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(PA School Q1) HAPE > Wk 10 pt 1: Children (10% of final) > Flashcards

Wk 10 pt 1: Children (10% of final) Flashcards

1
Q

List the 5 stages of development and the age ranges of each

A

1) Newborn/Neonate (first 28 days after birth)
2) Infancy (0-12 months)
3) Early childhood (1-4 years)
4) Middle childhood (5-10 years)
5) Adolescence (11-20 years)
-Early, middle, late

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2
Q

Child development proceeds along a predictable pathway, but the ___________ of normal development is wide.

A

range

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3
Q

What can affect child development and health?

A

Various physical, social, and environmental factors (plus diseases)

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4
Q

Expectation of milestones is adjusted for ______________.

A

prematurity

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5
Q

1) At what age should a baby respond to sounds?
2) At what age should a baby coo and gain head control?

A

1) Newborn
2) 2 months

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6
Q

1) At what age should a baby roll over?
2) At what age should they babble?
3) At what age should they sit?

A

1) 3 months
2) 6 months
3) 5 months

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7
Q

1) At what age begins “mama and dada specific”?
2) What age should a baby pull to stand, crawl, and actively manipulate reachable objects?
3) At what age may an infant recognize strangers?

A

1) 8 months
2) 9 months
3) 9 months

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8
Q

At what age should an infant be able to walk and use a spoon?

A

11 months

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9
Q

Physical/ motor development:
1) At what age should a child be able to pedal a tricycle, jump in place, and feed themselves with utensils?
2) At what age should a child be able to cut with scissors, hop, and balance on 1 foot?

A

1) 3 years
2) 4 years

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10
Q

Cognitive/ language:
1) At what age should a child be able to say 1-3 single words?
2) What abt 2-3 word phrases?
3) What abt having 100% understandable speech and talking in paragraphs?

A

1) 1 years
2) 2 years
3) 4 years

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11
Q

Cognitive/ language development:
1) What age should a child be able to know sentences, colors, and ask “why?”?
2) What age should a child be able to say ABCs, copy figures, and define words?
Social emotional development:
1) What age should a child know themself in a mirror?
2) What age should a child display imagination?

A

1) 3 years
2) 5 years
Social emotional:
1) 3 years
2) 4 years

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12
Q

1) Language development proceeds from cooing ~_____ months to babbling ~______ months.
2) What language development occurs at 8 months?
3) Vocabulary includes 1-3 words at what age?

A

1) 2; 6
2) “Dada” and “Mama” (specific)
3) 12 months

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13
Q

Describe Cognitive, Social, Physical Development milestones of: newborns, 2 mo, 3 mo, 5 mo, 9 mo, 10 mo, and 11mo

A

Newborn: Responds to sounds
2 mo: Lifts head with good control
3 mo: Rolls over
5 mo: Sits
9 mo: Pulls to stand, may recognize strangers, actively manipulate reachable objects
10 mo: Crawls
11 mo: Walks

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14
Q

Social development:
1) “Has an emerging drive for independence” describes what age?
2) At what age should a child recognize the self in the mirror?
3) At what age should imaginative play begin?

A

1) 2 years
2) 3 years
3) 4 years

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15
Q

1) What age group is impulsive and has poor self-regulation? What does this mean?
2) True or false: Some can have difficulty adapting and respond negatively to new stimuli.

A

1) Toddlers; temper tantrums are common.
2) True

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16
Q

1) Rate of physical growth slows by approximately _______.
2) After two years old, toddlers gain about _________kg/year and grow _______cm/year.
3) Toddlers become leaner and __________ muscular with _________ body fat.

A

1) half
2) 2-3 kg/ year; ~5cm/ year
3) more; less

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17
Q

1) What age should you begin to assess and follow child for obesity?
2) True or false: Obese children are more likely to be obese adults.
3) How do you assess BMI?

A

1) 3-4 years old
2) True
3) An age and sex specific chart

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18
Q

Fine motor skills:
1) At what age should kids be able to jump in place, pedal a tricycle, and feed themselves?
2) At what age should they be able to balance on one foot, hop, and cut w scissors?

A

1) 3 years
2) 4 years

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19
Q

Language development:
1) At what age should a child be able to form complex sentences and paragraphs w 100% understandable speech?
2) At what age should a child be able to form 3 word phrases?
3) At what age should a child be able to converse well and form sentences?

A

1) 4 y/o
2) 2 y/o
3) 3 y/o

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20
Q

Cognitive development:
1) What age group involves becoming a symbolic thinker and gaining the ability to solve simple problems?
2) What age should a child know colors and ask why?
3) What age should they define words and copy figures?

A

1) Toddlers
2) 3 y/o
3) 5 y/o

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21
Q

1) When does the height spurt peak in males? What is the age range?
2) What about the age range of growth spurts of the penis?
3) What abt testicular growth spurts?
4) What abt pubic hair development?

A

1) 14; 10.5-16 and 13.5-17.5
2) 10.5-14.4 or 12.5-16.5
3) 9-13.5 or 13.5-17
4) 10.7-14.5 for PH3

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22
Q

1) When does the height spurt peak in females? What is the age range?
2) What is the age range of menarche?
3) What abt of breast development?
4) What abt of pubic hair?

A

1) 11.5; 9.5-14.5
2) 11-14.1
3) 8.2-21.1 for B2
4) 9.3-13.9 for PH3

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23
Q

List 6 pediatric PE red flags

A

1) Tachypnea
2) Tachycardia
3) Temp. instability
4) Hepatomegaly
5) Splenomegaly
6) Acute or chronic limp

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24
Q

1) Define tachypnea in infants
2) What is normal RR in infants?

A

1) Increased breath rate; >60/min from birth to 2 months, and >50/min from 2-12 months.
2) Normal: 30-60 breaths per minute

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25
Define tachycardia in infants
Increased heart rate, HR >180 BPM
26
List the averages and ranges of HR in infants
1) Birth-1 month: 90-190, avg 140 2) 1-6 months: 80-180, avg 130 3) 6-12 months: 75-155, avg 115
27
1) What is a fever (temp instability)? 2) Is temp instability common in newborns? Explain the normal temp range. 3) What is the most accurate temp for infants?
1) >100.4o F (>38o C) 2) Temperature instability is common in newborns; normal is 99o F (37.2oC) to as high as 101o F (38.3oC) after activity (crying, anxiety) 3) Rectal temperature
28
What temp is most accurate for infants?
Rectal
29
Any fever lasting more than _______ days needs complete workup
5
30
1) Define hepatomegaly 2) How far does a normal liver edge extend? 3) Liver disease can lead to what?
1) liver extends >3 cm below the right costal margin 2) Normal liver edge extends 1-3 cm. 3) Decreased protein production and other complications
31
List 4 potential causes of hepatomegaly
1) Heart failure 2) Hepatitis 3) Epstein Barr Virus (EBV) infection 4) Biliary congestion
32
1) Define splenomegaly 2) Describe a normal spleen
1) Spleen extends >2 cm below the left costal margin 2) Moveable; rarely extends >1-2 cm.
33
List 5 potential causes of splenomegaly
1) **Mononucleosis (e.g., EBV)** 2) Hemolytic anemia 3) Leukemia 4) Autoimmune or inflammatory diseases 5) Portal hypertension
34
Slipped Capital Femoral Epiphysis (SCFE) is most common in what group of children? What does this cause?
Obese; growth plate damage and femoral head slips
35
List 3 potential causes of acute limp in kids
1) Trauma 2) Injury 3) Slipped Capital Femoral Epiphysis (SCFE)
36
List and define 5 potential causes of chronic limp
1) Blount disease: Growth disease of the tibia 2) Avascular necrosis of the hip: Blood flow to the bone is interrupted 3) Leg length discrepancy 4) Spinal disorder: Scoliosis 5) Leukemia: Build up of cells in the bone and joints of the legs and hip.
37
1) Define inspiratory stridor 2) What can it be caused by? 3) Give examples
1) Audible breath sound; high-pitched, inspiratory noise 2) Serious conditions 3) Laryngotracheobronchitis (croup), Epiglottitis, Foreign body -Not as important to know: Bacterial tracheitis, hemangioma (subglottic), vascular ring, tracheomalacia
38
1) Define coarctation of the aorta 2) What can happen if it's untreated?
1) Congenital narrowing of a section of the aorta. 2) Can stunt growth and can cause organ damage (since heart may not be able to pump enough blood to organs)
39
What are 2 physical exam findings that require follow up for suspected coarctation of the aorta?
1) Absent or decreased femoral pulses 2) Blood pressure (BP) differences between extremities
40
1) How do you measure blood pressure (BP) differences between extremities? Is there normally a difference? 2) What types of BP can coarctation cause?
1) Measure BP in both arms and one leg; normally, BP in lower extremities is slightly higher than upper. 2) Equal BP in LEs and UEs, or lower BP in lower extremities (compared to UEs).
41
1) Define hip dysplasia. Does it need to be Dxd early? 2) What is the Ortolani Test for?
1) Instability or dislocation of the hip in a newborn or infant; needs to be detected early to intervene 2) Presence of a posteriorly dislocated hip that is reducible
42
1) How is an ortolani test done? 2) What should you avoid?
1) From an adducted position and hip flexed to 90°, the hip is gently abducted with supination of the examiner’s hand while lifting the greater trochanter anteriorly 2) Extreme abduction
43
Describe the positive Ortolani Sign for DDH (2 things)
1) "Clunk” felt as the femoral head, which lies posterior to the acetabulum, enters the acetabulum (reduced to normal position). 2) Palpable movement of the femoral head back into place
44
1) What does Barlow test test for? 2) How is this test performed?
1) Ability to sublux or dislocate an intact but unstable hip 2) Hip is gently adducted with pronation of examiner’s hand (downward pressure no longer recommended)
45
1) What happens w a Barlow test when the hip is dislocatable? What abt if its subluxatable? 2) What does a positive Barlow test indicate?
1) If hip is dislocatable, posterior movement and palpable clunk may be detected as femoral head exits acetabulum (“jerk of exit”) -If the hip is subluxatable, there is subtle sliding movement or feeling of looseness (“tennis ball moving in a soup bowl”) 2) A reduced hip that is subluxatable or dislocatable
46
Combination of what two maneuvers has high specificity for DDH in infant < 3 months?
Barlow and Ortolani
47
1) Define pyloric stenosis 2) What causes it? 3) When does it usually present?
1) Narrowing due to thickening at the opening (pylorus muscle) from the stomach into the small intestine 2) Cause unknown 3) ~3-5 weeks of age.
48
What are two PE findings that require follow up for suspected pyloric stenosis?
1) Firm 2 cm “olive-like” mass of the RUQ or midline of the abdomen 2) Parent may report visible peristaltic waves across the abdomen and projectile vomiting (usually nonbilious) immediately after feeding, while infant remains hungry.
49
1) A Firm 2 cm “olive-like” mass of the RUQ or midline of the abdomen is suspicious for what? 2) What condition is described?: "Parent may report visible peristaltic waves across the abdomen and projectile vomiting (usually nonbilious) immediately after feeding, while infant remains hungry"
1) Pyloric stenosis 2) Pyloric stenosis
50
Define otitis media and include 4 of its characteristics
Middle ear infection: 1) Red, bulging tympanic membrane (TM) 2) Dull or absent light reflex 3) Decreased movement of TM 4) May see purulent material behind TM.
51
1) Define mastoiditis 2) What may be a physical symptom of this condition? 3) What is a common characteristic of this condition?
1) Infection of mastoid bone 2) Auricle of ear may protrude forward and outward 3) Area over mastoid bone is red, swollen, and tender.
52
List 3 potential pediatric PE findings of the throat
1) Streptococcal pharyngitis 2) Peritonsillar abscess 3) Retropharyngeal abscess
53
1) Define Streptococcal pharyngitis 2) What does it cause do to the tongue? 3) How doe it affect the tonsils/ post pharynx? 4) How doe it affect the uvula and palate?
1) Bacterial infection of the pharynx (aka “strep”) 2) “Strawberry” tongue 3) White or yellow exudates on the tonsils or posterior pharynx. 4) Beefy red uvula 5) Palatal petechiae
54
What are 3 symptoms of peritonsillar abscess?
1) Erythema of one tonsil 2) Asymmetric enlargement of one tonsil 3) Lateral displacement of uvula
55
1) What are the symptoms of retropharyngeal abscesses? 2) What swelling may occur?
1) Fever, stiff neck, pain with neck extension, dysphagia, etc. 2) Midline or unilateral of posterior pharyngeal wall (visualization may not be possible and should not be attempted if significant airway compromise)
56
Koplik spots are pathognomonic for what? Describe these spots
Measles; bluish white dots about 1 mm in diameter surrounded by a rose-red areola
57
1) What severity does asthma present with? 2) What does it do to the inspiratory: expiratory ratio? Define this ratio as well
1) Varying severity 2) Prolonged expiratory phase; proportion of time spent on inspiration versus expiration
58
What are 3 childhood resp diseases?
1) Asthma 2) Pneumonia 3) Respiratory foreign body
59
What are 3 symptoms of pneumonia?
1) Fever 2) Tachypnea 3) Dyspnea
60
List 2 symptoms of respiratory foreign body
1) Inspiratory stridor 2) Prolonged inspiratory phase
61
1) Do benign heart murmurs come w associated findings? (breathing difficulties, color changes, growth/activity restriction, feeding difficulty, CP/SOB/palpitations, etc.) 2) True or false: Most, if not all children, will have one or more functional or benign murmurs before reaching adulthood.
1) As a rule of thumb, usually no 2) True
62
Should you identify murmurs by their quality or intensity? Give examples
By their quality, not intensity -Ex: Systolic vs. diastolic, crescendo vs. decrescendo, high or low pitch, etc.
63
Give 4 examples of benign heart murmurs seen in pre-school aged children
1) Still's murmurs 2) Pulmonary flow murmur 3) Systemic flow murmurs / Supraclavicular systemic bruits 4) Venous hum
64
1) What is the most common heart murmur? 2) Where is it? What is it related to and can it move? 3) What are the common ages?
1) Still's murmur 2) Left lower sternal border; related to flow, can change with position/Valsalva 3) 3 years to adolescence
65
1) What murmur is prominent in high-flow situations? (anemia, fever) 2) Where is this murmur? 3) What demographic is it seen in?
1) Pulmonary flow murmur 2) Upper left sternal border 3) Older children, adolescence and older.
66
1) Are systemic flow murmurs / Supraclavicular systemic bruits true "carotid bruits"? 2) What causes them?
1) Heard over carotids, but no, they're not. 2) Normal blood flow into aorta and head/neck vessels
67
1) What causes venous hum? 2) What is it sensitive to?
1) Blood returning from great veins to heart 2) Posture and head/neck position
68
What 8 vital signs should you get during development? At what ages should you measure each?
1) Height: every visit 2) Weight: every visit 3) BMI (body mass index): at every visit 4) Head circumference: birth to 36 months 5) BP: start measuring at age 2 6) Pulse: higher in infancy; slows down with aging 7) RR: higher in infancy; slows down with aging 8) Temp: <2 months of age: rectal temp ≥2 months of age: tympanic temp
69
What vital signs should be measured at every visit throughout development?
Height, weight, BMI, BP (at age 2+)
70
What vital signs are higher in infancy and slow down with aging?
Pulse and RR
71
What does an APGAR score consist of?
Appearance (skin color) Pulse Grimace (reflex irritability) Activity (muscle tone) Respiration
72
1) Define acrocyanosis (a 1 on the color pt of APGAR) 2) Describe the scale APGAR is measured on
1) Pink trunk, blue extremities 2) 7 to 10 is reassuring -4 to 6 is moderately abnormal -0 to 3 is low
73
1) Is HR >100 a good thing on APGAR? 2) Is "grimace" or "cry or active withdrawal" a more positive expression of reflex irritability on APGAR?
1) Yes 3) Cry or active withdrawal is more positive
74
List the sequence of newborn assessment (8 steps)
1) Careful observation of activity 2) Head, neck, heart, lungs, abdomen, genitourinary system 3) Lower extremities, back 4) Ears, mouth 5) Eyes whenever they open spontaneously 6) Skin (throughout the exam) -Vernix caseosa: present at birth -Lanugo: shed within the first few weeks of life 7) Nervous system 8) Hips
75
1) What should you inspect about the head in an infancy PE? 2) Should you observe or palpate the two fontanelles? What are these and when does each close?
1) Inspect for symmetry 2) Palpate: Anterior fontanelle: closes between 4 - 26 months of age Posterior fontanelle: closes by 2 months of age
76
Infancy PE: 1) What should you inspect abt eyes? 2) What abt ears? 3) What reflex should you test w the ears? 4) What should you inspect abt the neck
1) Sclerae, pupils, irises, extraocular movements, and presence of **red reflex** 2) Position, shape, landmarks, patency of ear canal 3) Acoustic blink reflex 4) For masses
77
1) Do infants breathe through the nose or mouth? 2) What sinuses are present at birth? 3) What should you inspect abt the nose in an infancy PE?
1) Obligate nasal breathers for first the 2 months of life 2) Only ethmoid sinuses 3) Position of nasal septum
78
Infancy oral PE: 1) What should you inspect abt the mouth? 2) What should you palpate? 3) How do you know how many teeth a child should have? 4) Which teeth erupt first?
1) Mucosa, tongue, gums, palate, tonsils, and posterior pharynx 2) Gums and teeth 3) 6-26 months of age, 1 tooth per month 4) Central + lat. incisors first, molars last
79
Infancy neck PE: 1) What should you inspect for on the neck? 2) What should you palpate for? 3) What should you assess for?
1) Masses 2) Presence of adenopathy: unusual in infancy 3) Mobility of neck
80
Absence of red reflex in young children should lead to a high level of suspicion for __________________
retinoblastoma
81
Infancy thorax PE: 1) What should you inspect and listen to? 2) What should you palpate? When? 3) Is percussion helpful in infants? Why or why not?
1) RR, color, nasal component of breathing, & listen for audible breath sounds 2) Palpate tactile fremitus if infant is crying or making noise 3) Not helpful; thorax is more rounded in infants than in older children and adults
82
1) When you're listening to an infants lungs how may the sounds differ from an adult's? 2) What should you inspect abt the heart?
1) Louder and harsher sounds 2) For cyanosis
83
What two types of sounds should you distinguish between in infants? Describe each
1) Upper airway: loud, symmetric transmission throughout the chest - loudest as stethoscope is moved upward; coarse during inspiratory phase 2) Lower airway: loudest over site of pathology; asymmetric; often has an expiratory phase
84
Infancy heart PE: 1) What should you palpate? 2) What should you auscultate?
1) Palpate: Peripheral pulses, especially brachial PMI is not always palpable; 1 interspace higher than in adults Thrills 2) S1, S2 (split is normal but fuse together as single sound during deep expiration) S3 is frequently heard and is normal Murmurs – functional murmurs vs. pathologic
85
1) Why should you inspect an infant's breasts? 2) What should you palpate for?
1) Enlarged in newborns secondary to maternal estrogen 2) Masses
86
Infancy male genital PE: what should you inspect and palpate for?
Inspect and palpate for descent of testes into scrotal sac
87
Infancy female genital PE; what should you do?
Inspect genitals
88
Infant abd. PE: 1) What should you inspect abt the abdomen/ what should be gone by 2 weeks old? 2) What should you auscultate?
1) Umbilical cord remnant is gone by 2 weeks of age 2) Bowel sounds
89
Infancy abd PE: 1) What should you palpate? 2) Are infant rectal exams generally done
1) Liver edge 1-2 cm below costal margin is normal; palpable spleen tip is normal 2) Generally not done
90
Infant MSK exam: 1) What should you inspect and palpate? 2) When is bowlegged growth normal?
1) Inspect spine; palpate clavicle, hips, legs, and feet. 2) Until age 18 months.
91
Infant nervous system PE: 1) What should you do regarding motor tone? 2) What abt reflexes?
1) Inspect tone, and palpate motor tone through passive ROM of major joints 2) Normal reflexes
92
What should a nervous system PE look like in a newborn? (what reflexes/ tests should be included?)
Palmar grasp, plantar grasp, moro reflex, asymmetric tonic neck reflex (aka fencing reflex), positive support reflex, anal reflex, positive Babinski Fencing reflex
93
Nervous system PE: Triceps, brachioradialis, and abdominal reflexes are present starting at age _____ months
6
94
List 7 tips for examining a young child
1) Use a reassuring voice throughout the examination. 2) Let the child see and touch the examination tools you will be using. 3) Avoid asking permission to examine a body part because you will do the examination anyway; instead, ask the child which body part he or she would like to have examined first. 4) Examine the child **in the parent’s lap**; allow the parent to undress the child. 5) If unable to console the child, allow a short break. 6) Examine Mom or Dad! 7) Make a game out of the examination.
95
Describe the following unique features of early childhood: 1) Vital signs 2) Neck PE (explain why) 3) Eyes
1) Measure blood pressure starting at age 2 2) Palpate for lymph nodes; adenopathy is common 3) Cover and uncover test for position and alignment of eyes
96
List the unique early childhood features of: 1) Ears 2) Nose/ sinuses
1) Visualization of tympanic membrane is the greatest challenge 2) Maxillary sinuses present by age 4
97
Early childhood PE: 1) What pulses are easier to feel? 2) What type of abdomen is normal? 3) What liver and spleen sizes are normal? 4) What may you use to ID liver edge/ size?
1) Brachial pulses still easier to feel than radial 2) Protuberant abdomen still normal 3) Liver span 1-2 cm below costal margin is still normal 4) Spleen edge 1-2 cm below costal margin is normal 5) Scratch test
98
1) Testes undescended in scrotal sac by age _____ is abnormal and need to refer 2) From 18 months to 4 years of age what is seen in the knees? 3) Inspect spine for scoliosis in what children?
1) 1 year old 2) Knock-knees 3) Any child who can stand
99
Middle Childhood (5 to 10 years): give a general description of the PE for this age group
Physical examination is more straightforward; the same sequence that is used in adults can be used starting in this age group
100
1) Frontal sinuses present between what ages? 2) Sphenoid sinuses present by what age? 3) Peak tonsil growth is between what ages?
1) 6-7 2) 8 y/o 3) 8-16
101
Early childhood PE: 1) Development of what in girls is the first sign of puberty? How early can it start? 2) What should you inspect for
1) Breast; may start as early as age 6 2) Inspect legs and feet; inspect spine for scoliosis
102
1) What are Tanner stages? 2) While the age of puberty is highly variable, generally starts around age _________. 3) What age does puberty typically start in females? And in males?
1) Sexual maturity rating, to determine stage of puberty based on primary and secondary sex characteristics 2) 10-11 3) Females ~age 11; males ~age 12
103
1) What determine stage of puberty in both males and females? 2) What are stage 1 and stage 5 in both males and females?
1) Tanner stages 2) Stage 1: “Pre-puberty”; Stage 5: Full development
104
What is the first sign of puberty in females?
Breast budding
105
1) Height: every visit 2) Weight: every visit 3) BMI (body mass index): at every visit 4) Head circumference: birth to 36 months 5) BP: start measuring at age 2 6) Pulse: higher in infancy; slows down with aging 7) RR: higher in infancy; slows down with aging 8) Temp: <2 months of age: rectal temp ≥2 months of age: tympanic temp
What 8 vital signs should you get during development? At what ages should you measure each?
106
Height, weight, BMI, BP (at age 2+)
What vital signs should be measured at every visit throughout development?
107
Pulse and RR
What vital signs are higher in infancy and slow down with aging?

(PA School Q1) HAPE (41 decks)

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