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MSS - PCM 2 Exam 1 > Pediactric Exam 1 - Birth to Infancy > Flashcards

Pediactric Exam 1 - Birth to Infancy Flashcards

1
Q

well child exams

A

physical development
cognitive development
social/emotional development

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2
Q

newborn

A

0-28 days

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3
Q

infancy

A

0-12 months

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4
Q

toddler/early childhood

A

1-4 years

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5
Q

school-aged/middle childhood

A

5-10 years

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6
Q

adolescence

A

11-20 years

further separated to early, middle, and late

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7
Q

development and health of child

A

affected by physical, social, emotional factors, and disease

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8
Q

APGAR

A 
appearance
pulse
grimace
activity
respiratory effort

measured at birth - looks at neurologic recovery
-at 1 minute and 5 minutes

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9
Q

appearance score?

A

blue, pale = 0
pink body, blue extremities = 1
pink all over = 2

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10
Q

pulse score

A 
absent = 0
100 = 2
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11
Q

grimace score

A

aka reflex irritability

no response = 0
grimace = 1
crying, sneezing, coughing,

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12
Q

4 principles of child development

A

1 predictable pathway
2 wide range of normalcy
3 physical, social, environmental, disease all affect
4 childs level determines how you H and P

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13
Q

activity score

A

flaccid = 0
flexion of arms/legs = 1
active movement = 2

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14
Q

respiratory effort score

A 
absent = 0
slow/irregular = 1
good/strong = 2
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15
Q

levels at 1 minute

A

0-4 - severe depression
5-7 - some NS depression
8-10 - normal

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16
Q

levels at 5 minutes

A

0-7 - high risk for CNS and other organ system dysfunction

8-10 - normal

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17
Q

hospital evaluation

A

within 24 hours of delivery

  • review moms hx
  • review delivery record
  • full head-to-toe exam
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18
Q

given after delivery

A

erythromycin - eyes prevent infection

vitamin K - injection to prevent bleeding

full bath

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19
Q

gestational age and birth weight

A

help preduct medical problems in future

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20
Q

gestational age

A

neuromuscular sign and physical characteristics that change with gestational age

ballard scoring system

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21
Q

ballard scoring system

A

neuromuscular maturity
-1 to 5

physical maturity
-1 to 5

add numbers together to determine gestational age

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22
Q

preterm

A

< 37 weeks

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23
Q

term

A

37-42 weeks

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24
Q

post term

A

> 42 weeks

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25
Q

extremely low birth weight

A

<1000 grams

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26
Q

very low birth weight

A

<1500 grams

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27
Q

low birth weight

A

< 2500 grams

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28
Q

normal birth weight

A

> or = 2500 grams

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29
Q

small for gestation age

A

SGA

<10th percentile

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30
Q

appropriate for gestational age

A

AGA

10-90th precentile

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31
Q

large for gestational age

A

LGA

>90th percentile

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32
Q

neonate feeding

A

every 3 hours

  • breast feeding - initial colostrum
  • milk come in after 2-3 days
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33
Q

colostrum

A

initial small volume of breast milk

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34
Q

formula

A

15-30 ml (0.5-1 ounce)

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35
Q

weight change

A

normal to lose up to 10% of body weight

-should regain after 10-14 days

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36
Q

voiding regularity?

A

3-4 /day in 1-3 days

day 4-5 - should see 6-8/day

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37
Q

meconium

A

initial stool
-first 24 hours
dark, black, tarry

38
Q

breast fed stool

A

yellow, seedy

39
Q

formula fed stool

A

green/yellow

40
Q

initiate phototherapy

A

levels high or rising quickly

>5mg/dl per day

41
Q

jaundice

A

elevated bilirubin prior to 24 hours no good

-more than just physiologic jaundice

42
Q

high risk bilirubin zone

A

repeated 4-8 hours

43
Q

high intermediate bilirubin risk zone

A

repeated 8-12 hours

44
Q

low-intermediate bilirubin risk zone

A

repeated within 48 hours

45
Q

low risk bilirubin zone

A

3-5 days

46
Q

hospital discharge

A

vaginal 48 hours

c section 3 days

47
Q

prior to discharge of newborn

A

hep B
hearing screen
newborn screening blood test
circumcision, if desired

48
Q

follow up care after delivery

A

24-48 hours after discharge

49
Q

well child visits

A

continued assessment of growth as infant ages

  • immunizations
  • parent information
  • parent questions
50
Q

components of well child visit

A 
HPI
-feeding, stooling, voiding, sleeping, development, safety, parental concerns
PMH
-med problems, injuries, hosp, surgery
Meds
Allergies
Fam Hx
Social Hx
51
Q

well visit intervals

A 
3-4 days of life - growth only
2 weeks (with screen #2)
1 month
2 month
4 month
6 month
9 month - Hg
1 year

all look at growth and development

52
Q

growth review

A

weight
length
head circumference

53
Q

growth chart

A

need 3 points

-look at trend

54
Q

development through infancy

A

physical - fine/gross motor
language/cognitive
personal/social

55
Q

physical development

A

central to peripheral
gross to fine motor

head control > trunk control > arms > legs > hands and fingers

56
Q

language development

A

2 month cooing
6 months babbling
1 year 1-3 words

57
Q

cognitive development

A

cause/effect, object permanence, use of tools

9 months - recognize strangers, seek comfort from parent during exam, actively manipulate object

58
Q

personal social development

A

understanding self and family matures

bonding/attachment to caregivers

temperament - adaptability to changes, variable

59
Q

gross motor milestones

A

large groups to sit

stand, walk run, balance

60
Q

fine motor milestones

A

drawing, eating, dressing, playing, writing

61
Q

language milestones

A

speaking, body language and gestures, communicating, understanding

62
Q

cognitive milestones

A

problem solving, reasoning, remembering

63
Q

social milestones

A

interacting with others, friends, family, teachers, cooperating

64
Q

at 9 months

A

no more exam on table - do it on parent lap

65
Q

exam sequence for infant

A

heart/lung first

HEENT last

66
Q

head circumference

A

measured up to 3 years (36 months)

shape, symmetry, tilt, lesions, hair

67
Q

respiratory infant exam

A

signs of distress - nasal flaring, retractions, accessory muscles
auscultate lung fields

68
Q

blood pressure in child

A

not measured in child < 3 years

69
Q

pulse in infant

A

brachial and femoral

-compare B/L

70
Q

CV don’t miss

A

benign murmurs

71
Q

GI don’t miss

A 
normal:
no spleen palpable
can feel kidney
anal fissures
liver tip palpable below costal margin
72
Q

GU infant exam

A

descended testicles B/L
swelling of testicles normal

inguinal or femoral hernias

don’t miss labial adhesions

73
Q

neuro exam infant

A

cranial nerves
strength/muscle tone
deep tendon reflexes
primitive reflexes

74
Q

palmar grasp reflex

A

birth to 4 months

-grasp finger

75
Q

plantar grasp reflex

A

birth to 9 months

-toes curl

76
Q

moro reflex

A

birth to 4 months
startle reflex
-lower quickly - arms abduct and extend, hands open, legs flex, maybe cry

77
Q

asymmeric tonic neck reflex

A

birth to 4 months
supine, turn head to one side with jaw over shoulder

arm/leg same side extend opposite side flex

78
Q

positive support reflex

A

birth to 2 month or 6 months

feet touch surface
-hip, knee, ankle extend, partial weight bearing

79
Q

rooting reflex

A

birth to 3-4 months

stroke corner of mouth - turns head toward stimuli

80
Q

galants reflex

A

birth to 3 months
galants
stoke one side of back - spine curves toward stimuli

81
Q

placing/stepping reflex

A

one foot on surface
-hip/knee that foot flex and other foot step forward

birth to variable disappear

82
Q

landau reflex

A

suspend prone
-head up and spine straigten

birth to 6 months

83
Q

parachute reflex

A

suspend prone, slowly lower head

arms/legs extend in protective fashion

4-6 months - doesn’t disappear

84
Q

infant hip exam

A

barlow and ortolani maneuvers
-for signs of dislpcation

can indicate developmental hip dysplasia

effective until around 3 months
-look for other signs - galeazzi

85
Q

ortolani test

A

test for posteriorly dislocated hip

will relocate the hip

finger anterior pressure

86
Q

barlow test

A

test for ability to sublux or dislocate hip
-indicates intact but unstable hip

press hip posteriorly, to dislocate hip

87
Q

galeazzi test

A

flex knees, feet to butt
measure heights of knees

lower is posterior dislocated hip

88
Q

HEENT exam in infant

A

big difference - sutures and fontanelles

red reflex in eyes

89
Q

fontanelles

A

anterior - closes later (18 mo - 2 yr)
posterior - closes early (1-2 mo)

should be soft and flat

90
Q

red reflex

A

light on retina

  • should reflect red light
  • symmetrical reflection with light 18 inches away
91
Q

epstein pearls

A

mucus cyst in mouth

-normal

92
Q

immunizations 0 - 6 years

A

hospital - hep B
office - RV, DTaP, HIB, PCV, IPV, influenza, MMR< varicella, Hep A

lots 2 months, 4 months, 6 months - RV, DTaP, HIB, PCV, IPV

MSS - PCM 2 Exam 1 (7 decks)

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