Peds Flashcards
what are the 3 areas for well child exams
physical development
cognitive development
social and emotional development
What is considered newborn stage
0-28 days
What is considered infancy stage
0-12 months, includes neonate
what is considered toddler/early childhood stage
1-4 years
what is considered school-aged/middle childhood
5-10 years
what is considered adolescence stage
11-20 years, early middle and late
what type of social and environmental factors can alter childhood development
child abuse, chronic illness and low socioeconomic status
what type of neonatal resuscitation is needed at birth usually
drying and bulb suction
What are the 5 components of APGAR scoring
Appearance, pulse, grimace, activity and respiratory effort
what is the APGAR scoring
classify newborns neurologic recovery from birth and immediate adaptation
What is the scale for APGAR
0-2 want total score above 7
When are the APCAR scores taken
at 1 and 5 minutes
What is conisdered severe depression APGAR
score of 0-4 in first minute
score of 0-7 in five minutes
When is the hospital evaluation taken for neonate
within 24 hours after delivery
What is involved in hospital evaluation of neonate
maternal Hx, delivery record, full head to toe exam
What is included in head to toe hospital evaluation of neonate
molding/fontanelles red reflex palate genital hip exam primitive reflexes
what is included in the review delivery record for hospital evaluation of neonates
gestation, mode of delivery, duration of labor, augmentation/induction, complications (vacuum/forceps, O2), APGAR, blood lgucose
What is given in eye to prevent infection after birth
erythromycin ointment
What is given to neonates shortly after delivery to prevent bleeding
Vit K injection
What is the scoring system for gestational age in weeks
ballard scoring
what is the ballard scoring based on
neuromuscular sign and physical characterisitcs that change with gestational maturation
What are the parts of ballard scoring and what is the scale
neuromuscular maturity is 1-5
physical maturity is 1-5
use chart to determine
What is the gestational age for preterm, term and posterm
preterm is 42 weeks
What is a normal birth weight
> or = 2,500 grams
what percentile is considered small for age
<10th
what percentile is considered large for age
> 90th
Describe neonate feeding
every 3 hours
breastfeeding is initially small volumes, milk comes in after 2-3 days
formula 15-30 mL
Describe weight changes in neonates during first week
normally lose 10% then gain back by 10-14 days
Describe normal voiding of neonates
3-4 voids in first 1-3 days is normal
day 4-5 should see 6-8 voids ea 24 hour period
Describe the meconium
first stool, within 24 hours of life, dark, black tarry
describe stool by 4-5 days of life
breast feeding- yellow seedy
formula- green yellow
How is jaudice accounted for in hospital care of neonate
checked with transcutaneous bilimeter or serum direct/indirect bilirubin levels
compared to nomogram and repeal levels drawn
What indicates more than physiologic jaundice in neonate
elevated lecels of bilirubin prior to first 24 hours
what are types of non-physiologic jaundice in neonate
ABO incompatability/Rh Cephalohematoma Infection Hemoglobinopathies (thalassemia) Enzyme deficiencies (G-6-PD)
What is the difference of hospital discharge for vaginal delivery versus caesarean
vaginal 2 days after
caesarean 3 days after
what is done to neonate before discharge
hepatitis B immunization
hearing screen
newborn screening blood test
circumcision done
What is the follow up care for neonates, 24-48 hours after discharge
weight loss, hyperbilirubinemia
prematurity
What are main points of wellness visit in infants
continued assessment of growth and development
immunizations
give parental information
answer parent questions
What items of HPI are discussed in infant well visit
feeding stooling/voiding sleeping development safety additional parental concerns
What is included in PMHx for infants
medical problems. injuries, hospitilizations, surgery
What is included for rest of soap for infants
meds, allergies, FMHx, social Hx such as pets/guns/daycare
when is the second nerborn screen typically done
week 2
What are the intervals for well visits
3-4 days growth
week 2 growth and development (GD)
1 mo, 2 mo, 4 mo, 6 mo, 9 mo, 12 mo (GD)
When is the Hb lab usually included in well visit
9 months
how much weight does an infant gain in first year of age
triple birth weight
What are the factors of the growth chart
weight for age, length for age, head circumference for age, weight for length
What are the components used for assessment of developmental milestones
physical(gross motor and fine motor)
language.cognitive
personal/social
Describe neurological development of newborn
centrally to peripherally
head control trunk control arms. legs then hands then fingers
describe language progess of infant
2 months- cooing
6 months- babbling
1 year - 1-3 words
what are the cognitive skills for a infant
learn cause and effect, object permanence and use of tools
by 9 mo should recognize strangers, seek comofrot from parent in exam and manipulate objects
What are the personal/social milestones for infant
understanding self and family
social tasks like bonding and attachment to caregivers
temperment which can vary, can adapt to new environment and stimuli
predictability in schedules
When can physician do entire exam on a table
up to 9 mo, infant is in diaper
What is they exam guidline for infant 9 mo and older
on parent lap because stranger anxiety occurs
What is the general sequence for newborn exam
heart and lung first
HEENT last
Until when must head circumference be measured in infant
up to 36 months
Describe respiratory infant exam
breathing pattern, skin color, signs of distress & use of accessory muscles
auscultate lung fields (ant/post)
Describe CV infant exam
compare brachial and femoral pulses b/l
palpate PMI
auscultate with bell&diaphragm
BP no measured until 3 yrs
Describe abdominal exam for infant
observe shape, contour, and presnce of hernias, auscultate bowel sounds in all 4 quadrants
percuss
palpate and note size of liver and spleen
What do you make sure not to miss on infant lung exam
chest asymmetry
respiratory distress
What are examples of infant respiratory distress
nasal flaring, retractions, accessory muscle use
What do you make sure not to miss on infant CV exam
benign murmurs, PDS first 2-3 days of life, Still’s murmur, pulmonary glow murmur
brachial/femoral pulses
What do make sure not to miss on infant GI exam
liver tip palpable 1-2 cm below costal margin
no spleen palpable
can feel kidneys
anal fissures
Describe GI exam in male infant
visual inspection, retract foreskin to see urethral meatus
confirm b/l descended testes
palpate for inguinal or femoral hernias
Describe GI exam in female infant
visual inspection of external genitalia
palpate for inguinal or femoral hernias
Describe anal/rectal exam for infants
position, fissures, fistulas
describe neuro exam for infant
assess cranial nerves (grossly)
asses strength and muscle tone
attempt to elicit deep tendon reflexes
asses primitive reflexes in young infants
What are not to be missed in male and female infant GU exams
female: labial adhesions
male: urethral opening and circumcision
What is not to be missed in neuro exam for infants
primitive reflexes
What is the palmar grasp reflex and when is it tested for
finger in hand and press against palm-> should grasp finger
ages birth to 4 months
Describe plantar grasp reflex and when it is tested for
touch sole at base of toes–> toes curl
birth to 9 months
describe moro (startle reflex) and when it is tested for
hold supine support head, back and legs then abruptly lower 2 feet and see if arms abduct,extend, hands open and legs flex (+/- cry)
birth to 4 months
describe asymmetric tonic neck reflex and when it is tested for
supine, turn head to one side holding jaw over shoulder–> arm/leg on that side should extend and opposite arm and leg should flex
birth to 4 months
describe positive support reflex and when it is tested for
hold around trunk and lower till feet touch surface, hips, knees, ankles extend, partially bearing weight (sag after 20 seconds)
birth to 2-6 months
What is the rooting reflex and when is it tested for
stroke perioral skin at corner of mouth, mouth should open and turn head toward stimulated side
birth to 3-4 months
what is the trunk incurvation or galants reflex and when is it tested for
support prone position, stroke one side of back 1 cm from midline from shoulder to buttocks
spine should curve toward stimulated side
birth to 3 months
describe placing/stepping reflex and when is it tested for
hold upright, have one sole touch table
hip and knee of same foot will flex adn the other foot will step forward
birth (day 4) and varies when disappears
Describe Landau reflex and when it is tested for
suspended prone-> head lifts up and spine will straighten
birth to 6 months
describe parachute reflex and when it is tested for
suspend prone and slowly lower head toward surface
arms and legs extend in protective fashion
4 and 6 months, does not disappear
Describe MSK exam for infant
observe symmetry of extremities/length, deformities, digits
palpate spine for scoliocis, spina bifida occulta
palpate feet for curvature/rotation deformities (un utero)
What are the common foot deformities in infants
metatarsus varus and clubfoot
What is involved in hip examination of infant
Barlow and Ortolani maneuvers to test for signs of dislocation
effective until 3 months after hip capsuel begins to tighten
What signs do you look for in hip exam after hip capsule tightened
Galeazzi
What does the Ortolani test for? how is it done
presence of posteriorly dislocated hip
hold legs in supine then twist knee on one side laterally so hip joint rotates externally
What does the Barlow test test for and how is it done
tests for ability to sublux or dislocate intact but unstable hip
internally rotate knee and cause internal rotation of hip joint
What tests must you do on an infnat hip exam
ortolani/barlow
galeazzi
When inspecting the head of infant what is not to be missed
anterior fontanelle( close later) posterior fontanelle (close early) should be flat and soft in consistency
What must not be missed in eye exam of infant
red reflex, reflection of light on retina, generally red in color, should by symmetrical reflection
what does an abnormal red reflex indicate in infant
cataracts, galucoma, retinoblastoma, or other abnormalities of eyes
What is not to be missed in oral exam of infant
palate, teeth, mucuc-cysts (epstein pearls), tongue abnormalities like tongue tied or tonsils
What is not to be missed in neck palpation of infant
cervical lymph node abnormalities
What is not to be missed in ear exam of infant
pits/tags
TM using insufflator if possible ear infection
What do you check for in ROM of neck in infants
Torticollis
What is not to be missed in infant exam of skin
benign rashes mongolian spots nevi hemangiomas sacral dimple or hair tufts
What immunization within 6 years is given in hospital
hepatitis B
What immunzations are given up to 6 yrs old in office
hep B, rotavirus, diptheria, tetanus, acellular pertussis (DTaP) haemophilus influenza type B pneumococcal inactivated poliovirus influenza measles, mumps, rubella, varicella, hepA
What are the physical and motor developments in a toddler
rate of growth slows after infancy to approximately half
after 2 yrs gain 2-3 Kg& 5 cm per year
walk, jump hop and skip
can draw lines and make circles
Describe cognitive developments in toddlers
sensorimotor learning-touching and looking
simple problem solving(imitative play)
2-3 words to sentences, by 4 yrs should be 100% understandable
What are the social and emotional developments seen in toddlers
imitate activities to imaginative play
drive for independence
temper tantrums common
What are general considerations for toddler eam
down to diaper on parent lap use toys to distract can touch equipment use instrument on parent or toy first flexible sequence of exam
What area should be examined last in toddler
the area of complaint
In addition to growth chart what other standard of measurement is now used for toddler
BMI
What are the physical motor developments for a child 5-10 yr old
growth steady and slow
strength and coordination imrpove
What are the cognitive and language developments ina child 5-10 yrs old
concrete operational limited logic and more complex learning
self efficacy
what are the social and emotional developments in a child 5-10 yrs old
progressivley more independent, development of selft esteem-family and environment contribute greatly
evolving self identity
What other items do you begin to discuss with a child 5-10 yrs old
school issues
body changes
asthma symptoms, speech development etc
What are general considerations for a PE on child 5-10 yrs old
dressed in clothes examine on table describe what you are doing (yr4-10) resepct modesty flexible on sequence exam plot Ht Weight and calculate BMI
What changes in CV exam now in a child 5-10 yrs old
compate RADIAL and femoral pusles b/l
palpate PMI
auscultate with bell & diaphragm
measure BP in both arms in children >3 yrs
What is a Still’s murmur
Grade II/IV, musical, vibratory midsystolic
What is a venous hum
soft continuous, louder in diastole
what is a carotid bruit
midsystolic, louder on left, eliminated by carotid compression
What is added in male GU exam for ages 5-10
palpate for inguinal or femoral hernias
What changes in MSK exam for children 5- 10 yrs old
observe walking and standing barefoot
Galeazzie test/sign
What is genu carum
blowlegged
When is intoeing seen and when does it disappear
may increase up to 4 yrs then disappear by 10 yrs old
What is different on HEENT exam for child 5-10 yrs old
add palpation of all head lymph nodes palpate thyroid visual tracking visual acuity-- formal test speculum to asses nose mucosa
What must be done in ear inspection if suspect otitis media
pneumatic otoscopy
When do permanent teeth begin
age 6
When do you being the hearing test for ears
ages 3-4
What age group is early adolescence
10-14
When does physical puberty begin for males? females?
males 9-13.5 yrs
females 8-13 yrs
What is the cogniitive development in early adolescence
concrete operational
what is the social development for early adolescence
focus is on present
identity if normal, peer influence
independence- ambivalence
What ages are middle adolescence
15-16
What are the cognitive developments in middle adolescence
transitional (many ideas)
develop insight, reflect on feeling, though of others
what are the social developments of middle adolescence
identity- who am I,
independence, limit testings, experimental behaviors, dating
What ages are late adolescence
17-20 yrs old
What are the cognitive developments for late adolescence
formal operational
what are the social developments for late adolscence
identity role with respect to others
sexuality, future
independence-separation from family
What are general considerations for PE for late adolescence
patient gowned, on table, respect privacy, give pt option for parent to leave room have chaperone for breast and GU exam describe what you are diong ask patient to describe pain etc. plot Ht weight and BMI
On BMI what percentile is underweight
below 5th
What percentile of BMI is at risk of overweight and overweight
at risk is 85th percentile
overweight is > or equal to 95th percentile
What is adrenarche and when does it occur
activation of adrenal medulla for production of androgens
occurs before onset of puberty
What is gonadarche, differences in male vs female?
earliest gonadal changes of puberty (GnRH released) males the LH stimulates testosterone and FSH stimulates sperm maturation
females FSH stimulates estrogen and follicle formation and LH stimulates corpus luteum after ovulation
When does thelarch being
beginning of breast development at puberty
What is pubarche
beginning of pubic hair
What is menarche
occurence of first menstrual bleeding
What are the 5 stages of tanner development for breasts
1- preadolescent (elvation of nipple
2- evelation breast/nipple
3- enlargement of breast and areola, no separation of contour
4- projection areola/nipple to form secondary mound
5- mature stage, projection of nipple only
What are the order of changes for female puberty
breast buds
pubic hair
growth spurt (peaks age 12)
menarche
usually takes about 4 years
What are the tanner stages for men
1- preadolexcent, no pubic hair, penis and testes same size as childhood
2- pubic hair sparse, pigmented, penis is slightly larger, testes and scrotum are larger and lsightly reddened
3- pubic hair darker, penis larger, testes and scrotum larger
4- pubic hair coarse curly, not on thighs, penis larger in length and diameter, testes and scrotum larger and scrotal skin darker
5- pubic hair spread to medial thighs
penis is adult size and same with testes and scrotum
What are the order of changes for male puberty
testicular growth, pubic hair, penile enlargement growth spurt (peaks age 14)
takes average 3 years
