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Physical Assessment > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

What year of life has most rapid physical growth?

A

year 1

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2
Q

How does height and weight change in infancy

A

Ht: increased 50%
Wt: triples

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3
Q

What is infancy

A

first year of life

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4
Q

Infancy physical development

A

body proportions change

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5
Q

neuro development of infancy?

A

progresses central to peripheral

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6
Q

cognitive development in infants

A

-increase understanding of self and environment
-cause and effect (rattle=sount)
object permanence
strangers

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7
Q

language in infants

A

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

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8
Q

Social and emotional development of infants

A

Bonding, attachment and trust varied with temperments depending on environment

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9
Q

Rate of physical growth in early childhood

A

slows, about 1/2 of infancy

growth in spurts

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10
Q

early childhood

A

1-4 years

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11
Q

physical development in early childhood

A

walk: 15 mo
run: 2 yr
pedal and jump: 3 yrs
fine motor skills develop

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12
Q

sequence of exam

A

noninvasive nonthreatening first, painful last

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13
Q

neonatal age

A

first 28 days of life

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14
Q

When do you asses a newborn

A

immediately after birth and several hours later

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15
Q

What is APGAR used for

A

to asses adaption to extrauterine life at 1 min and 5 minutes after birth
-max points is 10, low score indicates medical emergency

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16
Q

what does APGAR stand for

A

Appearance skin color (blue/gray, acrocyanosis, normal)
Pulse (absent, below, above 100)
Grimace (reflexes)
Activity (muscle activity)- absent, arms/legs flexed, normal
Respiration absent, slow, crying

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17
Q

Ballard Scoring system

A

determine gestational age to see if size is consistent with dates

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18
Q

What age children should stay in parent’s lap for beginning of exam?

A

infancy and early childhood

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19
Q

At what age can you ask parents to leave

A

13, but make sure you get chaperone

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20
Q

how do you distract early childhood patients

A

simple conversation, engage mom in conversation and exam

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21
Q

what’s most important about assessing adolescents

A

comfortable and confidentiality

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22
Q

Best clue of illness in child

A

appearance

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23
Q

goals of observation

A
  1. sick or not sick (mood, activity level)
  2. family integrity (mom-child)
  3. age in yrs vs. demonstrates
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24
Q

how to measure somatic growth

A

height, weight, head circumference
compare with normal values, previous readings, patterns
-MEASURE CONSISTENTLY

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25
Q

most common cause of deviant measurement

A

technical errors

-REPEAT!!!

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26
Q

How do you measure height >2 yo

A

have patient stand bare foot against the wall with heels, back and shoulders against wall
-make sure head straight forward and midline!!!

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27
Q

how do you measure height <2 yo

A

supine on measuring board with legs fully extended

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28
Q

Rule of thumb average weight at birth, 1 year, 5 year and 10 year

A

Birth: 3.5 kg
1 yr: 10 kg
5 yr: 20 kg
10 yr: 30 kg

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29
Q

How do you measure head circumference

A

paper tape around eyebrows back to occipital prominence, then plot on chart

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30
Q

how long do you measure head circumference

A

until 2yo

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31
Q

causes of microencephaly

A

congenital, familial, chromosomal disorders

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32
Q

causes of macroencephaly

A

subdural hematoma, tumor, familial, hydrocephalus

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33
Q

When do you determine BMI

A

2 yo

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34
Q

BMI in children with percentils

A

underweight: 85%
overweight: >95%

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35
Q

infant blood pressure

A

80/60

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36
Q

preschool BP

A

90/75

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37
Q

adolescent BP

A

100/75

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38
Q

diastolic BP in children

A

60 in infants increases to 75 in childhood

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39
Q

Respirations in newborns

A

30-60

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40
Q

Respiration in early childhood

A

20-40

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41
Q

late childhood respiration

A

15-25

42
Q

At what age is rectal temperature recommended

A

<2 mo

43
Q

What is considered a fever?

A

rectal >100.4 F, 37 C

44
Q

head inspection

A

sutures, symmetry, fontanelles, facies

45
Q

neck exam

A 
nodes
masses
mobility
nuchal rigidity
assess clavicles in newborns
46
Q

Important eye exam in infants

A

Gaze, EOM, red reflex, fundoscopic exam

47
Q

Normal variants for eye in infants

A 
nystagmus for first few days
cross gaze for 3 mo
edema after birth
subconjunctival hemorrhage common
pupilllary asymmetry
48
Q

infant cloudines of cornea

A

congenital glaucoma

49
Q

dark light reflex in infants

A

cataracts

retinopathy of premie

50
Q

white light reflex in infant

A

cataract
retinal detachment
chorioretinitis
retinoblastoma

51
Q

eye exam early childhood

A

acuity

gaze

52
Q

late childhood/adolescent eye exam

A

annual acuity

same exam as adults

53
Q

infant ear exam

A

patency
gross hearing
inspect position, size, shape

54
Q

ear indication of defect

A

low set, small, deformed may indicated defects

55
Q

Early childhood ear exam

A

examine drum

>4yo need acoustic screening

56
Q

late childhood and adolescent ear exam

A

same as adult

57
Q

Nose and paranasal infant exam

A

patency

nasal septum

58
Q

which sinuses are only present at birth?

A

ethmoid

59
Q

Nasal exam for early/late childhood

A

inspect nose and mucosa

60
Q

development of sinuses

A

Ethmoid: birth
Maxillary 4yo
Sphenoids: 6 yo
Frontal 6-7

61
Q

by what age do you have all of your sinuses?

A

6-7

62
Q

which sinus develops last?

A

frontal

63
Q

at age 4 which sinuses do you have?

A

ethmoid and maxillary

64
Q

Mouth and pharynx exam

A

Infant: inspect, palpate and note cry quality
Childhood: inspect uvula, tonsils, teeth, gums, note voice quality and breath odor

65
Q

Heart exam in children

A

inspect
palpate
auscultate

66
Q

Which cyanosis in newborns is normal? abnormal?

A

acrocyanosis normal

central cyanosis abnormal

67
Q

what pulses do you evaluate in infants

A

brachial

femoral

68
Q

at what age do you take BP

A

3 yo

69
Q

PMI in infant

A

unreliable

70
Q

normal variant in children heart rhythm

A

sinus dysrhthmia, common

71
Q

Which is split S1 or S2

A

S2

72
Q

Breasts in newborn children

A

often enlarged “witch’s milk”

73
Q

common onset of puberty in breast development

A

8-13 yo, average of 11
may develop asymmetrically at first
-males can have gynecomastia during puberty

74
Q

protuberance in newborn

A

normal

75
Q

inspecting the umbilical cord in newborns

A

2 thick wall arteries and 1 large thin walled vein at 12:00

-look for hernias

76
Q

childhood abdominal exam

A

inspect
palpate
percuss

77
Q

What are you asessing for male genitalia exam in newborn and infants

A

hypospadias, chordee
foreskin not usually retratable
testes in scrotum, hernias, hydroceles

78
Q

size of the penis in childhood

A

not important unless enlarged

79
Q

Male genitalia tanner stages

A
  1. prepubertal testes 2mL, no hair
  2. enlargement of testes >4mL, redenned scrotum, few hairs at base of penis
  3. lengthening of penis, enlarge to 6-10mL, curly hair across pubes
  4. broadening of glans penis, growth 10-15mL, small adult hair
80
Q

Puberty in males onset and termination

A

onset: 10-13 yrs

complete 14-18

81
Q

inspection of female genetalia infants

A 
size of clitoris
color, size of labia majora (rashes, lesions)
urethral orifice and labia minora
hymen
d/c?
82
Q

what position do you perform childhood female genital exam

A

parents lap or knee, chest to examine external structurs, d/c or lesions
NOT IN STIRRUPS

83
Q

Female Tanner stages

A
  1. Prepubertal: no breast tissue or PH
  2. areolar enlargement with bud, few dark hairs on labia
  3. single mound areolar, breast with curly ph
  4. projection of areola, double mound, small adult ph
  5. adult single contour breast with adult PH
84
Q

Rectal exam

A

not apart of routine peds PE

done when intra-abdominal, pelvic or perirectal dz

85
Q

Two tests done in infants to test for hip sublux

A

ortolani’s and barlow’s

86
Q

Ortolani’s

A

tests for presence of posterior dislocation

-hip, knees flexed at 90 degrees, ABduct both until lateral leg hits exam table

87
Q

Barlow’s

A

same position as ortolani’s but tests for ability of unstable hip to sublux
-pul one leg forward and ADduct with a posterior force, no movement means stable hip

88
Q

Most common congenital foot disorder

A

club foot

89
Q

Neuro exam in infants

A

infantile refleces

90
Q

childhood neuro exam

A

modified glassgow

91
Q

Rooting

A

stroke perioral skin with hand, infant will turn head twd stimulus, open mouth and suck

92
Q

when does rooting disappear

A

3-4 month

93
Q

When does sucking diappear

A

10-12 months

94
Q

when does palmar grasp and plantar grasp disappear

A

palmar: 3-4 mo
plantar: 6-8 mo

95
Q

tonic neck (fencing)

A

turn head and hold head and shoulder down, ipsalateral arm will extned, other will flex

96
Q

when does fencing diappear

A

2 months

97
Q

moro (startle)

A

support supine and drop about two feet, arms will extend and abduct, hands open, legs flex, cry

98
Q

when does moro diappear

A

4 months

99
Q

when does babinski disappear

A

2 years

100
Q

when does stepping reflex diappear

A

2-6 mo

Physical Assessment (4 decks)

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