Peds Exam Facts Flashcards
what is the definition of neonatal period?
0-28 days
what is the definition of the postnatal period?
29 days to 1 year
when is the first exam of a newborn? how about the second?
First exam: delivery
2nd exam: within 48 hours of discharge at PCP (esp if less than 48 hrs in hospital)
what are the regular intervals for check-ups?
follow-up with PCP within 48 hrs of D/C, 1 mo, 2 mo, 4 mo, 6 mo, 9 mo, 1 yr, 15 mo, 18 mo, 2 yr, 30 mo, 3 yr, after 3 yr, every year through adolescence
what five things does the apgar score look at?
HR, RR, muscle tone, reflex irritability, color
how do you check apgar? what does the final score mean?
at one minute after birth, and then 5 minutes
1 min: 8-10 normal, 5-7 some nervous system depression, 0-4 severe depression, immediate resuscitation
5 min: 8-10 normal, 0-7 is high risk for CNS or other organ system dysfunction
what are the three main things that can cause a low apgar score?
difficult birth, c section, fluid in baby’s airway
**often a low score at 1 min will resolve by 5 mins, does not predict long term health problems
how to score apgar?
Color: 0 for blue/pale, 1 for body pink/extr blue, 2 all pink
HR: absent 0, less than 100 is 1, 2 is more than 100
RR: 0 is absent, 1 is weak cry/irreg breathing, 2 is good crying/reg breathing
Muscle tone: 0 is limp, 1 is bending of some limbs, 2 is active motion/flexed limbs
Reflex irritability: 0 is absent, 1 is grimace, 2 is grimace and cough or sneeze
what week range is considered term gestation?
37-42 weeks
*therefore, premature is before 37 weeks (late preterm 34-36), and post term is over 42 weeks
what week gestation do you screen for Group B strep?
36 or 37 weeks
what is a normal birth weight?
at or >2,500 grams (about 5.5 lbs)
in terms of a growth chart, what percentile is considered small for gestational age? normal or large?
small is under 10 percent
normal 10-90th percent
large over 90 percent
what age range is considered an infant?
birth to one year
birth to 28 days- neonatal, postnatal 29-1yr
what ages are considered early childhood? middle childhood? late childhood?
Early: 1-4 yrs
Middle: 5-10 yrs
Late: early 10-14 yrs, middle 15-17 yrs, later 18-21 yrs
birth weight changes within first 10 days of birth?
drop weight by 10%, gain it back by two weeks
by one year old, how should birth weight and height change?
birth weight should triple; height should increase by 50%
how is language development during the first year?
2 months- cooing
6 months- babbling
1 yr- 1 to 3 words
normal pulse for neonate, 1-6 mo, and 6-12 mo
neonate: 90-190
1-6 mo: 80-180
6-12 mo: 75-155
what is considered tachypnea in a kid under 1 year?
birth to 2 mo: > 60
2-12 mo: >50
how can a fever in an infant impact respirations?
can raise RR in in infants up to 10 RR/min for EACH degree centigrate of fever
what age range should you use rectal temperature to assess temp?
0-2 mo
what is the physical exam finding of congenital heart disease in an infant?
central cyanosis (MUCUS membranes- lips)
what are mongolian spots?
- dark or blue pigment over buttocks/lower lumbar areas
- benign and usually disappear in childhood
- MC in african, asian, and mediterrean descent
what are mongolian spots?
- dark or blue pigment over buttocks/lower lumbar areas
- benign and usually disappear in childhood
- MC in African, Asian, and Mediterranean descent
what is lanugo?
- fine, downy hair over entire body that infants have (more at shoulders and back)
- sheds within first few wks
describe pattern of jaundice in babies. how do you test this?
Normal physiologic jaundice that starts 2-3 day of life, peaks at 5 days, and usually gone within a week; test this by blanching the skin (make skin taut and see yellowing)
where is the anterior fontanelle located and when does it close?
between the coronal and sagittal suture lines; closes between 4-26 mo (usually 7-19 mo)
where is the posterior fontanelle located and when does it close?
between the sagittal and lambdodial sutures; closes by 2 months
what is plagiocephaly?
deformity in the cranial vault usually from dependent position on head (depresses head); improve this by promoting tummy time or pressure off site
what is the red reflex?
when looking into the retina of a young child’s eye, there should be a red reflex (NOT WHITE)?? white is a sign of retinoblastoma
which way do you pull pinna in an infant in order to see the TM?
downward
what is choanal atresia?
congenital issue; narrowing or blockage of nasal airway by tissue; why you check for nasal patency in infants
what two sinuses are present at birth?
maxillary and ethmoid
when does tooth development start? what teeth usually erupt first?
1 tooth per month for 6-26 months of age; central and lateral incisors erupt first, molars last
**usually all baby teeth present by age 3
what are three signs that show an infant has increased work of breathing?
nasal flaring, grunting, retractions (supraclavicular, intercostal, subcostal)
why are breasts enlarged in newborns?
maternal estrogen increases the size
when are the umbilical cord remnents gone?
usually by 2 weeks
when does cryptochordism usually resolve?
by one year
what do you have to check for on the back of an infant?
sinus tracks within 1 cm or so of the midline
when are bowlegged legs considered abnormal?
over 18 months
describe how to perform ortolani and barlow. what are these tests used for?
ortolani- tossing salad (up and out)
barlow- down and in (adduction of hip)
* tests used to check for hip dislocation
what are bulging out or sinking in fontanelles indicative of?
bulging- increased ICP
sunken in- dehydration
how does language transform over 1 yr to 4 yo?
18 mo- 10 words
2 yrs: 2-3 word sentences
3 yrs: can converse?
4 yrs: form complex sentences
what are the HR ranges for 1-2 yo, 2-6 yo, and 6-10 years old
1-2: 70-150
2-6: 68-138
6-10: 65-125
for childhood, what is considered normal BP?
<90th percentile
hypertensive >95th percentile
when do you start measuring blood pressure?
at age 3
are knocked knees common in children?
18 mo to 9-10 years old knocked knees are common; max at age 3-4
when do the sphenoid and frontal sinuses present?
sphenoid: age 8
frontal: 6-7
Female puberty: what ages do the following occur? breast growth, pubic hair growth, body growth, first period, underarm hair, acne
breast growth: 7-13 pubic hair: 7-14 body growth: 9.5-14.5 first period: 10-16.5 underarm hair/acne: 2 years after pubic hair
Male puberty: what ages do the following occur? testicles/scrotal sac, pubic hair growth, body growth, growth of penis, change in voice, underarm/facial hair, acne
testicles and scrotal sac: 10-13.5 growth of pubic hair: 10-15 body growth: 10.5-16.5 penis growth/voice change: 11-14.5 face/underarm hair and acne: 2 yrs after pubic hair
DM: Birth
gross motor, fine motor, language, social, safety/AG
Gross motor: no head control Fine motor: visually fixed Language: none Social: none Safety/AG: vitamin K, eye ABX proph for untreated gonorrhea, hearing screen, jaundice, fever > 100.4, crib safety, diaper area care, infant car seat, postpartum depression
DM: 1 Month
gross motor, fine motor, language, social, safety/AG
Gross motor: raises head from prone
Fine motor: eyes follow to midline, tight grasp (hands closed)
Language: alert to sound, spontaneous smile
Social: face regard
Safety/AG: FT infants regain body weight by 2 weeks, vitamin D if breast fed, discuss colic
DM: 2 Month
gross motor, fine motor, language, social, safety/AG
Gross motor: holds head in midline, lifts chest up when prone
Fine motor: eyes follow past midline (180 degree), hands open 50% of the time
Language: smiles in response, could start cooing
Social: recognizes parent, social smile
Safety/AG: fever = 102, SPF 15 when in sun, avoid being in sun (until at least 6 mo)
DM: 4 Month
gross motor, fine motor, language, social, safety/AG
Gross motor: rolls over, supports on wrists, shifts weight, no head lag when pull to sit
Fine motor: conjugate gaze, reaches with arms in unison, brings hands to midline, hands open 75% of time
Language: laughs, orients to voice
Social: enjoys looking around
Safety/AG: put down to sleep, awake/bedtime routine, introduce solid food (no honey or corn syrup until 1 year), no walkers
DM: 6 Month
gross motor, fine motor, language, social, safety/AG
Gross motor: sits up, rolls over in both directions, puts feet in mouth in supine position
Fine motor: unilateral reach, raking grasp, transfers objects hand to hand
Language: may babble, turns to sound/voice, lateral orientation to bell
Social: recognizes people as strangers, feed self ( 5mo)
Safety/AG: double birth weight, parachute reflex (6-9 mo), child proof home
DM: 9 Month
gross motor, fine motor, language, social, safety/AG
Gross motor: pivot when sitting, crawls well, pulls to stand, cruises (11 mo)
Fine motor: immature pincer grasp, probes with forefinger, holds bottle, throws objects
Language: says “mama” or “dada”, waves bye bye, understands “no”, localizes sound in all directions
Social: exploring environment, plays gesture games (pat-a-cake)
Safety/AG: introduce finger foods, avoid chokables, staircase gates, reinforce childproof
DM: 12 Month
gross motor, fine motor, language, social, safety/AG
Gross motor: walks w one hand out (without help 13 mo, well 15 mo)
Fine motor: mature pincer grasp, whole palmar grasp (make crayon mark), puts block in cup (11 mo)
Language: uses 1-2 other words, jargoning, one step command with gesture
Social: imitates actions, comes when called, cooperates with dressing, drink from cup 13 mo
Safety/AG: triple birth weight, table food, wean from bottle, infant car seat (rear facing until a year and 20 lbs)
DM: 15 Month
gross motor, fine motor, language, social, safety/AG
Gross motor: creeps up stairs, walks backward independently, plays ball, gives/takes toy
Fine motor: scribbles in imitation, builds tower of two blocks in imitation, points, drinks from cup, makes line with crayon
Language: uses 4-6 words, follows one step command without gesture
Social: starts to use spoon and fork
Safety/AG: discuss tantrum management, toddler safety: falls, drowning, burn
DM: 18 Month
gross motor, fine motor, language, social, safety/AG
Gross motor: runs, walks up stairs with hand held, throws objects from standing
Fine motor: scribbles spontaneously, builds tower of three blocks, turns 2-3 pages at a time
Language: mature jargoning (intelligible words), 7-10 word vocab, knows two body parts
Social: imitates household tasks, plays in company of other children, removes clothes (10 mo), feeds self with spoon
Safety/AG: discuss toilet training readiness
DM: 24 Month
gross motor, fine motor, language, social, safety/AG
Gross motor: walks up and down stairs without help, runs well, kicks ball, jumps with two feet, throws ball overhand
Fine motor: imitates stroke with pencil, turns pages one at a time, stacks tower of cubes (6-8 cubes)
Language: inappropriate, follows two step commands, 50 word vocab, 2-3 word sentences, 5 body parts
Social: parallel play
Safety/AG: after two years, annual growth until adolescence (2 in/yr), minimize screen time
DM: 3 year
gross motor, fine motor, language, social, safety/AG
Gross motor: can alternate feet going up steps, pedals tricycle, balance on one foot
Fine motor: copies a circle, undresses completely, dresses partially, dries hands if reminded, stacks tower of 10 cubes
Language: minimum 250 words, 3-word sentences, uses plurals, knows all pronouns, repeats two digits
Social: group play, shares toys, takes turns, plays well with others, knows full name
Safety/AG: start BP screening, birth length doubles by 3-4 yrs
DM: 4 year
gross motor, fine motor, language, social, safety/AG
Gross motor: hops on one foot, skips, alternates feet going down steps
Fine motor: copies a cross, square at 4 yrs, draws a simple person, does buttons and dresses self completely, catches ball
Language: knows colors, says songs or poem from memory, 4-5 word sentences, asks questions, counts 4 objects
Social: tells stories/tales, plays cooperatively with group of kids, counts, sings, says why
Safety/AG: can switch to lap belt if 4 yrs and 40 lbs
DM: 5 year
gross motor, fine motor, language, social, safety/AG
Gross motor: skips alternating feet, jumps over low obstacles
Fine motor: copies triangle, ties shoes, spreads with knife, draws person with 6 body parts
Language: prints first name, asks what a word means, names 4 colors, distinguishes fantasy vs reality
Social: plays competitive games (board games), abides by rules, likes to help in household tasks
Safety/AG:
what are contraindications to breast feeding?
milk protein allergy, colitis, active HIV infection, HSV lesions on breast, meds (chemo, street drugs, lithium), alcohol, galactosemia
When do you give a child vitamin D supplementation?
all breast fed infants and infants on formula eating less than 500 mL/day (30 ml/oz, 16 oz) should start receiving supplementation during first week of life
400IU per day
When do you give a child iron supplementation?
iron supplements start between 4-6 months (baby should have enough iron stores until about 4 months old, correlates with when baby should start eating more solid foods with iron)
dose: 1 mg/kg/day = full term
dose: 2-4 mg/kg/day = premature
puréed meats, iron-fortified infant cereal, iron-rich vegetables, liquid iron supplement
when do you give a child flouride supplementation?
at the six month age mark if the child isn’t drinking bottled water or has well water without fluoride
**six month mark is when kids start developing teeth
fluoride toothpaste or fluoride drops
if a mom is vegan, what vitamin supplements should a baby be given?
iron and B12
what should a child be fed from birth to one year old?
Breast milk from birth to 4-6 months
Start introducing solid foods at 4-6 months: foods such as iron-fortified rice cereal, try a new food once every 3 days
at 6 months, start to give small amounts of water in sippy cup (no water before 6 mo for risk of hyponatremia and seizure possibility)
at one year old, infant should start the transition to whole milk (2 8 oz cups per day)
what is the extrusion reflex and why is it important?
“Tongue-thrust reflex”
tongue is touched or depressed in any way by a solid and semisolid object which causes a tongue thrust to prevent the object from entering
**reflex has to disappear before introducing kids to solid food (4-6 mo)
what is the weight gain pattern of a child from birth to one year old?
0-3 month: 30 g or 1 oz per day (1 lb every 2 weeks)
**baby will lose 10% of birth weight within the first few days and regain it by two weeks old
3-6 mo: 20 g/day (baby should double weight by 6 mo)
6 mo-1 yr: 10 g/day (baby should triple weight by 1 year)
what are the BMI percentiles for a child?
<5% = underweight/failure to thrive
5-85% = normal
>85 % but under 95% = overweight
>95 % = obese
what is jargoning?
runs several unintelligible words together with tone or inflection
at what age does a kid ride a bike without training wheels?
6 years old
immunizations given at birth
Hep B (1st dose)
screening tests completed at birth
newborn hearing screen, newborn metabolic screen (depends on state)
2 month immunizations
Pediatrix (1) : Dtap, IPV (inactivated polio), Hep B
Hib (1)
Prevnar (1)
Rotateq (1): Rotavirus
4 month immunizations
Dtap, IPV (2) (could have Hep B here but usually birth, 2 mo, 6 mo) Hib (2) Prevnar (2) Rotateq (2): Rotavirus
6 month immunizations
Pediatrix (3) : Dtap, IPV, Hep B
*sometimes have 3rd Hib with 4th at 12 mo, or skip this month and have 3rd Hib
Prevnar (3)
Rotateq (3): Rotavirus
9 month immunizations
NONE
12 month immunizations
Hib (either 3rd or 4th dose )
Prevnar (4)
LIVE: MMR, varicella
15 month immunizations
DTap (4) Hep A (1)
18 month immunizations
NONE
24 month immunizations
Hep A (2)
3 year old immunizations
NONE
4-6 year old immunizations
Kinrix: DTAP (5) and IPV (4) combo
Proquad (LIVE): MMR (2) and varicella (2)
7-8 year old immunizations
NONE
9 year old immunizations
HPV (1)
10-11 year old immunizations
Tdap (1) about age 11
HPV (2)- 6-12 mo in-between first and second dose
Meningococcal
12-18 year old immunizations
Meningococcal age 15-16 (before college)
HPV if started after 15 (0, 2, 6 mo)
from what child ages do you screen for maternal depression?
birth to 6 month old
fluoride screening should occur at what well visits?
starting at six months to 4-6 years old
what well visit do you screen for hip dysplasia and refer to XR as needed?
6 month old
what are the four LIVE vaccines?
MMR, varicella, rotavirus, intranasal influenza
what vaccine does every pregnant woman get?
Tdap- because want to give baby passive immunity against pertussis
what happens if a child younger than 12 months old gets exposed to measles or chicken pox?
you can give them the vaccine early, but 9 months at the earliest
** still have to revaccinate at 12 months (original start date)
what is the three dose series for HPV?
if a child starts to get the vaccines after 15 years old:
0, 1-2 mo later, 6 mo later
at what well visit should you start BP, vision, and hearing screens?
age 3 and every year afterwards
at what well visits do you screen for anemia and lead?
12 month, 24 month, 4-6 years (POC)
additional Hgb screen: every 2 years between ages 7 and 18 (yearly once girl starts menarche)
at what well visits do you screen for autism using the MCHAT
18 month, 24 month, 30 month
at what well visits do you use the ages and stages questionnaire?
9 month, 18 month, 24 month, 30 month
at what well visits do you do a cholesterol screen?
9 years, 10-11 years
at what age well visit do you start the depression screening?
age 11 and continue every year until 21
at what age can children start getting the influenza vaccine?
at six months
for adolescents, what should be further assessed during their physical examination?
ages 11-21
Examine back and hip alignment for scoliosis
Examine for acne, acanthosis nigricans, nevi, piercings, self-injury
Consider pelvic exam for appropriate females
what are the intervals between Hep B shots for infants?
hospital (right after birth), 1-2 months later, and then 3rd dose around 6 months of age
palmar grasp reflex and age of occurrence
placing finger against baby’s palm causes baby to flex fingers to grasp your finger
birth-3-4 months
plantar grasp reflex and age of occurrence
touching the sole at the base of the toes causes the toes to curl
birth to 6-8 months
rooting reflex and age of occurrence
stroking the perioral skin at the corners of the mouth causes the mouth to open and baby will turn head to that side and start sucking
birth to 3-4 months
moro reflex (startle) and age of occurrence
hold baby supine and abruptly lower the entire body- arms should abduct out, hands open, and legs flex
birth to 4 months
Asymmetric tonic neck reflex and age of occurrence
in supine position, turn baby’s head to one side and hold jaw over shoulder. arm and leg on head turned side extend and other side extremities flex
birth to two months
landau reflex and age of occurrence
suspend the baby prone with one hand and the baby will lift the head and straighten the spine
birth to 6 months
Trunk incurvation or Galant’s reflex and age of occurrence
support the baby prone with one hand and stroke one side of the back (1 cm from midline) from shoulder to butt and spine will curve towards stimulated side
birth to two months
parachute reflex and age of occurrence
suspend the baby prone and slowly lower head towards a surface, baby will extend extremities to protect themselves
8 months and doesnt disappear
positive support reflex and age of occurrence
hold the baby and lower them to “standing’ on a surface, the baby will bear some weight by standing and sag after 20-30 seconds
birth or two months until 6 months
placing and stepping reflexes and age of occurrence
hold baby upright same as positive support reflex and have one sole touch the table, hip and knee of that foot will flex and the other foot will step forward (baby will alternate stepping)
birth to variable ages
what week of pregnancy are women screened for GBS? how is it treated to prevent neonatal infection?
between 35-37 weeks (vaginal or rectum swab)
Intrapartum antibiotic prophylaxis (PCN G IV) administered at least four hours before delivery, PCN allergic must be true allergy and either chlindamycin or erythromycin depending on sensitivity
when should B12 supplementation be given?
recommended for breastfed infants of strict vegan mothers (ie, those who avoid eggs and dairy products in addition to meat) if the mother is not taking supplemental vitamin B12 while lactating OR formula-fed infants whose parents provide a strictly vegan complementary diet
- 0.4 mcg per day for infants between birth and six months and 0.5 mcg per day for infants between 7 and 12 month
child with baker’s yeast allergy should not have which vaccine?
Hep B
child with neomycin or streptomycin should not have which vaccines?
MMR and IPV
child with gelatin allergy should not have which vaccines?
varicella and influenza
Tanner stage 2 for females: breast and pubic hair
breast: breast buds palpable, areola enlarges
pubic: minimal straight hair
Tanner stage 1 for females: breast and pubic hair
No changes
Tanner stage 3 for females: breast and pubic hair
Breast: elevation of areola
pubic: increased pubic hair (dark and course), lateral extension
Tanner stage 4 for females: breast and pubic hair
Breast: secondary mound of areola and papilla
Pubic: adult like, extends across pubis
Tanner stage 5 for females: breast and pubic hair
Breast: adult breast contour
Pubic: adult appearance, extends to medial thigh
Tanner stage 1 for males: pubic hair
No changes
Tanner stage 2 for males: pubic hair
Pubic: straight pubic hair at base of penis
Tanner stage 3 for males: pubic hair
Pubic: course dark and curly hair
Tanner stage 4 for males: pubic hair
Pubic: hair is almost completely full
Tanner stage 5 for males: pubic hair
Pubic hair looks like adult
Tanner stages correlate with roughly what ages
Tanner stage 1: before 11 Stage 2: 11 in females, 11-12 in males Stage 3: 12 in females, 13 in males Stage 4: 13 in females, 14-15 in males Stage 5: 14 in females, 16-17 in males
what is reye’s syndrome and what can cause it?
syndrome that leads to cerebral edema and fatty accumulation in the liver
-unknown cause but usually occurs after a viral infection or aspirin use in children
symptoms of reye’s and what are they due to
sudden persistent vomiting
nausea
combative/irritable personality
altered mental state that can lead into LOC, seizures, com
* due to drop in blood suagr, cerebral edema and fatty deposits in organs
how to treat reye’s
ICU hospitalization usually
Hypoglycemia: IV fluids with glucose/electrolytes
Increased ICP: mannitol, steroids
Blood clotting probs: vitamin K, plasma, platelets
what are the two main causes of vitamin B12 deficiency?
pernicious anemia: lack of intrinsic factor due to antibodies so B12 can’t bind to it and travel to duodenum to be absorbed
decreased intake: VEGANS (lack of meat consumption)
clinical symptoms of B12 deficiency
anemia symptoms: fatigue, HA, pallor, exercise intolerance
PLUS NEURO SXS: symmetric paresthesias, ataxia, weakness, DECRE DTRS, vibration or sensory deficits
how do you diagnose B12 deficiency?
CBC: shows macrocytic anemia (hypersegmented neutrophils)
decreased serum B12 levels, increased homocysteine, INC METHYLMALONIC ACID (difference between folate deficiency)
treatment of B12 deficiency
B12 replacement orally or by injection
**ORAL replacement if due to dietary deficiency
bulimia criteria
recurrent episodes of binge eating (eating a lot within 2 hour period) at least weekly for 3 months PLUS purging (vomiting, laxative abuse) or non purging (restricting caloric intake) behavior
only medication to treat bulimia
Fluoxetine (prozac)
describe weight of someone with bulimia
usually maintain normal weight and may even be overweight
which psych condition has the highest mortality rate and why
anorexia because of arrhythmias it can cause
what are the two types of anorexia?
restrictive (reduced caloric intake, dieting, fasting) and binge eating/purge (self induced vomiting and laxative abuse)
what is the BMI for a person with anorexia
17.5 or less (OR body weight <85% of ideal body weight)
what are the three main criteria for anorexia
restriction of caloric intake, intense fear of gaining weight/being fat, and distorted body image
what type of medications might help with anorexia?
SSRIs
go to treatment for typical and atypical CAP in children
typical- amoxicillin (S. pneumo)
atypical- macrolides (Mycoplasma) erythro, claritho
could use FQ after
