Pediatric PE

Question 1

neonate

Answer 1

defined as the first 28 days of life, after that point they are infants

Question 2

APGAR

Answer 2

appearance
pulse
grimace (reflex irritability) 
activity 
respiratory effort 

scores are 1 min and 5 min after birth

scale is 0-2, total scores out of 10

8-10= normal

Question 3

Ballard scoring system

Answer 3

used to determine gestational age in weeks

gives score based upon neuromuscular maturity and physical maturity

Question 4

Preterm

Answer 4

<37wks

Question 5

Term

Answer 5

37-42

Question 6

Post term

Answer 6

42 weeks

Question 7

general guidelines for infant exam

Answer 7

before 9mo they generally do not fear strangers
after this point, it may be good to have the parent with them
**be flexible
start with Heart and lungs
HEENT is generally last

Question 8

Ortolani tests

Answer 8

tests for presence of posterior dislocation of femoral head from acetabulum (congienital hip dysplasia) - effective until around 3 mo

this test actually causes a relocation of the femoral head

Question 9

Barlow tests

Answer 9

tests for ability to sublux or dislocate intact but UNSTABLE HIP

you are externally rotating the hip, which will cause a posterior hip dislocation (then need to reset with Ortolani)

“Barlow =Back”

Question 10

Galeazzi

Answer 10

flex the knees with heels against butt and compare knee height

if one is lower, this indicates a posterior dislocation

Question 11

Red reflex

Answer 11

reflection of light on the retina, generally RED in color

should be symmetrical reflection with light

Question 12

Stills murmur

Answer 12

generally a grade 2/6
accentuated by laying down
musical, vibratory

Question 13

BMI chart of adolescents

Answer 13

UW=95th per (at this point need to do further work up-think insulin etc)

Question 14

adrenarche

Answer 14

activation of adrennal medulla for producting of adrenal androgens
occurs before the onset of puberty

Question 15

Gonadarche

Answer 15

earlies gonadal changes of puberty
GnRH released
M: LH—>T and FSH—>sperm

Question 16

thelarche

Answer 16

beginning of breast development

Question 17

pubarche

Answer 17

beginning of pubic hair development

Question 18

female puberty changes

Answer 18

breast buds
pubic hair 
growth spurt peaks at age 12
Menarche (T4)
complete in an average of 4 yrs

Question 19

male puberty changes

Answer 19

testicular growth 
pubic hair 
penile enlargement
growth spurt (age 14) 
complete in an avg of 3 yrs

Question 20

Palmar grasp reflex

Answer 20

place finger in hand, should grasp finger, same for foot
disappear by age 4m
plantar till 9m

Question 21

Moro startle reflex

Answer 21

hold supine, abruptly lower 2 feet
arms abduct and extend, hand open and legs flex (startle) then the child should cry
gone by 4m

Question 22

asymmetric tonic neck

Answer 22

while supine, turn head to one side with jaw over shoulder—> “Fencing reflex”, arm and leg on ipsilateral side extend, and contralateral flex

4m

Question 23

rooting reflex

Answer 23

stroke perioral skin at corner of mouth—>mouth opens and turns head toward side stimulated

feeding reflex

4m

Question 24

trunk incurvation

Answer 24

support in prone, stroke on one side of back 1 cm from midline —>spin curves toward stimulated side
gone by 3m

Question 25

placing stepping reflex

Answer 25

hold upright with one sole touching the table—>hip and knee of that foot will flex and other foot will step forward
best after day 4, goes away once child is too heavy

Question 26

Well child exams

Answer 26

1) Physical development
2) Cognitive development
3) social and emotional development

• enable continued assessment of growth and development
  give immunizations, answer questions

Question 27

Meconium

Answer 27

should be passed within the first 24h of life

dark, black and tarry

stools normalize by day 4-5, color depending on type of feeding

Question 28

Components of developmental screening exam

Answer 28

1) Physical (gross and fine motor)
2) Language/ Cognitive
3) Personal/Social

Question 29

Physical development

Answer 29

neurological devo progress central—>peripheral (head control —>use of hands and fingers)

• sitting, standing, walking etc
• using hands to eat, draw, play etc

Question 30

Language/cog development

Answer 30

2 mo= cooing
6 mo=babbling
1 yr= 1-3 words

cause/effect, object permanence, use of tools by 12 mo

**recognize strangers and seek comfort from parent by 9 mo.

Question 31

personal/ social development

Answer 31

understanding of self and family mature

• bonding and attachment develops
• thinking skills, learning , understanding, reasoning

*interacting with other, relationships with others, cooperating

Question 32

immunizations up to 6 yrs

Answer 32

Hep B
RV
DTaP
HIB
PCV (pneumococcal) 
Flu
MMR 
Varicella 
Hep A

Question 33

benign heart murmurs in children

Answer 33

Still’s murmur II-VI, musical, midsystolic

venous hum (soft and continuous) 
carotid bruit (mid systolic, louder on L, eliminated by compression )

Question 34

Early adolescence

Answer 34

10-14yrs
puberty begins

Concrete operational (black and white)

social focus on the present
Self identity (compared to peers)- am i normal
independence -ambivalence

Question 35

Middle adolescence

Answer 35

15-16 yrs
females more comfortable, males awkward
transitional cognition (from concrete to formal operational thinking)

introspective identity (who am i) 
independence- limit testing (experimental behaviors and dating)

Question 36

Late adolescence

Answer 36

17-20 yrs
adult appearance
formal operation cognition

identity: sexuality, others, future
independence= separation from family

**behavior is related to developmental stage and not chronological age or physical maturity