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KM PCMII EXAM 1 > Pediatric Exam > Flashcards

Pediatric Exam Flashcards

1
Q

Well Child Exam

A

Physical development
Cognitive development
Social and emotional development

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2
Q

Newborn

A

0-28 days

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3
Q

Infant

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

Adolesence

A

Early, middle, late

11-20 years

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7
Q

Predictable pathway

A

Development controlled by the brain

Age specific milestones

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8
Q

Range of normal development

A

Wide, mature at different rates

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9
Q

What affects development/health

A

Physical, social, environmental, disease

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10
Q

Hx and PE of child

A

Varies based on stage of development

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11
Q

Neonatal resuscitation

A

Anything to help baby breathe at birth - usually only need drying and bulb suction

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12
Q

APGAR

A 
Assess neurological recovery after birth/adaptation
A-Appearance
P-Pulse
G-Grimace
A-Activity
R-Respiratory effort
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13
Q

APGAR Scoring

A

0-2 each category, add up total

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14
Q

When to assess APGAR

A

1 minute and 5 minutes

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15
Q

1 min

A 
0-4 = depression
5-7 = some nervous depression
8-10 = normal
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16
Q

5 min

A 
0-7 = High risk for CNS and system dysfunction
8-10 = normal
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17
Q

Appearance

A

Should be pink (although usually a little blue at first)

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18
Q

Pulse

A

Should be greater than 100

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19
Q

Grimace

A

Should be crying and vigorous when you hold them

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20
Q

Activity

A

Arms and legs should be moving around (arms and legs usually in flexed position,) limp is bad

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21
Q

Respiratory effort

A

Should be good/strong

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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

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23
Q

Hospital Eval of Newborn

A

Within 24 hours of birth
Review Mom Hx
Review delivery record
Head to toe exam

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24
Q

Review Mom Hx

A

Medications, medical hx, blood work

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25
Q

Review delivery record

A

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)

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26
Q

Head to Toe Exam

A

Includes: molding/fontanelles, red reflex, palate, genital, hip, primitive reflex

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27
Q

Hospital care after delivery

A

Erythromycin ointment for eye infection prevention, Vitamin K for bleeding (not enough production from bacteria in gut,) full bath

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28
Q

Ballard scoring system

A

Used to determine gestational age, neuromuscular and physical characteristics that change with gestational age

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29
Q

Gestational age

A

Time in utero - can predict health and development long term

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30
Q

Pre-term

A

less than 37 weeks

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31
Q

Post-term

A

more than 42 weeks

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32
Q

Normal weight

A

2500 grams

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33
Q

Low weight

A

less than 2500 grams

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34
Q

Very low weight

A

less than 1500 grams

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35
Q

Extremely low birth weight

A

less than 1000 grams

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36
Q

SGA

A

Small for gestational age (10th percentile) - mom could have had infection, decreased blood flow

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37
Q

AGA

A

Appropriate for gestational age

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38
Q

LGA

A

Large for gestational age (90th percentile) - mom could be diabetic

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39
Q

Neonate feeding

A

every 3 hours, approx 1 oz

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40
Q

Colostrum

A

Initial thick, yellow breast milk - milk comes in 2-3 days later

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41
Q

Neonate weight

A

Lose 10% week 1, gain back week 2

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42
Q

Neonate voiding

A

3-4 per day first few days, 6-8 after that

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43
Q

Meconium

A

Initial black, tarry stool - goes away with presence of more gut bacteria

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44
Q

Breast fed stool

A

Yellow, seedy

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45
Q

Formula fed stool

A

Yellow, green

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46
Q

Jaundice testing

A

Transcutaneous billimeter (screen) or serum indirect/direct, compare to nomogram (based on age)

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47
Q

Jaundice prior to 24 hours

A

Think more than physiologic

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48
Q

Prior to hospital discharge

A

Hep B immunization, hearing, blood screening, circumcision (if wanted)

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49
Q

Well child visit HPI

A

Feeding, pooping, sleeping, development, safety, parental concerns (rest of history is about the same as adult)

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50
Q

Well visit week 2

A

Newborn screen #2 (catch anything missed in #1)

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51
Q

Well visit 9 months

A

Hemoglobin

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52
Q

Growth rate in infant

A

Fastest during this stage (weight triple, hight increase by 50%)

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53
Q

Growth chart

A

Weight, length, head circumference - need three points at least to see a trend

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54
Q

Neurologic development in infant

A

Central to peripheral, gross to fine motor; head to trunk to limbs to hands to fingers

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55
Q

Language in infant

A

2 months - cooing
6 months - babbling
1 year - few words

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56
Q

Cognitive in infant

A

Cause/effect, object permanence, tools

9 mo - recognize strangers, comfort in familiar people, manipulate objects

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57
Q

Personal/Social in infant

A

Understand self, bonding with others, temperament, adaptability to new schedules

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58
Q

Ex Gross motor milestones

A

Sit, walk, run, stand, keeping balance, changing positions - using big muscles

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59
Q

Ex Fine motor milestones

A

Use of hands - eating, drawing, getting dressed etc.

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60
Q

Ex Language milestones

A

Using and understanding language with speech, body language and gestures

61
Q

Ex Cognitive milestones

A

Learning, understanding, problem solving, remembering

62
Q

Ex Social milestones

A

Relationships with friends, family, teachers, cooperating, and responding to feelings of others

63
Q

Infant Exam Guidelines

A 
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
Q

General Infant PE

A

Observe
Resp - observe and auscultate
Cardio - compare pulses, palpate, auscultate, no BP until age 3
Abdominal - observe, auscultate, percuss, palpate

65
Q

Resp distress in Infant

A

nasal flaring, ribs stick out (see intercostals)

66
Q

Pulse in infant

A

Best to use brachial (neck space is small)

67
Q

Murmurs

A

Normal - PDA (patent ductus - first couple days,) Still’s murmur
Watch murmurs to see if they resolve with time

68
Q

GI in infant

A

Can feel liver and sometimes kidneys, shouldn’t feel spleen, anal fissures (bleeding in diaper)

69
Q

Genital swelling

A

Redness and swelling normal first few days after birth - hormonal

70
Q

GU Male Infant

A

Inspect, visualize meatus (look for hypospadia,) make sure circumcision has healed (redness at first is normal,) testes should descend, palpate for hernias

71
Q

GU Female Infant

A

Inspect, palpate for hernias

72
Q

Anal/rectum Infant

A

position, fistulas, fissures

73
Q

Neuro Infant

A

Cranial nerves, muscle tone, tendon reflexes, primitive reflexes

74
Q

Labial adhesions

A

Due to irritation, can cause recurrent UTI or block urine, treat with estrogen creme

75
Q

Primitive reflexes

A

Should go away, if not there could be a problem with myelination

76
Q

Palmar grasp

A

If you tough their palm, they will grab your hand

B-4 mo

77
Q

Moro (startle) reflex

A

“Drop” baby 2 feet and they will abduct and extend arms, flex legs, and cry
B-4mo

78
Q

ATN reflex

A

Asymmetric tonic neck - turn head to one side, arm/leg same side extend and opposite arm/leg flex
B-4mo

79
Q

Positive support reflex

A

Hold baby and let feet tough ground - legs will briefly extend to attempt to bear weight
B or 2mo-6mo

80
Q

Rooting reflex

A

Stroke side of face and baby will turn towards stimulus and start suckling
B-4mo

81
Q

Trunk incurvation reflex

A

Hold baby prone and stroke back on one side 1 cm from midline - hips will move to that side
B-3mo

82
Q

Stepping

A

Hold baby and let one foot touch floor - other foot will move forward in walking motion
B-variable

83
Q

Landau reflex

A

Suspend prone - head lifts up and spine straigtens

B-6mo

84
Q

Parachute reflex

A

Suspend prone and lower head - arms and legs extend

4-6 mo and does not disappear

85
Q

Plantar reflex

A

Touch ball of foot - toes curl tight

B-9mo

86
Q

MSK Exam Infant

A

Observe (symmetry, digits, and deformities)

Palpate - spine and feet (scoliosis, spina bifida, club foot)

87
Q

Barlow maneuver

A

Test ability to sublux or dislocate unstable hip

88
Q

Ortolani maneuver

A

Test for presence of previously dislocated hip

89
Q

Galeazzi test

A

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
Q

Developmental hip dysplasia

A

Positive barlow, ortolani, and/or galeazzi require further imaging (xray if old enough)

91
Q

Anterior fontanelle

A

Larger, close between 4 and 26 months

92
Q

Posterior fontanelle

A

Smaller, close between 1 and 2 months

93
Q

Fontanelles

A

Should be soft, if hard and bulging there may be cranial pressure

94
Q

Red reflex

A

Should be symmetrical, eyes reflect red with light

If absent, there may be something blocking retina like a cataract

95
Q

Epstein pearls

A

Hard white balls on roof of mouth - normal

96
Q

Pits/tags around ear

A

Could be sign of something more serious - kidney problems

97
Q

Torticollis

A

Asymmetrical holding of the neck

98
Q

Mongolian spot

A

Big dark birthmark - benign

99
Q

Immunization at the hospital

A

Hep B - rest in doctor’s office

100
Q

Growth rate of toddler

A

Slows to half of infant, 2-3 kg and 5 cm per year

101
Q

Language in toddler

A

By 4 years should be understandable to all

102
Q

Social/emotional in toddler

A

Try to be more independent, temper tantrums

103
Q

Motor skills toddler

A

Walk, skip, hop, jump

Draw circles and lines

104
Q

Cognitive in toddler

A

Learn by touching and using mouth, imitative playing

105
Q

Exam in toddlers

A

In diaper on parents lap using toys, still use growth chart, head circumference until 36 months

106
Q

Motor in school aged

A

Growth is steady, more coordination

107
Q

Cognitive in school aged

A

Concrete operational - black and white, no gray areas

108
Q

Social/emotional in school aged

A

Independent, self esteem affected by environment, identity

109
Q

Common problems with school aged

A

asthma, joint pain from growing, speech development

110
Q

Exam with school aged

A

Keep modesty and dress in gown, head to toe exam on table, generally same PE as adult but not full GU

111
Q

Still’s murmur

A

Low grade (2-4,) musical, vibratory, midsystolic

112
Q

Venous hum

A

Soft, continuous, louder in diastole

113
Q

Carotid bruit

A

Midsystolic, usually louder left, eliminated by carotid compression

114
Q

Neuro exam after infancy

A

Cranial nerves, deep tendon reflexes

115
Q

MSK exam in older child

A

Have them walk around, look at arches and position of legs

116
Q

Back in older child

A

Look more for scoliosis

117
Q

Skin in older child

A

Look for rashes and moles, tell parents how to keep track of moles

118
Q

Palpebral fissure

A

Eliptical space of eye
Short can mean FAS
Upward slant can indicate trisomy

119
Q

Cover/uncover test

A

9mo to 3 years

Looks for strabismus

120
Q

Testing visual acuity

A

After 3 years

121
Q

Permanent teeth

A

Age 6

122
Q

Peak tonsillar growth

A

Age 8-16

123
Q

Hearing test

A

Age 3-4

124
Q

Ear exam

A

Done last in younger patients, have parent hold child to avoid injury

125
Q

Healthy habits eduation

A

Oral hygiene and diet, injury and illness prevention (seatbelts, helmets, etc.)

126
Q

Early adolescence

A 
10-14 year
Puberty begins
Concrete operational
Focus on present
Peers more important
Am I normal
127
Q

Puberty begins

A

F - 8-13 years

M - 9-13.5 years

128
Q

Middle adolescence

A

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
Q

Late adolesence

A 
17-20 years
Adult appearance
Formal operational thinking
More solid identity
Think more about future
Independence
130
Q

Adolescent behavior

A

A stage not an age

131
Q

BMI chart

A

5th percentile - underweight
85th percentile - overweight risk
95th percentile - overweight

132
Q

Immunization adolescent

A 
11-12 years - immunizations occur less frequently
Tdap
HPV
MCV
Flu
133
Q

Adolescent exam

A

Almost same as adult
MSK - scoliosis main thing
Neuro - sensation, cranial, reflex
Skin - rashes and moles

134
Q

GU exam

A

Visualize (for Tanner staging)
Palpate genitals and for hernias
Explain self exam

135
Q

Pelvic and breast exam

A

Not until 21

136
Q

Adrenarche

A

Before onset of puberty

Activation of adrenal medulla

137
Q

Gondarche

A

Earliest gonadal changes of puberty - GnRH released
LH - testosterone or corpus luteum
FSH - sperm formation or estrogen and follicle

138
Q

Thelarche

A

Begin breast development

139
Q

Pubarche

A

Begin pubic hair

140
Q

Menarche

A

First bleeding

141
Q

Tanner staging girls

A

Breast and pubic hair

142
Q

Tanner staging boys

A

Genital and pubic hair

143
Q

Tanner staging

A 
1 = prepubescent 
5 = adult
144
Q

Tanner staging breasts

A 
1 - nipple only
2 - elevate breast/nipple small mound
3 - further enlargement
4 - nipple forms secondary mound
5 - full breast, only nipple projects
145
Q

Tanner staging pubic hair

A 
1 - none
2 - whispy
3 - courser, sparse
4 - even courser, more hair
5 - more hair
146
Q

Female puberty changes

A

Breast buds, then pubic hair, growth spurt (peak 12,) menarche (T4)
Total 1.5 - 8 year span

147
Q

Tanner staging penis

A

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
Q

Male puberty changes

A

Testicular growth, pubic hair, penile enlargement, growth spurt (14)
Total 2-5 year span

149
Q

Adolescent health promotion

A

Sex, drugs, alcohol

Tell parents to allow them to be independent

KM PCMII EXAM 1 (1 decks)

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