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Patient Evaluation > Peds > Flashcards

Peds Flashcards

1
Q

Fontanelles -

Normal closure times: Posterior ?

A

1-3 mo

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2
Q

Fontanelles -

Normal closure times: Sphenoid ?

A

6 mo

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3
Q

Fontanelles -

Normal closure times: Mastoid ?

A

6-18 mo

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4
Q

Fontanelles -

Normal closure times: Anterior ?

A

9-18 mo

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5
Q

First offie visit - Less than 48 hours at hospital ?

A

: first visit within 2 days (quick)

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6
Q

First offie visit - more than 48 hours at hospital ?

A

3-5 days after discharge (longer)

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7
Q

First offie visit - complications at birth at hospital ?

A

within 24 hours (alot sooner)

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8
Q

BM protect against ?

A 
Diarrhea
URI
NEC
Otitis media
UTI
Type 1 and 2 DM
Lymphoma and leukemia

Obesity

Decrease maternal bleeding

Decrease risk of breast and ovarian cancers (mom)

Allergies at least through adolescence (Grasky, 1982)

** 7x less likely to have a cows milk allergy later on if BF **

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9
Q

Baby blues ?

A 
Up to 80% new moms
Overwhelmed
Frustration
Crying/weepy
Trouble falling asleep
Exhaustion
*Resolves within two weeks post partum
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10
Q

PPD ?

A 
10-20% new moms
Flat affect
Persistent sadness
Anxiety with occasional bizarre thoughts; hurting the baby
Thoughts of death
Somatic complaints
*Over 14 days
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11
Q

At one week after birth:

Stools should be _______________ and seedy now, about ____ a day. Green stools should be ending(meconium)

A

mustard colored

2-3

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12
Q

At one week after birth:____ wet diapers a day =adequate _________

Check color if there is a concern of not getting enough

A

4-6

hydration

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13
Q

Infants usually lose weight initially and they should be back to first weight in ?

A

2 weeks

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14
Q

1st visit: temp: infants: _________ add 1°,

A

axillary

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15
Q

1st visit: temp: toddlers: ______ subtract 1°

A

rectal

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16
Q

When do you check BP before 3 years old infant ?

A

neonatal cuff but only if cardiac or renal disease suspected or being monitored

Starting at 3 year old visit, do yearly

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17
Q

The fronto-occipital head circumference should be measured at its _______

A

maximum

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18
Q

Chest circumference can also be measured if concern about _________.

A

lung growth

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19
Q

It is usually within 2 cm of head circumference.

A

Chest circumference

measure until 2-3 years of age

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20
Q

1 visit milestone ?

A

Can suck and swallow and breathe easily
otherwise think cleft

*Can follow your face

Turns and calms to your voice

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21
Q

After the infants first visit when should the next one be ?

A

Next visit at one month or two months of age( 2 typically)

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22
Q

Infants and toddlers until __ years should ride in rear-facing seats (no air bag), once __ years then ?

A

2

2

forward facing seat

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23
Q

Car seats until at least ___ years and __ pounds, then booster

A

4

40

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24
Q

Until __ years – rear seat of car

A

13

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25
Q

fever in an infant is considered ?

A

100.4 (38)

101 go to the ER immediately

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26
Q

2 mo WCC: sleep: ______ daytime naps normal with approximately _____ total hours asleep. Most 2 month olds are up every 3-4 hours to eat

A

Three

15.5

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27
Q

2 mo WCC physical development ?

A

Lifts head in prone position

Holds head erect when upright (briefly)

Symmetrical movement

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28
Q

2 mo WCC social. emotional ?

A

Reciprocal smile

Coos

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29
Q

2 mo WCC: fine motor ?

A

Hands un-fisted (50%)

Retains rattle if placed

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30
Q

2 mo WCC: cognitive ?

A

Recognizes mother
Follows large highly contrasting objects
Opens mouth at sight of bottle or breast

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31
Q

2 mo WCC: anticipatory guidance ?

A

Discuss immunizations and normal reactions

Reinforce breast feeding & supplements of Vitamin D

No solid food until at LEAST next visit at 4 months

Tummy time
for neck movement and eye muscle movement

Back to sleep

No bottle in bed and no propping of bottle

  • Burn injuries
  • Cigarette smoke, second hand smoke
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32
Q

Fire and burn injury ?

A

Lower water heater temps to avoid scalding (120°)

Smoke detectors

Fire evacuation plan

Sunscreen, sun avoidance, SPF>30 apply 30 min before sun and reapply every 2 hours

By next visit infants can be reaching for hot beverages

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33
Q

Inquire about starting infants that are bottle fed on any solid foods ?

A

4 mo

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34
Q

Iron supplements *1-2mg/kg/day until solids

A

4 mo

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35
Q

4 mo sleep ?

A

More regular sleep pattern
15 hours about average
Less night time feedings
Starting to stay awake longer daytime hours
Three naps
Set more routine times for nap and bedtime

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36
Q

4 mo development milestones ?

A

Good head control (no head lag when pull to sit)

Begin to reach for objects

Sit with trunk support

Holds hands predominantly open
LOL

Vocalizes when alone

Turns head to voice

Shakes rattle (gross motor)

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37
Q

Neuro-Moro and rooting reflexes suppressed ?

A

4 mo

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38
Q

Neck: Torticollis, may take 2-3 months to appear after delivery ( maybe a lump along the muscle)

Neuro: stepping reflex disappears

A

2 mo

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39
Q

4 mo anticipatory guidance ?

A

Solid foods and when to start

Breastfeeding

Weight gain and spurts

*Keep drugs out of reach (4mo till grown)

Fears and phobias

Social development

Stranger anxiety soon

Drowning

choking

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40
Q

4 mo WCC when is the next visit ?

A

6 mo

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41
Q

Choking ?

A

Food, small objects

Especially under 3 years

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42
Q

Foods associated with choking ?

A

Hot dogs, hard candy, nuts, popcorn, raw vegetables, chunks of meat, fruit, cheese, peanut butter

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43
Q

Nonfoods

for choking ?

A

Coins, latex balloons, button batteries, marbles, small toys and parts

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44
Q

Drowning ?

A

Second leading cause of injury-related death, especially 1-3 years

10% survivors have brain damage

Bathtub, pools

Close supervision

Swimming lessons

Parents trained in CPR

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45
Q

what is the 6 mo ROS mainly focused on ?

A

feeding and elimination, sleep and activity (no TV)

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46
Q

6 mo feeding information ?

A

Infants that are breast and/or bottle fed can begin on solid foods. Milk intake will decline

Shows signs of readiness for solids

Introduce one food at a time. Wait a few days in between in case of allergies

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47
Q

When can you introduce cup ?

A

6mo

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48
Q

6 mo elimination ?

A

Usually only about two stools a day

More foul smelling

Undigested bits of food normal

Unusual colors normal depending on what was eaten last

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49
Q

6 mo sleeping ?

A

90% of 6 month olds can sleep through the night without feeding (6 hour span at least)

Sleeps about 10 hours per night

2-3 daytime naps (individual)

Total sleep is 14-15 hours in a
24 hour span

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50
Q

6 mo milestones ?

A

Sits without support but may be unsteady (gross)

Transfers hand-hand (fine)

Feeds self (cheerios)

Bangs and shakes toys

Stranger anxiety

Rolls over both ways

Starts to recognize name, enjoys vocal turn taking

Raking grasp - cant pick up things but they can rake things towards them (fine motor)

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51
Q

raking graps ?

A

6 mo

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52
Q

Legs: Genu varus still normal

by

A

6 mo

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53
Q

What reflex disappears at 6 mo ?

A

palmar reflex - grasp

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54
Q

baby proof house by ?

A

6 mo

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55
Q

at 6 mo WCC when is the next app ?

A

9 mo

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56
Q

9 mo typically eat how much BM ?

A

Feeding-typically eating 24-32oz of breast milk/formula in a 24 hour period plus solid foods three times a day

Self feeding
Using sippy cup

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57
Q

When is it more common to see more C ?

A

9 mo -12

as they get more solid foods

Identify not just by straining but what it looks like (hard pellets that look like small marbles)

58
Q

Big players in constipation-favorites ?

A

Bananas

cheese

cows milk

*miralax - cause it doesn’t mess with the babies , they dont get used to it

59
Q

When do sleep regression begin ?

A

9 mo

and teething

60
Q

9 mo WCC milestones ?

A

Cruising - assisted walking (coffee table - gross)

Pull to stand

Three finger grasp-two fingers and thumb (fine motor)

Separation anxiety

Waves bye bye/Pat-a-cake

Mama/dada non specific (sometimes dada is specific?)

61
Q

Neuro: Parachute reflex should be observed ?

A

9 mo

62
Q

Anterior fontanelle may be just starting to close ?

A

9 mo

63
Q

9 mo WCC anticipatory changes ?

A

Transition to cup

Self feeding

Child to be walking soon- prepare house!

Shaken baby syndrome 
Next visit at 1 year
Sleep practices
Reading 
Stranger awareness
Sibling interaction
Toothpaste
Posion control
64
Q

12 mo PE ?

A

make sure eyes are no longer crossed

65
Q

12 mo WVV ROS ?

A

Feeding

Three meals and two snacks

Picky eating may start (limit sugary snacks)

Switch from formula to cow’s milk (whole)

Sippy cup now?

66
Q

at 12 mo sleep decreased to what ?

A

Typically 11 ½ hours at night and two naps for approximately 14 hours total in 24 hours

67
Q

12 mo screening ?

A

Daily tooth brushing now

Lead level taken

Hemoglobin and Hematocrit

*TB risk assessment

68
Q

12 mo WCC developmental milestones ?

A

Says first words (mama/dada specific)

2 finger grasp (pincer grasp)

Stands well, independent steps

Scribbles, holds crayon

Uncovers toy under cloth (10 months)

Imitates parents

69
Q

12 mo WCC anticipatory guidance ?

A

Talk about milk change and amount

*Whole milk unless risk for obesity

Limit to 24 ounces daily

No need for Vitamin D supplements now

Cow’s milk allergy is rare

Little awareness of others

Not sharing and physical responses normal

Great imitator-beware!!

Next visit in 3 months
Prepare house for a walking child

70
Q

15 mo WCC ?

A

none unless catching up

71
Q

15 mo milestones ?

A

3-5 words

points to body part

turn book pages

creeps up stairs

walks carrying toy

72
Q

15 mo AG ?

A

Nutrition/exercise

Fire safety

*Risk assessment for H/H

73
Q

Most common hematological condition affecting millions of children worldwide ?

A

IDA

74
Q

____ in cow milk has lower bioavailability than human breast milk (5%-10% vs. 50%)

A

Iron

75
Q

Start Fe 1-2mg/kg/d in all __ month old infants who are exclusively breastfed until iron enriched cereal started

A

4

76
Q

Check Babinski reflex-should be gone / decreasing ?

A

18 mo

77
Q

Answer questions about toilet training ?

Ask about speech and if there are any concerns (about a dozen words)

Inquire about colds, illnesses

Breast or whole milk?

A

18 mo

78
Q

sleep is how long at 18 mo?

A

11-12

79
Q

18 mo AG ?

A

Violence prevention

*Gun safety

Setting limits

Discuss concerns of autism-screening

Next appointment at 2 years old

**time out - once they are calm they sit there for 1 minutes for however old they are **

80
Q

24 mo Hx/SocHx. ?

A

Tantrums/discipline

Toilet training readiness

Preschool or playgroups-colds and flu?

Picky eating started?

Ask about concerns of speech and social interactions (eye contact) Screen for ASD - autism spectrum

Dyslipidemia screening starts-ask about risks

81
Q

When do you start to plot BMI ?

A

24 mo

**10% of weight they should be 10% of height **

82
Q

when should all the fontanelles be closed ?

A

24 mo

83
Q

Bowing of legs should be straighter now that child is walking ?

A

24

84
Q

24 mo milestones ?

A

50-300 words are within normal range

2-step commands understood

2 word sentences (most can do 3)

Go down stairs two feet on each step

Parallel play

Stack about 6 cubes

Suck through straw

85
Q

24 mo AG ?

A

stop pacificier

toilet training readiness

TV is okay

burns

fears and phobias

self control

dont push them to eat

86
Q

24 mo when is the next visit ?

A

6 mo from now so when they are 2.5

87
Q

2.5 years WCC is mainly for what ?

A

screening for delays

Speech
Developmental
Parental concerns

If child is seen during that year for sick visits, then may not be necessary

**skip , they can wash hands , use stairs **

88
Q

3 yo sleep how long now ?

A

11.5 hrs

89
Q

3 yo eat how much now ?

A

3 meals and 2 snacks

90
Q

*Potty trained during day but accidents common and diaper needed at night
primary enuresis ?

A

3 yo.

91
Q

BP measurements start, vision screening, check teeth (pea sized toothpaste now) ?

A

3 yo

92
Q

3 yo milestones ?

A

String three or more words together

Pedal tricycle (gross)

Copy a circle-360’ (fine)

Play make believe

Dress and undress with little
help

Brush teeth

Understandable most of the time when speaking

93
Q

3 yo AG ?

A

helmet saftey

gun safety

nightmares

social interactions

read to them every day

time out instead of spanking

94
Q

Helmet safety ?

A

75% of bike related fatalities could
have been prevented by using a helmet

About 20% of children in Ohio wear bike helmets, though > 70% ride regularly -AAP

Bill is being considered to mandate helmet use in children under 16 in Ohio

Can reduce the risk of head injury by 85% and brain injury by 88%

Educate parents

95
Q

Gun safety ?

A

Keep guns locked up with ammunition locked up in separate location

For every one intentional shooting for self defense, 4 accidental shootings occur

Gun in the home triples the likelihood of a lethal suicide attempt, double homicide

Adolescents with a history of depression or violence at higher risk

96
Q

4 yo milestones ?

A

copies cross

draws stick figure

hops

use scissors

plays with others

97
Q

5 yo WCC H and P - toilet habits ?

A

Constipation due to being in school bathroom and “holding it” common

98
Q

5 yo WCC H and P - sleep ?

A

10-11 hours per night, no naps usually

99
Q

5 yo PE ?

A

Hearing and vision screen before entering school using standard equipment

100
Q

5 yo milestones ?

A

Hops on one foot, may skip

Speaks clearly

Count to 10, knows 10 colors, reads 25 words

Draws at least 6 body parts on a person

Knows right and left on self

Knows his or her gender

writes first name

walks down stairs alternating feet, no rial

101
Q

when is the pre adolescent visit ?

A

10-11 y.o.

102
Q

Pre-adolescent visit ? talk about ?

A

Showering daily, use of deodorant

Undiagnosed learning disabilities, bullying

Puberty (menses usually 2 years after breast development)

Out of booster at 4 feet 9 inches, backseat >13

Drug and alcohol use (cigarettes, *e-cigarettes)

Depression screening (starting at 11)

103
Q

E-cigarettes ?

A

Battery operated products designed to turn nicotine and other chemicals into vapor (“vaping”)

Contains nicotine which is highly addictive and some contain carcinogens and toxic chemicals such as formaldehyde, as well as heavy metals

Increasingly popular among adolescents (2 million kids have tried e cigarettes already-web MD)

Ohio banned sales to minors but easily available on the internet

Concern that they may be a “gateway” or introductory product to youth trying tobacco

104
Q

Tanner staging pre - adolescent: female breast 1 ?

A

preadolescent

105
Q

Tanner staging pre - adolescent: female breast 2 ?

A

breast bud

106
Q

Tanner staging pre - adolescent: female 3 breast ?

A

areolar diameter enlarges

107
Q

Tanner staging pre - adolescent: female 4 breast ?

A

secondary mound

separation of contours

108
Q

Tanner staging pre - adolescent: female 5 breast ?

A

mature female

109
Q

Tanner staging pre - adolescent: male genitalia 1 ?

A

childhood size

110
Q

Tanner staging pre - adolescent: male genitalia 2 ?

A

enlargement of scrotum/testes

111
Q

Tanner staging pre - adolescent: male genitalia 3 ?

A

penis grows in length

testes continue to enlarge

112
Q

Tanner staging pre - adolescent: male genitalia 4 ?

A

penis grows in length/breadth

scrotum darkens

testes enlarge

113
Q

Tanner staging pre - adolescent: male genitalia 5 ?

A

adult shape and size

114
Q

Tanner staging pre - adolescent: male and female pubic hair 1 ?

A

none

115
Q

Tanner staging pre - adolescent: male and female pubic hair 2 ?

A

sparse, long, straight

116
Q

Tanner staging pre - adolescent: male and female pubic hair 3 ?

A

darker, curling, increased amount

117
Q

Tanner staging pre - adolescent: male and female pubic hair 4 ?

A

coarse

curly

adult type

118
Q

Tanner staging pre - adolescent: male and female pubic hair 5 ?

A

adult

extends to thighs

119
Q

Adolescent WCC basics: confidentiality ?

A

conditional vs. unconditional

Talk with patient & parent on first visit and document

120
Q

Adolescent WCC basics:

A

Screen for alcohol, drugs, smoking

Depression

HIV (16-18 years old)

STD screening

*Teen pregnancy (condoms least effective for pregnancy but must be used every time
for STD protection!)

*Sleep-changes in puberty

121
Q

Teenage pregnancy: talk about OCP ?

A

most effective are implants like nexplanon and IUD

worse are condoms

122
Q

5 P’s of taking a sexual history ?

A

Partners,

sexual Practices,

Protection from STD,

Past history of Pregnancy and STD,

Prevention pregnancy

123
Q

History and PE, height and weight done ?

A

every visit

124
Q

Psychosocial screening done ?

A

every visit

125
Q

*Congenital Heart disease- done ?

A

NB before discharge

126
Q

H/H for anemia- done ?

A

12 month

127
Q

Head circumference - done ?q

A

birth to 24 months

128
Q

BMI - done at ?

A

24 mo

129
Q

BP - done at ?

A

3 years

130
Q

Vision- done ?

A

3-4 years old (visual acuity)

131
Q

Hearing- done ?

A

birth then again at 4 years

132
Q

Developmental screening- done ?

A

9,18,30 months

133
Q

Autism screening- done ?

A

18 and 24 months

134
Q

Lead level- done?

A

12 months if at risk

135
Q

TB- done ?

A

if at risk can start as early as 1 month

136
Q

*Dyslipidemia- done ?

A

9-11 then 17-21 years

137
Q

*Cervical dysplasia- done ?

A

21 years old

138
Q

*H/H risk assesment added at ?

A

15-30 months

139
Q

*HIV- screening at ?

A

16-18 years

140
Q

*Depression - done at ?

A

11-21 years with suggested tools

Patient Evaluation (29 decks)

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