Special Populations

Question 1

The pediatric exam consists of what two important things?

Answer 1

Screening and anticipatory guidance

Question 2

How does each age react to the physical exam?

• Newborn to 6 months
• 6 months-12 months
• 13 months- 4 years
• 4 years to school age

Answer 2

• little fear, quiet with abd/thorax and cry with mouth and ears
• fear of strangers
• challenging, moving, don’t want to be held down
• like an adult

Question 3

Fontanelles

Answer 3

Anterior closes by 9-18 months

Posterior closes by 2 months

May have temporal bruit, not normal at 4-5 years old.

Bulging means increased ICP, depressed means dehydration

Question 4

Eye exam

• Newborn
• 3-4 months
• Fundoscopic
• Visual acuity
• Strabismus
• Dolls eyes
• Setting sun sign
• Amblyopia exanopsia

Answer 4

Newborn- flash for red reflex
3-4 months should follow objects
Fundoscopic exam referral
Visual acutiy grade school
Strabismus 6 years (EOM, cover/uncover, Bruckner)
Dolls eyes- should be gone by 10 days old
Setting sun- hydrocephalus, eyes point down
-Amblyopia exanopsia- vision loss d/t strabismus

Question 5

Ears

Answer 5

Newborns- bell
2 weeks- jump
10 weeks- stop what they’re doing
3-6 months- should turn towards

Question 6

Koplick spots

Answer 6

Inside mouth look like grains of salt r/t measles

Question 7

Ortalani Test

Answer 7

Flex leg at right angle to hip and rotate leg to see if dislocation moves.

Question 8

Barlow Test

Answer 8

Press 1 hip at a time with legs flexed. Press back and out.

Question 9

Reflexes

Answer 9

Palmar grasp until 4 months
Rooting- until 3-4 months
Morro- after 6 months need referral
Fencing- 5-7 months

Question 10

Beers Criteria

Answer 10

The AGS Beers Criteria® includes lists of certain medications worth discussing with health professionals because they may not be the safest or most appropriate options for older adults. Though not an exhaustive catalogue of inappropriate treatments, the five lists included in the AGS Beers Criteria® describe particular medications with evidence suggesting they should be:

Avoided by most older people (outside of hospice and palliative care settings);
Avoided by older people with specific health conditions;
Avoided in combination with other treatments because of the risk for harmful “drug-drug” interactions;
Used with caution because of the potential for harmful side effects; or
Dosed differently or avoided among people with reduced kidney function, which impacts how the body processes medicine.

Question 11

MNA Criteria

Answer 11

1) Food intake amount
2) Weight loss
3) Mobility
4) Stress
5) Neuropsychological problems
6) BMI/Calf circumference

Question 12

Gender Identity

Answer 12

A person’s internal sense of self and how they fit into the world, from the perspective of gender.

Question 13

Sex

Answer 13

Historically has referred to the sex assigned at birth, based on assessment of external genitalia, as well as chromosomes and gonads. In everyday language is often used interchangeably with gender, however there are differences, which become important in the context of transgender people.

Question 14

Gender expression

Answer 14

The outward manner in which an individual expresses or displays their gender. This may include choices in clothing and hairstyle, or speech and mannerisms. Gender identity and gender expression may differ; for example a woman (transgender or non-transgender) may have an androgynous appearance, or a man (transgender or non-transgender) may have a feminine form of self-expression.

Question 15

Transgender

Answer 15

A person whose gender identity differs from the sex that was assigned at birth. May be abbreviated to trans. A transgender man is someone with a male gender identity and a female birth assigned sex; a transgender woman is someone with a female gender identity and a male birth assigned sex. A non-transgender person may be referred to as cisgender (cis=same side in Latin).

Question 16

Gender nonconforming

Answer 16

A person whose gender identity differs from that which was assigned at birth, but may be more complex, fluid, multifaceted, or otherwise less clearly defined than a transgender person. Genderqueer is another term used by some with this range of identities.

Question 17

Nonbinary

Answer 17

transgender or gender nonconforming person who identifies as neither male nor female.

Question 18

Trans-masculine/trans-feminine

Answer 18

Terms to describe gender nonconforming or nonbinary persons, based on the directionality of their gender identity. A trans-masculine person has a masculine spectrum gender identity, with the sex of female listed on their original birth certificate. A trans-feminine person has a feminine spectrum gender identity, the sex of male listed on their original birth certificate. In portions of these Guidelines, in the interest of brevity and clarity, transgender men/women are inclusive of gender non-conforming or nonbinary persons on the respective spectrae.

Question 19

They/Them/Their

Answer 19

Neutral pronouns used by some who have a nonbinary or nonconforming gender identity.

Question 20

Transsexual

Answer 20

A more clinical term which had historically been used to describe those transgender people who sought medical intervention (hormones, surgery) for gender affirmation. Term is less commonly used in present day, however some individuals and communities maintain a strong and affirmative connection to this term.

Question 21

Crossdresser

Answer 21

These terms generally refer to those who may wear the clothing of a gender that differs from the sex which they were assigned at birth for entertainment, self-expression, or sexual pleasure. Some cross dressers and people who dress in drag may exhibit an overlap with components of a transgender identity. The term transvestite is no longer used in the English language and is considered pejorative.

Question 22

Sexual orientation

Answer 22

Describes sexual attraction only, and is not directly related to gender identity. The sexual orientation of transgender people should be defined by the individual. It is often described based on the lived gender; a transgender woman attracted to other women would be a lesbian, and a transgender man attracted to other men would be a gay man.