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140 Cards in this Set
- Front
- Back
Infancy includes what two parts?
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- neonatal (1-29 days)
- postneonatal (30d -1 year) |
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Identify the components of the APGAR scale.
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Appearance: 0= central cyanosis, 1= perhipheral cyanosis 2= pink
Pulse: 0= absent, 1= <100, 2= >100 Grimace: 0= none, 1= grimace, 2 = crying actively, sneeze, or cough Activity: 0= flaccid, 1= some flexion of arms and legs, 2= active movement Respirations: 0= absent, 1= slow irregular, 2= good, strong |
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The following APGAR scores at 1 min indicate what?
- 8 - 5 - 2 |
- 8: normal (8-10)
- 5: some depression (5-7) - 2: severe depression (0-4) |
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The following APGAR scores at 5 mins indicate what?
- 8 - 5 - 2 |
- 8: Normal (8-10)
- 5,2: risk for subsequent CNS depression and organ dysfunction (0-7) |
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Describe neonatal clssification by age and weight.
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Age:
- preterm: < 37wks - term: 37-42 wks - postterm: >42wks Weight: - ELBW: <1000g - VLBW: <1500g - LBW: <2500g - Nml: >2500g |
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Identify the percentile for the following:
- SGA - AGA - LGA |
- SGA: <10th
- AGA: 10-90th - LGA: >90th |
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By 1 year, an infant's weight should have ___ and height ___
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- weight tripled
- height doubled |
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At what age do normal infants:
- say 2 word phrases - follow faces - say 'dada' or 'mama' - roll over - sit - smile - pull to stand up - walk - grasp a rattle - feed self - imitates activities - use a spoon |
- 2 words: 10m
- follow faces: 0m - dada/mama: 6m - roll: 2-3m - sit: 5-6m - smile: 0m - pull to stand: 7-8m - walk: 12m - grasp rattle: 2-3m - feed self: 4-5m - imitate activities: 10m - spoon: 11-12m |
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Define failure to thrive in infants. WHat does it consist of?
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- inadequate weight gain for age.
- growth <5th percentile - growth drop >2 quartiles in 6m - weight for height <5th percentile |
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Small head size when measured may suggest ___
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premature closure of sutures or microcephaly
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Abnormally large head size when measured is called ____ and an be caused by ___
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1. macrocephaly
2. hydrocephalus, subdural bleed, tumor, genetic problem |
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A rapid heart rate too rapid to count can indicate ___
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paroxysmal SVT
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Bradycardia in infancy may be due to __
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drug ingestion, hypoxia, intracranial or neuro conditions, or arrhythmia
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Describe the average heart rate:
- 0-2m -0-6m - 6-12m |
- birth- 2m: 90-190
- 0-6m: 80-180 - 6-12m: 75-155 |
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Fever can cause increased respirations by up to ____
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10 respirations/min per degree centigrade of fever
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Cutoffs for tachypnea are:
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- 0-2m: >60/min
- 2-12m: >50/min |
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What is acrocyanosis?
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Cyanosis of hands and feet, esp if exposed to cold.
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What is lanugo?
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Fine, downy growth of hair at birth, over the entire body especially the shoulders and back. Thishair isshed within first few weeks.
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A 6 month old presents with a light-brown, flat lesion approx 1.5cm wide. It is most likely due to what?
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- cafe au-lait spot
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What is vernix?
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- vernix caeosa.
- sebum and desquamated epithelium that covers the neonatal body at birth. |
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Midline hair tufts over the lumbosacaral spine suggest __-
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Spinal cord defect
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Neonatal jaundice can be normal,b ut if it persists beyond 2-3 weeks may suggest ___
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biliary obstruction or liver disease
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Central cyanosis in a baby or any aged child should raise suspicion of ___
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congenital heart disease
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Where is the bets place to look for central cyanosis?
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- tongue and oral mucosa
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What is a "salmon patch"?
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flat, irregular, light pink patches seen on the nape of the neck, upper eyelids, forehead, or upper lip. Benign resulting rom distended capillaries and disappear by age 1
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What is a "port wine stain"?
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unilateral dark, purplish lesion over the distribution of the ophthalmic branch of trigeminal nerve - may suggest Sturge-Weber syndrome
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Significant edema in hands and feet of newborn girl may suggest ___
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turner's syndrome
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A baby is born with cyanosis in the palms of his hands and soles of his feet, this is called __-
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acrocyanosis
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Scattered vesicles on an erythematous base on the face and chest suggest ___
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Miliaria - obstructed sweat glands.
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A 2 day old infant presents iwth a rash of erythematous macules and central pinpoint vesicles scattered over teh entire body. They look like "flea bites" these suggest ___
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Erythema toxicum - disappear by 1 week on their own
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A newborn black baby presents with small vesiculopustules over a macular base. This suggests ___
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pustular melanosis
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A 2 week old infant presents with white, raised areas the size of a pin-head on his nose and cheeks. He likely has __
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Milia - retention of sebum in openings of sebaceous glands
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At birth, the anterior fontanelle measures ___
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4-6cm
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At what age does the anterior fontanelle close?
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between 4-26 months
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At what age does the posterior fontanelle close?
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- 1-2cm at birth closes by 2m
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How might the posterior fontanelle look in congenital hypothyroidsm?
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enlarged
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Bulging or tense fontanelle is seen in ____, whereas a sunken fontanelle may be a sign of __
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infants with ICP = bulging
sunken = dehydration |
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What is molding?
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- overlap of cranial bones at sutures at birth - disappears within 2 days of birth
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What is the most common dysrhythmia in infants?
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Paroxysmal SVT
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Describe normal heart finidngs in an infant.
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- split S2 (usually)
- S3 |
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Presence of S4 in pediatrics suggests ___
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decreased ventricular compliance suggesting CHF
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Common causes of heart murmurs in infans include:
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- closing ductus (transient, soft, ecjection murmur at ULSB
- Peripheral pulmonary flow (soft, ejectile, systolic, L of upper L sternal border and in lungs and axillae |
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Two common scrotal masses in newborns are __
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hydroceles and inguinal hernias, esp on the right side
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What is the Ortolani test?
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- test the presence of posterior hip dislocation : place the baby supine with legs toard you. Flex to form R angles at hips and knees. Push posteriorly
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What is the Barlow test?
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test for anterior hip dislocation: knees bent, abduct and externally rotate hip, press anteriorly from behind the leg to assess for ant. dislocation
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The Galeazzi or Alice test looks for
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- femoral shortening: bring feet to buttocks and feet flat on table - look for variations in knee height
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The most common severe congenital foot deformity is ___
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talipes equinovarus = club foot
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Babinski response to plantar stimultaion may be present in babies up to age ____
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2.
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Triceps, brachioradialis, and abdominal reflexes are difficult to elicit before what age?
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6 mos
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In assessing clonus, up to ___ pulsations are normal in newborns and young infants. Tthis is called
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- 10 pulsations
- unsustained ankle clonus |
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What are primitive reflexes?
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Responses that are typically demonstrable at birth and disappear at defined ages.
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Name the most common primitive reflexes andthe age they are commonly found
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- palmar grasp, 3-4m
- plantar grasp (feet), 0-6/8mos - Moro reflex (startle reflex), 0-4mos - Asymmetric tonic nex reflex (0-2m) - positive support reflex, 0/2m-6m - Rooting reflex (suckling) 0-4mos - Trunk incurvation 0-2m - Stepping reflexes, variable ages - Landau reflex, 0-6m - Parachute reflex 4-6 mos and doesn't go away (protective) |
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Define the following ages for dvelopmental milestones
- walking - pedaling tricycle - jumps in place - throws - plays games (peek a boo) - speaks in 2-3 words - Speaks in sentences - Copies figures and defines words - imagination present - Dresses self |
- walking 1 year
- pedaling - 4 yrs - jump in place 3 - throw 2 yrs - play peek a boo 1 year - speaks in 2-3 workds 1yr - speaks in sentences 3yr - copies and defines 5 yr - imagination 4 yr - self dress: 5yr |
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At what age range do children become capable of logical thinking?
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5-10 years
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Well child checks are recommended at what ages?
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- 12, 15, 18, 24 months and 30 months, with annual visits ages 3+
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After age 2, children should grow at least ___cm /year
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5
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Interpret the following BMI ranges for children:
- <5th percentile - >85th - >95th |
- <5th = underweight
- >85th = risk for overweight - >95th = overweight |
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What is the most frequent cause of an elevated blood pressure in kids?
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improperly performed exam, often due to wrong sized cuff
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Define the average heart rates of the following age groups:
- 1-2 yrs - 2-6 yrs - 6-10 yrs |
- 1-2: 70-150
- 2-6: 68-138 - 6-10: 65-125 |
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Sinus bradycardia in children occurs at what rate?
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- <100 in children under age 3
- <60 in children 3-9 |
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A 4 year old child presents with a grade I-II "musical" murmur at early and midsystolic stages. It is best heard ____, and is called a ___
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- best heard at mid/lower L sternal border
- Still's murmur |
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A 5 year old child presents with a contnuous humming sound that is louder in diastole. This is a ____
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venous hum
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A 6 year old child presents with early and midsystolic murmur louder on the L side and eliminated by carotied compression. This is called a ___
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Carotid bruit
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Define findings of precocious puberty in males
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- enlarged penis and testes
- signs of pubertal changes at early age. |
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Common causes of a painful testicle in children include __
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- epididymitis, orchitis, torsion of the testicle, torsion of the appendix testis
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The appearance of pubic hair before age ___ shoudl be considred precocious puberty.
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7
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A common injury in toddlers resulting from "tugging" on the radial head is ___
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nursemaid's elbow (subluxation of radial head)
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Bowing of the legs is called ___
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genu varum
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Inward bowing of the legs or "knock-knees" is called ___
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genu valgus
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A common benign murmur heard in adolescents is the ___
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pulmonary flow murmur - grade I-II/VI, soft, ejection murmur at upper L sternal border with normal S2
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A pulmonary flow murmur with a fixed split S2, suggests what?
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R heart volume load (ASD)
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masses in breasts of adolescent girls are usually
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benign fibroadenomas or cysts
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Describe the Tanner stages of female breast development.
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Stage 1: preadolescent (elevation of nipple only)
Stage 2: breast bud stage (elevation of breast and nipple as small mound, areolar enlargement Stage 3: further enlarement and elevation of breast and areola, no separation of contours Stage 4: progjection of areola and nipple to form secondary mound above level of breast Stage 5: mature - projection of nipple only, areola has receded to general contour of breast |
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Describe the sex maturity rating in boys:
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-Stage 1: no pubic hair, no change in penis size or testicular/ scrotal size
- stage 2: sparse pubiv hair, slight or no penile enlargement, testes larger, scrotum larger and slightly reddened Stage 3: darker, coarser pubic hair growing sparsely, penis larger and longer, testicles and scrotum further enlarged Stage 4: coarse and curly pubic hair as in adult, but not as great of area as adult, penis further enlarged and development of glans, testicles enlarged with scrotal skin darkened Stage 5: Adult features of pubic hair, penis size and shape, and testicular and scrotal features |
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What is the most common cause of delayed puberty in males? When is delayed puberty suspected?
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- most common cause: constitutional delay (familial issue)
- usually suspected in boys without signs of puberty by age 14 |
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Nocturnal or daytime ejaculation may begin at what sexual maturity rating stage?
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Stage 3
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Describe the tanner stages of female pubic hair development
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Stage 1: none
Stage 2: sparse growth of long, downy hair along labia Stage 3: darker, coarser, curlier hair spreading sparsely over symphysis Stage 4: Coarse and curly, greater area but doesn't include thighs Stage 5: adult growth |
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A 16 year old female presents with delayed puberty. She is 5'7" and weighs 100lbs. you should suspect _
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1. anorexia
2. chronic disease |
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An infant presents with yellowish white pustules on a red base. They are on teh cheeks. You should suspect ___
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Erythema toxicum
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An infant presents with red pustules and papules on the cheeks and nose, they have no other problems. You suspect __
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Neonatal acne
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A salmon-red, scaly eruption of the face, neck, axilla, and diaper area suggests ____
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Seborrhea
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A child has multiple >5 cafe au lait spots and axillary freckling. You should consider ___
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Neurofibromatosis
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A 6 month old presents with a bright red rask in the intriginous folds of the genitalia iwth satellite lesions along the edges...
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Candidal diaper dermatitis
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A 4 month old has had diarrhea recently. You notice a rash along the areas the diaper runs. What do you suspect?
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Contact diaper dermatitis
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___ is an infection that presents with bullous or crusty and yellowed lesions.
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Impetigo
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Adolescents can present with acne that involes open and closed ____ (blackheads and white heads) and inflamed pustules.
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Blackheads = open comedones
Whiteheads = closed comedones |
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A 10 your old presents with scaling, crusting, and hair loss along the scalp with painful plaque and enlargement of occipital lymph nodes. You suspect ____
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Tinea capitis
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A 15 year old presents with an annular lesion on the R posterior shoulder with small papules along the border. You suspect ___
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tinea corporis
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A 2 month old presents with bulging in the anterior fontanelle, eyes deviated downward, and abnormally shaped head. You suspect ___
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hydrocephalus
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What is craniosynstosis?
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premature closure of one or more sutures ofthe skull. Results in abonormal growth and shape of the head.
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A small child presents with short palpebral fissures, wide and flattened philtrum, and think lips. You suspect ___
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Fetal Alcohol syndrome
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An infant presents with coarsse facial features, low-set hair line, sparse eyebrows, and enlarged tongue. You also note a hoarse cry, umbilical hernia, and mottled skin. You believe the child may also be developmentally delayed. You suspect ___
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Congenital hypothyroid
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An infant presents with bulging of frontal bones and nasal bridge dpression. He also has significant rhinitis, and a rash around his lips. You suspect
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Congenital syphillis
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A child presents with a small, rounded head, flattened nasal bridge, prominnent epicathal folds, and very small, low ears. He also has a large tongue. You suspect ___
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down's syndrome
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A 4 year old presents with staring eyes and a large bulge on his anterior neck. He's also very tall for his age. You suspect ____
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Hyperthyroidism
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What are brushfield's spots?
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abnormal speckling spots on the iris suggest Down Syndrome
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A 6 month old presents with white plaques on the internal buccal mucosa that do not clean off with rinsing... you suspect ___
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oral candidiasis
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Tender ulcerations on the oral mucosa surrounded by erythema suggest ___
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Herpetic stomatitis
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A child presents with a murmur with the following characteristics:
- heard in the upper L sternal border - especially on ejection, with a peak in systole. |
- Pulmonary valve stenosis
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Describe teh murmur associated with an aortic valve stenosis
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- Midsternal to upper R sternal border
- radiation to carotid arteries and supraternal notch - may have thrill - harsh ejection murmur |
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What is tetralogy of Fallot?
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- VSD, malrotation of the aorta, and right-to-left shunting at VSD
- may present with pulmonic stenosis or pulmonic atresia |
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A child presents with increased cyanosis on activity, with a continuous grade IV murmur at the left sternal border that peaks on systole. You suspect
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Tetrology of fallot
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The most common congenital penile abnormality is ___
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hypospadius
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What is hypospadius?
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- urethral meatus opens abnormally on ventral surfae of the penis.
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Another word for "flat feet"
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pes planus
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Inversion of the foot suggests ____
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Varus
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Describe metatarsus adductus
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forefoot is adducted but not inverted
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Newborn health supervision visit should include:
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- bonding
- how is feeding - mom milk production - signs of dehydration - healing from delivery |
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Neonates will lose some weight after birth, but should return to birth weight by____
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1-2 weeks
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At what age should you begin considering examining a child without their parent present?
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around age 11
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How do you select the proper BP cuff size for children?
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width of cuff should be 2/3 circumference of arm.
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The most common causes of HTN for __ include:
a) infancy-preschool b) middle school c) adolescent |
a) renal artery or renal disease, coarctation of aorta
b) above + primary HTN c) primary HTN, renal disease, drug induced |
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What should you recall regarding temperatures in infants?
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- do tympanic or rectal
- fever = >100.4 in 1st 3 months, after that returns to standard 98.6 ish... |
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Children affect CO through ____
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Heart rate (can't change SV)
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What should you keep in mind regarding children presenting with abnormal respiratory rates?
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- only a few tricks in their bags, so respiratory rate can change for a lot of reasons - there IS a problem just don't necessarily tell where...
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A pt presents with a lacy reddish or purplish coloration especially when exposed to cold temperatures. This suggests __
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cutis marmorata
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Describe the differences in presentaiton of eczema among children by age.
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- young children = face and forearms (exposed surfaces)
- older kids and adults = creases of joints |
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Visual acuity charts can commonly be used with children age ____
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3+
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Children should receive a formal vision exam by age ___
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4
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____ has the highest sensitivity for hearing loss in children.
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Parental observation
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Formal hearing test should be done for children at age ___
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4
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What method do infants use for breathing?
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Obligate nose breathers
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What is choanal atresia?
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Obstruction of nasal passages that results in cyanosis at rest but pink when crying, and often won't eat due to difficulty breathign
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Pale, boggy mucosa in children or early adolescents suggests ___
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allergies
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Nasal polyps in children suggest ___
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cystic fibrosis
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A pt presents with "hypernasal speech"... you suspect ___
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Submucosal cleft palate
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A pt presents with a nasal voice and snoring, you consider ___
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adenoidal hypertrophy
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A child presents with a hoarse voice and cough, you suspect ____
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viral infection
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A child presents complaining it feels like they have "rocks in the mouth"... you suspect ___
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Tonisillitis
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Upper airway sounds in infants have what qualities?
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- same sound at nose and stethoscope
- harsh and loud - symmetric - louder as stethoscope moves superiorly - almost always inspiratory |
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Lower airway sounds in infants have what qualities?
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- different sound from nose and stethoscope
- variable harshness - asymmetric - louder in lower chest near abdomen - often has expiratory phase |
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Wheezing in infants and young children should raise suspicion of ___
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asthma or RSV
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The insp:exp ratio for respiration in children is usually __
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1:1
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An S4 sound (gallop) suggests what in children??
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CHF, poor ventricular functioning
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What findings are abnormal on cardiac auscultation?
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- clicks,
- snaps - S4 |
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Distinguish between benign and pathological murmurs in children.
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- Benign: <grade III, systolic, soft, low-pitch, vibratory, musical, humming
- Pathologic: VSD, PDA audible at 1-2 weeks, stenosis, AV regurg, ASD often >1yr |
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You palpate the abdomen of a neonate and find a small "olive-like" knot at the epigastrium... you suspect ___
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pyloric stenosis
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First sign of puberty in boys is ___ and occurs at what age?
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- enlargement of testes, age 9-13.5
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First sign of puberty in girls is ___ and occurs at what age?
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- growth spurt
- age 9.5-14.5 |
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Neonates can do what activities in each category:
- habituation - attachment - state regulation - perception |
- habituation: selectively and progressively shut out negative stimuli
- attachment - bonding with caregiver - State regulation: modulate level of arousal in response to stimulation - perception: regard faces, turn to voices, quiet in presence of singing, track colorful objects, respond to touch, recognize familiar scents |