Peds Physical Exam Flashcards
principles of development?
- predictable path
- range of normal development is wide
- various factors affect child development & health
- development levels determines how you conduct the HPI/PE
when to perform physical exams?
every few months until 4 yo, then annually through middle childhood & adolescence until adulthood
newborn
0-28 days
infant
0-12 months
toddler/early childhood
1-4 yrs
school-aged / middle childhood
5-10 years
adolescence (11-20)
early, middle, late
what is neonatal resuscitation?
warm, dry, suction
APGAR
appearance (color)
pulse
grimace (reflex irritability)
activity (muscle tone)
respiratory (effort)
*you want 2s in all categories / assign at 1 min & 5 min
what is given immediately after birth?
-erythromycin ointment in eyes
-Vit K to prevent bleeding
-full bath
ballard scoring system
neuromuscular activity (square window, scarf sign) + physical maturity (skin, lanugo, plantar surface, ear recoil)
neonatal intake
- q2-3 hours
- breastfeeding w/ some colostrum
- formula 15-30 ml
*normal to lose 7-10% weight first few days of life
neonatal output
-6-8 voids per day by day 4-5
-initial stools = meconium (should stool within first 24 hrs of life)
-breast fed = yellow, seedy
- formula = green-yellow
physiologic jaundice
“normal”
-in 1/2 all newborns
-appears on 2nd & peaks on 5th day
-disappears within a week
pathologic jaundice
*risk of kernicterus
any jaundice within first 24 hrs = pathologic
-breastfeeding jaundice
-ABO incompatibility/Rh
-cephalohematoma
-infection
-enzyme deficiencies
hospital discharge after birth?
- 2 days after vaginal delivery
-3 days after C section
what needs to be done prior to discharge?
- Hep B immunization
-hearing screen
-1st newborn screening blood test
-circumcision
what is the expected weight gain?
1 ounce per day
-should be back to birthweight by 10-14 days
common issues in early infancy?
-congestion
-constipation
-colic (fussy, crying, usually in evenings - use white noise, car rides / resolves by 3-4 months)
infant developmental milestones?
- babbling @ 6 months, 1-3 words @ 1 yr
-6 mos recognize strangers
-9 mos stranger anxiety, object permanance
infant developmental milestones?
- babbling @ 6 months, 1-3 words @ 1 yr
-6 mos recognize strangers
-9 mos stranger anxiety, object permanancet
toddler milestones
-after 2 yrs gain 2-3 kg & 5 cm per year
-2 yr old = 2 word sentence
-3 yr old = 3 words sentences
-by 4 yrs speech is 100% understandable to all
-temper tantrums are common
head injury in neonate
- caput succedaneum crosses suture lines
-cephalohematoma does not
plagiocephaly
positional deformity of skull
craniosynostosis
early fusion of sutures
fontanelle closure?
-anterior: larger and 18m-2 yr
-posterior: smaller & 1-2 mos
infant seborrheic dermatitis
“cradle cap”
-scaling of scalp or eyebrows
eyes exam
-cover/uncover test 9 mo-3 yo
-formally assess visual acuity starting at 3 yrs
ear exam
-otitis externa
-otitis media (kids have wider, shorts tubes compared to adults which predisposes them to infection)
mouth/throat exam
observe philtrum, vermillion border, tongue, cleft pallate
-usually 1 tooth for each month b/n 6-26 mos
neck exam
thyromegaly, lymph nodes, torticollis
CV exam
-brachial & femoral pulses b/l, PMI, murmurs
-BP not measured in kid under 3 yo
neonate HR & RR
40-60 breaths
120-160 beats
lung exam
-periodic breathing in infants
-apneic = <15-20 sec pause
-skin color, retractions, grunting, nasal flaring, ascultation
abdominal exam
auscultate, percuss, palpate
-spleen should not be palpable
GU exam
labial adhesions or discharge
descended testicles, hydroceles, urethra position
*do not forcible retract foreskin in uncircumcised infants
-rectal exam using pinky
MSK exam
-obvious deformities, edema, muscle wasting, calluses, ROM, scoliosis
-* normal to have increased lumbar concavity & decreased thoracic convexity, protuberant abdomen, bowlegged/knock kneed
hip exam
-ortolani test: for post dislocated hip that you attempt to reduce
-barlow test: ability to sublux or dislocate intact but unstable hip
neuro exam
gross assessment unless concerned otherwise
-primitive reflexes
-gross CNs
-strength & muscle tone
primitive reflexes
-palmar grasp: place finger in hand and they grasp finger (B-4 mo)
-moro (startle): hold supine support head, quickl lower feet & move arms (cry or not) (B-4 mo)
-rooting: stroke perioral skin, mouth opens & turns head toward side stimulated (B-4 mo)
-parachute: suspend prone & lower head to surface, extrems then extend (4 mo, doesn’t disappear)
skin exam
-rashes = atopic dermatitis
-color = pink vs cyanotic
-lesions = mongolian spots, nevi, hemangiomas
impetigo
honey crusted lesions, commonly from staph
-tx with abx cream
ringworm
tinea infection
-elevated red rings with central depression
school aged children
-consider bullies, school performance, special ed, behavioral issues
-puberty / body changes
adolescent
-pt gowned & on table -give pt option of asking parent to leave room during HPI & most PE
-need chaperone for breast & GU exam
early adolescent
10-14 yo
-puberty begins
-concrete operational cognition
-social identity is important
middle adolescence
15-16 yo
-females more comfortable than males
-insight developed
-independence-limit testing, experimentation, dating
late adolescence
17-20 yo
-adult appearance
-formal operational cognition
future oriented
HEADSS approach for teens
H - how are things going at home?
E - how is school going?
A - do you or your friends drink etoh?
D - do you or your friend do drugs?
S - sexual activity
S - suicidal thoughts (depression screening)
tanner stages of sexual maturity ratings (SMR)
-description of development of secondary sex characteristics
Tanner Female
- preadolescent, nipple elevation only, no pubic hair
- elevation breast/nipple as small mound, sparse pubic hair growth
- further enlargement, darker, coarse pubic hair
- projection areola/nipple, coarse & curly pubic hair as in adults
- projection of nipple only, hair adult in quantity & quality
Tanner Male
- preadolescent
- sparse pubic hair, no penis enlargement, larger testes
- darker pubic hair, longer penis, enlarged tests/scrotum
- coarse & curly pubic hair, enlarged penis, further enlarged testes/scrotum
- adult quant/quality of hair, adult penis & testes
