Starred slides children Flashcards by Morgan Evans

List the 5 stages of development

1) Newborn/Neonate (first 28 days after birth)
2) Infancy (0-12 months)
3) Early childhood (1-4 years)
4) Middle childhood (5-10 years)
5) Adolescence (11-20 years)
-Early, middle, late

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Expectation of milestones is adjusted for ______________.

prematurity

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What temp is most accurate for infants?

Rectal

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1) What is avg HR at birth?
2) What abt at 1-6 months?
3) 6-12 months?

1) 140
2) 130
3) 115

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Any fever lasting more than _______ days needs complete workup

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List 3 potential causes of acute limp in kids

1) Trauma
2) Injury
3) Slipped Capital Femoral Epiphysis (SCFE)

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Slipped Capital Femoral Epiphysis (SCFE) is most common in what group of children? What does this cause?

Obese; growth plate damaged, femoral head slips

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List and define 5 potential causes of chronic limp

1) Blount disease: Growth disease of the tibia
2) Avascular necrosis of the hip: Blood flow to the bone is interrupted
3) Leg length discrepancy
4) Spinal disorder: Scoliosis
5) Leukemia: Build up of cells in the bone and joints of the legs and hip.

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1) Define inspiratory stridor
2) What can it be caused by?
3) Give examples

1) Audible breath sound; high-pitched, inspiratory noise
2) Serious conditions
3) Laryngotracheobronchitis (croup), Epiglottitis, Foreign body
-Not as important to know: Bacterial tracheitis, hemangioma (subglottic), vascular ring, tracheomalacia

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Give the Coarctation of the aorta brief definition

Congenital narrowing of a section of the aorta

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1) What is the Ortolani test for?
2) Is the hip abducted or adducted?

1) The presence of a posteriorly dislocated hip that is reducible
2) Abducted

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The combination of what two maneuvers has a high specificity for DDH in infants <3 months?

Barlow and Ortolani

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1) What happens w a Barlow test when the hip is dislocatable? What abt if its subluxatable?
2) What does a positive Barlow test indicate?

1) If hip is dislocatable, posterior movement and palpable clunk may be detected as femoral head exits acetabulum (“jerk of exit”)
2) If the hip is subluxatable, there is subtle sliding movement or feeling of looseness (“tennis ball moving in a soup bowl”)
-A reduced hip that is subluxatable or dislocatable

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1) What does Barlow test test for?
2) What is done?

1) Ability to sublux or dislocate an intact but unstable hip
2) Hip is gently adducted with pronation of examiner’s hand (downward pressure no longer recommended)

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Describe the positive Ortolani Sign for DDH

1) “Clunk” felt as the femoral head, which lies posterior to the acetabulum, enters the acetabulum (reduced to normal position).
2) Palpable movement of the femoral head back into place

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1) How is an ortolani test done?
2) What should you avoid?

1) From an adducted position and hip flexed to 90°, the hip is gently abducted with supination of the examiner’s hand while lifting the greater trochanter anteriorly
2) Avoid extreme abduction

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1) Define hip dysplasia. Does it need to be Dxd early?
2) What is the Ortolani Test for?

1) Instability or dislocation of the hip in a newborn or infant.
Needs to be detected early to intervene
2) Test for the presence of a posteriorly dislocated hip that is reducible

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Give 4 examples of benign heart murmurs pre-school aged children

1) Still’s murmurs
2) Pulmonary flow murmur
3) Systemic flow murmurs / Supraclavicular systemic bruits
4) Venous hum

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Absence of red reflex in young children should lead to a high level of suspicion for __________________

retinoblastoma

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1) At what age should a baby respond to sounds?
2) At what age should a baby coo and gain head control?

1) Newborn
2) 2 months

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1) At what age should a baby roll over?
2) At what age should they babble?
3) At what age should they sit?

1) 3 months
2) 6 months
3) 5 months

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1) At what age begins “mama and dada specific”?
2) What age should a baby pull to stand, crawl, and actively manipulate reachable objects?
3) At what age may an infant recognize strangers?

1) 8 months
2) 9 months
3) 9 months

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At what age should an infant be able to walk and use a spoon?

11 months

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Physical/ motor development:
1) At what age should a child be able to pedal a tricycle, jump in place, and feed themselves with utensils?
2) At what age should a child be able to cut with scissors, hop, and balance on 1 foot?

1) 3 years
2) 4 years

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Cognitive/ language: 1) At what age should a child be able to say 1-3 single words? 2) What abt 2-3 word phrases? 3) What abt having 100% understandable speech and talking in paragraphs?

1) 1 years 2) 2 years 3) 4 years

**Cognitive/ language development:** 1) What age should a child be able to know sentences, colors, and ask "why?"? 2) What age should a child be able to say ABCs, copy figures, and define words? **Social emotional development:** 1) What age should a child know themself in a mirror? 2) What age should a child display imagination?

1) 3 years 2) 5 years Social emotional: 1) 3 years 2) 4 years

1) When does the height spurt peak in males? What is the age range? 2) What about the age range of growth spurts of the penis? 3) What abt testicular growth spurts? 4) What abt pubic hair development?

1) 14; 10.5-16 and 13.5-17.5 2) 10.5-14.4 or 12.5-16.5 3) 9-13.5 or 13.5-17 4) 10.7-14.5 for PH3

1) When does the height spurt peak in females? What is the age range? 2) What is the age range of menarche? 3) What abt of breast development? 4) What abt of pubic hair?

1) 11.5; 9.5-14.5 2) 11-14.1 3) 8.2-21.1 for B2 4) 9.3-13.9 for PH3

1) Define hepatomegaly 2) How far does a normal liver edge extend? 3) Liver disease can lead to what?

1) liver extends >3 cm below the right costal margin 2) Normal liver edge extends 1-3 cm. 3) Decreased protein production and other complications

List 4 potential causes of hepatomegaly

1) Heart failure 2) Hepatitis 3) Epstein Barr Virus (EBV) infection 4) Biliary congestion

1) Define splenomegaly 2) Describe a normal spleen

1) Spleen extends >2 cm below the left costal margin 2) Moveable; rarely extends >1-2 cm.

List 5 potential causes of splenomegaly

1) **Mononucleosis (e.g., EBV)** 2) Hemolytic anemia 3) Leukemia 4) Autoimmune or inflammatory diseases 5) Portal hypertension

1) Define pyloric stenosis 2) What causes it? 3) When does it usually present?

1) Narrowing due to thickening at the opening (pylorus muscle) from the stomach into the small intestine 2) Cause unknown 3) ~3-5 weeks of age.

What are two PE findings that require follow up for suspected pyloric stenosis?

1) Firm 2 cm “olive-like” mass of the RUQ or midline of the abdomen 2) Parent may report visible peristaltic waves across the abdomen and projectile vomiting (usually nonbilious) immediately after feeding, while infant remains hungry.

What are two PE findings that require follow up for suspected pyloric stenosis?

1) A Firm 2 cm “olive-like” mass of the RUQ or midline of the abdomen is suspicious for what? 2) What condition is described?: "Parent may report visible peristaltic waves across the abdomen and projectile vomiting (usually nonbilious) immediately after feeding, while infant remains hungry"

1) Pyloric stenosis 2) Pyloric stenosis

1) What is the most common heart murmur? 2) Where is it? What is it related to and can it move? 3) What are the common ages?

1) Still's murmur 2) Left lower sternal border; related to flow, can change with position/Valsalva 3) 3 years to adolescence

1) What murmur is prominent in high-flow situations? (anemia, fever) 2) Where is this murmur? 3) What demographic is it seen in?

1) Pulmonary flow murmur 2) Upper left sternal border 3) Older children, adolescence and older.

1) Are systemic flow murmurs / Supraclavicular systemic bruits true "carotid bruits"? 2) What causes them?

1) Heard over carotids, but no, they're not. 2) Normal blood flow into aorta and head/neck vessels

1) What causes venous hum? 2) What is it sensitive to?

1) Blood returning from great veins to heart 2) Posture and head/neck position

1) What should you inspect about the head in an infancy PE? 2) Should you observe or palpate the two fontanelles? What are these and when does each close?

1) Inspect for symmetry 2) Palpate: Anterior fontanelle: closes between 4 - 26 months of age Posterior fontanelle: closes by 2 months of age

True or false: you should test for red light reflex in infants

True

Infancy male genital PE: what should you inspect and palpate for?

Inspect and palpate for descent of testes into scrotal sac

Infancy female genital PE; what should you do? (very general q)

Inspect genitals

1) At what age should a baby respond to sounds? 2) At what age should a baby coo and gain head control?

1) Newborn 2) 2 months

1) At what age should a baby roll over? 2) At what age should they babble? 3) At what age should they sit?

1) 3 months 2) 6 months 3) 5 months

1) At what age begins "mama and dada specific"? 2) What age should a baby pull to stand, crawl, and actively manipulate reachable objects? 3) At what age may an infant recognize strangers?

1) 8 months 2) 9 months 3) 9 months

At what age should an infant be able to walk and use a spoon?

11 months

Physical/ motor development: 1) At what age should a child be able to pedal a tricycle, jump in place, and feed themselves with utensils? 2) At what age should a child be able to cut with scissors, hop, and balance on 1 foot?

1) 3 years 2) 4 years

Cognitive/ language: 1) At what age should a child be able to say 1-3 single words? 2) What abt 2-3 word phrases? 3) What abt having 100% understandable speech and talking in paragraphs?

1) 1 years 2) 2 years 3) 4 years

List 3 potential pediatric PE findings of the throat

1) Streptococcal pharyngitis 2) Peritonsillar abscess 3) Retropharyngeal abscess

1) Define Streptococcal pharyngitis 2) What does it cause do to the tongue? 3) How doe it affect the tonsils/ post pharynx? 4) How doe it affect the uvula and palate?

1) Bacterial infection of the pharynx (aka “strep”) 2) “Strawberry” tongue 3) White or yellow exudates on the tonsils or posterior pharynx. 4) Beefy red uvula; palatal petechiae

What are 3 symptoms of peritonsillar abscess?

1) Erythema of one tonsil 2) Asymmetric enlargement of one tonsil 3) Lateral displacement of uvula

1) What are the symptoms of retropharyngeal abscesses? 2) What swelling may occur?

1) Fever, stiff neck, pain with neck extension, dysphagia, etc. 2) Midline or unilateral of posterior pharyngeal wall (visualization may not be possible and should not be attempted if significant airway compromise)

Koplik spots are pathognomonic for what? Describe these spots

Measles; bluish white dots about 1 mm in diameter surrounded by a rose-red areola

1) What severity does asthma present with? 2) What does it do to the inspiratory: expiratory ratio? Define this ratio as well

1) Varying severity 2) Prolonged expiratory phase; proportion of time spent on inspiration versus expiration

What are 3 childhood resp diseases?

1) Asthma 2) Pneumonia 3) Respiratory foreign body

What are 3 symptoms of pneumonia?

1) Fever 2) Tachypnea 3) Dyspnea

List 2 symptoms of respiratory foreign body

1) Inspiratory stridor 2) Prolonged inspiratory phase

1) Do benign heart murmurs come w associated findings? (breathing difficulties, color changes, growth/activity restriction, feeding difficulty, CP/SOB/palpitations, etc.) 2) True or false: Most, if not all children, will have one or more functional or benign murmurs before reaching adulthood.

1) As a rule of thumb, usually no 2) True

Should you identify murmurs by their quality or intensity? Give examples

By their quality, not intensity -Ex: Systolic vs. diastolic, crescendo vs. decrescendo, high or low pitch, etc.

What 8 vital signs should you get during development? At what ages should you measure each?

1) Height: every visit 2) Weight: every visit 3) BMI (body mass index): at every visit 4) Head circumference: birth to 36 months 5) BP: start measuring at age 2 6) Pulse: higher in infancy; slows down with aging 7) RR: higher in infancy; slows down with aging 8) Temp: <2 months of age: rectal temp ≥2 months of age: tympanic temp

What vital signs should be measured at every visit throughout development?

Height, weight, BMI, BP (at age 2+)

What vital signs are higher in infancy and slow down with aging?

Pulse and RR

What does an APGAR score consist of?

Appearance (skin color) Pulse Grimace (reflex irritability) Activity (muscle tone) Respiration

1) Define acrocyanosis (a 1 on the color pt of APGAR) 2) Describe the scale APGAR is measured on

1) Pink trunk, blue extremities 2) 7 to 10 is reassuring -4 to 6 is moderately abnormal -0 to 3 is low

1) Is HR >100 a good thing on APGAR? 2) Is "grimace" or "cry or active withdrawal" a more positive expression of reflex irritability on APGAR?

1) Yes 3) Cry or active withdrawal is more positive

1) What should you inspect about the head in an infancy PE? 2) Should you observe or palpate the two fontanelles? What are these and when does each close?

1) Inspect for symmetry 2) Palpate: Anterior fontanelle: closes between 4 - 26 months of age Posterior fontanelle: closes by 2 months of age

Infancy PE: 1) What should you inspect abt eyes? 2) What abt ears? 3) What reflex should you test w the ears? 4) What should you inspect abt the neck

1) Sclerae, pupils, irises, extraocular movements, and presence of **red reflex** 2) Position, shape, landmarks, patency of ear canal 3) Acoustic blink reflex 4) For masses

1) Do infants breathe through the nose or mouth? 2) What sinuses are present at birth? 3) What should you inspect abt the nose in an infancy PE?

1) Obligate nasal breathers for first the 2 months of life 2) Only ethmoid sinuses 3) Position of nasal septum

Infancy oral PE: 1) What should you inspect abt the mouth? 2) What should you palpate? 3) How do you know how many teeth a child should have? 4) Which teeth erupt first?

1) Mucosa, tongue, gums, palate, tonsils, and posterior pharynx 2) Gums and teeth 3) 6-26 months of age, 1 tooth per month 4) Central + lat. incisors first, molars last

Infancy neck PE: 1) What should you inspect for on the neck? 2) What should you palpate for? 3) What should you assess for?

1) Masses 2) Presence of adenopathy: unusual in infancy 3) Mobility of neck

Absence of red reflex in young children should lead to a high level of suspicion for __________________

retinoblastoma

1) Why should you inspect an infant's breasts? 2) What should you palpate for?

1) Enlarged in newborns secondary to maternal estrogen 2) Masses

Infancy male genital PE: what should you inspect and palpate for?

Inspect and palpate for descent of testes into scrotal sac

Infancy female genital PE; what should you do?

Inspect genitals

Infant abd. PE: 1) What should you inspect abt the abdomen/ what should be gone by 2 weeks old? 2) What should you auscultate?

1) Umbilical cord remnant is gone by 2 weeks of age 2) Bowel sounds

Infancy abd PE: 1) What should you palpate? 2) Are infant rectal exams generally done

1) Liver edge 1-2 cm below costal margin is normal; palpable spleen tip is normal 2) Generally not done

1) Testes undescended in scrotal sac by age _____ is abnormal and need to refer 2) From 18 months to 4 years of age what is seen in the knees? 3) Inspect spine for scoliosis in what children?

1) 1 year old 2) Knock-knees 3) Any child who can stand

1) What are Tanner stages? 2) While the age of puberty is highly variable, generally starts around age _________. 3) What age does puberty typically start in females? And in males?

1) Sexual maturity rating, to determine stage of puberty based on primary and secondary sex characteristics 2) 10-11 3) Females ~age 11; males ~age 12

1) What determine stage of puberty in both males and females? 2) What are stage 1 and stage 5 in both males and females?

1) Tanner stages 2) Stage 1: “Pre-puberty”; Stage 5: Full development

What is the first sign of puberty in females?

Breast budding

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Starred slides children Flashcards

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