Well Peds Flashcards
What is graphesthesia?
Ability to recognized symbols/letters written on skin
What is stereognostic function?
Ability to recognize an object by touch
What is gold standard of temperature check in infants?
Rectally
What is considered fever in children?
> 100.4
Apical pulse is recommended for kids less than…
2 yo
Radial pulse is appropriate for kids over…
2 yo
What effect does a BP cuff that is too large have on reading?
Reading too low
What effect does a BP cuff too small have on reading?
Reading too high
What does erythematous, swollen mucous membranes indicate?
Bacterial or viral infection
What does pale, boggy mucosa indicate?
Allergies
When is a temporal temperature appropriate?
Kids older than 3 months
What is normal temp range for infant (less than 1 year old)?
97.7—–99.3
Normal temp range for a child over 1 year to 18 yo?
97.5——98.6
Normal pulse range for infant (less than 1 year)?
80——150
Normal pulse range for 1-3 yo?
70——-110
Normal pulse range for 3-6 yo?
65———110
Normal pulse range for 6-12 yo?
60——-95
Normal pulse range for 12+ yo children?
55—–85
Normal respiratory rate for infant less than 1 year old?
22——-55
Normal respiratory rate for 1-3 yo?
20———30
Normal respiratory rate for 3-6 yo?
20——–25
Normal respiratory rate for 6-12 yo?
14——–22
Normal respiratory rate for 12+ yo?
12——–18
Normal BP for infant (less than 1 yo)?
65—–100 Systolic
45——-65 Diastolic
Normal BP for 1-3 yo?
90——105 Systolic
55——–70 Diastolic
Normal BP for 3-6 yo?
95——110 Systolic
60——-75 Diastolic
Normal BP range for 6-12 yo?
100———120 Systolic
60————75 Diastolic
Normal BP range for 12+ yo?
110———135 Systolic
65———-85 Diastolic
How do you choose the right size BP cuff for kids?
Bladder of cuff should wrap around 80-100% of circumference of arm.
What is acanthosis nigricans?
Darker, thicker skin on back of neck, armpits, behind knees and elbows
—-Suspect Diabetes mellitus type 2—
At what age is the posterior fontanelle typically closed?
2-3 months
At what age is the anterior fontanelle typically closed?
12-24 months
What is hypertelorism?
Hypotelorism?
Eyes too far apart
Eyes too close together
What is hypoplastic philtrum?
Shallow or nonexistent cupids bow
—Sign of fetal alcohol syndrome–
How do you test cranial nerve 12 (hypoglossal) on kid?
How well can they move their tongue?
“Stick out tongue or act like licking a sucker”
How do you test cranial nerve 1 (olfactory)?
Close eyes—Identify the smell…
How do you test cranial nerves 3, 4, 6? (oculomotor, trochlear, abducent)
–Test these 3 together–
6 cardinal fields of gaze
–How well do they move their eyes?–
How do you test cranial nerve 5 (trigeminal)?
Sensation of face and also chewing strength.
Close eyes
Tickle face with soft something-very light touch.
Can they feel it?
Bite down on tongue depressor-how is their grip?
How do you test cranial nerve 7 (facial)?
This tests muscles of face.
Have them imitate you making different faces–eyebrows up and down, frown, smile, puff cheeks, wrinkle forehead, etc.
How do you test cranial nerves 9 and 10? (glossopharyngeal and vagus)
–These are tested together–
Gag reflex, swallowing, speaking
Use tongue depressor to gently stimulate gag reflex.
Evaluate swallowing and speaking passively during exam.
How do you test cranial nerve 11? (spinal accessory)
Controls muscles of neck
Shrug shouldesr against resistance of my hands
Why is eye muscle function testing on kids <5 yo important?
Common for kids to have weak eye muscles.
Easily correctable if caught early.
If not corrected, can lead to long term vision changes.
What does an Ishihara chart test for?
Color vision deficits
—Color vision deficit much more common in boys than girls–
—Genetic trait–
How do you straighten ear canal for exam in child younger than 3?
Pull pinna down and back.
How do you straighten ear canal for exam in child older than 3?
Pull pinna up and back.
What are Rinne and Weber hearing tests?
Use a vibrating tuning fork to determine conduction of sound waves.
Rinne (fork is placed on mastoid)
Weber (fork is place on top of head)
When is barrel chest a normal finding in children?
Less than 6 years old.
What is pectus excavatum?
Funnel chest
Depression under sternum
—Not a problem, unless it becomes so deep it puts pressure on heart or lungs–
What is pectus carinatum?
Pigeon chest
–Deformity that makes sternum stick out–
Not a problem, just weird
What is tactile fremitus?
When place your hands on chest (either anterior or posterior) and have them speak, cough, etc, feel vibration.
–Normal finding–
What position is best one for listening to breath sounds?
Sitting upright
In what 3 positions is heart assessed?
Supine
Left lateral recumbent
Sitting while leaning forward slightly
Where is apical pulse usually found in child younger than 7?
4th intercostal
Lateral to midclavicular line
Where is apical pulse usually found in child older than 7?
5th intercostal
mid clavicular line
When listening to heart what sequence should we follow?
- ID rate and rhythm
- ID S1 and S2.
- Find spot where S1 and S2 are best heard.
- Listen for extra heart sounds.
- ID murmurs.
What should we have child do while we are listening for heart sounds and why?
Hold their breath
This distracts them and keeps their breathing from speeding or slowing HR.
What is coarctation of the aorta?
Birth defect
Narrowing of aorta
Will be discovered when differences between pulse strength of upper and lower extremities are felt.
Example: Take femoral pulse at same time as radial pulse–is there a difference in strength or rate?
What is genu varus deformity?
Bow legged
What is genu valgus deformity?
Knock kneed
What is normal age baby will start rolling over?
3-6 month
What is normal age baby will sit alone?
by 7 month
What are cerebellar function tests?
Test balance, coordination, proprioception (sense of movement and location)
When are the primitive reflexes of NB diminished?
3-4 months
What are neurologic soft signs?
Inability to perform expected tasks for age. Subtle clues something is wrong.
Examples:
Short attention span
Poor motor coordination
Clumsiness
Frequent falling
Language disturbances
How are neurologic evaluations done on very young children?
Developmental milestones
When do children no longer need a car seat or booster?
Book says: Until they reach 4 foot 9 inches tall.
?PP says until they are 8 years old?
When can a child ride in the front seat?
13 years old
When can a child ride in forward facing car seat?
2 years old AND met the height and weight requirements of that particular seat.
What age is normal for separation anxiety?
6-30 months
Five stages of grief.
Denial
Anger
Bargaining
Depression
Acceptance
–DABDA–
What are three stages of separation anxiety?
Protest (crying)
Despair (quiet down)
Detachment (starts to play and become interested in environment)
