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Summer Disciplines 2 > Well child exam > Flashcards

Well child exam Flashcards

1
Q

What are key components of a well child exam

A
  • Development achievement (physical, motor, cognitive, emotional, social)
  • Health supervision visits (medical and oral health)
  • Integrate PE findings with special needs
  • Immunizations!!!
  • Anticipatory guidance (health habits, nutrition, safety, injury prevention, sexual development, family relationships, emotional/mental health
  • Partner w/ child and family member
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2
Q

When does AAP recommend well child visits

A 
birth 
1 mo
2 mo
4 mo
6 mo
9 mo
12 mo
15 mo
18 mo
2 yr
Yearly in adolescence
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3
Q

How are vitals different in peds

A 
HR higher (110-160 nl in 0-3 mo) 
BP lower (65-85 / 45-55 nl in 0-3 mo) 
RR higher (30-60 nl in 0-3 mo)
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4
Q

How long do you assess head circumference

A

2 years to assess for brain growth

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5
Q

Growth curves can vary based on

A

Gestational age (premature, Down syndrome)

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6
Q

What are growth chart results

A

Underweight: <5 percentile
Overweight: 85-95 percentile
Obese >95 percentile

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7
Q

How do you classify a newborn

A 
Preterm: <37 weeks gestation 
Term: 37-42 weeks 
Post-term: >42 weeks 
First year of life: Infancy 
Neonatal: 0-28 d
Post-natal: after first month of life
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8
Q

How do you classify birth weight

A

Extremely low: <1000 g (2.2 lb)
Very low: <1500 gm (3.3 lbs)
Low: <2500, (5.5 lbs)
Normal: >2500 (5.5 lb)

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9
Q

How are newborns classified on growth curve (at birth)

A

Small: <10 percentile
Appropriate: 10-90 percentile
Large: >90 percentile

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10
Q

What is the APGAR score

A

Key assessment of newborn at birth (1 & 5 minutes after birth)
Scores 0-100 bsed on HR, Resp effort, muscle tone, response to catheter in nostril, and color
Continue q5 min. until score >7

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11
Q

What is the newborn screen

A

blood sample (heel stick) collected prior to dc and 7-14 days of life

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12
Q

PEARLS for a newborn peds exam

A

Support head
Take PE when convenient
Listen to heart and lungs when baby is sleeping
Look at red reflex when eyes are open

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13
Q

General PE should include inspection of

A

Cry
Respiratory effort
Posture (leg & arm flexion when supine=nl)
Color (mild cyanosis @ birth, peripheral for 1-2 days, jaundice can be nl based on race)

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14
Q

What is Vernix Caseosa

A

cheesy white covering of lipid matrix (fetal corneocytes and sebaceous glands) that should decrease as term approaches

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15
Q

What is milia

A

pinpoint papules of blocked sebaceous glands, W/O erythema

Common to nose, chin, forehead, and cheeks

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16
Q

What is a mongolian spot

A

a congenital dermal melanocyte (birth mark) with blue tint that should fade with time, but do not grow or migrate
Common over lumbar, buttocks, or extremities
Common in asian, native american, hispanic, east indian, and african

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17
Q

What is erythema toxicum

A

yellow eosinophilic papule W/ red base, likely 2/2 immature pilosebaceous follicles
Usually disappear w/in 1 week of life
Common on trunk and face
-NOT caused by scented lotions, soaps, etc.

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18
Q

What are the sutures of the head

A

sagittal, coronal, lambdoid, and frontal
Birthing can mold or cause sutures to override
If widely split, suspect elevated ICP (meningitis, hydroceohalus)
If raised and bony edge, suspect craniosynostosis

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19
Q

What are the fontanelles

A

Areas where major sutures intersect; should be soft and flat
Bulgind indicated high ICP (bleed? meningitis?)
Sunken indicates dehydration

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20
Q

Large fontanelles can be the first sign of

A

HYPOthyroidism!!

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21
Q

When do the fontanelles close

A

Anterior: 9-18 mo
Posterior: 1-2 mo

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22
Q

What is Cephalohematoma

A

swelling 2/2 blood collection over one or both parietal bones (more deep)
does NOT cross suture lines
resolves on it’s own in wks to months

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23
Q

What is Caput Succedaneum

A

edema of the scalp (more SF)
CAN cross suture lines
resolves in days

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24
Q

A pathologic face finding on newborn exam can be

A

Facial palsies from nerve birth injury

check face symmetry

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25
Q

Eye findings we should always look out for are

A 
Hypertelorism 
Subconjunctival hematoma (common from birth) 
Red reflexes (should be present and b/l)
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26
Q

What nose abnormality do we have to look for in newborns

A

Obstructions!

Infants <1 mo are nose breathers

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27
Q

What should you always screen for in newborns

A

Hearing loss!

preauricular pits and tags are common

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28
Q

How do you inspect a newborn ear

A

pull auricle DOWNward gently (at 2-3 y/o, start pulling up)

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29
Q

What are Epstein’s pearls

A

small, white, benign inclusion cysts common in 2-4 y/o
common over palate
resolve spontaneously, no Tx needed

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30
Q

What are Bohn nodules

A

similar to Epstein’s pearls, but seen on the GINGIVAL ridge

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31
Q

What is Ankyloglossia

A

congenital short lingual frenulum limiting movement of tongue (midline tongue tip puckers
Can make nursing painful
Can cause speech difficulty

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32
Q

How do you Tx Ankyloglossia

A

Frenulectomy in neonatal period (1-28 days)

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33
Q

How do you perform a neck exam

A

Infants: palpate while supine

Older kids: upright

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34
Q

What is congenital torticollis

A

Firm mass 2/2 bleeding into the SCM during birth, appearing 2-3 weeks after birth
Disappears over months

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35
Q

What is plagiocephaly

A

Flat spot on baby’s head

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36
Q

What chest abnormalities have we discussed

A

Clavicle fracture: 2/2 birth, esp w/ difficult arm extraction
Pectus Excavatum: sternal depression
Pectus Carinatum: pigeon chest (associated w/ scoliosis)

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37
Q

How do you perform a lung exam on baby

A
  • Observe; RR, color, nasal component, audible breath sounds and work of breathing
  • Stethoscope; 30-40 normal. diminished BS on one side indicate unilateral lesion
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38
Q

Diminished femoral pulses indicate

A

Coarcation of the aorta

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39
Q

Infants with cardiac disease often present with these symptoms

A 
poor feeding 
FTT 
irritability 
tachypnea 
hepatomegaly 
clubbing 
poor overall appearance 
weakness
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40
Q

Why is NS dysrhythmia normal in infants and kids

A

bc HR increases on inspiration and decreases on expiration

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41
Q

What is the MC dysrhythmia in infants

A

Paroxysmal SVT

can occur at any age, even in utero

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42
Q

What is an umbilical granuloma

A

pink granulation tissue formed during healing of umbilical cord, at base of navel
Leave the cord alone! don’t submerge in water; should not be oozy

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43
Q

2-5% of full term and 30% of pre-term infant males are born with

A

cryptorchidism

44
Q

What are the abnormal male urethral openings that can be found

A

Hypospadias: abnormal VENTRAL placement of urethra; check before circumcision! (hypO=belOw)
What is epispadias: abnormal DORSAL urethra, uncommon. (Epi=Eye)

45
Q

What are the common scrotal masses in newborns

A

hydrocele (overlie testis and spermatic cord) and inguinal hernia (separate from testes)
can coexist
more common on RIGHT side

46
Q

Hydroceles can be _ on PE

A

Transilluminated

resolve by 18 mo, but refer to urology to r/o hernia

47
Q

Hernias are usually

A

reducible; do NOT transilluminate and don’t resolve

48
Q

What are findings that can be found on female GU

A

Milky white discharge (can be blood tinged) 2/2 estrogen from moms pregnancy
Labial adhesions
imperforate hymen

49
Q

What are the two abnormal anal findings

A

Imperforate anus: if baby doesn’t pass meiconium w/in 48 hours, get US- could be sinus tract or spina bifida
Sacral dimple: If you can see the bottom, normal. if not, get an US

50
Q

A single palmar crease indicates

A

trisomy 21

but can also be a normal variant

51
Q

RF for developmental dysplasia of hips include

A 
breech
caucasian
first born female 
family Hx 
prior child born with DDH 
premature
52
Q

When evaluating for DDH, a “click” with these maneuvers requires further work up

A

Barlow: tests ability to sublux or dislocate an intact but unstable hip
Ortolani: tests for posteriorly dislocated hip

53
Q

Another DDH test is

A

evaluate leg creases: they should be symmetric. if not, suspect DDH

54
Q

Tx for DDh is

A

ortho eval and pavlik harness to prevent progression to degenerative hip disease

55
Q

What are the primative reflexes

A
  • Palmar grasp: when you put your finger into baby’s hand, they will grasp you. until 3-4 months
  • Plantar grasp: when you touch sole of foot, toes will curl. until 6-8 months
  • Moro Reflex: if persistent past 4 mo, indicates cerebral palsy. If asymmetric, indicates clavicle Fx
  • Asymmetric tonic neck: if persistent past 2 mo, indicates asymmetric CNS development
  • Positive support reflex: If not present indicates hypotonia or flaccidity
  • Rooting reflex: stroke perioral skin at mouth corners; mouth opens, baby turns head. until 3-4 mo
  • Trunk incurvation: absence suggests transverse spinal cord lesion. until 2 mo.
  • Placing and stepping reflexes: hold baby up from behind, let one sole touch table top. that hip and knee will flex, other foot will step forward
56
Q

How do you perform the moro reflex

A

Hold baby supine (support head, back, and legs)
Abruptly lower baby 2 feet
Arms should ABduct and extend, hands open, and legs flex
baby may cry

57
Q

How do you test asymmetric tonic neck reflex

A

with baby supine, turn head to one side and hold jaw over shoulder
Arm and leg on the side of the way baby faces= extend
Arm and leg on oppo side= flex

58
Q

How do you perform the positive support reflex

A

Hold baby around trunk, lower until feet touch flat surface
Hips, knees, and ankles extend and baby partially bears weight for 20-30 seconds
Until 2-6 months old

59
Q

How do you perform trunk incurvation

A

Support baby prone w/ 1 hand
stroke one side of back, 1cm from midline, shoulder to buttocks
spine will curve toward the stimulated side

60
Q

Absence of red reflex indicates

A

Retinoblastoma

61
Q

What are age appropriate visual acuities

A

3-5 y/o: 20/40

6+: 20/30

62
Q

AAP recommends this vision screening

A

Annual photo screen between 1-3 y/o

Also do cover uncover, and Gocheck vision

63
Q

This is the MC cause of childhood blindness

A

Amblyopia!

2/2 uncorrected strabismus

64
Q

AAp recommends this hearing screen

A

universal hearing screen before leaving hospital

**If there is a speech delay in a child, get a hearing screening!!

65
Q

BP checks should start at

A

3 y/o; Sooner if RF, kidney disease, premature, congenital heart disease, recurrent UTI, hematuria, proteinuria, neurofibromatosis, or tuberous sclerosis

66
Q

Older teens need a BP screen esp if on

A

birth control

adderall

67
Q

Screen Hgb at

A

9-12 mo, checking for iron deficiency

If low, get iron fortified cereal, eat meat and leafy greens

68
Q

CDC recommends to screen for this at 1-2 y/o

A

Lead!

targeted screenings in communities w/ homes built before 1950

69
Q

Screen for autism at

A

18 mo and 24 mo.

70
Q

IF RF or FHx are present, screen for

A

Fasting lipids: 2-10 y/o
RF include obese, overweight, HTN, DM, FHx of hyperlipidemia or early CV disease
If no RF, don’t need to screen

71
Q

Dental visits should occur

A

First: 12 mo- 2-3 years old, continue every 6 months
Wash gums w/ wash cloth prior to first dental visit
brush teeth 2xday (CAN use fluoride, ok if they swallow a bit)
Floss 1x day

72
Q

Car safety includes

A

Rear facing car seat until 2 y/o
booster seat until 4’9”
NO front seat until 13 y/o

73
Q

What is the number for poison control

A

1-800-222-1222

74
Q

1 month milestone is

A

Fixes and follows face
some head control
responds to sounds and noises
spontaneous smile

75
Q

2 month milestone is

A

responsive smile
coos/vocalizes
lifts head when prone
follows to midline

76
Q

Is there a 3 month visit

A

NAHHHHHH

77
Q

4 month milestone is

A 
Rolls from tummy to back 
good head control 
laughs, squeals 
follows past midline 
grasps objects
78
Q

6 month milestone is

A 
sits with support 
bears weight on legs 
vocalizes "ba, da-da" 
reaches for toys 
follows 180 degrees 
stranger danger, separation anxiety
79
Q

What meds can babies take

A

<6 mo. Tylenol only
6+ months, tylenol and ibuprofen
NO honey until 1 y/o (botulinum toxin)

80
Q

9 month milestone is

A 
crawls 
pulls up to stand 
cruises on furniture 
says mama dada 
immature pincer grasp 
responds to name
81
Q

12 month milestone is

A 
walks (can take up to 18 months) 
waves bye-bye 
says mama/dad
points with index finger 
self feeds w/ fingers
82
Q

15 month milestone is

A

3-6 words
walks well
climbs stairs
imitates actions

83
Q

18 month mile stone is

A 
5-15 words 
some 2 word phrases 
uses spoon/fork 
scribbles 
follows simple commands 
runs, walks backwards
84
Q

24 month milestones are

A 
20-50 words 
2 word phrases 
kicks ball 
build 3-4 block tower 
50% understandable speech
85
Q

What we need to know about the hepatitis B vaccine

A

3 doses; birth, 1-2 mo, 6-18 mo
Contraindication: severe allergy to yeast
ADE: fever, pain at injection site

86
Q

What we need to know about hepatitis B

A

Spread by contact with blood or body fluids (aka birth)
Sx: asymptomatic, jaundice, HA, weakness, vomiting, joint pain
Complications: chronic liver infection, liver failure, liver cancer

87
Q

What we need to know about Rotavirus vaccine

A

Live, oral vaccine; give at 2, 4, and 6 mo (MUST start by 4 mo. to be able to receive)
Contraindications: Hx of intussusception, has severe combined immunodeficiency, acute gastroenteritis
ADE: increased risk of intussusception, vomiting, diarrhea, cough, runny nose

88
Q

What we need to know about Rotavirus

A

Leading cause of hospitalization and death from acute gastroenteritis
Spread by saliva and oral contact
Sx: diarrhea, fever, vomiting
Complications: severe diarrhea/dehydration

89
Q

What we need to know about DTaP vaccine

A

5 doses; give at 2, 4, 6, 15/18 mo, 4 years
Contraindications: Encaphalopathy w/in 7 days of a previous DTaP dose, progressive neuro d/o, previous high fever, inconsolable crying, or shocked state w/in 48 hours of a DTaP dose
ADE: swelling and redness at site, fever

90
Q

What we need to know about Diphtheria

A

Spread by air or direct contact
Sx: sore throat, fever, weakness, swollen neck glands
Complications: pericarditis, HF, coma, paralysis, death

91
Q

What we need to know about Tetanus

A

Spread by exposure through cut skin
Sx: stiffness in neck and abd muscles, difficulty swallowing, muscle spasms, fever
Complications: broken bones, breathing difficulty, death

92
Q

What we need to know about pertussis

A

Spread by air or direct contact
Sx: severe cough, runny nose, apnea
Complications: PNA, death

93
Q

What we need to know about the HIB vaccine

A

4 doses; give at 2, 4, 6, and 12 or 15 mo
Contraindications: <6 weeks old, allergic reaction to previous HIB dose
ADE: uncommon, pain and redness at site

94
Q

What we need to know about HIB

A

Spread by air or direct contact
Used to be the leading cause of invasive bacterial disease in kids <5 y/o
Sx: ASx unless bacteria enter blood (sepsis)
Complications: meningitis, intellectual disability, epiglottitis, PNA, death

95
Q

What we need to know about the PVC-13 vaccine

A

4 doses; give at 2, 4, 6, and 12 or 15 months
CI: severe previous allergy, defer if sick, rehardless of fever
ADE: fever, local irritation, increased or decreased sleep, risk of febrile seizure if given WITH flu vaccine

96
Q

What we need to know about Pneumococcus

A

Spread by air or direct contact
Common cause of AOM and sinusitis
Sx: ASx, PNA
Complications: bacteremia, PNA, meningitis, death

97
Q

What we need to know about IPV (polio) vaccine

A

4 doses; give at 2, 4, 6-18, and 4 years old
NOT a live vaccine anymore
Contraindications: allergic rxn to previous dose, pregnancy, defer when sick
ADE: minor local redness or pain at injection, no serious ADE!

98
Q

What we need to know about polio

A

Spread by air, direct contact, or through mouth
Sx: ASx, sore throat, fever, nausea, HA
Complications: paralysis, death

99
Q

What we need to know about the MMR vaccine

A

2 doses; give at 12-15 mo, and 4 years old
CI: pregnant women (or want to be pregnant in 28 days), immunocompromised, egg or neomycin anaphylactic allergy
ADE: fever 6-12 days s/p vaccine, transient morbilliform rash

100
Q

What we need to know about Measles

A

Spread by air or direct contact
Sx: rash, fever, cough, runny nose, pink eye
Complications: encephalitis, PNA, death

101
Q

What we need to know about mumps

A

spread by air or direct contact
Sx: swollen salivary glands, fever, HA, fatigue, muscle pain
Complications: meningitis, encaphalitis, testicle/ovary inflammation, deafness

102
Q

What we need to know about Rubella

A

Spread by air or direct contact

Complications: miscarriage, stillbirth, premature delivery, and birth defects in pregnant women

103
Q

What we need to know about the varicella vaccine

A

2 doses; give at 12-15 months, and 4 years
Live vaccine
CI: allergic rxn to previous dose, pregnant women
ADE: minor injection site rxn, sparce varicellaform rash

104
Q

What we need to know about varicella

A

Spread by air or direct contact
Sx: rash, fever, HA, fatigue
Complications: infected blisters, bleeding disorders, encephalitis, PNA

105
Q

What we need to know about Hepatitis A vaccine

A

2 doses; give at 12 and 18 mo (second dose has to be at least 6 mo. from first dose)
CI: previous allergic rxn, caution in pregnancy or illness
ADE: Pain, swelling, induration at injection, HA, no appetite

106
Q

What we need to knoe about hepatitis A

A

Spread by direct contact w/ contaminated food or water
Sx: fever, stomach pain, loss of appetite, fatigue, vomiting, jaundice, dark urine
Complications: liver failure, arthralgia, kidney pancreatic or blood disorders

Summer Disciplines 2 (8 decks)

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