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Physical Assessment 2 > Peds > Flashcards

Peds Flashcards

1
Q

neonatal pd

A

1st day-28th day

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2
Q

postnatal pd

A

29 days-1year

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3
Q

infancy

A

0-12MO aka 1st yr of life

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4
Q

early childhood

A

1-4YO

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5
Q

middle childhood

A

5-10YO

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6
Q

adolescence

A

11-20YO

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7
Q

when do we exam newborn

A
  1. first one is immediately after birth

2. comprehensive is done w/in 24 hrs after birth

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8
Q

what can encourage eye opening in newborn

A

light dimmed

slight rocking

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9
Q

APGAR

  • minutes?
  • what are we scoring
A

1 min
5 min

HR (>100) 
Resp effort 
muscle tone 
reflex irritability (virgorous cry, sneeze, cough) 
color
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10
Q

preterm

A

<34 weeks

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11
Q

late preterm

A

34-36 weeks

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12
Q

moms with DM can have?

A

larger babies

-hypoglycemia is an concern with them

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13
Q

define failure to thrive

A

inadequate weight gain for age

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14
Q

APGAR scoring

A

HR:
absent=0
<100= 1
>100= 2

Resp effort:
Absent= 0
SLow and irreg= 1
Good/strong= 2

Muscle tone:
flaccid=0
Some flexion of arms/legs=1
active movement= 2

Reflex irritability
no response=0
grimace=1
cry virogoursly, sneeze, cough= 2

Color
blue/pale=0
pink body, blue extrems=1
pink all over=2

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15
Q

1 min APGAR score
0-4=?
5-7=?
8-10=?

A

0-4= severe depression, requirring immediate resuscitation

5-7= some NS depression (should improve by 5 min APGAR)

8-10= normal

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16
Q

5 min APGAR score
0-7=?
8-10=?

A

0-7= high risk for subesquent central nervous system and other organ system dysfunction

8-10= normal

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17
Q

what period of life is the most rapid rate of growth }?

A

infancy (0-12MO)

  • birth wt triples
  • height increases by 50% by end of year one
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18
Q

by end of year one:

  • bright weight____
  • height increases by?
A

weight triples

height incrs by 50%

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19
Q

sequence of exam for infancy

A
  1. perform non-disturbing maneuvers early
  2. most imp indicator of infant health is measurement of growth
  3. measure
    - height (length <2)
    - weight
    - head circumference
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20
Q

postterm infants are at risk for

A

perinatal mortality and morbidity

  • asphyxia
  • meconium aspiration
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21
Q

MC complication for LGA newborns

A

hypoglycemia—- s/s= jitteriness, irritability, cyanosis and other health issues

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22
Q

etiology for SGA infants

A
  • fetal, placental and maternal factors

* maternal smoking **

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23
Q

preterm appropriate for gestational age AGA are at risk for?

A
  • resp distress
  • apnea
  • PDA with R—>L shunt
  • infection
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24
Q

preterm SGA infants are at risk for

A

asphyxia

  • hypoglycmia
  • hypocalcemia
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25
Q

Physical
Cognitive/language
social/emotional

  • *birth
  • *1 MO
  • *2 MO
  • *3 MO
A

Birth:

physical: focuses, fixes/follows
cognitive: responds to sounds
social: regards face

1-2MO
physical: head control
cognitive/language: coos
Social: smiles

3MO:

  • physical: rolls over, grasps rattle, works for toys
  • language: babbles
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26
Q

Physical
Cognitive/language
social/emotional

  • *4MO
  • *5 MO
  • *7-8 MO
A

4MO
Language: squeals
Emotional/social: laughs

5MO:
physical: sits

7-8MO

  • cognitive/language: dada/mama
  • social/emotional: feeds self (more so puts food to their mouth) and indicates wants
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27
Q

Physical
Cognitive/language
social/emotional

  • *9MO
  • *11-12MO
A

9 MO

  • physical: pulls to stand, crawls
  • social/emotional: waves and plays peek-a-boo

11-12MO

  • physical: walks
  • language: 2-3 words
  • social/emotional: uses spoon
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28
Q

at what age do we start taking BP

A

3 YO

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29
Q

RR of newborn

A

30-60

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30
Q

HR for newborn, 1-6MO, 6-12MO

A

newborn: 140
1-6MO: 130
6-12MO: 115

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31
Q

how to take newborn temp (unitl wht age)

A

rectal

until 2MO

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32
Q

central cyanosis in infant suggests?

A

incr suspicion of congenital heart disease

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33
Q

acrocyanosis

A

blueish, discoloration of palms/soles

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34
Q

lanugo

A

fine

downy growth of hair

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35
Q

jaundice can suggest?

A

normal finding (common)–physiologic jaundice
OR
hemolytic dz of the newborn (yellowing persisting past first 24 hours following birth)

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36
Q

milia

A

white raised areas
size of pinhead
sebaceous glands are still open
*common skin finding

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37
Q

Milia rubra

A

scattered vesicles on erythematous base-face/trunk

  • sweat gland duct obstruction
  • resolves in few weeks
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38
Q

Neurofibromatosis

A

yellowing of skin
-starts in first five days of life
HEAAD TO TOE presentation

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39
Q

cafe au lait spots

  • describe
  • pathologic or benign?
  • assoc with ?
A

pigmented brown lesions with unifrom borders

  • can be normal on its OWN
  • more than 5…. considered to be assoc with neurofibromatosis
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40
Q

Pustular melanosis

A

small vesiculopustules

  • benign
  • MC in AA pts
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41
Q

Salmon patch

  • also called?
  • describe
  • benign or pathologic?
A

also called “stork bite” or “angel kiss”

  • vascular marking
  • splotchy pink mark
  • fades with age
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42
Q

best areas to loook for central cyanosis

A

tongue and oral mucosa

NOT: nail beds, lips or extrems

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43
Q

skin desquamation

A

normal in full term newborns

rarely can be a sign of placental circulatory insuff or congenital ichthyosis

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44
Q

midline hair tufts over the lumbosacral spine suggests?

A

possible spinal cord defect

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45
Q

jaundice persistenting over 2-3 weeks suggest q

A

biliary obstruction or liver dz

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46
Q

common source of jaundice in the firt couple weeks?

A

breastfeeding jaundice– resolves aorund 10-14 days

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47
Q

significant edema of hands/feed of newborn suggests

and/or webbed neck

A

turner syndrome

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48
Q

molloscum contagiosum

  • describe
  • benign or pathologic?
A

dome shaped
fleshy lesions
painless
viral infection

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49
Q

impetigo

A

bac infection
appears crusty yellow
“honey crusted lesion”

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50
Q

slate blue patch

A

common in darker skinned PT
blue pigment cells
not be mistaken for bruise

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51
Q

sutures?

A

membranous tissue spaces separating bones of the skull

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52
Q

Fontanelles?

A

Areas where major sutures intersect

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53
Q

anterior fontanelle closes b/w?

A

2-26 MO

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54
Q

Posterior fontanelle closes?

A

by 2 MO

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55
Q

depressed anterior fontanelle

A

dehydration

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56
Q

enlarged posterior fontanelle

A

congenital hypothyroidism

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57
Q

bulging or tense fontanelle

A

increased ICP–from CNS infections (meningitis), neoplastic dz, hydrocephalus

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58
Q

early closure of fontanelles

A

microcephaly
craniosynostosis
metabolic dz

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59
Q

delayed closure of fontanelle

A

hypothyroidism
megalocephaly
rickets
incr ICP

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60
Q

dilated scalp veins

A

long standing increased ICP

61
Q

plagiocephaly

A 
positional common cause 
basically flat head 
-infant lies mostly on one side resulting in flattening of the parieto-occipital region 
-prominence on ipilaterla side 
****why we do tummy time for babies

But can be pathologic due to torticolis from injury to the SCM at birth or lack of stimulation of infant (being on its back too much)

62
Q

congenital hypothyroidism

A

coarse facial features
low set hairlinfe
enlarged tongue—- macroglosia

63
Q

what is the name of the eye reflex in first 10 days of life

A

dolls eye reflex

-if infants head is turned in one direction, w/o moving the body, eyes may stare in one direction

64
Q

what eye finding is common for babies born vaginally

A

subconjunctival hemms

65
Q

nystagmus

  • define
  • sugests?
A

wandering/shaking eye movement

-persistent after a few days—- suggests poor vision and/or CNS dz

66
Q

persistent occular discharge/tearing suggests?

A

dacryocystitis or nasolacrimal duct obstruction

67
Q

Leukokoria

A

white retinal reflex may suggest cataract, retinal detachement or retinoblastoma

68
Q

myopia

A

nearsightedness (diff seeing far)

MC visual disorder in kids

69
Q

what is MC visual disorder in kids

A

myopia–near sightedness aka cannot see far

70
Q

brushfield spots

  • describe
  • suggests?
A

abnormal speckling on iris

suggests down syndrome

71
Q

Strabismus

  • describe
  • can lead to?
A

misalignment of the eyes

leading to visual impairment

72
Q

small, deformed, low-set auricles may indicate

A

congenital defects

esp: renal disease ***

73
Q

most newborns in US undergo….

A

hearing screenings in nursery

MADATORY in us

74
Q

what direction to pull on the ear to view eardrum of newborn? oldr children?

A

pull DOWN for newborns

pull upwards and backawrds for oldr kids

75
Q

pneumatic otoscope used to assess?

A

mobility of TM

76
Q

decreased TM mobility suggests

A

OM with effusion

77
Q

mastoid bone is tender, swollen,

A

mastoiditis

78
Q

auricle protruding forward.outward suggests

A

mastoidits

79
Q

which ear infection is very common in kids

A

Acute otitis media

80
Q

ear pain + TM red, bulging, dull or absent light reflex with decrease movement on pneumatic otoscopy

81
Q

moving the auricle or pushing on tragus elicits pain

A

otitis externa

82
Q

pale, boggy nasal mucous membranes

A

allergic rhinitis

83
Q

foul smelling, purulent, unilateral discahrge

MC seen in young preschool kids

A

FB in nose

84
Q

flesh colored growths in the nares

A

Nasal polyps

85
Q 
purulent rhinorrhea (unilateral) for more than 10 days
\+HA
\+sore throat 
\+fever 
\+tenderness over sinuses
86
Q

what age do babies say “mamma/dada”

87
Q

what age do babies start to pull to stand

88
Q

pulling to stand and baby saying “mamma/dada” would be what age

89
Q

milestones for 6MO (gross motor, fine motor, language, social/emotional)

A

GROSS MOTOR:

  1. sits propped on hands
  2. lateral protection
  3. bounces when held

FINE MOTOR:

  1. transfers objects from hand-hand
  2. reaches out with one hand
  3. feeds self crackers

Language:

  1. babbles–consonant sounds
  2. understands “no”

Social-emotional:

  1. enjoys reflection in mirror
  2. looks from object to parent and back when wanting help–indicating want
90
Q

baby with meningitis would show _____ or ____ fontanelles

A

bulging or tense

91
Q

swelling/discoloration below eyes

+ grimacing to relieve nasal itching

A

allergic shiners

92
Q

transverse line on nose

child keeps pushing back on their nose

A

allergic salute

93
Q

short frenulum limitig the protrusion of the tongue

A

ankyloglossia

or tongue tie

94
Q

when does first tooth appear

95
Q

how many primary teeth do kids have

96
Q

shrill or high pitched crying in newborns suggest?

A

they were born to narcotic addicted moms

97
Q

white plaques that do not rub/scape off

A

thrush

*common in newborns

98
Q

Tender ulcerations on oral mucosa surrounded by erythema

A

herpetic stomatitis

99
Q

posterior pharynx is erythematous with palatal petechial foul smelling exudate

A

streptococcal pharyngitis aka strep throat

*very common in children

100
Q

what can prolonged bottle feeding lead to

A

teeth erosion

101
Q

what is the most common health problem in children

A

teeth erosion

102
Q

list intrinsic cause of teeth staining

A

tetracyclines bfore age of 8

teeth can look yellow, gray or brown

103
Q

list extrinsic cause of teeth staining

A

iron preparations–black stains

fluoride–white stain

104
Q

what can thumb sucking lead to in older children

A

malocclusion and misalignment of teeth

105
Q

portion of the tongue has rough, unusual apperance

  • benign
  • chronic condition
A

geographic tongue

106
Q

at what age is strep throat uncommon?

107
Q

describe PE findings for strep throat

A

strawberry tongue
white/yellow exudates on tonsils
beefy red uvula
palatal petechia

108
Q

scarlet fever is caused by?

A

group A strep

109
Q

PE findings for scarlet fever

A

strawberry tongue
sandpaper rash–fine bumps that feel like sandpaper
when the rash resolves— skin may begin to peel/desquamate—- esp on hands and feet

110
Q 
asymmetric enlargemnt of one tonsil 
\+erythema 
\+pain 
\+displacement of uvula 
"hot potato voice"
A

peritonsilar abscess

111
Q

is actue epiglotittitis common or rare in US?

A

rare bc of the H influenza type B vaccine

112
Q

child c/o sore throat, unable to swallow their saliva, they are sitting up stiffly and tripoding
usually hx of no vaccines

A

acute epiglotititis

113
Q

tonsillitis can be viral or bacterial?

114
Q

voice described as “rocks in mouth”

A

tonsilitis

115
Q

halitosis causes for kids

A 
infection 
FB in nose 
sinusitis 
dental dz 
GERD
116
Q

congenital torticolis also called

117
Q

bleeding into the sternocleidomastoid muscle due to stretching process during delivery

A

congenital torticolis

118
Q

firm, fibrous mass is felt in newborns neck muscles 2-3 weeks after birth

A

congential torticolis

119
Q

with a difficult arm or shoulder extraction during delivery, what on the neck are you inspecting

A

clavicles for fx

120
Q

lymphadenopathy is usually viral or bacteria?

A

can be both

121
Q

is lymphadenopathy common in infancy? childhood?

A

uncommon infancy

common in childhood

122
Q

supraclavicular lymph nodes raises suspicion for?

A

malignancy

123
Q

node is >2cm, hard or fixed and accompanied by systemic s/s like wt loss

A

malignancy

124
Q

nuchal rigidity suggests?

A

meningitis

125
Q

enlarged cervical lymph nodes

A

lymphadenopathy

126
Q

what is tachypnea for

  1. birth-2MO
  2. 2-12 months
A

birth-2 MO= >60 breaths/min

2MO-12MO= >50 breaths/min

127
Q

apnea is cessactino of breathing for more than ___ seconds and accompanied by?
*what does apnea indicate

A

20 seconds
accompanied by bradycardia

indicates: CNS, cardiopulmonary conditions, or res dz

128
Q

infats are ___ breathers

129
Q

nasal flaring can indicate?

A

-congestion
or
-more serious pathology like pnm or other seirous resp dz

130
Q

breastbone is sunken into his or her chest.

A

pectus excavatum

131
Q

child’s breastbone protrudes outward abnormally.

A

pectus carinatum

132
Q

heart rate:

  1. 1-2 YO
  2. 2-6YO
  3. 6-10YO
A
  1. 70-115
  2. 68-138
  3. 65-125
133
Q

sinus brady

  1. infats/toddlers
  2. 3-9YO
A
  1. <100

2. <60

134
Q

BP readings from ___ are higher than from the ___

A

thigh has higer BP reading… by 10 mmHg vs upper arm

135
Q 
wheezing 
grunting 
nasal flaring 
retractions 
*signs of?
A

respiratory distress

136
Q

steps to assess infants breathing

A
  1. gen app
  2. RR
  3. color
  4. audible breath sounds
  5. work of breathing
137
Q

stridor can indicate

A

FB
croup
epiglottits

138
Q

noisy work of breathing (stridor) + abnormal findings on auscultation=?

139
Q

best sign to rule out pneumonia is?

A

absence of tachypnea

140
Q

diminished breath sounds unilaterally

A

pneumothorax

diaphragmatic hernia

141
Q

how to tell difference b/w upper and lower airway sounds in infant?

A

hold scope up to nose and compare

142
Q

common breath sounds in infants?

-indicates?

A

wheezes and rhonchi

wheezing most likely has asthma, bronchiolitis
rhonchi–URI

143
Q

what does crackles in an infant indicate

A

pneumonia

bronchiolitis

144
Q

List the cyanotic heart lesions

A

Tetralogy of Fallot
Truncus Arteriosus
Transposiiton of the Great vessels
tricuspid atresia

145
Q

is it common or uncommon for kids to have abdomenal protruberance

146
Q

painless mass on testicle

147
Q

babinski response

-describe

A
  • **normal finding in infants
  • occurs when sole of the foot is stroked–then big toe moves upward or toward the top of the surface of the foot

hyperreflexia
clonus at the wrist, knee, ankle, extensor plantar reflexes

seen in CNS lesions of descending corticospinal tract
-can be transiently + in unconscious states fro drug or ETOH intoxication

148
Q

tanner stages

  • define
  • scale is based off?
A

scale of physical development in children, adolescents and adults
-scale defines physical measurements of development based on external primary and secondary sex characteristics—- size of breasts, genitles, testicular volume and devlp of pubic hair

Physical Assessment 2 (6 decks)

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