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Advanced Clinical Assessment Across Lifespan > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

When does the anterior fontanelle close?

A

2 years

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2
Q

When does the posterior fontanelle close?

A

2 months

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3
Q

When does the metopic suture begin closing?

A

2 months

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4
Q

When does the sagittal suture begin closing?

A

22 months

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5
Q

When does the coronal suture begin closing?

A

24 months

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6
Q

When does the lamboid suture begin closing?

A

26 months

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7
Q

Craniosynostosis

A
  • Occurs when one or more sutures closes (fuses) early
  • The fusion restricts the growth of the skull
  • In order to accommodate the growing the brain, compensatory skull growth occurs across sutures that have not closed
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8
Q

Scaphocephaly

A
  • Closure of the sagittal suture
  • Causes elongated head
  • Most common cause of craniosynostosis
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9
Q

Brachycephaly

A
  • The head flattens uniformly, causing a wider and shorter shape.
  • Increased head height is also common
  • Can be positional or a result of closure of the coronal, metopic sutures
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10
Q

Plagiocephaly

A
  • Plagiocephaly means “oblique head”
  • It’s called a parallelogram deformity because if you look down on the infant’s head (bird’s-eye-view), this is the shape you will see.
  • Misalignment of the ears
  • Can be positional or due to unilateral closure of the coronal or lambdoid sutures
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11
Q

Average head circumference at birth?

A

35cm

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12
Q

How much does the head circumference increase?

  • first 3 months
  • 3-12 months
  • 1 year+
A
  • Head circumference increases 2 cm/month for the first 3 months of life
  • Then decreases to 1cm per month from 3-12 mths of age
  • After one year growth slows for a total of 10cm for rest of life
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13
Q

How is abnormal head growth defined?

A

a head circumference greater than 2 standard deviations above or below the mean for a given age, gender and gestation

  • either micro or macrocephaly
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14
Q

Microcephaly

A

2 SD below mean

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15
Q

Macrocephaly

A

2 SD above mean

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16
Q

Respiratory rate of infant (birth to 1 year)

A

30-60

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17
Q

Respiratory rate of 1-3 year old

A

24-40

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18
Q

Respiratory rate of 3-6 year old

A

22-34

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19
Q

Respiratory rate of 6-12 year old

A

18-30

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20
Q

Respiratory rate of 12-18 year old

A

12-16

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21
Q

What are signs of respiratory distress?

A
  • tachypnea
  • retractions
  • tripod
  • grunting
  • nasal flaring
  • cyanosis
22
Q

Bronchiolitis

A

Respiratory Syncytial Virus (most common)

Causes acute respiratory disease in children

“Happy wheezer”- inflammation of the bronchioles

Most common in winter months

23
Q

Symptoms of Bronchiolitis

A

Rhinorrhea

Pharyngitis

Cough

Tachypnea

Wheeze

24
Q

Laryngomalacia

A

Stridor beginning at birth, up to a week

Collapse of the epiglottis during inspiration

Self-limiting, and no tx unless hypoxic

Inspiratory stridor and with feeding

25
Q

Aspiration of a foreign object

A

Common in children under the age of 4

Usually clear cut history of choking

Unwitnessed or no choking, symptoms usually present with:

  • Unilateral absence of breath sounds (right side)
  • Localized wheezing
  • Stridor
  • Bloody Sputum

Untreated aspiration could lead to pneumonia

26
Q

Internal Femoral Torsion

A
  • Patella turns inward and In-toeing
  • On exam, gently rotate the patella so that they face forward
  • If femoral torsion is the problem the feet suddenly point forward.
27
Q

Internal Tibia Torsion

A
  • Common 6-18mths
  • Patella and feet point directly forward, but in-toeing present
  • Worse when they start to walk, but resolves by age 2
28
Q

Genu Varnum

A
  • Bow legged
  • Internal tibia torsion often accompanies physiologic bowed appearance
    Spontaneous correction by age 2
29
Q

What are pathologic causes of Genu Varnum?

A

Blount disease

Rickets

Skeletal dysplasia

Asymmetric growth

30
Q

Genu Valgum

A
  • Knock knees
  • May occur after genu varnum and/or after the age of 2
  • Spontaneously disappear by age 8
  • Associate with obese children
31
Q

What are pathologic causes of Genu Valgum?

A

Rickets

Post traumatic

Skeletal dysplasia

32
Q

What is toeing out?

A

Eversion of legs

Spontaneously corrects 6-12 mths

External rotation of the hips

33
Q

What is toe walking?

A

Favor their toes in the early months of walking, prior to developing heal to toe gait

  • Intermittent
  • At rest will stand flat footed on the floor
34
Q

What is toe walking associated with?

A
  • cerebral palsy,
  • tethered spinal cord
  • muscular dystrophy
35
Q

What are risk factors for developmental hip dysplasia?

A

Breech positioning at >34 weeks
Family history of dysplasia
Female
First born

36
Q

Developmental dysplasia?

A

Abnormal development of the acetabulum and proximal femur leading to mechanical instability of the hip joint

37
Q

Barlow test

A
  • “dislocation test,” used to discover hip instability
  • The thigh is flexed and adducted with gentle downward pressure
  • Dislocation is palpable as the femoral head slips out of the acetabulum
  • Dx confirmed with Ortolani
38
Q

Ortolani test

A
  • “reduction test,” used to reduce a recently dislocated hip
  • Infant thigh is flexed and abducted and the femoral head is lifted anteriorly toward the acetabulum
  • A positive test is a “clunk” or a “click” as the femoral head is reduced into the acetabulum
39
Q

Galeazzi Sign

A
  • While the infant is supine, Feet are placed together with hips and knees flexed (Use after 3-4 months)
  • Uneven knee length is a positive Galeazzi sign
40
Q

Trendelenburg Pelvic Tilt Test

A
  • Have the patient stand and raise leg, to 90 degrees with knee flexed
  • Should be able to hold position
  • If unable to hold position or there is a tilt of the pelvis that is a positive sign
41
Q

Nursemaids Elbow

A
  • Subluxation of the annular ligament of the radial head
  • Occurs when there is longitudinal traction on the arm
  • The child will present with the arm flexed or at their side with the palm down and refuse to move their arm or reach for items
  • Treatment is reduction of the ligament
42
Q

When should palmar grasp occur?

A

birth to 3-4 months

43
Q

When should plantar grasp occur?

A

Birth to 6-8 months

44
Q

When should the stepping reflex occur?

A

Birth to 3 months (variable)

45
Q

When should the rooting reflex occur?

A

Birth to 3-4 months

46
Q

When should the moro reflex occur?

A

Birth to 4 months

startle reflex

47
Q

When should the tonic clonic reflex occur?

A

Birth to 2 months

48
Q

What are examples of concerning behaviors of a 1 month old baby?

A

Sucks poorly and feeds slowly

Doesn’t blink when shown a bright light

Doesn’t focus and follow a nearby object moving side to side

Rarely moves arms and legs; seems stiff

Seems excessively loose in the limbs, or floppy

Lower jaw trembles constantly, even when not crying or excited

Doesn’t respond to loud sounds

49
Q

What are examples of concerning behaviors of a 3 month old baby?

A

Doesn’t notice her hands by two months

Doesn’t smile at the sound of your voice by two months

Doesn’t follow moving objects with her eyes by two to three months

Doesn’t grasp and hold objects by three months

Doesn’t smile at people by three months

Cannot support her head well at three months

Doesn’t reach for and grasp toys by three to four months

Doesn’t babble by three to four months

Doesn’t bring objects to her mouth by four months

Begins babbling, but doesn’t try to imitate any of your sounds by four months

Doesn’t push down with her legs when her feet are placed on a firm surface by four month

50
Q

What are examples of concerning behaviors of a 1 year old?

A

Does not crawl

Drags one side of body while crawling (for over one month)

Cannot stand when supported

Does not search for objects that are hidden while he watches

Says no single words (“mama” or “dada”)

Does not learn to use gestures, such as waving or shaking head

Does not point to objects or pictures

51
Q

What are examples of concerning behaviors of a 2 year old?

A

Cannot walk by eighteen months

Fails to develop a mature heel-toe walking pattern after several months of walking, or walks exclusively on his toes

Does not speak at least fifteen words by eighteen months

Does not use two-word sentences by age two

Does not seem to know the function of common household objects (brush, telephone, bell, fork, spoon) by fifteen months

Does not imitate actions or words by the end of this period

Does not follow simple instructions by age two

Cannot push a wheeled toy by age two

Advanced Clinical Assessment Across Lifespan (12 decks)

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