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PHA 581 > Well Child Exam > Flashcards

Well Child Exam Flashcards

1
Q

AAP recommended well visit schedule

A 
birth
1mo
2mo
4mo
6mo
9mo
12mo
15mo
18mo
2yr
annually
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2
Q

What is the Apgar score?

When is it done?

A

assessment of newborn immediately after birth

scored 1 and 5 min after birth

continue at 5min intervals until score > 7

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3
Q

Newborn Screen:

  • what is it
  • when is it done
A

testing for metabolic and genetic diseases

blood sample collected from heel stick

  • before discharge
  • again at 7-14d
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4
Q

Newborn Exam: general

A

cry (strong, weak, abnormal)

respiratory effort (nasal flaring, accessory muscle use, RR)

posture/tone (abnormal: low, floppy)

color (cyanosis, peripheral cyanosis, jaundice)

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5
Q

Newborn Exam: skin: vernix caseosa

A

cheesy white covering
rich lipid matrix
dec as term approaches

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6
Q

Newborn Exam: skin: milia

  • what are they
  • etiology
  • common location
  • course
A

pinpoint white papules w/out erythema

caused by blocked sebaceous glands

nose, chin, forehead, cheeks

appear: 1st few weeks
disappear: several weeks

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7
Q

Newborn Exam: skin: mongolian spot

  • aka
  • what is it
  • common locations
  • course
  • common populations
A

congenital dermal melanocytosis

blue patches of pigment

lumbar area, buttocks, extremities

fade w/ time

asian, native american, hispanic, east indian, african

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8
Q

Newborn Exam: skin: erythema toxicum

  • what is it
  • common location
  • course
A

yellow eosinophilic papules on red base

trunk

appear: 2-4th day of life
disappear: w/in a week of birth

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9
Q

Newborn Exam: head:

widely split sutures can be a sign of…

A

elevated ICP (meningitis, hydrocephalus)

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10
Q

Newborn Exam: head:

a raised bony ridge at a suture line can be a sign of…

A

craniosynostosis

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11
Q

Newborn Exam: head: bulging fontanelles may indicate…

A

inc ICP (bleed, meningitis)

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12
Q

Newborn Exam: head: sunken fontanelles may indicate…

A

dehydration

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13
Q

Newborn Exam: head:

a large fontanelles may indicate…

A

hypothyroidism

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14
Q

Newborn Exam: head: when do the fontanelles close?

A

anterior: 9-18mo
posterior: 1-2mo

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15
Q

Newborn Exam: head: cephalohematoma:

  • what is it
  • course
A

swelling/collection of blood over one/both parietal bones

does NOT cross suture lines

resolves in wks-mos

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16
Q

Newborn Exam: head: caput succedaneum:

  • what is it
  • course
A

edema of the scalp

CAN cross suture lines

resolves in days

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17
Q

Newborn Exam: face

A

facial symmetry (facial palsies)

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18
Q

Hypetelorism: definition

A

abnormally wide eye spacing

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19
Q

Newborn Exam: nose

A

<1mo: nose breathers

ensure no obstruction

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20
Q

Newborn Exam: eyes

A 
eye spacing 
subconjunctival hemorrhages (common from birth trauma)
red reflex (present, symmetric)
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21
Q

Newborn Exam: ears

  • how to get the best view
  • common findings
A

under 2/3: pull auricle downward

common: preauricular pits, tags

always screen for hearing loss

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22
Q

Newborn Exam: mouth: Epstein’s Pearls, Bohn Nodules

A

epstein’s pearls: sm white benign inclusion cysts, palate

bohn nodules: yellow white cysts, gingival ridge

**seen bt 2-4mo, resolve spontaneously

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23
Q

Newborn Exam: mouth: ankyloglossia

  • what is it
  • complications
  • treatment
A

congenital short lingual frenulum

can lead to: 
limited tongue movement
pain w/ nursing
speech difficulty
dental problems

frenotomy/frenulotomy in neonatal period

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24
Q

Newborn Exam: neck: congenital torticollis

  • etiology
  • presentation
  • course
A

bleeding in the SCM muscle during stretching of birth

firm, fibrous mass within muscle w/in 2-3wks after birth

disappears: months

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25
Q

Newborn Exam: chest

-findings

A 
clavicle fracture 
pectus excavatum (sternal depression)
pectus carinatum (pigeon chest deformity)
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26
Q

Newborn Exam: lungs:

diminished breath sounds in one side of the chest suggest…

A

unilateral lesions (congenital diaphragmatic hernia)

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27
Q

Newborn Exam: cardiovascular:

diminished femoral pulses may indicate…

A

coarctation of the aorta

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28
Q

Newborn Exam: cardiovascular: common non cardiac findings in patients with cardiac disease

A

poor feeding, FTT, irritability
tachypnea, hepatomegaly, clubbing
poor overall appearance, weakness

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29
Q

Newborn Exam: cardiovascular: normal auscultation finding

A

normal sinus dysrhythmia (inc insp - dec exp)

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30
Q

Newborn Exam: cardiovascular: MC dysthymia in infants

A

paroxysmal supra ventricular tachycardia

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31
Q

Newborn Exam: abdomen: umbilical granuloma

-what is it

A

pink granulation tissue formed during the healing process

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32
Q

Newborn Exam: male GU:
hypospadias
-what is it

A

abnormal ventral placement

**check before circumcision

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33
Q

Newborn Exam: male GU: epispadias

-what is it

A

abnormal dorsal placement

34
Q

Newborn Exam: male GU:

  • what are 2 common scrotal masses in newborns?
  • which side are the MC on?
A

hydroceles and inguinal hernias

MC on R side

35
Q

Newborn Exam: male GU: hydrocele

A

not reducible
transilluminate
resolve by 18mo

36
Q

Newborn Exam: male GU: hernia

A

reducible
do NOT transilluminate
don’t resolve

37
Q

Newborn Exam: female GU: findings

A

milky white discharge
labial adhesions
imperforate hymen

38
Q

Newborn Exam: anus/spine: findings

A

imperforate anus (cannot assume until baby passes meconium)

sacral dimple (US if you cannot see base)

39
Q

Newborn Exam: extremities

A

syndactyly

palmar crease

40
Q

Newborn Exam: extremities: a single palmar crease (simian crease) is associated with…

A

trisomy 21

**may be normal variant

41
Q

Newborn Exam: hip:

risk factors for DDH

A

breech, caucasian, 1st born female
FH, prior child born w/ DDH
prematurity

42
Q

Newborn Exam: hip: DDH physical exam

A

Barlow (down): sublux/dislocate intact unstable hip

Ortolani (out): posteriorly dislocated hip

evaluate leg creases (asymmetry)

43
Q

Newborn Exam: hip: DDH treatment

A

ortho eval

pavlik harness

44
Q

Primitive Reflexes

A 
palmar grasp (birth-3/4mo)
plantar grasp (birth-6/8mo)
moro (startle) reflex (birth-4mo)
asymmetric tonic neck reflex (birth-2mo)
positive support reflex (birth-2/6mo)
rooting reflex (birth-3/4mo)
trunk incurvation (galant's reflex) (birth-2mo)
placing &amp; stepping reflexes (birth-variable age)
45
Q

Moro reflex beyond 4mo suggests…

A

neurologic disease (CP esp beyond 6mo)

46
Q

Asymmetric moro reflex indicates…

A

fracture of clavicle

brachial plexus injury

47
Q

Asymmetric tonic neck reflex beyond 2mo suggests…

A

asymmetric CNS development

48
Q

Lack of positive support reflex indicates…

A

hypotonia

flaccidity

49
Q

Absence of trunk incurvation reflex suggests…

A

transverse spinal cord lesion/injury

50
Q

Vision: age appropriate visual acuity

A

3-5: 20/40

6+: 20/30

51
Q

Vision: components of exam

A

red reflex
visual acuity
cover/uncover, gocheck vision (toddler, preschool)

52
Q

Vision: what is the most common cause of childhood blindness

A

amblyopia

53
Q

Hearing: AAP recommends universal hearing screen…

A

before leaving the hospital

54
Q

Blood Pressure:

  • at what age do you start checking?
  • risk factors for earlier checks
A

3yr

kidney disease, prematurity
congenital heart disease, rec UTI, hematuria, proteinuria
other conditions associated w/ HTN

55
Q

When do you begin screening for iron deficiency anemia?

A

9 or 12mo well exam

hemoglobin

56
Q

What is the CDC recommendation for lead screening?

A

universal screening for children ages 1-2

targeted screening for high risk communities (homes built before 1950)

57
Q

When do you screen for autism?

A

18mo and 24mo

58
Q

Which population is indicated for STI testing?

A

high risk adolescents

59
Q

Indications for fasting lipid screening

A

ages 2-10 w/ risk factors:

FH of HLD, HF of early CV disease, obesity, overweight, HTN, DM

60
Q

When should the first dental visit be scheduled?

A

bt 12mo -2/3yrs

then every 6mo

61
Q

Car Safety

A

rear facing seat until 2yrs
booster seat until 4’9”
no front seat until 13yo

62
Q

1 month milestones

A

fixes/follows on face
some head control
responds to sounds/noises
spontaneous smile

63
Q

2 month milestones

A

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

64
Q

4 month milestones

A 
rolls from tummy to back
good head control
laughs, squeals
follows past midline
grasps toys/objects
65
Q

6 month milestones

A 
sits w/ support
bears weight on legs
vocalizes "ba da da"
reaches out for toys
follows 180 deg
stranger danger, separation anxiety
66
Q

9 month milestones

A 
crawls
pulls up to stand, cruises furniture
says mama/dada
immature pincer grasp
responds to name
67
Q

12 month milestones

A 
walks (can be delayed up to 18mo)
waves bye bye
says mama/dad
points w/ index finger
self feeds w/ fingers
68
Q

15 month milestones

A

3-6 words
walk well
climb stairs
imitates actions

69
Q

18 month milestones

A 
5-15 words
some 2 word phrases
uses spoon/fork
scribbles
follows simple commands
runs, walks backward
70
Q

24 month milestones

A 
20-50+ words 
2 word phrases
kicks ball
builds 3-4 block tower
50% understandable speech
71
Q

Hep B Vaccine:

  • schedule
  • contraindication
A

birth, 1-2mo, 6-18mo

sev yeast allergy

72
Q

Rotavirus:

  • vaccine type
  • schedule
  • contraindications
A

live oral vacccine

2, 4, 6mo

hx of intussusception
SCID
acute mod-sev gastro

73
Q

DTaP (Diphtheria-tetanus-acellular pertussis):

  • schedule
  • contraindications
A

2mo, 4mo, 6mo, 15/18mo, 4yr

encephalopathy related to prev dose
progressive neurological disorders
high fever, inconsolable crying, shock like state w/in 48hr of prev dose

74
Q

HIB (Haemophilus influenzae type B) :

  • schedule
  • contraindications
A

2mo, 4mo, 6mo, 12/15mo

<6wks of age
prev allergic rxn

75
Q

PCV 13 (Pneumococcal):

  • schedule
  • contraindications
A

2mo, 4mo, 6mo, 12/15mo

sev prev allergic rxn
mod-sev acute illness

76
Q

IPV (Poliomyelitis):

  • schedule
  • vaccine type
  • contraindications
A

2mo, 4mo, 6-18mo, 4yr

no longer a live vaccine

prev allergic rxn
mod-sev acute illness
pregnancy

77
Q

MMR (Measles, Mumps, & Rubella):

  • schedule
  • vaccine type
  • contraindications
  • ADEs
A

12-15mo, 4yr

live vaccine

pregnant, intending to become pregnant in 28d
IM
egg or neomycin allergy

fever (6-12d following vaccine)
transient morbilliform rash
GBS

78
Q

Varicella:

  • schedule
  • vaccine type
  • contraindications
  • ADEs
A

12-15mo, 4yr

live vaccine

prev allergic reaction
pregnant

sparse varicelliform rash (5-26d after vaccine)

79
Q

Hepatitis A:

  • schedule
  • contraindications
A

12mo, 18mo (must be 6mo from 1st dose)

prev allergic rxn
pregnancy/illness

80
Q

HPV:

  • schedule
  • contraindications
A

<15: 2 doses 6mo apart
>15: 3 doses

prev allergic rxn
pregnancy

PHA 581 (6 decks)

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