Unit 2 Flashcards
Scoliosis:
definition
a lateral curve of the spine greater than 10 degrees of deviation from straight
5-6 y/o Physical Exam
Measure Blood pressure – compare with norms
Measure & Plot: Height, weight, and BMI
Assess/Observe: ocular motility, caries, gingival
inflammation, malocclusion; fine/gross motor
skills, gait
7-8 y/o Physical Exam
Measure Blood pressure – compare with norms
Measure & Plot: Height, weight, and BMI
Assess/Observe: caries, gingivitis, malocclusion;
SMR; hip, knee, ankle function and gait
9-10 y/o Physical Exam
Measure Blood pressure – compare with norms
Measure & Plot: Height, weight, and BMI
Assess/Observe: signs of self-injury, SMR
Examine: back
11-14 y/o Physical Exam
Measure Blood pressure – compare with norms
Measure & Plot: Height, weight, and BMI
Assess/Observe: acne, acanthosis nigricans,
atypical nevi, piercings, signs of abuse or selfinjury
Examine: back, spine
Females: assess breast by inspection / palpation;
assess/observe for SMR
Males: assess/observe for gynecomastia; SMR;
testicular hydrocele, hernias, varicocele, masses
15-17 y/o Physical Exam
Measure Blood pressure – compare with norms
Measure & Plot: Height, weight, and BMI
Assess/Observe: acne, acanthosis nigricans,
atypical nevi, piercings, signs of abuse or selfinjury
Examine: back, spine
Females: assess/observe for SMR
Males: assess/observe for gynecomastia; SMR;
testicular hydrocele, hernias, varicocele, masses
18-21 y/o Physical Exam
Measure Blood pressure – compare with norms
Measure & Plot: Height, weight, and BMI
Assess/Observe: acne, acanthosis nigricans,
atypical nevi, piercings, hirsutism, signs of abuse
or self-injury
Females: perform pelvic exam
Males: assess/observe for gynecomastia; SMR;
testicular hydrocele, hernias, varicocele, masses
5 y/o Screenings
Universal 5yr: Hearing (audiometry), oral health (absence of dental home), vision (HOTV or LEA symbols)
6 y/o Screenings
Universal 6yr: hearing (audiometry),
vision (HOTV or LEA symptoms,
Sloan / Snellen Letters)
7 y/o Screenings
None
8 y/o Screenings
Universal 8yr: hearing (audiometry),
vision (HOTV or LEA symptoms,
Sloan / Snellen Letters
9 y/o Screening
Universal 9yr: dyslipidemia (lipid profile; once, between 9- 11yr visits)
10 y/o Screening
Universal 10yr: dyslipidemia (lipidprofile; once, 9-11yr visits); hearing (audiometry), vision (HOTV or LEA symptoms, Sloan / Snellen Letters)
Universal Screenings 11-21 y/o
Universal 11-21yr: Dyslipidemia: lipid profile (once between 9-11yr visits & 17-21yr visits) Hearing (once between 11-14yr visits; 15-17yr, 18-21yr visits) Depression screen (begins at 12yr) Vision (12yr and 15 yr; HOTV or LEA symptoms, Sloan / Snellen Letters) HIV test (once between 15-18yr visits) Tobacco, alcohol, or drug use (begins at 15yr visit) Cervical dysplasia (pap smear; all young women @ 21yr visit)
3 leading causes of adolescent MORTALITY
- unintentional injury (MVC, poisoning/drug OD)
- suicide (guns)
- homicide (guns)
males>females
MVC decreasing, suicide increasing
major causes of MORBIDITY in adolescents
psychosocial and often r/t poverty:
- unintended pregnancy
- STI
- substance abuse
- smoking
- dropping our of school
- depression
- running away from home
- physical violence
- juvenile delinquency
high risk behavior in one are often associated with problems in another
Sexual Maturity Rating
tool used to categorize genital development
- the appearance of pubic hair precedes axillary hair by 1 year
SMR 1: pre-puberty
SMR 2: pubic hair is sparse, fine, non pigmented, and downy; male genitalia development begins
SMR 3: pubic hair is pigmented and curly, increases in amount
SMR 4: pubis hair is adult in texture but limited in area
SMR 5: adult maturity
first sign of puberty in girls
measurable: height spurt
conspicuous: breast buds (8-11 y/o)
height spurt correlates more closely with breast development stages than pubic hair
firs sign of puberty in boys
scrotal and testicular growth
boys: mid puberty signs
axillary hair
depended voice
chest hair
puberty growth spurts
girls peak 11.5-12 y/o
boys peak 13.5-14 y/o
happens in girls 2 years before boys
lasts about 2-4 years, longer in boys than girls
psychosocial development:
early adolescence
(10-13 y/o)
Rapid growth and secondary sex characteristics.
Feel more comfortable with
same sex.
Think concretely and don’t think about the future.
Vague and unrealistic professional goals.
psychosocial development:
middle adolescence
(14-16 y/o)
Become more comfortable with their bodies.
Mood swings are typical.
Formal operations and abstract thinking.
They think the world can change by just thinking about it.
Sexually active and don’t think they need to use
contraception.
Self-centered at times.
Different self-images.
They want to be independent and autonomous
psychosocial development:
lte adolescence
(>17 y/o)
Becomes less self-centered and cares for others.
Dating becomes more
intimate.
By 10th grade, 40% have had sex and by 12th grade, 62% have had
sex.
Abstract thinking and plan for the future.
Period of idealism.
Scoliosis: categories
- Idiopathic (no definite cause. most common)
- congenital
- neuromuscular
- syndromatic
Scoliosis: when seen
- during adolescent growth spurt
- usually develops 8-10 y/o
girls: 10-18 y/o usually 10-12 y/o
Cobb Angle
measurement for quantifying spine curvature in Scoliosis
- maximum distance degree of side-to-side curvature
- measured on standing PA of XR of spine
Scoliosis Screening
girls: 10 and 12
boys: 13 or 14
severe scoliosis impairments
lung and heart function, usually if curve >35%
Scoliosis: classification
thoracic or lumbar
Kyphosis
exaggerated front-to-back forward rounding curve of upper thoracic spine
- more common in older women
- congenital or trauma, degenerative/developmental abnormalities
- most common cause r/t failure of segmentation or formation
Osgood-Schlatter
- caused by the recurrent traction on the tibial tubercle apophysis (growth plate) that occurs in jumping and running sports. Fragmentation and microfractures of the tibial tubercle occur during its time of rapid growth.
- The condition occurs in the pre-teen and adolescent years and is most common in boys aged 12–15 years and girls aged 11–13 years.
- Pain is localized to the tibial tubercle and is aggravated by activities using eccentric quadriceps muscle movement. The pain can become so severe that routine activity must be curtailed. Radiographs typically demonstrate fragmentation or irregular ossification of the tibial tubercle.
Enuresis
must be >5 y/o
repeated urination in daytime clothing to bed at night
- more common in boys
Encopresis
must be >4 y/o
repeated passage of stool into inappropriate places usually r/t constipation
1st line treatment for pediatric insomnia
sleep hygiene education and cognitive behavioral therapy
BEARS pneumonic
used to screen for sleep problems: Bedtime resistance Excessive daytime sleepiness Awakening during night Regularity and duration of sleep Sleep disordered breathing
ADD triad of symptoms
impulsivity
inattentive
combined
Inattention type ADHD can occur with ??
Obstructive sleep apnea
criteria for ADD diagnosis
(1) Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities.
(2) Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.
(3) Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (eg, at home, school, or work; with friends or relatives; in other activities).
(4) There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.
(5) The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (eg, mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).
Autism levels
general developmental levels are determined by severity:
Level I - required support
Level II - requires substantial support
Level III - requires very substantial support
What must apply to have a Intellectual Disorder diagnosis?
Adaptive function: ability to function in his/her environment, predict level of independence in daily living skills
Cognitive testing: tend to predict academic success
Both must be >2 standard deviations below mean AND IQ <70 (69 or less)
Overweight BMI
25-29.9%
Obese BMI
> 30
Weight Percentile Categories
Underweight: <5%
Healthy 5-85%
Overweight 85-95%
Obese > 95%
Depression Screening
> 12 y/o
PHQ2
Substance Abuse Screening
> 11 y/o
CRAFFT
BSTAD and S2BI
