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General Pediatrics > Well Child Visits > Flashcards

Well Child Visits Flashcards

1
Q

What is the difference between a screening and a diagnositic test?

A

Screening test: test designed for mass application to an asymptomatic population

Diagnostic Test: evaluates a diagnostic possibility in patients with significant history, symptoms, physical findings, and positive screening test

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2
Q

When should I newborn screening be done?

A

draw blood before discharge, after 24 hrs but no later than 7 days of age.

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3
Q

Vision Screening

A

Visual fixation occurs in the newborn and achieves accuracy by 6-9 weeks

Infants have the ability to follow an object by 3 months of age

Most term infants are far sighted, hyperopic at birth while premature infants are near sighted, myopic

Children reach 20/20 vision by 5 years

Ability to match colors is present by 2 years of age

Test visual acuity starting at age 3

Refer preschoolers with acuity worse than 20/40 in either eye

Refer children 5 years of age with 20/30 or if there is a difference between >1 line between the left and right eyes

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4
Q

Optic Nerve Hypoplasia

A

nonspecific finding due to damage of the visual system before it is fully developed

It is associated with

  • maternal diabetes
  • alcohol abuse
  • maternal exposure to toxins
  • hypothyroidism
  • growth hormone deficiency
  • neonatal hypoglycemia
  • midline facial defect such as hypopituitarism
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5
Q

Retinoblastoma

A

leading malignant ocular tumor of childhood

associated with 13 q deletion

white pupil
(Congenitial cataracts also may present with a white pupil)

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6
Q

Strabismus

Amblyopia

A

Strabismus: misalignment of eyes

Amblyopia: loss of vision secondary to disuse or misuse of visual pathways during critical periods of visual development

Treatment: occlusive patch on the strong eye

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7
Q

Unilateral cover test

A

Cover and uncover each eye while child is looking straight ahead at an object 10 feet away.

Movement in the uncovered eye when the opposite is covered or uncovered suggests potential ocular misalignment or strabismus.

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8
Q

Corneal Abrasions

A

Pain, tearing, photophobia, decreased vision

Diagnose with fluorescein dye and slit lamp

Treatment: topical antibiotic

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9
Q

Hyphema

A

Presence of blood in the anterior chamber of the eye
after blunt or perforating injury

Eye pain

Immediate ophthalmologic consult

Treatment:

topical steroid and cycloplegia drops

protective eye shield

bed rest

head elevated to 30-45 degrees with close monitoring of intraocular pressure

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10
Q

Conductive hearing loss

A

disruption of mechanical components required for transduction of sound wave energy

generally caused by ear wax impaction and fluid in the middle ear

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11
Q

Hearing

A

Hearing loss is deficiency in hearing >90dB

Severe or profound hearing loss is always sensorineural and most often affects high frequencies

Deafness is inherited in 50% of all cases as autosomal recessive pattern

Prolonged exposure to loud noises is a common cause of high pitched hearing loss in adolescents

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12
Q

Hearing Screen

A

Screening is done with Evoked Otoacoustic emissions initially, then with auditory brainstem response systems if baby less than 6 months fails the initial hearing test

Auditory brainstem response testing measures how CN 8 responds to sound. Hearing loss of 35 dB or greater in the 500 Hz to 4,000 Hz range requires a referral.

Formal hearing screen for all children at 3, 4, 5 years of age and every 2 years after until adolescence

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13
Q

Jervell and Lange-Nielsen syndrome

A

Autosomal recessive disorder

prolonged Q-T syndrome and hearing loss

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14
Q

Causes of acquired hearing loss

A

number one cause of hearing loss is otitis media effusion

CMV and Toxoplasmosis account for majority of infectious causes of hearing loss

Rubella can also be a rare cause of deafness

10% of bacterial meningitis causes deafness

Prolonged exposure to loud noises is a common cause of high pitched hearing loss in adolescents

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15
Q

Acute otitis media

A

test with pneumatic otoscopy

patients must have symptoms

Treatment: No antibiotics at diagnosis in uncomplicated acute otitis media. Give antibiotics if there is an underlying chronic otitis media with effusion

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16
Q

Otitis media with effusion

A

most common between 6 months- 4 years

Fluid in the middle ear

Most resolve within 3 months

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17
Q

Tympanograms

A

measures volume of air in the external cavity of the ear

Maximum compliance: vertical peak on the y-axis: 1cm

Peak pressure: point of greatest mobility: x axis: 0

18
Q

Obesity

A

Measure BMI in children > 2years of age

BMI= (weight in Kg)/ (height in meters) ^2

Overweight is BMI of 85-95th percentile

Obesity is BMI > 95%

Severe obesity is BMI > 35

No TV for children < 2years of age

Less than 2 hrs of TV for children >2 years of age

Treatment of obesity is family support and involvement

19
Q

Blood Pressure Screening

A

Blood Pressure Measurements for children every year starting at 3 years of age

Normal Blood Pressure is BP less than 90th percentile for age and sex

High normal 90-95% for age and sex

Hypertension >95% for age and sex

20
Q

Cholesterol and Lipid Screening

A

Only screen children and adolescents with a positive family history of cardiovascular disease or unknown family history

For patients 8 years or older with LDL >190 mg/dL, consider pharmacological intervention to get LDL below 130mg/dl

21
Q

Metabolic Syndrome

A

Cluster of related diseases that increases cardiovascular and other health risk

  • BMI>97%
  • Triglycerides >110mg/dL
  • HDL cholesterol: <40mg/dL
  • Blood pressure: >90th percentile
  • Glucose abnormalities: fasting glucose >110mg/dL, oral glucose tolerance test >140mg/dL
  • Waist circumference: >90% percentile
22
Q

Lead Screening

A

Universal blood lead screening for all children 1 year and 2 year olds

Consider Lead screening in children with inattentive and hyperactive behaviors

Normal values of lead levels < 10 ug/dL

Hypochromic microcytic anemia and basophilic stippling

See lead lines in chronic lead toxicity which are dense bands in the metaphysis from incorporation of lead in the bone, can find in wrists, other long bones, and axial skeleton

Lines disappear with growth

23
Q

Iron Deficiency Screening

A

Is the #1 nutrition deficiency and the number one cause of anemia

Deficiency between 6 and 20 months, may affect development and cognitive abilities

Hematocrit/Hemoglobin screening at 1 year of age

Anemia is defined as hemoglobin that is 2 standard deviations below the mean for age and sex

24
Q

Urinanalysis

A

Annual dipstick urine testing for leukocytes to look for Chlamydia and gonorrhea in sexually active males and females between 11-21 years old

Only perform urinalysis screen if there is a family history of inheritable renal disease

25
Q

Oral Health Screening

A

Referral to dentist at 12 months of age, then every 6 months after

When a tooth erupts, child’s teeth should be brushed twice daily with plain water

From 2-6 years old, brush teeth twice a day with a pea-sized amount of fluoride toothpaste

26
Q

Dental Care

A

First tooth erupts by 6 months with 6 teeth present by the 1st year

Delays in tooth eruption beyond 1 year require investigation

Topical local anesthetics for teething have been associated with methemoglobinemia

27
Q

Breast Feeding

A

Initial few days postpartum: mothers can attempt 10-15 mins per breast with each feed. The infant should take from both breasts at each feeding. Newborns should not go longer than 4 hrs between feedings.

At 2 months of age, most infants will stop one of the middle of night feedings

28
Q

Formula Feedings

A

Soy based formulas have high aluminum levels, do not recommend soy-protein formulas to infants weighting < 1,800 grams

For newborns: 2 ounces every 2 hrs

At 2months: 4 ounces every 4 hrs

At 6 months: < 30 ounces a day

Most babies can be weaned from bottle to cup at 9 months

If there is a documented cows milk protein allergy, switch to hydrolyzed formula

29
Q

Advancement of Diet

A

Introduce solids prior to milk before a meal

At 4-6 moths of age, infants can start with iron-fortified cereals, then strained vegetables, followed by meats and poultry products.

Introduce only one new food at a time and observe for any adverse effects over the next week before adding another item.

At 1 year old: Whole milk

At 2 year old: 2% skim milk

30
Q

Vitamin and Mineral Supplementation

A

Vitamin D supplementation 400 IU/day for exclusively and partially breastfed infants

Cow milk should be used after 12 months of age

Folate deficiency in infants fed with goat’s milk

Vitamin B12 deficiency in breastfed infants whose mothers are strict vegetarians

31
Q

Iron

A

Always recommend iron-fortified formulations if using formula

Breastfed babies should begin daily supplementation of 1mg/kg of elemental iron at 4 months of age

32
Q

Fluoride

A

No Fluoride supplementation to any child under 6 months of age

33
Q

Sleep

A

Newborns: 18 hours a day

6-15 month olds: 10-12 hours a night with 2 naps during the day

15 months: 1 nap per day

By 3-4 months of age, infants can put themselves back to sleep, parents must put the child down drowsy and not yet asleep in their own cribs

Stop middle of the night feedings at 6 months of age

Encourage a regular daily sleep routine

34
Q

Nightmares

A

occurs during REM sleep

peak age of onset is 3-5 years old

occurs several hours after onset of sleep

35
Q

Night terrors

A

occurs during non REM sleep

occurs in the first third of the night

The child appears to be awake but is unresponsive and unaware of the parent’s presence, difficult to arouse, cries intensely, is diaphoretic, and appears disoriented.

The child has no recollection of the episode the next morning

Night terrors peak at 5-7 years old

Parents should observe night terrors without awaking the child

36
Q

Sleep walking

A

occurs during stage 4 non REM sleep

occurs in children between 4 and 8 years old

Encourage parents to ensure the environment is safe, to observe the child and to gently lead the child back to bed

37
Q

Crying

A

On average, 2 week old infant cries on average 2 hours a day

6 week old infants cries 3 hours a day

3 month old infants cry 1 hour a day

Most crying occurs during the evening hours

38
Q

Colic

A

Colic is excessive unexplained crying greater than 3 hours a day and more than 3 days a week for greater than 3 weeks

30-50% of children have colic, generally cries during the same time during the day, generally starts in the first week of life and goes away by 3 months of age

Differential Diagnosis of Colic

1) Anomalous left coronary artery: poor feeder who cries excessively and becomes diaphoretic during feeds
2) Pseudoparalysis of a limb associated with congenital syphilis
3) Caffey disease: infantile cortical hyperostosis

39
Q

Discipline

A

Time out at 12 months of age until 5 years of age

Length of time is 1 minute per year of age

No discussion during time out

After 5 years old, children understand loss of privileges

40
Q

Child Safety Restraints

A

Infants to 2 year olds: Rear facing car seat

2 year old until school age: Front facing car seat

School age children until 8 years old: booster seat

8 years old to 13 years old: back seat

41
Q

What temperature should the hot water heater be set to?

A

Hot water heater temperature should be 120 degrees F or less

General Pediatrics (1 decks)

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