Pediatric Exam Flashcards
1
Q
Well Child Exam
A
Physical development
Cognitive development
Social and emotional development
2
Q
Newborn
A
0-28 days
3
Q
Infant
A
0-12 months
4
Q
Toddler (early childhood)
A
1-4 years
5
Q
School-aged (middle childhood)
A
5-10 years
6
Q
Adolesence
A
Early, middle, late
11-20 years
7
Q
Predictable pathway
A
Development controlled by the brain
Age specific milestones
8
Q
Range of normal development
A
Wide, mature at different rates
9
Q
What affects development/health
A
Physical, social, environmental, disease
10
Q
Hx and PE of child
A
Varies based on stage of development
11
Q
Neonatal resuscitation
A
Anything to help baby breathe at birth - usually only need drying and bulb suction
12
Q
APGAR
A
Assess neurological recovery after birth/adaptation A-Appearance P-Pulse G-Grimace A-Activity R-Respiratory effort
13
Q
APGAR Scoring
A
0-2 each category, add up total
14
Q
When to assess APGAR
A
1 minute and 5 minutes
15
Q
1 min
A
0-4 = depression 5-7 = some nervous depression 8-10 = normal
16
Q
5 min
A
0-7 = High risk for CNS and system dysfunction 8-10 = normal
17
Q
Appearance
A
Should be pink (although usually a little blue at first)
18
Q
Pulse
A
Should be greater than 100
19
Q
Grimace
A
Should be crying and vigorous when you hold them
20
Q
Activity
A
Arms and legs should be moving around (arms and legs usually in flexed position,) limp is bad
21
Q
Respiratory effort
A
Should be good/strong
22
Q
What does APGAR tell you?
A
Only tells you how baby did during the birthing process, cannot necessarily make correlations to health later in life
23
Q
Hospital Eval of Newborn
A
Within 24 hours of birth
Review Mom Hx
Review delivery record
Head to toe exam
24
Q
Review Mom Hx
A
Medications, medical hx, blood work
25
Review delivery record
Gestation, mode of delivery, duration of labor, augmentation/induction, complications, APGAR, blood glucose (look to see what kind of stress baby went through during birth)
26
Head to Toe Exam
Includes: molding/fontanelles, red reflex, palate, genital, hip, primitive reflex
27
Hospital care after delivery
Erythromycin ointment for eye infection prevention, Vitamin K for bleeding (not enough production from bacteria in gut,) full bath
28
Ballard scoring system
Used to determine gestational age, neuromuscular and physical characteristics that change with gestational age
29
Gestational age
Time in utero - can predict health and development long term
30
Pre-term
less than 37 weeks
31
Post-term
more than 42 weeks
32
Normal weight
2500 grams
33
Low weight
less than 2500 grams
34
Very low weight
less than 1500 grams
35
Extremely low birth weight
less than 1000 grams
36
SGA
Small for gestational age (10th percentile) - mom could have had infection, decreased blood flow
37
AGA
Appropriate for gestational age
38
LGA
Large for gestational age (90th percentile) - mom could be diabetic
39
Neonate feeding
every 3 hours, approx 1 oz
40
Colostrum
Initial thick, yellow breast milk - milk comes in 2-3 days later
41
Neonate weight
Lose 10% week 1, gain back week 2
42
Neonate voiding
3-4 per day first few days, 6-8 after that
43
Meconium
Initial black, tarry stool - goes away with presence of more gut bacteria
44
Breast fed stool
Yellow, seedy
45
Formula fed stool
Yellow, green
46
Jaundice testing
Transcutaneous billimeter (screen) or serum indirect/direct, compare to nomogram (based on age)
47
Jaundice prior to 24 hours
Think more than physiologic
48
Prior to hospital discharge
Hep B immunization, hearing, blood screening, circumcision (if wanted)
49
Well child visit HPI
Feeding, pooping, sleeping, development, safety, parental concerns (rest of history is about the same as adult)
50
Well visit week 2
Newborn screen #2 (catch anything missed in #1)
51
Well visit 9 months
Hemoglobin
52
Growth rate in infant
Fastest during this stage (weight triple, hight increase by 50%)
53
Growth chart
Weight, length, head circumference - need three points at least to see a trend
54
Neurologic development in infant
Central to peripheral, gross to fine motor; head to trunk to limbs to hands to fingers
55
Language in infant
2 months - cooing
6 months - babbling
1 year - few words
56
Cognitive in infant
Cause/effect, object permanence, tools
| 9 mo - recognize strangers, comfort in familiar people, manipulate objects
57
Personal/Social in infant
Understand self, bonding with others, temperament, adaptability to new schedules
58
Ex Gross motor milestones
Sit, walk, run, stand, keeping balance, changing positions - using big muscles
59
Ex Fine motor milestones
Use of hands - eating, drawing, getting dressed etc.
60
Ex Language milestones
Using and understanding language with speech, body language and gestures
61
Ex Cognitive milestones
Learning, understanding, problem solving, remembering
62
Ex Social milestones
Relationships with friends, family, teachers, cooperating, and responding to feelings of others
63
Infant Exam Guidelines
```
Up to 9 mo - do exam on table (but ask mom first how baby will react)
Over 9 mo - do in mom's lap
Generally heart/lung first and HEENT last (but be flexible)
Head circumference (until 36 months)
Growth chart
```
64
General Infant PE
Observe
Resp - observe and auscultate
Cardio - compare pulses, palpate, auscultate, no BP until age 3
Abdominal - observe, auscultate, percuss, palpate
65
Resp distress in Infant
nasal flaring, ribs stick out (see intercostals)
66
Pulse in infant
Best to use brachial (neck space is small)
67
Murmurs
Normal - PDA (patent ductus - first couple days,) Still's murmur
Watch murmurs to see if they resolve with time
68
GI in infant
Can feel liver and sometimes kidneys, shouldn't feel spleen, anal fissures (bleeding in diaper)
69
Genital swelling
Redness and swelling normal first few days after birth - hormonal
70
GU Male Infant
Inspect, visualize meatus (look for hypospadia,) make sure circumcision has healed (redness at first is normal,) testes should descend, palpate for hernias
71
GU Female Infant
Inspect, palpate for hernias
72
Anal/rectum Infant
position, fistulas, fissures
73
Neuro Infant
Cranial nerves, muscle tone, tendon reflexes, primitive reflexes
74
Labial adhesions
Due to irritation, can cause recurrent UTI or block urine, treat with estrogen creme
75
Primitive reflexes
Should go away, if not there could be a problem with myelination
76
Palmar grasp
If you tough their palm, they will grab your hand
| B-4 mo
77
Moro (startle) reflex
"Drop" baby 2 feet and they will abduct and extend arms, flex legs, and cry
B-4mo
78
ATN reflex
Asymmetric tonic neck - turn head to one side, arm/leg same side extend and opposite arm/leg flex
B-4mo
79
Positive support reflex
Hold baby and let feet tough ground - legs will briefly extend to attempt to bear weight
B or 2mo-6mo
80
Rooting reflex
Stroke side of face and baby will turn towards stimulus and start suckling
B-4mo
81
Trunk incurvation reflex
Hold baby prone and stroke back on one side 1 cm from midline - hips will move to that side
B-3mo
82
Stepping
Hold baby and let one foot touch floor - other foot will move forward in walking motion
B-variable
83
Landau reflex
Suspend prone - head lifts up and spine straigtens
| B-6mo
84
Parachute reflex
Suspend prone and lower head - arms and legs extend
| 4-6 mo and does not disappear
85
Plantar reflex
Touch ball of foot - toes curl tight
| B-9mo
86
MSK Exam Infant
Observe (symmetry, digits, and deformities)
| Palpate - spine and feet (scoliosis, spina bifida, club foot)
87
Barlow maneuver
Test ability to sublux or dislocate unstable hip
88
Ortolani maneuver
Test for presence of previously dislocated hip
89
Galeazzi test
Flex both legs and see if one appears shorter than the other - short leg is posteriorly dislocated
Use this test after 3 months when the hip capsule has naturally begun to tighten
90
Developmental hip dysplasia
Positive barlow, ortolani, and/or galeazzi require further imaging (xray if old enough)
91
Anterior fontanelle
Larger, close between 4 and 26 months
92
Posterior fontanelle
Smaller, close between 1 and 2 months
93
Fontanelles
Should be soft, if hard and bulging there may be cranial pressure
94
Red reflex
Should be symmetrical, eyes reflect red with light
| If absent, there may be something blocking retina like a cataract
95
Epstein pearls
Hard white balls on roof of mouth - normal
96
Pits/tags around ear
Could be sign of something more serious - kidney problems
97
Torticollis
Asymmetrical holding of the neck
98
Mongolian spot
Big dark birthmark - benign
99
Immunization at the hospital
Hep B - rest in doctor's office
100
Growth rate of toddler
Slows to half of infant, 2-3 kg and 5 cm per year
101
Language in toddler
By 4 years should be understandable to all
102
Social/emotional in toddler
Try to be more independent, temper tantrums
103
Motor skills toddler
Walk, skip, hop, jump
| Draw circles and lines
104
Cognitive in toddler
Learn by touching and using mouth, imitative playing
105
Exam in toddlers
In diaper on parents lap using toys, still use growth chart, head circumference until 36 months
106
Motor in school aged
Growth is steady, more coordination
107
Cognitive in school aged
Concrete operational - black and white, no gray areas
108
Social/emotional in school aged
Independent, self esteem affected by environment, identity
109
Common problems with school aged
asthma, joint pain from growing, speech development
110
Exam with school aged
Keep modesty and dress in gown, head to toe exam on table, generally same PE as adult but not full GU
111
Still's murmur
Low grade (2-4,) musical, vibratory, midsystolic
112
Venous hum
Soft, continuous, louder in diastole
113
Carotid bruit
Midsystolic, usually louder left, eliminated by carotid compression
114
Neuro exam after infancy
Cranial nerves, deep tendon reflexes
115
MSK exam in older child
Have them walk around, look at arches and position of legs
116
Back in older child
Look more for scoliosis
117
Skin in older child
Look for rashes and moles, tell parents how to keep track of moles
118
Palpebral fissure
Eliptical space of eye
Short can mean FAS
Upward slant can indicate trisomy
119
Cover/uncover test
9mo to 3 years
| Looks for strabismus
120
Testing visual acuity
After 3 years
121
Permanent teeth
Age 6
122
Peak tonsillar growth
Age 8-16
123
Hearing test
Age 3-4
124
Ear exam
Done last in younger patients, have parent hold child to avoid injury
125
Healthy habits eduation
Oral hygiene and diet, injury and illness prevention (seatbelts, helmets, etc.)
126
Early adolescence
```
10-14 year
Puberty begins
Concrete operational
Focus on present
Peers more important
Am I normal
```
127
Puberty begins
F - 8-13 years
| M - 9-13.5 years
128
Middle adolescence
15-16 years
Females more comfortable than males
Transition to formal operational thinking
Develop insight and reflection
Who am I - with introspection
Limit testing - drinking, sex, breaking rules
129
Late adolesence
```
17-20 years
Adult appearance
Formal operational thinking
More solid identity
Think more about future
Independence
```
130
Adolescent behavior
A stage not an age
131
BMI chart
5th percentile - underweight
85th percentile - overweight risk
95th percentile - overweight
132
Immunization adolescent
```
11-12 years - immunizations occur less frequently
Tdap
HPV
MCV
Flu
```
133
Adolescent exam
Almost same as adult
MSK - scoliosis main thing
Neuro - sensation, cranial, reflex
Skin - rashes and moles
134
GU exam
Visualize (for Tanner staging)
Palpate genitals and for hernias
Explain self exam
135
Pelvic and breast exam
Not until 21
136
Adrenarche
Before onset of puberty
| Activation of adrenal medulla
137
Gondarche
Earliest gonadal changes of puberty - GnRH released
LH - testosterone or corpus luteum
FSH - sperm formation or estrogen and follicle
138
Thelarche
Begin breast development
139
Pubarche
Begin pubic hair
140
Menarche
First bleeding
141
Tanner staging girls
Breast and pubic hair
142
Tanner staging boys
Genital and pubic hair
143
Tanner staging
```
1 = prepubescent
5 = adult
```
144
Tanner staging breasts
```
1 - nipple only
2 - elevate breast/nipple small mound
3 - further enlargement
4 - nipple forms secondary mound
5 - full breast, only nipple projects
```
145
Tanner staging pubic hair
```
1 - none
2 - whispy
3 - courser, sparse
4 - even courser, more hair
5 - more hair
```
146
Female puberty changes
Breast buds, then pubic hair, growth spurt (peak 12,) menarche (T4)
Total 1.5 - 8 year span
147
Tanner staging penis
1 - same as childhood
2 - some or no penis enlargement, slight scrotum enlargement
3 - further enlargement both
4 - enlarge length and width of penis, enlarge scrotum and darken
5 - adult size and shape
148
Male puberty changes
Testicular growth, pubic hair, penile enlargement, growth spurt (14)
Total 2-5 year span
149
Adolescent health promotion
Sex, drugs, alcohol
| Tell parents to allow them to be independent
