Peds Exam 1 Flashcards
1
Q
one of the most imp aspects of visit since child can’t talk
A
History
2
Q
Schedule for maintenance visits
A
newborn, 1, 2, 4, 6, 9, 12, 15, 18 Months
2, 2.5 Years
3-6 Annually
6-adol every 2 Yrs
3
Q
Add behavioral-developmental screening to routine
A
9 months, 18 months, 2 yr, 2.5 yr
4
Q
5 Developmental categories
A
Fine motor skill Gross motor skill Personality/social skill Speech/communication skill Neuro landmarks
5
Q
M-CHAT test
A
modified checklist to check for Autism in toddlers
6
Q
Denver developmental screen
A
great for getting referrals
7
Q
AZEIP
A
AZ Early Intervention Program. Healthcare worker comes to house to do an evaluation for free to see what intervention child needs
8
Q
AHCCCS Form
A
AZ Healthcare Cost Containment System. “Medicaid for Kids”
9
Q
Measurements to take from 0-2 yrs of age
A
Height, Weight, Head circumference
10
Q
Who makes normal growth chart for age 0-2
A
WHO, World Health Organization
11
Q
Measurements to take starting at age 2
A
Height, Weight, Head circumference, + BMI, weight for length
12
Q
Who makes normal growth chart for age 2 and older?
A
CDC, Center for Disease Prevention
13
Q
Measuring Weight for Infant
A
take to nearest .01 kg or 1/2 oz
14
Q
Normal weight for infant
A
5th-85th percentile
15
Q
When to take BMI
A
2 yr and older
85-95th percentile: overweight
>95th percentile: obese
16
Q
Head Circumference
A
Measure 0-3 y.o.
Head circumference percentile should match length percentile on respective normal growth chart
17
Q
“Failure to Thrive”
A
- Height or weight <3rd percentile
- Drop of 2 or more major percentile lines on standard growth chart
18
Q
Congenital Viral Infections cause “TORCH”
A
Toxoplasmosis
Rubella
Cytomegalovirus CMG
Herpes
19
Q
Prematurity
A
subtract wks of prematurity from postnatal age when plotting growth
Head: 18 mo
Weight: 24 mo
Height: 40 mo
20
Q
HTN in peds
A
Systolic and/or Diastolic >/ 95th percentile on 3 separate occasions
Further categorized into 2 stages:
Stage 1: <5 mmHg above 99th percentile
Stage 2: >5 mmHg above 99th percentile
21
Q
When to start screening BP regularly?
A
3 YEAR OLD
22
Q
What is persistent HTN?
A
> 6 mo in a row, requires further evaluation
23
Q
Most common disorders among children & adults
A
Language, Learning, Intellectual
24
Q
When to do screening for developmental-behavioral
A
9, 18 months, 2 & 2.5 y.o.
25
**Red Flag**
painful, unilateral solitary adenopathy >2cm in diamater, weight loss
26
When to get tonsillectomy
3-5 documented strep in one year or obstruction @ night
27
50% children have innocent murmur
should be grade 1 or 2, anything above not normal
28
Tanner Sexual Maturity
used for devel of secondary sex characteristics
29
Vision Screening test that start at 3 y.o.
Fundoscopic and Visual Acuity
30
preschooler less than 20/40
refer
31
6 yr or younger less than 20/30
refer
32
Hearing screening
infant by 1 mo
| comprehensive by 3 mo if OAE are not passed
33
AABR test
Automated Auditory Brainstem Response
| 3 electrodes on baby's head, measure how nerves respond to stimuli
34
OAE test
Otoacoustic Emissions
| tiny probe in ear canal- measure sound waves in inner ear
35
Cholesterol & Lipids
screen recommended if BMI is >85th percentile or children @ high risk for hyperlipidemia
36
When to perform Formal Hearing Screening
4,5,6,8, 10 y.o.
| unless children at risk for hearing loss, do again by age 2-2.5
37
Lead levels usually peak @
18-24 months
38
Hgb and Hct levels
9-12 mo
39
Estblsh dentist by age
2
40
SIDS
peak age 2-4.
| 90% cases happen before 6 month
41
Plagiocephaly
misshapen head
| after 6 mo- send to cranail technicion
42
Colic
```
starts 2-3 wks
ends ~12 wks
"Rules of 3":
3 hours
3 days/week
3 weeks
```
Treat cause and can try Ranitidine
43
Introduce potty chair
18 months
44
Daytime potty control achieved
2-4 yrs old
45
Nighttime potty control achieved
5-7 yrs old
46
When is a stutter concerning?
if it last more than 6 months
| if it occurs w/tics or extreme self consciousness
47
Autism screening
| example: M-CHAT
screen two diff times
| 18 and 24/30 months
48
Main complaint with ASD
Language Delay
49
Red flags indicating evaluation for ASD
12 mo: no babbling, pointing, or gestures
16 mo: no single words
24 mo: no 2 word phrases
any age: loss of skill once had
50
2 Months
```
Lift & turn head
Track past midline
Primitive Reflexes present
Turns head towards sound
Alert to voices, follow objects w/eyes
Begin to SMILE responsively
```
51
Most common time of SIDS occurence
2-4 months
| sleep on BACK
52
Diapers at 2 months
5-8 wet
| 3-4 stools
53
4 Months
Hold head steady
Rolls stomach to back (1 way)
Laugh & squeal
Start tummy time
54
6 Months
```
Sit supported (unsupported @ 6-8 mo)
Reach for object --> bring to mouth
Roll over BOTH WAYS
Vowel & consonant sounds
Respond to other's emotions
```
55
Rice cereal
4-6 months
56
Teething
6-9 months
57
9 months
```
Crawling (many versions)
Pull to stand, Cruising
"Mama" "Baba" "Dada" without meaning
Understands "no"
Peek-a-boo, object dominance
Stranger danger
```
58
12 Months
```
takes steps
stands alone 2 seconds
beings to walk alone
simple gestures
"Mama" "Dada" WITH meaning
copies gestures
```
59
15 Months
walks well, stoops down to pick stuff up
5+ words
knows purpose of ordinary things & attempt to use (brush, spoon, phone)
60
18 Months- Birm's son
```
run, kick ball
eats well with spoon, feeds self
over 6 words (5-20 word vocab)
knows importance of ordinary objects
Introduce Potty Chair!
```
61
24 Months- 2 yrs old
```
throw ball overhead
stand on tip toes
short phrases
*repeats overheard words
Emphathy
Helps undress and put things away
complete familiar sentences & rhymes
might start to establish Hand dominance (R or L)
```
62
36 Months- 3 yrs old
```
Stand on 1 foot
understandable 50% of time
speak in sentences
pretend play & simple games
imagination
make believe
```
63
3 yr old
stand on 1 foot
draw circle
3 word sentence
64
4 yr old
Hop on 1 foot
draw square
Why? Why?
65
5 yr old
Skips
draw triangle
respond to Why Qs
66
6-12 yr old
5-7 word sentences
5 step commands by age 10
concentrate for 15 minutes
concentrate for 1 hour by age 9
67
APGAR
```
Activity
Pulse
Grimace (w/stimulation)
Appearance (skin color)
Respiration
```
68
When to take APGAR
1 and 5 minutes
1: <4 score needs immediate resuscitation
7-10 is normal
5: 6 score high risk CNS/organ system dysfx- Intervention needed!!
>/ 7 score: proceed w further testing
Continue every 5 minutes until score is greater than or equal to 7 and you can then proceed
69
Differentiation of 1 pt and 2 pt with respirations
<100 bpm or >100 bpm
70
Neonate
1-28 days
71
Infant
29 days-12 months
72
What is considered premature
before 37 weeks
73
Transitional period
```
first 4-6 hours of life
every 30-60 min, take these measurements:
-Heart rate (120-160 is normal)
-Respirations (40-60 is normal)
-Temperature (97.5-99.5 is normal)
```
74
Ballard Scoring System
pretty accurate way to estimate gestational age within 2 weeks
Measuring: Neuromuscular & Physical maturity
75
Normal time for birth
37-42 weeks
76
Normal birth weight
greater than or equal to 2500 g
77
Birth weight
```
<2500= low
<1500= very low
<1000= extremely low
```
78
Hypothyroidism
Screened for in AZ
| One of the most preventable causes of mental retardation
79
Be concerned if baby doesn't pass stool within 24 hours
concerned for Meconium Ileus- bowel obstruction
80
Sweat Chloride Testing
most important diagnostic test for Cystic Fibrosis
| should f/u with newborn screening
81
Anterior Fontanelle
the LARGER one (4-6 cm)
| closes b/w 4 and 26 months
82
Posterior Fontanelle
smaller (1-2 cm)
closes @ 2 months
Larger hints at Hypothyroidism
83
Rooting Reflex
sucking
| Birth--> 3-4 months
84
Moro/Startle Reflex
drop baby
| Birth --> 5-6 months
85
Palmar Grasp
Birth --> 4-6 months
86
Plantar Grasp
Birth --> 6-8 months
87
Asymmetric Tonic Reflex
Birth --> 2-3 months
88
Positive Support Reflex
Birth/2 mo --> 6 months
89
Small weight for gestational age
<10th percentile
90
Normal weight for gestational age
10-90th percentile
91
Large weight for gestational age
>90th percentile
92
Risk for sepsis
```
mother temperature >100.4
membrane rupture >18 hours before delivery (water broke >18 hours before delivery)
delivery <37 wks (gestation)
Chorioamnionitis
Maternal group B strep colonization
```
93
Chorioamnionitis
intra-amniotic infection- inflammation of fetal membranes d/t bacterial infection
usually from bacteria descending from vagina into uterus: often associated w/prolonged blabor
94
Prophylactic Erythromycin Eye ointment 0.5%
Prevent gonococcal ophthalmia
95
Wet diapers and stools by day 5
6-8 wet diapers/day
| 3-4 yellow, seedy stools per day
96
D/c from hospital
Insurance covers:
up to 48 hrs for vaginal delivery
up to 96 hrs for C section
F/u visit:
If d/c before 48 hrs: come back within 48 hours!
If d/c after 48 hrs: come back within 3-5 days
97
Vernix caseosa
thick, white, gooey substance covering skin of baby
98
Milia
smooth, white, raised areas pinpoint papules
on nose and cheeks of baby
retention of keratin and sebaceous material
appears w/in first few weeks
disappears over several weeks
99
neonatal acne
starts 2-3 wks
| gone by 4-6 wks
100
Miliaria Rubra
scattered vesicles on erythematous base
face, neck, and trunk
obstruction of sweat glands- "heat rash"
disappears spontaneously w/in weeks
101
Erythema Toxicum
usually appears on 2-3 day ols
gone within 1st week
erythematous macules w/pinpoint vesicles --> progress to pustules
scattered diffusely
102
Acrocyanosis
bluish coloration but only on hands and feet
103
Central Cyanosis
** Associated w/congenital heart disease **
| around the mouth and nose
104
Pustular Melanosis
```
more common in black infants
3 stages
superficial white pustules
unroof macules w/surrounding scale
hyperpigmented macules gradualy face
can last several months
```
105
congenital hairy nevus
hairy mole
| significant malignant potential
106
Neonatal Jaundice
problem if BEFORE 24 hours or AFTER 2 weeks
| "Non physiologic Jaundice"
107
Worry with Jaundice
```
Acute Bilirubin Encephalopathy ABE- reversible
Kernicterus- neurologic dysfx
Cerebral Palsy
Hearing loss
Gaze abnormalities
Dental enamel dysplasia
```
108
Cephalohematoma
if you suction baby's head too much at birth
does not cross suture line
Resolves on own within ~3 wks
109
Choanal atresia
excessive growth of tissue in nares - unilateral or bilateral episodes of cyanosis
110
Epstein's Pearls
Benign!
in baby's mouth
clustered at midpoint of junction b/w soft and hard palate
111
Cryptorchidism
undescended testicles
| most cases, testes will descend by 1 year
112
Hydroceles in testes
check for swelling on exam
113
Hypospadias
opening of urethra on ventral surface of penis
114
Hypergrowth of hymen
closed vagina at birth
115
Spina Bifida occulta
hair patches, deep pits, dimple, pigmented spots
116
Hips
look for dysplasia of the hip
Galeazzi test- femoral shortening
Ortalani- test for presence of posteriorly dislocated hip
Barlow test- ability to sublux or dislocate an intact but unstable hip
