circumference is not complete on the 3 year old because
toddler not able to hold head still
