Pediatric Examination - SRS

Question 1

What 3 specific areas should be addressed at each well child exam?

Answer 1

1. physical development
2. cognitive development
3. social and emotional development

Question 2

When are kids called the following?

• Newborn
• Infancy
• Toddler/Early Childhood
• School-aged/Middle Childhood
• Adolescence (11-20 years)

Answer 2

•Newborn

0-28 days

•Infancy

0-12 months

•Toddler/Early Childhood

1-4 years

•School-aged/Middle Childhood

5-10 years

•Adolescence (11-20 years)

Early, middle, & late

Question 3

What are the components of the APGAR scoring?

Answer 3

• A: Appearance (color)
• P: Pulse
• G: Grimace (reflex irritability)
• A: Activity (muscle tone)
• R: Respiratory effort

Question 4

Most babies start out at what apgar score?

Answer 4

9 - due to aprocynosis (spelling?)

Question 5

In APGAR, what does activitys stand for?

Answer 5

Muscle tone

Question 6

What are three things given shortly after delivery?

Answer 6

1. –Erythromycin ointment in eyes to prevent infection (prevent STD infection)
2. –Vitamin K injection to prevent bleeding
3. –Full bath

Question 7

What is the ballard scoring system for?

What are the subranges?

Answer 7

To determine gestational age in weeks.

Neuromuscular maturity

-1 to 5

Physical maturity

-1 to 5

Question 8

what defines a pre-term baby?

Answer 8

less than 37 weeks

Question 9

What is post term baby time fram?

Answer 9

more than 42 weeks

Question 10

How often should neonates feed?

Answer 10

Every three hours

Question 11

In first week of life, what should happen to a childs weight?

Answer 11

Normal to lose up to 10% of birth weight over first week.

Question 12

Elevated bilirubin prior to first 24 hours of life indicate it is more than physiological jaundice.

What are common causes of pathological jaundice of the newborn?

Answer 12

•ABO incompatibility/Rh
•Cephalohematoma
•Infection
•Hemoglobinopathies
–ex: thalassemia
•Enzyme deficiencies
–ex: G-6-PD

Question 13

What is a cephalohematoma?

Answer 13

Large bruise that doesn’t cross suture lines

Question 14

What is done prior to discrharge from the hospital?

Answer 14

–Hepatitis B immunization
–Hearing screen
–Newborn Screening blood test

Question 15

When should there be PCP follow up after discharge?

Answer 15

24-48 hours

Question 16

What components are used for assessment of developmental milestone?

Answer 16

•Physical
–Gross Motor
–Fine Motor
•Language/Cognitive
•Personal/Social

Question 17

How does neurologic development progress?

Answer 17

Centrally to peripherally

1. –Head control
2. –Trunk control
3. –Use of arms
4. –Use of legs
5. –Use of hands then fingers

Question 18

What are the normal language milestones up to 1 yr?

Answer 18

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

Question 19

At 9 months and older, how should you examine the child?

Answer 19

On parent’s lap

Question 20

Until when should you measure head circumference?

Answer 20

At each visit until 36 months

Question 21

At what age would you begin checking BP at a well child exam?

Answer 21

3 years

Question 22

What are the primitive reflexes to test?

Answer 22

1. Palmar grasp
2. Plantar grasp
3. Moro (startle reflex)
4. Asymmetric Tonic Neck
5. Positive support
6. Rooting

Question 23

How do you test the palmar grasp

Answer 23

finger in hand and press against palmar surface –> grasps finger

Question 24

How do you check plantar grasp?

Answer 24

Touch sole at base toes –> toes curl

Question 25

How do you test the Moro reflex?

Answer 25

Hold supine support head, back, legs; abruptly lower 2 feet --\> arms abduct& extend, hands open, & legs flex, +/-cry

Question 26

What do you use Barlow and Ortolani maneuvers to test for?

Answer 26

Signs of hip dislocation Can indicated developmental hip dysplasia (DHD) If positive, imaging

Question 27

What does ortolani test look for?

Answer 27

presence of posteriorly dislocated hip

Question 28

What does the barlow test reveal?

Answer 28

ability to sublux or dislocate intact but unstable hip

Question 29

When does the anterior fontanelle close?

Answer 29

4-26 months

Question 30

When does posterior fontanelle close?

Answer 30

2 months

Question 31

At what age should a toddler be understandable to all?

Answer 31

By 4 years of age

Question 32

Where should you examine a toddler?

Answer 32

On parents lap

Question 33

Where should you examine a school age child?

Answer 33

On table

Question 34

What are new topics to discuss for school age children?

Answer 34

•School issues –Performance, bullying, special ed, behavioral issues? –Does your child have a place to do homework? •Start talking about body changes of puberty/age appropriate •Remember that health and development is heavily influenced by physical, social, environmental factors and disease (child abuse, chronic illness, socioeconomic status)

Question 35

When does puberty begin for females?

Answer 35

8-13 years

Question 36

When does puberty begin for males?

Answer 36

9-13.5

Question 37

What is adrenarche?

Answer 37

–Activation of adrenal medulla for production of adrenal androgens –Occurs before the onset of puberty

Question 38

What is gonadarche? What are the hormonal changes for boys and girls respectively?

Answer 38

–Earliest gonadal changes of puberty-GnRH released •Boys-LH stimulates testosterone production and FSH stimulates sperm maturation •Girls-FSH stimulates estrogen & follicle formation and LH stimulates corpus luteum after ovulation

Question 39

What is Thelarche?

Answer 39

Beginning of breast development at puberty

Question 40

What is pubarche?

Answer 40

beginning of pubic hair

Question 41

What is Tanner 1 for breasts?

Answer 41

elevation of nipple only, preadolescent

Question 42

What is tanner 2 for breasts?

Answer 42

2-elevation breast/nipple as small mound (breast buds)

Question 43

What is tanner 3 for breasts?

Answer 43

further enlargement breast/areola, no separation of contour

Question 44

What is tanner 4 for breast development?

Answer 44

Projection areola/nipple to form secondary mound

Question 45

What is tanner 5 for breasts?

Answer 45

mature stage, projection of nipple only

Question 46

What is tanner 1 for boys?

Answer 46

preadolescent-no pubic hair (fine body hair only); penis/testes same size as childhood

Question 47

What is tanner 2 for boys?

Answer 47

Pubic hair-sparse slightly pigmented, straight. Penis-slight or no enlargement. Testes/scrotum-larger, slightly reddened

Question 48

What is tanner 3 for male?

Answer 48

Pubic hair-darker, coarser, curlier, sparsely over pubic sym; Penis-larger in length. Testes/scrotum-further enlargement

Question 49

Tanner 4 for boys?

Answer 49

Coarse/curly greater than stg 3 but not as great as adult; not on thighs. Penis-further enlargement length/breadth w/ dev. of glans. Testes/scrotum-further enlarged, scrotal skin darkened

Question 50

What is tanner 5 for males?

Answer 50

Pubic hair-adult quantity & quality, spread to medial thighs. Penis-adult size &shape. Testes/scrotum-adult size & shape.

Question 51

What is the acronym for how to approach topics with teens?

Answer 51

HEADS H- Home how are things? E - Education, how is school? A - Alcohol, are your friends drinking? D - Drugs - do your friends try drugs? S - Sex: Do you have a boyfriend/girlfriend? Sexually active?

Question 52

When do you kick parents out of the room?

Answer 52

When a child ilooks mature enough that someone might mistake them for an adult.

Question 53

What is the typical order of changes in males during puberty?

Answer 53

- Testicular growth - Pubic hair - Penile enlargement - Growth spurt peaks (age 14)

Question 54

What is the typical order of changes in females during puberty?

Answer 54

- Breast buds - Pubic hair - Growth spurt peaks (age 12) - Menarche (T4)