well child visits & gen peds Flashcards
1
Q
what are key components of ped health promotion
A
age approp. developmental achievement of the child
health supervision visits
integration of PE findings w/healthy lifestyles
immunizations
anticipatory guidance
Partnership btwn health care provider & child, adolescent & family
2
Q
what are some components of age age appropriate developmental achievement of the child
A
Physical (maturation, growth, puberty)
Motor (gross & fine motor skills)
Cognitive (achievement of milestones, language, school performance)
Emotional (self efficacy, self esteem, independence, morality)
Social (social competence, self responsibility, integration w/ family & community)
3
Q
what are some examples of anticipatory guidance
A
healthy habits nutrition, healthy eating safety & prevention of injury sexual development & sexuality family relationships emotional & mental health oral health school & vocation peer relationships
4
Q
when does AAP recommend well visit schedules?
A
birth, 1mo, 2mo, 4mo, 6mo, 9mo, 12mo, 15mo, 18mo, 2yr, then annually through adolescence
5
Q
what are some vital signs for 0-3mo old
A
HR 110-180bpm
BP 85/45-55
RR 30-60
6
Q
what does the pediatric growth curve compare?
A
the pt’s height, weight, head circumference & BMI to population (measured in %tiles)
7
Q
At what age does BMI start being used?
A
2 yrs
8
Q
to what age is head circumference tracked?
A
2-3yrs of age
important to assess for brain growth
9
Q
what are the % tiles for growth curves?
A
Overweight = 85-95%ile Obesity = >95 %ile Underweight = <5 %ile Microcephaly = <3%ile Macrocephaly = >97%ile
10
Q
classification of gestational age:
A
Preterm = <37wks Term = 37-42wks Post-term = >42wks
11
Q
Classification of birth wt.
A
Extremely low BW = <1000g (2.2lbs)
Very low BW = <1500g (3.3lbs)
Low BW = <2500g (5.5lbs)
Normal BW = >2500g
12
Q
what %tiles for small gestational age, appropriate for gestational age, large for gestational age?
A
SGA = < 10th %ile
AGA = 10-90th %ile
LGA = >90th %ile
13
Q
1st yr of life is called…
A
infancy
14
Q
neonatal period =
A
day 1-28
15
Q
postneonatal period =
A
day 29-1yr
16
Q
what are some tips for a newborn exam
A
swaddle newborn
dim the lights to see the eyes
observe feeding (nursing) if possible
17
Q
what is apgar?
A
key assessment of the newborn immediately after birth
18
Q
when is it used?
A
Scored at 1 & 5 minutes after birth
Scores range from 0 to 10
Scoring may continue at 5 min intervals until the score is > 7
19
Q
what is a newborn screen test?
A
population wide testing for metabolic & genetic diseases
blood samples collected by heel stick before discharge then again at 7-14 days of life
20
Q
tips for newborn peds exam
A
Support the head
Take what parts of the PE are easily available
listen to heart & lungs while baby is asleep
Look at that red reflex if the baby’s eyes are open
21
Q
general PE findings
A
Cry:
strong vs. weak, abnormal sounding
Respiratory effort:
nasal flaring, use of accessory muscles (abdomen, intercostal), respiratory rate
Posture/Tone:
Normal = flexion of legs & arms when supine
Abnormal = low tone, floppy
Color:
Cyanosis- mild can be normal at birth, but baby should be pink soon thereafter
Peripheral cyanosis (finger tips)- can be normal for 1-2 days
Jaundice (yellowing of the skin)- sometimes difficult based on the baby’s race
22
Q
what is vernix caeosa?
A
cheesy white covering
decreases as term approaches
made from fetal
corneocytes/sebaceous gland activity
rich lipid matrix
23
Q
what is milia?
A
Pinpoint white papules w/out surrounding erythema
caused by blocked sebaceous glands
commonly on nose, chin, forehead & cheeks
usually appears w/in the 1st few weeks & disappears over several weeks
24
Q
what is mongolian spot?
A
aka congenital dermal melanocytosis
blue patches of pigment
commonly seen over lumbar area, buttocks or extremities
they generally fade w/ time
common in those of Asian, Native American, Hispanic, East Indian & African descent
25
what is erythema toxicum?
yellow eosinophillic papules on red base
may appear on 2nd to 4th day of life
mostly seen on trunk
unknown etiology but thought to be due to the immaturity of the pilosebaceous follicles
typically disappear w/in 1 week of birth
26
what can be a sign of elevated ICP (meningitis or hydrocephalus)
Widely split sutures
bulging fontanelles (bleed vs. meningitis)
27
what suggests craniosynostosis?
A raised, bony ridge at a suture line
28
what are the areas where major sutures intersect?
fontanelles (should be soft, not depressed)
*always palpate
29
what can be the 1st sign of congenital hypothyroidism?
large fontanelle
30
a sunken fontanelle may indicate...
dehydration
31
characteristics of anterior fontanelle
closes by approx. 9-18mo
varies in size- 1 to 4cm
located at the juncture of the metopic, sagittal & coronal sutures
32
characteristics of posterior fontanelle
closes by approx. 1-2mo
should be <1cm
located at juncture of the sagittal & lambdoid suture
33
what is a cephalohematoma?
extracranial finding: swelling/collection of blood over one or both parietal bones
does NOT cross suture lines
resolves in wks to months
34
what is a caput succedaneum?
edema of the scalp,
CAN cross suture lines,
resolves in days
35
which one crosses suture lines? bilateral cephalohematoma or caput succedaneum?
caput succedaneum can cross
B/L cephalohematoma does NOT
36
what are you looking for on PE for face?
facial symmetry -- facial palsies from nerve birth injury
37
what are you looking for on PE for eyes?
spacing of eyes: Hypetelorism (abn. wide)
subconjunctival hemorrhages are common from birth trauma
Red reflexes should be present & symmetrical
38
what are you looking for on PE for nose?
infants <1mo are nose breathers- ensure no obstructions
39
what are you looking for on PE for ears?
pull the auricle gently downward for the best view
preauricular pits & tags are common: always screen for hearing loss
40
what are epstein's pearls
small, white benign, inclusion cysts
typically seen on palate
Bohn nodules are usually seen on gingival ridge
No tx needed, they will resolve spontaneously,
usu. seen between 2-4mo of age
41
what is ankyloglossia?
tongue tie -- congenital short lingual frenulum
42
characteristics of ankyloglossia?
can limit movement of tongue
can cause pain w/ nursing
usually see puckering of the midline tongue tip w/ movement
may lead to speech difficulty or dental problems
43
Tx for ankyloglossia?
frenulectomy in neonatal period
44
What is included in PE for neck?
Palpate the neck while infants are lying supine
Sitting upright for older children
45
what is congenital torticollis?
aka "wry neck"
results from bleeding into the sternocleidomastoid m. during the stretching process of birth
appears as a firm fibrous mass within the muscle 2-3 weeks after birth
generally disappears over months
46
when can you see a clavicle fx?
may occur during birth, particularly during delivery of a difficult arm or shoulder extraction
47
what is pectus excavatum? prevalence?
“funnel chest”- sternal depression
1/400-1000 live births
M > F (3x)
48
what is pectus carinatum? prevalence?
“chicken breast deformity or pigeon chest”
1/1500 live births
M > F (4x)
49
what is important to remember for lung PE?
Observe 1st, stethoscope after
50
peds PE for lungs
look at general appearance, RR (30-40bpm is normal for infants), color, nasal component, audible breath sounds & work of breathing
ribs don’t move much during quiet breathing for infants
diminished breath sounds in one side of the chest of a newborn suggest unilateral lesions (ie. congenital diaphragmatic hernia)
51
upper airway lung PE findings
harsh and loud, symmetric, louder as stethoscope moves up chest, usu. inspiratory
52
lower airway lung PE findings
often symmetric, louder lower in chest toward abd., often expiratory
53
cardiovascular peds PE
Femoral pulses: diminished may indicate coarctation of the aorta
Common non cardiac findings in infants w/ cardiac disease:
- poor feeding, failure to thrive, irritability
- tachypnea, hepatomegaly, clubbing
- poor overall appearance, weakness
54
HR ____ on inspiration & ____ on expiration
increases
decreases
often normal to have sinus dysrhythmia
55
what is the MC dysthymia in infants?
paroxysmal supra ventricular tachycardia PSVT (any age, even in utero)
56
umbilical cord anatomy
2 umbilical arteries, 1 umbilical vein
57
what is an umbilical granuloma
develops at the base of the navel
pink granulation tissue formed during the healing process
58
male GU exam
presence of testes, size of penis, appearance of scrotum
btwn 2-5% of full term & 30% pre term male infants are born w/ an undescended testicle
59
what is hypospadias?
urethral opening (hypO=“belOw”)- abnormal ventral placement
(check for this BEFORE circumcision
60
what is epispadias?
urethral opening (Epi- hits you in the “Eye”)- abnormal dorsal placement- this is uncommon
61
what are 2 common scrotal masses in newborns?
hydroceles & inguinal hernias
both frequently coexist, both MC on right side
62
Tx for peds hydrocele?
usu. resolves by 18mo- however refer to urology to r/o hernia
63
characteristics of hyroceles?
trasilluminated but NOT reducible
64
hernia characteristics and tx?
usu. reducible, often do NOT transilluminate but don't resolve so refer
65
Female GU PE findings
Often a milky white discharge present- may be blood tinged (norm. from mom's estrogen)
Labial adhesions
imperforate hymen may be noted at birth
66
anus/spine peds PE
Imperforate anus is not always obvious: cannot assume until baby passes meconium, usually w/in 48hrs
Sacral dimple: need to do ultrasound if you cannot see the bottom!!
67
Extremities peds PE
Count fingers & toes
Syndactly
Palmar crease: single palmar crease, aka simian crease- assoc. w/ trisomy 21 (may be normal variant)
68
what is a do not miss on Hip peds PE?
do not miss = developmental dysplasia of the hips (DDH)
1/1,000 births
69
risk factors for DDH?
breech, caucasian, 1st born female
family hx / prior child born w/ DDH
prematurity
70
DDH eval/PE?
an audible “click” heard w/ these maneuvers should prompt further work up
eval leg creases- asymmetry may be related
71
what does Barlow test for?
the ability to sublux or dislocate an intact, but unstable hip
72
what is ortolani test for?
tests for posteriorly dislocated hip
73
tx for DDH?
ortho eval & pavlik harness
| can lead to degenerative hip disease if untreated
74
how do you perform the palmar grasp? what age?
place your fingers into the baby’s hands & press against the palmar surfaces
baby will flex all fingers to grasp your fingers
tests primitive reflex
Age: Birth to 3-4mo
75
how do you perform the plantar grasp reflex?
touch the sole at the baseof the toes, toes will curl
| Age: Birth to 6-8mo
76
what is the moro reflex? age?
Hold the baby supine while supporting the head, back & legs
Abruptly lower the entire body about 2 feet
Arms should abduct & extend, hands open, & legs flex (baby may cry)
age: birth to 4mo
77
persistence beyond during Moro reflex suggests...
neurologic disease ( cerebral palsy, especially beyond 6mo)
78
asymmetric response during Moro reflex suggests...
indicates fracture of clavicle or brachial plexus injury
79
Asymmetric tonic neck reflex? age?
with baby supine, turn head to one side, holding jaw over shoulder
the arms/legs on side to which head is turned extend (think bow & arrow)
the opposite arm/leg flex
age: birth - 2mo
80
persistence beyond 2 mo's during asymmetric tonic neck reflex suggests...
asymmetric central nervous system development
81
what is the positive support reflex?
Hold the baby around the trunk & lower until the feet touch a flat surface
the hips, knees & ankles extend & baby stands up, partially bearing weight, sags after 20-30sec
82
age of positive support reflex? what does a lack of reflux indicate?
Age: birth or 2mo to 6mo
lack of reflux = hypotonia or flaccidity
83
what is the rooting reflex? age?
stroke the perioral skin at the corners of the mouth
the mouth will open & baby will turn the head toward the stimulated side
Age: birth to 3-4mo
84
What is trunk incurvation (galant's reflex)?
Support the baby prone w/ one hand
stroke one side of the back 1cm from midline, from shoulder to buttocks
the spine will curve TOWARD the stimulated side
85
age and absence of trunk incurvation (galant's reflex)?
Age: birth to 2mo
absence suggests a transverse spinal cord lesion or injury
86
placing and stepping reflexes? age?
hold baby upright from behind (as in positive support reflex)
have one sole touch the tabletop
the hip & knee of that foot will flex & the other foot will step forward
alternate stepping will occur
Age: birth (best after 4 days) to variable age to disappear
87
Vision PE: visual acquity?
Ages 3-5: 20/40
| Ages 6 & up: 20/30
88
Vision PE?
always check red reflex!
Toddler/preschool- cover/uncover, Gocheck vision
AAP recommends annual photo screening btwn 1-3yrs old
89
what is the MC cause of childhood blindness?
amblyopia
90
hearing recommendation from AAP?
universal hearing screen before leaving the hospital
91
when do you start checking a BP?
3 yr well but sooner if RF's
kidney dz, prematurity, congenital heart dz, recurrent UTI's/hematuria/proteinuria, other assoc. w/HTN (neurofibromatosis)
92
Additional Lab screening
Hgb screen for Fe deficiency at 9mo or 12 mo
lead: ages 1-2 or high risk
autism at 18mo & 12mo
STI's high risk
lipid panel
93
when would you order a lipid panel?
fasting lipid screening for children btwn ages 2-10 if certain RF's: FHx hyperlipidemia, early CV dz, obesity, overweight, HTN, DM
94
dental pt education for peds
Wash gums & teeth prior to 1st dental visit
1st dental visit between 12mo-2 or 3yrs of age
brush teeth 2x a day
floss 1x a day
Dental visit every 6mo
95
car safety Pt education
Rear facing car seat until 2yrs
Booster seat until 4’9”
No front seat until 13yrs of age
96
1 month old milestones
fixes/follows on face
some head control
responds to sounds/noises
spontaneous smile
97
2 month old milestones
Responsive smile
coos/vocalizes
lifts head when prone
follows to midline
98
4 month old milestones
```
rolls from tummy to back
good head control
laughs, squeals
follows past midline
grasps toys/objects
```
99
6 mo old milestones
```
sits w/ support
bears weight on legs
vocalizes “ba, da-da”
reaches out for toys
follows 180 degrees
stranger danger/separation anxiety
```
100
9 mo old milestones
```
crawls
pulls up to stand & cruises on furniture
says mama/dada
immature pincer grasp
responds to name
```
101
12 mo old milestones
```
walks (however, may be delayed up until 18mo)
waves bye-bye
says mama/dad
points w/ index finger
self feeds w/ fingers
```
102
15 mo old milestones
3-6 words
walks well
climbs stairs
imitates actions
103
18 mo old milestones
```
5-15 words
some 2 word phrases
uses spoon/fork
scribbles
follows simple commands
runs, walks backward
```
104
24 mo old milestones
```
20-50 words or more
2 word phrases
kicks ball
builds 3-4 block tower
50% speech understandable
```
105
HBV Vaccine: how many doses? when?
3 doses given at birth, 1-2mo, & between 6-18mo
106
HBV transmitted? sxs? complications?
spread: contact w/ blood or body fluids, birth
sxs: may be asx, jaundice, HA, weakness, V, joint pain
complications: chronic liver infx, liver failure, liver CA
107
contraindication to HBV vaccine?
severe allergy to yeast
108
ADE's from HBV vaccine?
fever (1-3%)
| pain at injection site (3-29%)
109
Rotavirus: given? transmission, sxs, complications?
live, oral vaccine given at 2,4,6 mo's
transmish: saliva, oral contact
dz sxs: V/D, fever
complications: severe D, dehydration
110
contraindications to Rotavirus vaccine?
hx of intussusception
infants w/ SCID (severe combined immunodeficiency)
defer in those w/ acute moderate to severe gastro
111
ADE's from rotavirus vaccine?
slightly increase risk of intussusception
possible vomiting & diarrhea, cough or runny nose
112
DTap doses and age?
5 total vaccines given at 2mo, 4mo, ,6mo, 15 or 18mo, then again at 4yrs
113
DTap dz's spread?
Diphtheria = air, direct contact
Tetanus = exposure through cuts in skin
Pertussis = air, direct contact
114
Dz sxs for DTap?
Diphtheria = sore throat, fever, weakness, swollen glands in neck
Tetanus = stiffness in neck & abdominal muscles, difficulty swallowing, muscle spasms, fever
Pertussis = severe cough, runny nose, apnea
115
Dz complications for DTap?
Diphtheria = pericarditits, heart failure, coma, paralysis, death
Tetanus = broken bones, breathing difficulty, death
Pertussis = pneumonia, death
116
contraindication to DTap vaccine?
do not give to children who have developed encephalopathy w/in 7 days of a previous dose of this vaccine
defer for those w/ progressive neurological disorders (infantile spasms, uncontrolled epilepsy) until condition is stabilized
precaution if pt developed high fever, inconsolable crying or shock like state previously w/in 48hrs of vaccine admin
117
ADE's to DTap?
swelling & redness at site, fever
118
Haemophilus influenzae type B vaccine doses and age?
4 total vaccines given at 2mo, 4mo, 6mo, 12 or 15mo
119
HIB transmission? sxs? complications?
Dz spread by: air, direct contact
Dz sxs: asymptomatic unless bacteria enter blood (sepsis)
Dz complications: meningitis, intellectual disability, epiglottis, pneumonia, death
120
Contraindication to HIB vaccine?
infants <6 wks of age
| individuals w/ allergic reaction to previous HIB vaccine
121
ADE's to HIB vaccine
very uncommon, redness or pain at site
122
doses and age for PCV 13
4 total given at 2mo, 4mo, 6mo, 12 or 15mo
| common cause of AOM & sinusitis
123
transmission, sxs, complications for PCV 13
Disease spread by: air, direct contact
Disease symptoms: asymptomatic, pneumonia
Disease complications: bacteremia, pneumonia, meningitis, death
124
contraindications to PCV 13 vaccine?
severe previous allergic reaction to vaccine
defer for individuals during moderate or severe acute illness w/ or w/o fever
125
ADE's to PCV 13
fever, local reaction, irritability, increased or decreased sleep
possible risk for febrile seizure when administered w/ influenza vaccine
126
IPV age and dose?
4 given at 2mo, 4mo, 6-18mo, & 4yrs
| no longer a live vaccine
127
transmission? sx? complications?
Disease spread by: air, direct contact, through the mouth
Disease symptoms: asymptomatic, sore throat, fever, nausea, headache
Disease complications: paralysis, death
128
contraindications to (poliomyelitis) IPV?
allergic reaction to previous IPV vaccine
defer during moderate or severe acute illness
pregnancy
129
ADE's from IPV vaccine?
minor local redness &/or pain at injection site
| no serious adverse reactions have been described
130
MMR given and dose?
2 given at 12-15mo & 4yrs
live vaccine
does NOT cause autism
131
Dz's spread MMR
air, direct contact
132
Dz sxs for MMR
Measles: rash, fever, cough, runny nose, pink eye
Mumps: swollen salivary glands, fever, headache, fatigue, muscle pain
Rubella: rash, fever, swollen lymph nodes
133
complications of MMR
Measles: encephalitis, pneumonia, death
Mumps: meningitis, encephalitis, inflammation of testicles or ovaries, deafness
Rubella: very serious in pregnant women- can lead to miscarriage, stillbirth, premature delivery, birth defects
134
contraindications to MMR
pregnant women, women intending to become pregnant within 28days
immunocompromised persons
egg or neomycin allergy (anaphylactic)
135
ADE's to MMR vaccine?
fever (5-15%) about 6-12 days following vaccine
transient morbilliform rash
GBS (1 case per 3million)
136
varicella given, dose?
2 given at 12-15mo & 4yrs
| live vaccine
137
transmission, sxs, complications for varicella?
Disease spread by: air, direct contact
Disease symptoms: rash, fatigue, headache, fever
Disease complications: infected blisters, bleeding disorders, encephalitis, pneumonia
138
contraindications to varicella vaccine?
allergic reaction after previous Varicella vaccine
pregnant women
139
ADE's to varicella vaccine?
minor injection site reactions (20%)
rash at injection site (3-5%)
sparse varicelliform rash
outside injection site (3-5%)
5-26 days after vaccine
140
HAV dose and given?
2 doses given at 12mo & 18mo (must be 6mo from 1st dose)
141
transmission, sxs, complications for HAV?
Disease spread by: direct contact, contaminated food or water
Disease symptoms: asymptomatic, fever, stomach pain, loss of appetite, fatigue, vomiting, jaundice, dark urine
Disease complications: liver failure, arthralgia, kidney, pancreatic & blood disorders
142
contraindications to HAV
previous allergic reaction
| caution w/ pregnancy or illness
143
ADE's to HAV
minor local redness &/or pain at injection site
| no serious adverse reactions have been described
