Peds Flashcards
Neonatal period?
1st 28 days.
Post Neonatal period?
29 days to 1 year.
Infancy?
0-12 months; first year of life..
Most rapid rate of growth.
Birth weight triples, height increases by 50% by the end of year one.
Early childhood?
1-4 years
Middle childhood?
5-10 years
Adolescence?
11-20 years
Apgar score tested when?
at 1 min and 5 min right after birth.
What does Apgar score test?
heart rate (>100), respiratory effort (good and strong), muscle tone (active movement), reflex irritability (vigorous cry, sneeze, cough), color (pink)
Preterm?
less than 34 wks
Late preterm?
34-36 wks
Mothers w/ DM may have?
Large infants and infant complication hypoglycemia.
Infants w/ inadequate weight gain for age?
Failure to thrive.
1 min. Apgar score: 0-4?
Severe depression requiring immediate resuscitation.
1 min. Apgar score: 5-7?
Some NS depression
1 and 5 min Apgar score: 8-10?
Nml
5 min Apgar score: 0-7?
High risk for CNS and other organ system dysfunction.
What is the most important indicator of infant health?
Measurement of growth.
Measure: height (length < 2),weight, head circumference.
Observing an infant, while awake and sitting on parents lap, can reveal what?
hypotonia vs hypertonia abnormal skin color: jaundice, cyanosis, obvious rash, jitteriness (from drug withdrawal) respiratory problems observing parent-infant interactions*
Developmental Milestones for Premature Infant?
Adjust expected developmental milestones (goes by gestational age).
Infants w/ milestones that plateau or may be out of sequence?
Autism or cerebral palsy.
1 month gross motor, fine motor, language, & social-emotional?
Gross motor: Lifts chin up in prone position. Turns head up when prone.
Fine motor: Hands fisted.
Language: Makes throaty noises. Startles to sound.
Social-Emotional: Discriminates parents’ voice. Follows face.
4 month gross motor, fine motor, language, & social-emotional??
Gross motor: Sits w/ support. No head lag. Rolls from front to back.
Fine Motor: Hands predominately open. Reaches for objects.
Language: Laughs out loud. Stops crying to soothing voice.
Social-Emotional: Social Smile.
6-7 months gross motor, fine motor, language, & social-emotional?
Gross motor: Sits propped on hands. Lateral protection. Bounces when held.
Fine motor: Transfers object from hand to hand. Reaches out with one hand. Feeds self cracker.
Language: Babbles, consonant sounds. Understands “no”.
Social-emotional: Enjoys reflection in the mirror. Looks from object to parent and back when wanting help.
9 month gross motor, fine motor, language, & social-emotional?
Gross motor: Pulls to stand. Bear walks. Begins creeping.
Fine Motor: Pincer grasp. Bangs two cubes together.
Says “mama”. nonspecifically. Imitates sounds. Orients to name.
Social-Emotional: Follows a point. Enjoys peek a boo. Develops stranger anxiety.
12 month gross motor, fine motor, language, & social-emotional?
Gross motor: Stands independently. Starts taking first steps.
Fine motor: Scribbles. Hold crayon. Makes tower with two cubes.
Language: Says one word with meaning. Points to objects. Follows one step commands w/ gestures.
Social-Emotional: Shows objects to parents to share.
Infant BP?
Starts at age 3. Nml is 64/41.
Infant RR?
Newborn: 30-60
Infant HR?
Newborn: 140 bpm.
1-6 month: 130 bpm.
6-12 month: 115 bpm.
Infant temperature?
Rectal temp. < 2 months.
Central cyanosis in newborn?
Congenital Heart Disease
Acrocyanosis?
Bluish discoloration palms/soles.
Lanugo?
Fine, downy growth of hair.
Jaundice?
Can be normal; physiologic jaundice (common) or….
hemolytic disease of newborn (yellowing in first 24 hours following birth, can be very concerning).
Neurofibromatosis?
Yellowing of skin.
Milia rubra?
Scattered vesicles on erythematous base, sweat gland duct obstruction, resolved in a few weeks.
Milia?
White raised area, size of pinhead, sebaceous glands opened still.
Cafe-au-lait spots?
Pigmented brown lesions assx. with neurofibromatosis.
Pustular melanosis?
Small vesiculopustules.
Salmon Patch (stork bite)?
Vascular marking, splotchy pink mark, fades w/ age.
Molluscum contagiosum?
Dome shaped, fleshy lesions.
Impetigo?
Bacterial Infx., appears crusty yellowed. **honey crusted lesion.
Slate blue patch?
Common in darker skinned babies. result of blue pigment cells, not to be mistaken for bruise.
Sutures?
Membranous tissue spaces separating bones of the skull.
Fontanelles?
Areas where major sutures intersect.
When does anterior fontanelle close?
2-26 months (90% between 7-19 months).
When does posterior fontanelle close?
2 months.
Early closure of fontanelles?
Microcephaly, metabolic abnml.
Delayed closure of fontanelles?
Hypothyroidism, megalocephaly.
Bulging fontanelle?
ICP
Depressed fontanelle?
dehydration
Plagiocephaly?
Positional MCC. Infant lies mostly on one side resulting in flattening of parieto-occipital region and prominence on ipsilateral side.
Prevention of Plagiocephaly?
“Tummy time”
Congenital hypothyroidism?
Coarse facial features, low set hairline, and enlarge tongue.
Doll’s eye reflex?
In first 10 days of life, if an infants head is turned in one direction, without moving body, eyes may stare in one direction.
What may newborns have from birth process?
Edematous eyes or subconjunctival hemorrhages (broken blood vessels in eye).
Nystagmus?
Poor vision, CNS disease.
Persistent ocular discharge/tearing?
Dacryocystitis or nasolacrimal duct obstruction.
Leukokoria?
White retinal reflex may suggest cataract, retinal detachment, or retinoblastoma.
Myopia?
Nearsightedness (difficult seeing far), is the most common visual disorder in childhood.
Brushfield spot?
Abnormal speckling on iris suggest Down syndrome.
Strabismus?
Misalignment of the eyes leading to visual impairment.
Small, deformed low set auricles?
Congenital defects, especially renal disease.
What screening for newborn?
Hearing screenings
Pneumatic otoscope?
Used to assess mobility of TM.
Decreased movement on pneumatic otoscope?
OM w/ effusion.
Mastoiditis?
Mastoid bone red, swollen, tender, auricle may protrude forward/outward.
Acute OM?
Very common in childhood, on exam TM red, bulging, with a dull or absent light reflex, and decreased movement on pneumatic otoscopy. Ear pain + above finding on exam together make AOM a likely diagnosis.
Otitis externa?
Infection in the ear canal, movement of auricle (or pushing on tragus) elicits pain.
Pale, boggy nasal mucous membranes. “allergic solute”?
Allergic rhinitis.
Foul-smelling, purulent, unilateral discharge. Most often seen in young preschool children?
Foreign body sensation.
Flesh colored growths inside the nares?
Nasal polyps.
Purulent rhinorrhea (unilateral) more than 10 days, HA, sore throat, fever, and tenderness over the sinuses?
Sinusitis.
Child pushing nose back “allergic salute”, causing transverse line to appear on nose. Swelling/discoloration below eyes, and grimacing (wrinkling nose) to relieve nasal itching?
Allergic rhinitis.
Tongue tie or ankyloglossia?
A short frenulum that can limit the protrusion of the tongue.
When does first tooth appear?
6-12 months old.
How many primary teeth do children have?
20.
Shrill/high pitched infant cry?
Narcotic addicted moms
Thrush?
Common in infants. White plaques that do not rub/scrape off.
Herpetic stomatitis?
Tender ulcerations on oral mucosa surrounded by erythema.
Streptococcal Pharyngitis- “strep throat”?
Posterior pharynx – erythema, palatal petechial, foul smelling exudate.
Common childhood infection.
uncommon before age 3. may be associated with strawberry tongue, white/yellow exudates on tonsils, beefy red uvula, palatal petechia.
Dental caries?
Early stages,
Major global health and pediatric problem.
Erosion of teeth?
Prolonged bottle feeding.
* Most common health problem in children.
Staining of teeth?
Intrinsic cause – tetracycline before age 8 (yellow, gray, brown stain).
Extrinsic cause – iron preparation (black stain) and fluoride (white stain).
What can thumb sucking lead to?
Malocclusion and misalignment of teeth.
Portion of tongue has rough, unusual appearance, benign, chronic condition.
Geographic tongue
Caused by group A strep (same as above), strawberry tongue, sandpaper rash (fine bumps that feel like sandpaper)
when rash resolves, skin may begin to peel, especially on hands/feet.
Scarlet fever.
Suggested by erythema, asymmetric enlargement of one tonsil, pain, displacement of uvula. “hot potato voice”?
Peritonsillar abscess
RAre in US bc of H influenza type B immunizations.
Child c/o ST, unable to swallow saliva, sitting up stiffly in “tripod” position because of throat obstruction.
Acute epiglottis
Can be viral or bacterial. Voice described as “rocks in mouth”?
Tonsillitis
Cause of halitosis?
Infx, FB in nose, sinusitis, dental disease, or GERD.
Congenital torticollis?
(wry neck) – bleeding into sternocleidomastoid muscle due to stretching process during delivery. A firm fibrous mass is felt within the muscle 2-3 weeks after birth, disappears over months.
Clavicle fractures?
Due to during delivery with difficult arm or shoulder extraction.
What should supraclavicular lymph nodes raise suspicion for?
Malignancy; if node is >2cm, is hard, or fixed (non-mobile) and accompanied by systemic signs, ex: weight loss.
Nuchal rigidity?
Neck stiffness
Tachypnea In peds?
> 60/min (birth-2 months) & > 50/min (2–12 months)
Apnea and bradycardia?
Respiratory disease, CNS or cardiopulmonary condition.
Nasal flaring?
May be due to congestion since infants are obligate nasal breathers, but may be caused by pneumonia or other serious respiratory infections.
Pectus excavatum?
a person’s breastbone is sunken into his or her chest
Pectus carinatum?
breastbone protrudes outward abnormally.
Lack of breath sounds?
Obstruction.
Signs of respiratory distress?
Nasal flaring, grunting, retractions, wheezing.
Audible breath sounds?
Grunting, wheezing, stridor, obstruction.
Work of breathing?
Nasal flaring, grunting, retractions.
Stridor?
croup, epiglottitis, FB
Abnormal work of breathing + abnormal finding on auscultation?
PNA
Diminished breath sounds on one side of chest?
PTX or diaphragmatic hernia.
Wheezing?
Asthma, bronchiolitis
Rhonchi?
URI
Crackles?
PNA, bronchiolitis
Cyanotic heart lesions?
The 4 T's Tetralogy of Fallot Truncus Arteriosus Transposition of the Great Vessels Tricuspid Atresia
VSD Assx and murmurs?
Assx: Apert’s Down, FAS, TORCH, Sri Du Chat, Trisomy 13, 18.
Murmur: Holosystolic LLSB.
ASD Assx and murmurs?
Assx: Holt-Oram, FAS, Down.
Murmur: Wide fixed split 2, systolic ejection at ULSB.
PDA Assx and Murmurs?
Assx: Rubella, prematurity, females.
Murmurs: Machinery at 2nd left intercostal space.
Tetralogy Assx and murmurs?
Assx: Maternal PKU, Di George
Murmurs: Systolic ejection at ULSB.
Transposition Assx and murmurs?
Assx: Di George, DM
Murmurs: None
Coarctation Assx and murmurs?
Assx: Turner’s, Berry Aneurisms, males, bicuspid aortic valve.
Murmur: Systolic murmur in left axilla.
Tanner staging?
sex maturity rating stages
Painless mass on GU?
Hydrocele
Breast stage 1?
Preadolescent: elevation of nipple only
Breast stage 2?
Breast bud stage: elevation of breast and nipple as a small mound; enlarge- ment of areolar diameter
Breast stage 3?
Further enlargement of elevation of breast and areola, with no separation of their contours.
Breast stage 4?
Projection of areola and nipple to form a secondary mound above the level of breast.
Breast stage 5?
Mature stage: projection of nipple only; areola has receded to general contour of the breast (although in some normal individuals the areola continues to form a secondary mound)
Boys Tanner Stage 1?
Pubic hair: Preadolescent—no pubic hair except for the fine body hair (vellus hair) similar to that on the abdomen.
Penis: Preadolescent—same size and proportions as in childhood.
Testes and scrotum: Preadolescent—same size and proportions as in childhood
Boys Tanner Stage 2?
Pubic hair: Sparse growth of long, slightly pigmented, downy hair, straight or only slightly curled, chiefly at the base of the penis
Penis: Slight or no enlargement.
Testes and Scrotum:
Testes larger; scrotum larger, somewhat red- dened, and altered in texture.
Boys Tanner Stage 3?
Pubic Hair:
Darker, coarser, curlier hair spreading sparsely over the pubic symphysis
Penis: Larger especially in length.
Testes and Scrotum: Further enlarged.
Boys Tanner Stage 4?
Pubic hair:
Coarse and curly hair, as in the adult; area covered greater than in stage 3, but not as great as in the adult and not yet includ- ing the thighs
Penis: Further enlarged in length and breadth, with devel- opment of the glans.
Testes and scrotum: urther enlarged; scrotal skin darkened.
Boys Tanner Stage 5?
Pubic hair: Hair adult in quantity and quality, spreads to the medial surfaces of the thighs but not up over the abdomen
Penis: Adult in size and shape.
Testes and scrotum: Adult in size and shape.
Girls pubic hair Stage 1?
Preadolescent—no pubic hair except for the fine body hair (vellus hair) similar to that on the abdomen
Girls pubic hair stage 2?
Sparse growth of long, slightly pigmented, downy hair, straight or only slightly curled, chiefly along the labia
Girls pubic hair stage 3?
Darker, coarser, curlier hair, spreading sparsely over the pubic symphysis.
Girls pubic hair stage 4?
Coarse and curly hair as in adults; area covered greater than in stage 3 but not as great as in the adult and not yet including the thighs
Girls pubic hair stage 5?
Hair adult in quantity and quality, spreads on the medial surfaces of the thighs but not up over the abdomen.
