The Pediatric Hisotry And Physical Examination

Front 1

Because a pediatric pt. may be less cooperative, what parts of the exam should be completed last?

Back 1

distressing portions, so that crying and yelling doesn't happen until the end

Front 2

If an infant is alert with open eyes while history is being taken, the opportunity should be taken to check what?

Back 2

the red reflexes while it is available

Front 3

Infancy (birth to 1 year)
What is the first thing that should be done in order to take the infants history?

Back 3

to take a history from the parent

Front 4

Infancy (birth to 1 year)
When taking the history from the parent, what should it include? (3)

Back 4

mother's obstetrical history, including amount and type of prenatal care

where the baby was delivered

any complications that occurred

Front 5

Infancy (birth to 1 year)
Where should the baby be examined?

Back 5

on the examination table or in the mother's arms

BE FLEXIBLE! :-)
*If the child is able to sit and wants to sit, then begin with the child sitting.

Front 6

Infancy (birth to 1 year)
How should the baby be examined? (clothing wise)

Back 6

thoroughly with clothes off, but this may be done is a sequential manner

if the infant is undressed to the diaper, be aware of the office temperature, and offer a blanket if necessary

Front 7

Infancy (birth to 1 year)
At what age do infants start to be anxious about the exam?

Back 7

7 to 8 months of age

Front 8

Infancy (birth to 1 year)
Careful observation should be made first. This can be done during what?

Back 8

while you are taking the history

Front 9

Infancy (birth to 1 year)
What things should be noted while observing an infant? (3)

Back 9

"funny looking" features
parent-child interaction
overall appearance of health

Front 10

Infancy (birth to 1 year)
When the infant is not crying, what should the dr. take the opportunity to do?

Back 10

auscultate the heart and lungs

*it is best to do this part of the exam early

Front 11

Infancy (birth to 1 year)
If the infant will not stop crying, what should the dr. do to examine the heart and the lungs?

Back 11

attempt to listen to the heart between cries

listen too the lungs during the inspiratory part of the cry

Front 12

Infancy (birth to 1 year)
What are the 5 ESSENTIAL parts o the infant examination?

Back 12

heart
eyes
pulses
hips
genitourinary

Front 13

Infancy (birth to 1 year)
Conclude the exam with the parts that are more distressing to the infant. What falls into this category? (3)

Back 13

ears
throat
hips

Front 14

Toddler (1year - 2 1/2 years)
What should the dr. do the first thing when he walks into the room? Second?

Back 14

speak to the child first. Call him by his first name.
*children usually respond positively to adults whom they sense like them.

Then, take the history from the parent

Front 15

Toddler (1year - 2 1/2 years)
Where should the examination start?

Back 15

with the child on the mother's lap

Front 16

Toddler (1year - 2 1/2 years)
What can you do to make the examination as fun as possible?

Back 16

offer to let them see your medical equipment (tongue blades, flashlight, etc.)

Front 17

Toddler (1year - 2 1/2 years)
Should you ever ask permission to the child to do something?

Back 17

NO! you will be sorry!

Say: "Open your mouth, Brittany."

Don't Say: "Will you please open your mouth, Brittany?"

Front 18

Toddler (1year - 2 1/2 years)
What 3 things should be examined first?

Back 18

heart
lungs
abdomen

Front 19

Toddler (1year - 2 1/2 years)
What two things should be examined last?

Back 19

ears
throat

Front 20

Toddler (1year - 2 1/2 years)
What should happen if a child is resistant?

Back 20

it is important they be restrained so they will not be hurt during the exam

Front 21

Toddler (1year - 2 1/2 years)
What are essential component of the exam in this age group? (3)

Back 21

heart
eyes (for strabismus)
genitourinary (for undescended testicles, imperforate hymen)

Front 22

Toddler (1year - 2 1/2 years)
When examining the eyes it is important to look for what? (1)

Back 22

strabismus

Front 23

Toddler (1year - 2 1/2 years)
When examining the genitourinary, it is important to look for what? (2)

Back 23

undescended testicles
imperforate hymen

Front 24

Toddler (1year - 2 1/2 years)
What anticipatory guidance should be given to this age group? (3)

Back 24

diet
development
**Safety**

Front 25

Toddler (1year - 2 1/2 years)
What type of screening should be taken at age 1 and age 2?

Back 25

lead screening

Front 26

Older toddler and school-aged child (2 1/2 years to teenager)
What should the dr. do the first thing when he enters into the room?

Back 26

Recognize the child by name when you enter the room.

Obtain part of the history from child

finish by take a history from the parent

Front 27

Older toddler and school-aged child (2 1/2 years to teenager)
When beginning the exam, what should the dr. do to make the child feel more comfortable?

Back 27

explain to the child what you are doing

allow them to listen with the stethoscope, look through the otoscope, etc.

Front 28

Older toddler and school-aged child (2 1/2 years to teenager)

What two things need to be addressed?

Back 28

school performance

safety

Front 29

Older toddler and school-aged child (2 1/2 years to teenager)

What are important parts of the school aged well visit? (4)

Back 29

screening for hearing, vision, anemia, and scoliosis

Front 30

Teenager

How should the history be taken?

Back 30

Begin by take the history from the parent and teenager together, talking mostly to the teenager, but making sure to get a complete history from the parent. Establish that you are the teen's doctor, not the parent's doctor.

Ask the parent to leave the room while you finish taking the history from the teenager alone.

Front 31

Teenager

What should be discussed when the dr. talks to the teenager alone once the parent has left? (8)

Back 31

Discuss the limits for confidentiality and under what conditions information obtained will be discussed with the parent.

Obtain the SOCIAL, SCHOOL, SEXUAL, and DRUG histories.

Obtain descriptions of parent, sibling, and peer relationships.

*Don't assume anything*

Be nonjudgmental, but provide encouragement for good choices.

Ask the patient whether or not the parent should be invited back into the room during the physical exam.

Front 32

Teenager

It is important for the doctor to address the teen's concern and the parents.

T or F :-) easy one!T

Back 32

true

a parent may be concerned regarding behavior issues, but a teen may be concerned regarding their acne.

Front 33

Teenager

Who should be present during sensitive parts of the examination?

Back 33

chaperone

Front 34

Teenager

What is it important to screen for at this age?

Back 34

Males: testicular examination is important because of the risk of testicular cancer

In sexually active females, a pelvic exam and Pap smear should be done

Breast self examination should be taught.

Front 35

Teenager

Is a breast examination necessary?

Back 35

no

breast self examination should be taught. It is not always necessary to do a breast examination, as cancer is very rare in this age group. Be aware of patients discomfort- best if male examines male, etc.

Front 36

What age group is it important to look at Tanner staging?

Back 36

all children

esp. preteen and teen age groups

Front 37

Tanner staging can usually be accomplished with a what?

Back 37

quick look

Front 38

Tanner staging for breast development.

Back 38

1- prepubertal
2- breast bud
3- increased size of breast tissue
4- separation of areola above breast tissue
5- adult breast

Front 39

Tanner staging for pubic hair development.

Back 39

1- prepubertal
2- light, straight, sparse hair
3- darker, coarser hair
4- adult type pubic hair, limited to pubic area
5- adult pubic hair, with extension onto medial thighs, and in males up towards the umbilicus

Front 40

Tanner staging for male genitourinary development.

Back 40

1- prepubertal child
2- enlargement of testes and scrotum
3- increase in penile length and testes growth
4- increased penile breadth and length, glans development, darkening of scrotal skin, larger testes
5- adult

Front 41

Peak height velocity for girls occurs in what Tanner stages?

Back 41

2-3

Front 42

Menarche occurs in Tanner stage__?

Back 42

4

Front 43

Peak height velocity for boys occurs after what Tanner stage?

Back 43

after Tanner stage 4

Front 44

In the U.S. the average age for menarche is___?

Back 44

12

Front 45

The average age for onset of puberty in girls (usually breast development) is ?

Back 45

9-10

Front 46

The average age for onset of puberty in boys in the U.S. is?

Back 46

11-12

Front 47

Puberty is considered "precocious" in the U.S when it occurs before age:
___ in Caucasian girls
___ in African American girls
___ in boys

Back 47

7 in Caucasian girls
6 in African American girls
9 in boys

Front 48

Puberty is considered delayed if there are no changes by age _____ in girls.

However, 1-2% of normal girls will not have experienced menarche by age____.

Back 48

14

16

Front 49

What is adrenarche?

Back 49

onset of pubic hair development

Front 50

What is adrenarche due to?

Back 50

adrenal androgen production

Front 51

In premature adrenarche levels of ____?______ may be measured.

Back 51

dehydroepiandrostenedione-sulfate

Front 52

Pelvic exams are indicated only when.....? (3)

Back 52

there is a history of sexual activity
when the child is 18 years or older
when the child reports gynecologic problems

*should be done only by the most experienced physician seeing the pt.

Front 53

When are rectal exams done?

Back 53

They are NOT done routinely on any pediatric pt. (risk of rectal carcinoma is low)

Should be performed on all pts. with a chief complaint suggestive of gastrointestinal disease, such as constipation or abdominal pain

*should be performed by the most experienced physician seeing the pt.

Front 54

What 8 things should the dr. look for when he gives a general inspection of a child?

Back 54

1. characteristics of the child's cry (strong, weak, absent, high pitched)
2. is the child alert aware of his environment or is the child listless
3. observe the child's interaction with the parent, look for unusual activity
4. determine the state of nutrition (obese? undernourished?)
5. any abnormalities in the child's feature? - compare with parent present ("FLK" funny looking kid= may have a syndrome or may have inherited features)
6. look for Down's syndrome symptoms
7. look for fetal alcohol syndrome symptoms
8. observe movements of child to make sure they are symmetrical

Front 55

What are the characteristics of Down's syndrome that are important for a dr. to look for when performing a general inspection?

Back 55

facial features with upward slanting palpebral fissures, epicanthal folds, flat nasal bridge

Brushfield spots, simian crease, wide space between first and second toes, short fifth fingers, small ears, and a flat occiput

Front 56

What are the characteristics of fetal alcohol syndrome that are important for a dr. to look for when performing a general inspection? (physical characteristics, things it is associated with, IQ?)

Back 56

narrow and widespread eyes, long single philtrum, thin upper lip, short nose and hypoplasia of the nails and distal phalanges

associated with microcephaly, growth deficiency, and congenital heart disease

IQ is usually 50 to 80
these children are usually hyperactive and have problems with fine motor skills

Front 57

Major evidence of fetal alcohol syndrome is observed in ___% to ___% of offspring of chronic severe alcoholics. What is the safe level of alcohol intake in pregnancy?

Back 57

30- 50%

there is NO safe level

Front 58

When observing a child's movements, any persistent positioning should be taken note of. This could be indicative of what?

Back 58

of a problem such as a fracture, hip dislocation, or neurological abnormality

Front 59

Which fluctuate more: body temperatures of children or adults? by how many degrees?

Back 59

children, normally higher by 1 degree F

Front 60

What is diurnal variation?

Back 60

children 2 to 6 years old may have significant diurnal variation in temp., with a pm temp as much as 1.6 degrees F higher than in the morning.

Front 61

Do infants have (less or more) diurnal variation in temperature than children?

Back 61

less

Front 62

What may infants temperature be affected by?

Back 62

environmental factors (heavily wrapped infant may have a higher temp and then when unwrapped it will go down)

Front 63

How may temperature be measured?

Back 63

rectal
axillary
tympanic
other oral measurements

Front 64

Oral temperatures are not usually taken until after what age?

Back 64

7

Front 65

What is the gold standard way of taking a temperature?

Back 65

rectal temperature...but it is used infrequently

Front 66

Axillary temperatures are usually 1 degree (higher or lower??) than oral, while rectal temperatures are usually 1 degree (higher or lower??) than oral measurement.

Back 66

Axillary temperatures are usually 1 degree LOWER than oral, while rectal temperatures are usually 1 degree HIGHER than oral measurement.

Front 67

Which way of taking a temperature may be unreliable?

Back 67

axillary temp.

Front 68

which way of taking a temperature is accurate if done correctly?

Back 68

tympanic

Front 69

What is the definition of a fever in a newborn?

Back 69

greater than 37.8 degree Celsius

Front 70

Can temperatures as high as 38.4 be normal in newborns?

Back 70

NO...but that is normal in older children

Front 71

When should temperatures be take?

Back 71

when the child is quiet, not after exercise

Front 72

How does the heart rate of a child differ from that of an adult?

Back 72

it is faster and fluctuates more in a child

as the child ages the heart rate decreases

Front 73

What is the average heart rate at birth?
What does it drop to by one year of age?

Back 73

140/min
drops to 110/min. by year one

Front 74

At what age does the average heat rate decrease below 110/min.?

Back 74

6 years old

Front 75

How can the heart rate be obtained?

Back 75

by palpating the femoral or brachial arteries or by auscultating the heart directly

Front 76

What are the characteristics of sinus tach?

Back 76

usually begins gradually

heart rate may vary by 10 to 15 beats per min.

Front 77

What are the characteristics of SVT?

Back 77

heart rate starts and stops abruptly

the rate is usually greater than 200

Front 78

What may SVT present with in infants? (3)

Back 78

irritability
decreased feeding
increased respirations

Front 79

What is a normal and common finding in a children over 3 years of age whose pulse rate increases during inspiration and decreases during expiration?

Back 79

sinus arrhythmia

Front 80

How does the respiratory rate differ from that of a child to that of an adult?

What are the respiratory rate ranges for the following: newborn, infancy, 6 yrs?

At what age does it decrease to adult levels?

Back 80

child- it is more variable and rapid

respiratory rate ranges:
30-80/ min = newborn
20-60 / min= infancy
16-25/min= 6 yrs
decreases to adult levels by 15 years of age.

Front 81

How long should the respiratory rate be measured in young children in order to be accurately determined?

Back 81

one minute

Front 82

Because diaphragmatic breathing is predominant in small children, the respiratory rate is best measured by observing what?

Back 82

abdominal (not chest) excursions

Front 83

T or F

in infancy, respirations can be irregular, intermittent, and variable in rate and depth.

Back 83

true

Front 84

What are normal (but scary to the parents) respiration patterns that can occur while an infant is sleeping?

Back 84

periodic breathing, with brief respiratory pauses of up to 10 seconds and no color change

Front 85

What is apnea?

Back 85

a respiratory pause of over 20 seconds, or one that is associated with cyanosis, pallor, or change in heart rate

Front 86

A respiratory rate greater than ____ in infants less than 2 months old, greater than ____ in 2-12 month olds, and greater than ___ in toddlers is probably abnormal.

Back 86

A respiratory rate greater than __60__ in infants less than 2 months old, greater than __50__ in 2-12 month olds, and greater than _40__ in toddlers is probably abnormal.

Front 87

At what age should the blood pressure of a child be measured?

How is blood pressure measured in younger children and infants?

Back 87

every child over 3 years of age

younger children and infants usually tested using Doppler flow techniques

Front 88

How should the blood pressure be taken in a child?

Back 88

it must be measured with a cuff that is wide enough to cover 75% of the diameter of the upper arm, but not so big that the cuff overlies the antecubital fossa, or that the bladder of the cuff overlaps itself.

Front 89

What will happen if the dr. uses a blood pressure cuff that is too large for the child's arm?

Back 89

cause readings that are falsely low

Front 90

What are the mean systolic and diastolic blood pressure readings for boys and girls?

Systolic (birth, 1 mo., 6 mo., 5 yrs, 8 yrs, 13 yrs, 18yrs.)
Diastolic (1 yr., 8 yrs., 11yrs., 18yrs.)

Back 90

BOYS
Systolic:
Birth- 70 mm Hg
1 month- 85 mm Hg
6 months- 90 mm Hg
5 years- 95 mm Hg
8 years- 100 mm Hg
13 years- 110 mm Hg
18 years- 120 mm Hg

Diastolic:
1 year- 55 mm Hg
8 years- 60 mm Hg
11 years- 65 mm Hg
18 years- 70 mm Hg

** girls are about 5 mm Hg lower than boys at all ages**

Front 91

How much lower are girls systolic and diastolic blood pressure readings?

Back 91

about 5 mm Hg lower at all ages

Front 92

What should the dr. do if the blood pressure reading is elevated?

Back 92

must measure the child's blood pressure in all 4 extremities

Front 93

What is hypertension?

Back 93

blood pressure greater than the 95% for age and sex determined on 3 different occasions

Front 94

Do children or adults have a higher incidence of secondary hypertension with elevated blood pressure?

Back 94

children

a cause for the hypertension should be sought

Front 95

What is even more important than the actual position of the child's height or weight on the chart?

Back 95

the pattern of growth

Front 96

What % of the normal population will fall outside the "normal" range on the growth chart?

Back 96

5%

Front 97

What is the most common cause of failure to thrive?

Back 97

psychosocial depreviation

Front 98

What does the growth chart look like in a child who has failure to thrive?

Back 98

the weight decreases first, then the height, and finally head circumference (an ominous sign)

Front 99

When should the head circumference be measured? How should it be plotted?

Back 99

at every visit from birth until age 3

plotted on a chart according to the child's current age, gestational age, and sex

Front 100

More than 85% of children who have a head circumference more than 2 std. deviations above or below the mean have what?

Back 100

mental retardation or other neurological problems

Front 101

What should the skin be examined thoroughly for?

Back 101

abnormalities of color, pigmentation, texture, hair distribution, and turgor

Front 102

What is skin turgor or elasticity a good indicator of?

Back 102

nutrition and hydration

Front 103

How is skin turgor estimated?

Back 103

by grasping the subcutaneous tissue over the abdominal wall between the thumb and index finger, and then releasing it

Front 104

What occurs with decreased skin turgor?

Back 104

the skin fails to snap back to its original position

occurs with intravascular volume depletion and poor nutrition

Front 105

On what day in newborn infants does normal "physiologic" jaundice appear? When does it peak? When does it disappear?

Back 105

appears on the 2nd or 3rd day
peaks about the 5th day of life
and usually disappears within a week

Front 106

Does jaundice progress from head to toe or from toe to head?

Back 106

head to toe

Front 107

How does one detect jaundice?

Back 107

apply pressure to the skin and look for yellowing "blanching"

also look at the infant's sclera

Front 108

What is a Mongolian bruise?

Back 108

a type of birthmark which may be confused with a bruise

Front 109

What disease may café au lait spots be seen in?

Back 109

neurofibromatosis

Front 110

What may tufts of hair overlying the spine be a sign of?

Back 110

underlying spina bifida occulta

Front 111

Many infants have distended capillaries at the napes of their necks. What are these called?

Back 111

stork bites

Front 112

What is the head to body weight proportion at birth?
What is the head to body length proportion at birth?

Back 112

1/3 of body weight
1/4 of body length

Front 113

What is an early indicator of motor development in infancy?

Back 113

head control

Front 114

By what month should the infant be able to steadily hold the head forward in the sitting position?

Back 114

4 mo of age

Front 115

What is macrocephaly?

Back 115

a head circumference greater than 2 std. deviations above the mean for a child of similar age and sex.

children who plot at greater than the 95th percentile on growth charts are macrocephalic

Front 116

It is important to remember, by definition, ___% of normal children will have head circumferences greater than 95the percentile.

Back 116

5%

Front 117

If a child has a large head what should you do to make sure they are ok?

Back 117

measure the parents head

they are often inheritied

Front 118

During the first 6 mo. of life, an increase in head size exceeding ____cm/month is abnormal.

Back 118

2 cm/ month

Front 119

What is the most frequent cause of macrocephaly?

What are some other causes?

Back 119

hydrocephalus

subdural hematoma, subdural effusions, intracranial tumor, thickening of the skull, benign familial megalocephaly

Front 120

What can be done in a child under 1 year of age with macrocephaly or suspected effusions?

Back 120

transillumination

Front 121

What are the steps to performing transillumination of the skull in a child with macrocephaly?

A translucent area greater than ___cm may be abnormal.

Back 121

place a flashlight equipped with a narrow, opaque rubber cuff around its glass end firmly against the infant's scalp in a darkened room.

A translucent area greater than 2 cm may be abnormal.

Front 122

What is microcephaly?

Back 122

head circumference measuring more than 2 std deviations below the mean

Front 123

A head circumference less than the 5th percentile for age and sex is regarded as what?

Back 123

microcephalic

Front 124

What are some causes of microcephaly?

Back 124

congenital infections, such as cytomegalovirus, toxoplasmosis, or syphilis, trauma, and craniosynostosis

Front 125

At birth the brain is normally ___% of its adult volume. It is ___% of its adult volume by age 1.

Back 125

25%
75%

Front 126

The bones of the skull are separated by spaces called what?

Back 126

sutures

Front 127

What are sutures?

Back 127

fibrous septa between cranial bones

Front 128

When are sutures normally not palpable anymore?

Back 128

after the 6th month of life

Front 129

When does the final closure of sutures occur?

Back 129

not until early adulthood

Front 130

Where do the sutures intersect?

Back 130

at the posterior and anterior fontanelles

Front 131

What does the anterior fontanelle measure at birth?

Back 131

4-6 cm in its largest diameter

Front 132

When does the anterior fontanelle close?

Back 132

between 4 and 26 months of age

90% close between 7 and 19 months

Front 133

Intracranial pressure is reflected by the condition of what?

Back 133

anterior fontanelle

Front 134

What kind of pressure is reflected by the condition of the anterior fontanelle?

Back 134

intracranial pressure

Front 135

What leads to depression of the anterior fontanelle?

Back 135

volume depletion

Front 136

What causes the anterior fontanelle to bulge?

Back 136

intracranial pressure

Front 137

Noramlly, is the anterior fontanelle (slightly depressed or slightly bulged?) relative to the frontal and parietal bones.

Back 137

slightly depressed

Front 138

What happens to the anterior fontanelle with crying?

Back 138

the fontanel bulges, but remains pulsatile

Front 139

Is a true bulging fontanelle visibly pulsatile?

Back 139

no

Front 140

What are causes of a bulging fontanelle? (5)

Back 140

hydrocephalus
meningitis
subdural hematoma
shaken baby
tumor

Front 141

When does the posterior fontanelle usually close to palpation?

Back 141

within a few weeks after birth, and should always close by 2 mo of age

Front 142

What is premature closure of the sutures called? and what does it present as?

Back 142

craniosynostosis and presents as asymmetry of the head or with a decreased in head growth

Front 143

Because cranial bones in infancy grow predominately at their borders, craniosynostosis can hamper normal enlargement of the head and lead to what?

Back 143

distortions

Front 144

What is 10-20% of craniosynostosis related to?

Back 144

various syndromes

Front 145

What is molding? When should it go away by?

Back 145

some overlapping of the skull bone that is commonly present at birth. Normal head shape should be regained by the 1st month of life

Front 146

What can infants do that may cause them to develop abnormal head shape without craniosynostosis?

Back 146

sleep primarily on their backs

Front 147

What is caput succedaneum?

Back 147

a diffuse boggy swelling of the scalp brought on by pressure that usually disappears by the first day or two of life. It does cross suture lines.

Front 148

What is a cephalohemotoma caused by? Does it cross suture lines? When does it usually decreased by>

Back 148

caused by a subperiosteal collection of blood over one or more flat bones of the skull.

The swelling does NOT cross suture lines.

Usually decreases by 3 to 6 weeks, but may persist

Front 149

The mastoid air cells do not fully develop until ____ years of age?

Back 149

3

Front 150

What 2 sinuses are present at birth?

Back 150

maxillary and ethmoid

Front 151

When are the maxillary and ethmoid sinuses aerated at?

Back 151

6 months

Front 152

When are the sphenoid sinuses aerated by?

Back 152

3 years

Front 153

When are the frontal sinuses aerated by?

Back 153

3-7 years

Front 154

What is a newborns visual acuity?

Back 154

can distinguish between light and dark
estimated visual aquity of 20/400

Front 155

What will usually indicate that the infant has some vision (in the absent of cortical blindness)?

Back 155

a pupillary light reflex

Front 156

What is the estimates of visual acuity at one year?

Back 156

20/40- 20/60

Front 157

By 3 years old what is visual acuity approx. at?

Back 157

20/30

Front 158

When is macular development complete?

Back 158

not until after 6-7 years of age

Front 159

20/30 vision by Snellen testing may be considered normal until what age?

Back 159

4 or 5

Front 160

How does testing for visual acuity differ from an infants to a baby that is 3 months of age?

Back 160

infants- a central and steadily maintained fixation indicates 20/200 or better vision

3 months of age- a baby should fix and follow on objects such as a human face 180 degrees

Front 161

When does a fixation reflex develop?

Back 161

in the first 1 to 2 months of life

Front 162

How can visual evoked responses be done?

Back 162

by measuring the cortical response to light on the retina

Front 163

Screening for visual acuity in toddlers can be done using what?

Back 163

standard objects
a dime recognized at 5 feet is consistent with 20/50 vision

Front 164

When should formal vision screening begin at?

Back 164

3 years of age

Front 165

What 2 things can be used for vision screening at 2 1/2 to 3 yrs of age?

Back 165

Allen picture cards: if these cards are recognized at 20 feet it indicates at least 20/30 vision.

Illiterate Snellen charts, with the E pointing different directions

Front 166

Who should the red reflex be present in?

Back 166

all children

Front 167

What can the absence of red reflex indicate?

Back 167

ataracts or retinoblastoma

Front 168

What are the 3 reasons a child may have cataracts?

Back 168

1/3 hereditary
1/3 due to syndromes
1/3 from unknown etiology or due to congenital infections

Front 169

Is the fundoscopic exam more difficult to perform in younger children or an adult?

Back 169

younger children

Front 170

Bcuz small children are usually slightly myopic, in a examiner with normal vision the retina will come to focus on ophthalmoscopy at ____ TO ____ diopter.

Back 170

-1 to -2

Front 171

On fundoscopic exam of small children, what is retinal arteries and veins ration?

Back 171

bout the same

Front 172

On fundoscopic exam, does the AV ratio decrease or increase as the child gets older?

Back 172

decrease

Front 173

What are retinal hemorrhages in infants and small children almost always a sign of?
What exam is indicated?

Back 173

child abuse (shaken baby syndrome)

a complete dilated eye exam is indicated in every case of suspected child abuse

Front 174

How does a newborns pupil at rest differ from that in older children?

Back 174

at rest a newborn's pupil is small and will contract and dilate more slowly

Front 175

Tears are present at birth, but not in response to emotion until how old?

Back 175

2nd month of life

Front 176

One third of term babies have what wrong with their eyes?

Back 176

nasolacrimal duct obstruction

Front 177

What is nasolacrimal duct obstruction caused by?

Back 177

a thin membrane located across the lower end of the tear duct

Front 178

What is the symptom of nasolacrimal duct obstruction? When does it usually clear by?

Back 178

persistent watering of the eye

usually spontaneously clear in the first few weeks of life

Front 179

In a baby with nasolacrimal duct obstruction, persistent blockage beyond 6 months of life is an indication for what? What is a potential complication?

Back 179

ophthalmology referral

potential complications include persistent conjunctivitis

Front 180

What do Brushfield spots appear as? What are they associated with?

Back 180

a speckled appearance of the iris

associated with Down's syndrome

Front 181

What is hypertelorism?

Back 181

increased distance between the eyes and is associated with many syndromes

Front 182

Where are epicanthal folds seen at? What are they associated with?

Back 182

seen at the nasal side of the eye
associated with Down's symdrome

Front 183

When may glaucoma be present?

Back 183

at birth or the first several weeks of life

Front 184

What are symptoms for glaucoma? (3)

Back 184

excessive tearing
photophobia
blepharospasm

Front 185

What happens to the cornea in a baby with glaucoma?

Back 185

the cornea increases in diameter and may be cloudy

Front 186

What happens to the pupil in a baby with glaucoma?

Back 186

it dialates

Front 187

What may happen to the eye in a baby with glaucoma?

Back 187

may enlarge overall
appears red and irritated and may be confused with conjunctivitis

Front 188

In 50% of glaucoma cases in young infants, what is the first sign?

Back 188

photophobia

Front 189

When does Strabismus commonly occur? When should it be absent by?

Back 189

occurs in the first few months of life
should be absent by 6 months of age

Front 190

What is the terminology used for Strabismus? (4)

Back 190

eso (turning inward)
exo (turning outward)
tropia (obvious, constant deviation)
phoria (a latent tendency for eye deviation)

Front 191

Constant eso or exotropia should be referred to ophthalmology is present at ____ months of age.

Back 191

3 months
in general, any strabismus noted after 6 months of age should be referred.

Front 192

What are the 3 types of strabismus?

Back 192

infantile esotropia
accommodative esotropia
nonaccommodative esotropia

Front 193

Which type of srabismus almost always required surgery?

Back 193

infantile esotropia

Front 194

What are some characteristics of infantile esotropia?

Back 194

present at birth
tends to run in families
almost always requires surgery

Front 195

What is accommodative esotropia related to?

Back 195

hyperopia

Front 196

What is nonaccommodative esotropia usually due to?

Back 196

poor vision, trauma, or prematurity

Front 197

When does accommodative esotropia occur?

Back 197

children who are farsighted compensate by increased accommodation. If the hyperopia is severe enough (+5 or +6 diopters), the eye may not be able to diverge in order to compensate for the convergence. Esotropia then develops that disappears with treatment of the hyperopia.

Front 198

Name the 2 tests for strabismus?

Back 198

corneal light reflex
alternate cover

Front 199

How in the corneal light reflex test given? What is seen if esotropia is present?

Back 199

by shining a penlight onto the eyes from a distance on 1 meter. The light reflex should occur nearly in the center or slightly to the nasal side of each pupil. Have the child first look at the light, then at a distanct object 20 feet away. If the light reflex is seen laterally on the pupil, esotropia is present.

Front 200

How is the alternate cover test given?

Back 200

by covering one eye, and seeing if eye movement occurs on removal of the eye cover

Front 201

What is the most frequent cause of visual loss in children?

Back 201

amblyopia

Front 202

When does amblyopia occur?

Back 202

normal vision development requires that the visual cortex receive focused images simultaneously from both eyes. If this does not occur the visual image from the dysfunctional eye is suppressed and amblyopia will occur.

Front 203

What are the causes for amblyopia? (3)

Back 203

strabismus
uncorrecter hyperopia or myopia
cataracts

Front 204

At what age does treatment become rarely effective for amblyopia?

Back 204

8 years old
the earlier the treatment the better the outcome

Front 205

Normally, where does the upper edge of the pinna align?

Back 205

normally, the upper edge of the pinna aligns on or above an extension of a line drawn across the inner and outer canthi of the eye.

Front 206

What do low set ears generally accompany?

Back 206

renal and auditory abnormalities

Front 207

What does otoscopic examination in the infant require? How about a toddler?

Back 207

infant- that the pinna be pulled gently downward to straighten the ear canal

(the angle of the ear canal changes as children age)

toddlers- ear must be pulled either straight back or up and back as in adults

Front 208

When examining a child's tympanic membrane what is essential?

Back 208

proper positioning

the child's head must not be mobile during the exam. If the child might move his head It should be restrained either against the table or against the parent's shoulder.

Front 209

What does pneumatic otoscopy evaluate?

Back 209

the mobility of the tympanic membrane

Front 210

Besides the pneumatic otoscopy what may also be done in infants over 6 months of age to document tympanic membrane mobility?

Back 210

tympanograms

Front 211

What is decrease mobility of the tympanic membrane the most sensitive indicator of?

Back 211

an effusion

Front 212

What may generalized erythema of the tympanic membrane be due to? (2)

Back 212

crying or fever

Front 213

What does the tympanic membrane show in a small child with suppurative otitis media?

Back 213

increased vascularity and is often bright red

it may be retracted or bulging depending on the degree of pus behind the TM

An air fluid level may be present

Front 214

What are 22 complication of otitis media?

Back 214

mastoiditis and hearing loss

Front 215

What is mastoiditis? Why is it important to detect?

Back 215

an infection in the mastoid bone

important to detect due to the possibility of intracerebral due to direct extension of the infection

Front 216

What is external otitis of the ear characterized by?
What is it usually associated with?
What will cause it to have pain?

Back 216

inflammation and redness of the ear canal

usually associated with an exposure to excess moisture

pressure of movement of the tragus usually causes pain

Front 217

What does the acoustic blink reflex involve? What is a normal response?

Back 217

creating a sudden loud noise (hand clap) about 12 inches from a child's ear

a normal response is blinking

Front 218

What are otoacoustic emissions? How can they be detected?

Back 218

faint sounds produces by the motion of the outer hair cells of the cochlea in response to a clicking noise

can be detected by a microphone sealed in the external auditory canal

Front 219

What do brainstem auditory evoked potentials measure?

Back 219

the action potentials generated from the 8th cranial nerve to the inferior colliculus of the midbrain in response to a click

Front 220

How is play audiometry done and by who?

Back 220

done by audiologists who introduce different sounds while playing with children and observe the child's response to the sounds

Front 221

At what age can formal screening of the ear be initiated?

Back 221

in the office at age 4, when child is able to cooperate

Front 222

What are important red flags to hearing loss?

Back 222

delayed speech development
parental suspicion of decreased hearing

Front 223

What children are at risk for hearing loss? (4)

Back 223

premature infants
children who have had meningitis
children with cleft palates
those with a family history of deafness

** screen these children early for hearing loss**

Front 224

The patency of the nares should b determined at birth by doing what?

Back 224

occluding one nostril at a time

Front 225

How long are infants obligate nose breathers for?

Back 225

in the first 1-3 months of life

Front 226

What is choanal astresia?

Back 226

a bony (90%) or membranous (10%) obstruction that can be either unilateral or bilateral

Front 227

What does bilateral choanal atresia present with?

Back 227

severe respiratory distress at delivery

Front 228

In an infant with bilateral choanal atresia, how is the affected infants cyanosis relieved? How is the diagnosis made?

Back 228

relieved by crying (paradoxical cyanosis)
the diagnosis is made by the inability to pass a plastic suction catheter through the nares

Front 229

In children, what may unilateral purulent or bloody nasal secretions indicate?

Back 229

the presence of an intranasal foreign body

Front 230

A child has foul smelling breath and unilateral purulent. What is the dx?

Back 230

presence of an intranasal foregin body

Front 231

What does flaring of the nasal alae during breathing usually indicate?

Back 231

respiratory distress

Front 232

What may nasal flattening in children be associated with?

Back 232

an underlying cleft palate

Front 233

What are nasal polyps usually due to?

Back 233

recurrent infection

Front 234

Nasal polyps are unusual in children less then ___ years old EXCEPT in children with what?

Back 234

unusual in less than 10 years old

EXCEPT in children with cystic fibrosis

Front 235

What % of children with cystic fibrosis develop nasal polyps?

Back 235

25%

Front 236

If a child under 10 years of age who does not have cystic fibrosis is found to have polyps, what test needs to be given? What 2 things is it crucial to rule out?

Back 236

CT

rule out glioma or encephalocele

Front 237

How should the mouth be examined in a younger child?

Back 237

should be adequately restrained and the gag reflex should be assessed only once
Never pinch the nose
Ask kids to pant like a puppy :-)

Front 238

How should the mouth of an older child be examined?

Back 238

should be given the opportunity to open their mouths widely without the use of the tongue blade

Front 239

What 3 things should the teeth be examined for? What should be noted?

Back 239

number
condition
position

whether or not the child has a normal chronology of tooth eruption

Front 240

At 10 months most children have what teeth?

Back 240

two upper and two lower central incisors

Front 241

After 10 months, how many teeth are usually added every four month?

Back 241

4 teeth are usually added ever four months (8 teeth at 14 months, 12 teeth at 18 months, 16 teeth at 22 months

Front 242

At what age does a child have a full set of teeth?

Back 242

age 2 (20 baby teeth)

Front 243

When do secondary teeth begin erupting?

Back 243

about age 7

Front 244

What are bottle carries? What are they usually due to?

Back 244

can be severe and usually affect the maxillary incisors.

they are usually due to children being put to bed with a bottle

Front 245

What can prolonged thumb sucking after 5 years of age, or pacifier or bottle use after 18 months potentially alter?

Back 245

can potentially alter the palate shape and affect growth of the mouth, causing malocclusion later in life

Front 246

What should the posterior pharynx and tonsils be examined for? (3)

Back 246

size
color
exudates

Front 247

At what age do tonsils usually enlarge?

Back 247

8 to 10 years of age

Front 248

How are tonsils usually graded?

Back 248

as 1 to 4 plus

Front 249

Tonsillar symmetry needs to be observed since asymmetrical tonsils may be due to what?

Back 249

abscess

Front 250

Is strep throat common in toddlers and infants?

Back 250

no... school aged children

children under 6 do not localize pain to the throat very well

Front 251

Is pain a symptom of tonsillitis in a young child?

Back 251

no, children under 6 do not localize pain to the throat very well, so they may not report pain

Front 252

Palatal malformations vary widely in what?

Back 252

severity

Front 253

What fraction of births is cleft palate found in? And what may is be associated with?

Back 253

1/2000 births
may be associated with cleft lip

Front 254

When is the cleft lip usually repaired?

Back 254

3 months of age

Front 255

When is the cleft palate usually repaired?

Back 255

at 8 months of age

Front 256

Children with cleft palate are at increased risk of what?

Back 256

recurrent otitis media

Front 257

What may a bifid uvula indicate?

Back 257

submucous cleft palate

Front 258

How does the neck of the newborn appear?

Back 258

relatively short

Front 259

What should the dr. check for when examining the neck? (5)

Back 259

size
anomalies
webbing ( a sign of Turner's syndrome
enlarged lymph nodes or masses
examine the thyroid gland

Front 260

Are pulsations in the jugular venous pulse that are visible when the child is sitting upright always normal or always abnormal?

Back 260

always abnormal

Front 261

What is a thyroglossal duct cyst? Where is it usually located? What happens when a pt. sticks their tongue out?

Back 261

a round smooth firm swelling 1/4 to 1 1/2 inches in diameter.

usually located in the neck midline between the tongue and suprasternal notch

the cyst moves up the neck when the tongue sticks out

Front 262

What are 3 neck abnormalities that may be seen?

Back 262

thyroglossal duct cyst
branchial cleft cysts
cystic hydromas

Front 263

Why is bacterial meningitis extremely important to diagnosis early?

Back 263

it has a high risk of mortality and morbidity

Front 264

Name 2 maneuvers for detecting meningitis that are unreliable in children under 3 years?

Back 264

Bridzinski's sign
Kernig's sign

Front 265

How is Brudzinski's sign performed when checking for meningitis?

What 3 results makes it a positive test?

Back 265

it is elicited by flexing the child's neck toward the chest while the child is lying supine.

The sign is positive for meningeal irritation if flexion of the neck simultaneously results in involuntary flexion of the hips and/or knees, resistance to flexion of the neck (stiffness) or neck pain with flexion of the neck.

Front 266

Kernig's sign is positive for meningeal irritation when?

Back 266

when there is an inability to extend the leg because of pain when one hip is flexed

Front 267

What are the characteristics of the breasts of newborns?

Back 267

they are often enlarged and engorged with white liquid referred to as witch's milk.

Front 268

Why are the breasts of newborns often enlarged and engorged with white liquid?

Back 268

it is due to the effects of maternal estrogen on the breast tissue which may last for several weeks

Front 269

The respiratory pattern needs to be inspected.
What is the breathing pattern of an infant? What does this result in?

Back 269

diaphragmatic

this results in protrusion of the abdomen during inspiration and retracted of the abdomen during expiration

Front 270

What are 3 signs of respiratory distress?

Back 270

respiratory grunting
intercostal, subcostal and supraclavicular retractions
flaring of the nostrils with breathing

Front 271

What do retractions in the chest occur due to?

Back 271

due to increased negative intrathoracic pressure from the forced expansion of the chest cage during labored breathing

Front 272

Why is it particularly important to inspect the child's breathing pattern with their shirt off?

Back 272

in order to detect retractions

Front 273

What are the characteristics of an infants chest?

Back 273

they are rounded with the antero-posterior diameter equal to the lateral diameter

Front 274

By 6 years of age, what is the ration of the transverse diameter of the chest to the AP diameter?

Back 274

3.5:1

Front 275

How may tactile fremitus be evaluated in the infant?

Back 275

while the baby cries

decreased and increased fremitus have the same implication as in the adult

Front 276

What does percussion of the normal infant chest produce?

Back 276

a hyperresonant note throughout

Front 277

Lack of hyperresonance in the infant has the same significance as ________ does in the adult

Back 277

dullness

Front 278

You are my everything!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Back 278

I love you so much honey!!!!!!!!!!!!!!!!!!!!!!!

Front 279

Back 279

:-)

Front 280

What is the difference between breath sounds of an infant/ small children and an adult?

Back 280

usually louder and harsher in infants and small children than in adults

Front 281

What are normal sounds in the lung periphery called?

Back 281

bronchovesicular or bronchial

the type of breath sound present offers little help in the diagnosis of consolidation

Front 282

Crackles and wheezes still occur in infants and have (more, the same, less) significance as they do in adults.

Back 282

the same

Front 283

How can auscultation in a crying child be timed?

Back 283

with inspiration between cries

Front 284

What is stridor?

Back 284

a characteristically harsh inspiratory noise created by obstruction of the larynx or extrathoracic trachea.

Front 285

Stridor in a child with a mild degree of narrowing may only be heard with what?

Back 285

exertion

Front 286

What is the most common acute cause of stridor?
What is the most common chronic cause?

Back 286

acute- laryngotracheaobronchitis (croup)

chronic- laryngomalacia

Front 287

When should the cardiac examination begin with? What 3 things should be noted in addition?

Back 287

inspection, notin visible cardiac impulses or precordial bulging

in addition, note the child's overall growth, color, and any dysmorphic features

Front 288

Congenital heart disease is more common in children with what?

Back 288

syndromes (ex. Down's syndrome)

Front 289

How is the apical impulse normally palpated?

Back 289

in the fourth intercostal space until age 7, when it moves to the fifth intercostal space

Front 290

Where is the apical impulse located at age 6 and age 7?

Back 290

6- fourth intercostal space
7- fifth intercostal space

Front 291

The apical impulse lies tot he left of the midclavicular line until age____, at the midclavicular line between ages ____ & ___, and it medial to the midclavicular line by age ____.

Back 291

The apical impulse lies tot he left of the midclavicular line until age_4___, at the midclavicular line between ages __4__ & _6__, and it medial to the midclavicular line by age __7__.

Front 292

How should auscultation be performed?

Back 292

while the child is both sitting and supine

Front 293

Are heart sounds in children softer or louder than adults?

Back 293

louder

Front 294

Which sound is normally louder until adolescence: aortic closure sound or pulmonary closure sound

Back 294

pulmonary closure sound

Front 295

Is splitting of the S2 normal or abnormal at the cardiac apex in many infants and small children? Why?

Back 295

normal

bcuz the pulmonary closure sound is normally louder than the aortic closure sound until asolescence

Front 296

Why is it particularly important to listen for physiologic splitting of S2 at the base of the heart?

Back 296

its presence rules out many congenital heart diseases

Front 297

Are murmurs graded differently in children vs adult? If so why?

Back 297

graded the same way

Front 298

Why is it important to distinguish innocent from pathologic murmurs?

Back 298

innocent murmors occur in the absence of cardiac pathology

Front 299

What % of children have an innocent murmur sometimes during childhood?

Back 299

over 50% or normal children

Front 300

Innocent murmurs are never solely diastolic in timing. They tend to change in character with what?

Back 300

changes in position or phase of respiration, and increase during fever, exercise or anemia

Front 301

What 3 things are innocent murmurs NEVER associated with?

Back 301

cyanosis
hepatomegaly
tachypnea

Front 302

Name the 3 most common innocent murmurs.

Back 302

A Still's murmur
venous hum
pulmonary ejection murmur

Front 303

What is Still's murmur and who is it common in?

Back 303

very common in children age 3 to 7 years. It is grade II-III, brief in duration, early to mid systolic, and heard maximally at the left sternal border. It is a vibratory murmur that decreases with standing or sitting.

Front 304

Where can a continuous venous hum be heard? What does this murmurs intensity vary with? What position is it loudest in?

Back 304

can be heard over the upper sternum, clavicle and vessels of the neck in young children.

this murmur's intensity varies with the child's head position and decreases with recumbent position (it is loudest in the upright position)

Front 305

What is a pulmonary ejection murmur and who is it common in? Where is it best heard?

Back 305

commonly heard in adolescents

this is a grade I-II, short early to midsystolic murmur, blowing in quality, best heard at the second and third interspaces of the left sternal border.

Front 306

Many pathologic murmurs are not heard until when? What is this due to?

Back 306

a few days after birth

due to the changing physiology, with the closing of the ductus arteriosis, and the increase in pulmonary blood flow that occurs in the perinatal period

Front 307

When do ductal dependent lesions usually present?

Back 307

in the first day r two of life, when physiologic closure of the patent ductus arteriosis occurs

Front 308

What 3 things does ductal dependent lesions include? (**In each of these where does the dutus provide blood flow)

Back 308

pulmonary atresia (the ductus was providing blood flow to the pulmonary circulation)

hypoplastic left heart syndrome (the ductus was providing blood flow to the systemic circulation)

Pre-ductal coarctation of the aorta (the ductus was providing blood flow to the systemic circulation).

Front 309

Infants may have Pre-ductal coarctation of the aorta, so it important to evaluate what to rule this out?

Back 309

essential to evaluate pulses in the newborn infant , comparing volume and timing between the femoral and brachial pulses

Front 310

What are murmurs to be particularly concerned about that are potentially pathologic? (5)

Back 310

pansystolic, diastolic, have abnormal S1 or S2 splits, or occur in children with signs of heart failure or abnormal pulses

Front 311

Non-ductal dependent lesions usually have a delayed presentation. What are 5 examples of this?

Back 311

ventricular septal defects
atrial septal defects
aortic valve stenosis
pulmonary valve stenosis
tetralogy of fallot

Front 312

When are ventricular septal defects usually present at?

Back 312

usually present at 2 to 4 weeks of age, when they are large

Front 313

Describe the murmurs of a child with ventricular septal defects.

Back 313

harsh, holosystolic murmurs, loudest at the lower left sternal border

Front 314

In a child with ventricular septal defects, what may they develop signs of?

Back 314

congestive heart failure (lung crackles, hepatomedaly, failure to thrive)

Front 315

In a child with ventricular septal defects, the drop in pulmonary vascular resistance during the first few weeks of life allows for what?

Back 315

increased left to right flow through the defect, and increased pulmonary congestion.

Front 316

Atrial septal defects are usually not detected until after _____year(s) of age.

Back 316

1 yr

Front 317

What do Atrial septal defects present?

Back 317

a mild ejection type murmur at the left upper sterna border

Front 318

In a child with Atrial septal defects, what is it important to identify since it is often mistaken as innocent?

Back 318

it is important to identify the widely split second sound throughout all phases of respiration, as this murmur is often mistaken as innocent

Front 319

When may aortic valve stenosis be detected? What does it present with? What does severe stenosis present with?

Back 319

at various ages, depending on the degree of stenosis

There is often an associated ejection click, and the mid systolic murmur typically radiates to the carotids.

Severe stenosis present with the same peripheral findings as in adults.

Front 320

When does pulmonary valve stenosis present itself? and what does it present as?

Back 320

present at variable ages

this mid systolic murmur is loudest at the left upper sterna border, and can be distinguished from a pulmonary flow murmur due to the associated ejection click and softening of P2

Front 321

What is Tetralogy of Fallot?
What does it consist of? (4)

Back 321

it is a complex congenital heart defect, consisting of a ventricular septal defect, right ventricular outflow obstruction (usually pulmonary stenosiss). malrotation of the aorta and right ventricular hypertrophy.

Front 322

What does the typical murmur of Tetralogy of Fallot present as?

Back 322

a mid-peaking systolic ejection murmur at the mid to upper left sterna border

Front 323

When is a third heart sound often heard? What is this thought to be due to?

Back 323

during early to middle diastole in normal children

thought to be due to the end of rapid filling of the third ventricle

Front 324

If a fourth heart sound in heard, is this considered normal or abnormal?

Back 324

abnormal

Front 325

What are 4 signs of heart failure in children?

Back 325

hepatomegaly
diaphoresis
poor feeding
respiratory distress

Front 326

How should the abdomen exam begin?

Back 326

with inspection and auscultation, and then proceed to percussion and palpation

Front 327

When palpating the abdomen, should you examine the areas of pain first or last?

Back 327

last

Front 328

How should the stomach be palpated? How bout in a crying pt.?

Back 328

examine the areas of complaint last

it is also helpful to distract the child with conversation, and relax the abdominal musculature by flexing the hip and knees.

in a crying pt., palpation is best accomplished at the time the infant inspires following a cry

Front 329

What is prune belly syndrome?

Back 329

involves atonic abdominal musculature. A scaphoid abdomen can occur in newborns with a diaphragmatic hernia

Front 330

Is "potbelly" contour normal in infants and toddlers?

Back 330

yes

Front 331

How far below the left coastal margin may the spleen in a normal newborn be palpated?

Back 331

1-2 centimeters

Front 332

At what age is anything larger than a palpable small spleen tip abnormal?

Back 332

child of any age

Front 333

What is the normal liver size in the midclavicular line, as estimated by percussion at 6 months, 3 years, 10 years, and for teenagers?

Back 333

5cm at 6 months
7cm at 3 years
8-10cm at 10 years
9-12 cm for teenagers

Front 334

The liver edge is normally palpable ____cm below the right costal margin in the midclavicular line in many children

Back 334

2cm

Front 335

Can both kidneys be normally palpable in infants and small children?

Back 335

yes

Front 336

Umbilical hernies are often found in children at what age? what race are they more common in?

Back 336

less than 2 years of age

black children

Front 337

What are umbilical hernias caused by? When do they usually resolve?

Back 337

caused by a defect in the abdominal wall that allows abdominal contents to herniate into the umbilicus

usually resolve by age 5

Front 338

In children with abdominal pain, when asked where the abdomen hurts where do they almost always point to?

Back 338

the umbilicus

Front 339

If the child points to abdominal pain anywhere else other then the umbilicus, what is there a high likelihood of?

Back 339

significant pathology

Front 340

What is the reliability for rebound tenderness in small children?

Back 340

limited reliability

Front 341

What should inspection of the musculoskeletal in children include?

Back 341

a general screening exam of spontaneous movement, posture, gait, station, and stance. Then focus on areas at risk for the child's age

Front 342

What should the posterior back of the musculoskeletal be examined for? (5)

Back 342

tufts of hair
dimples
discolorations
cysts
masses that may indicate an underlying spina bifida

Front 343

What is the name for lateral curvature of the spine?

Back 343

scoliosis

Front 344

How can scoliosis be detected? What is the steps?

Back 344

by asking the child to bend forward and marking the spinous processes with a felt-tip pen

From behind, watch for asymmetries of the scapulas, rib cage and hips, as the child slowly stands erect

Then look for a curve in the line of ink dots.

Front 345

What musculoskeletal test should be done at check-ups from age 6-7 through puberty?

Back 345

forward bending test

Front 346

When does scoliosis rapidly worsen?

Back 346

during a child's growth spurt

Front 347

How can scoliosis be quantified?

Back 347

on X-ray

Front 348

What is recommended at 20 degrees and at 40 degrees in a child with scoliosis?

Back 348

20 degrees- bracing
40 degrees- surgery

Front 349

What should the hips of all children be evaluated for? When should they be checked?

Back 349

congenital hip dislocation

during every well visit until the child is walking normally

Front 350

What gender is hip dislocation more common in?

Back 350

first born girls, particularly following a traumatic birth

Front 351

The hips are examined with what test? How is this test performed?

Back 351

Barlow's test
flex the hips and knees at 90 degrees. Gently adduct hips with gentle pressure applied to the lesser trochanter by the thumb. A palpable clunk is posterior dislocation.

Front 352

What is Ortalani's test?

Back 352

attempts to return an already dislocated hip into the acetabulum by abducting the hips

Front 353

What is a positive test present when the hips are examined for dislocation?

Back 353

a palpable clunk

Front 354

Clicking in the hips occurs in what % of newborns and is not diagnostic.

Back 354

8-10%

Front 355

How may unilateral hip dislocation affect skin folds?

Back 355

may cause the skin folds of the thighs and buttocks to be asymmetrical, with the affected side elevated

Front 356

When do the femoral head ossify? How bout those in a infant with congenital hip dislocation?

Back 356

3-6 months of age

even later in infants with congenital hip dis.

Front 357

What is used for evaluation for congenital hip dislocation in children less than 4 months of age?

Back 357

ultrasound

Front 358

The treatment of congenital hip dislocation varies by the age when it is detected.
Under 6 months?
Children 6-18 months?
Over 18 months?

Back 358

Under 6 months- treated with a Pavlik hardness
Children 6-18 months- placed in a spica cast
Over 18 months- surgery is usually required

**the risk of permanent disability increases with later detection**

Front 359

What are 5 deformities of the lower extremities that are common in infants and small children?

Back 359

Genu varum
Blount's disease
Genu Valgum
Tibial torsion
Metatatsus adductus

Front 360

Genu Varum:
What age group is it common in?
What does it cause?
How does it resolve?

Back 360

(bow legs) is common in 1 to 3 year old children. It causes an increased distance between the knees. X-rays will show symmetric bowing of the femur and tibia. This resolves with growth. Casting, bracing, shoes and surgery are not indicated.

Front 361

What is Blount's disease?
How may it be detected?
How is it treated?

Back 361

is a growth disturbance of the medial tibial epiphysis that may be confused with genu varum. The proximal tibia develops an angular deformity. Blount's disease may be detected on X-ray, which reveals abnormal fragmentation of the medial epiphysis of the tibia. Treated with surgery or bracing. If genu varum is asymmetrical, or abnormally severe, consider Blount's disease in you differential.

Front 362

What is Genu Valgum? What age group are they common in? What does it cause?

Back 362

(knock knees) are common n 3-5 year olds. It causes increased distance between feet when the knees are touching. It is self correcting?

Front 363

What is tibial torsion? What age is this seen in? At what age does it usually correct itself by?

Back 363

most common cause of in-toeing. This is nonpathologic, and seen in children under age 5. It is a rotational deformity caused by in utero molding. The hips and knees are normally aligned, but the lower leg and feet rotate inward. Prominent in toeing and frequent tripping are seen. Tibial torsion usually correct itself by age 2.

Front 364

What is metatarsus adductus? When does it self- resolve by>

Back 364

adduction of the forefoot without inversion. This positional deformity should be able to be correct to the neutral position. It self-resolves by age 1 or 2.

Front 365

What should you be careful to distinguish metatarsus adductus from?

Back 365

clubfoot, or talipes equinovarus

Front 366

What is clubfoot, or talipes equinovarus?

Back 366

a true foot deformity that cannot bee returned to the neutral position through manipulation

Front 367

How should children be dressed during the genitalia and anus exam?

Back 367

should be allowed to keep their underwear on

Front 368

When examining the genitalia in males, what should be verified?

Back 368

that both testes have descended into the scrotal sac

Front 369

In about what % of male neonates will one or two testes not be palpable in the inguinal canal or scrotum? How about in premature male infants?

When will most of these testicles descend?

Surgical correction is usually done from ____to ___ months of life in order to decrease the risk of future infertility and cancer

Back 369

3%

premature- 33%

most of these testicles will descend in the first few months of life

Front 370

Many male infants have retractile testes in the inguinal canal. How can you get them to descend?

Back 370

when placed in warm, comfortable environment like the bathtub!

Front 371

The foreskin is not retractable at birth. Approx 90% will be retractable by age ____. Circumcision for phimosis is usually not done until age ___ to ___

Back 371

The foreskin is not retractable at birth. Approx 90% will be retractable by age __3__. Circumcision for phimosis is usually not done until age _7__ to _10__

Front 372

What is ambiguous genitalia of the newborn considered?

Back 372

a medical emergency die to far reaching emotional consequences for the family when informed of the wrong sex of their newborn infant.

Front 373

Ambiguous genitalia, if due to congenital adrenal hyperplasia may cause what?

Back 373

severe electrolyte disorders that may affect the viability of the child.

Front 374

What should be checked in ambiguous babies to rule out potentially life-threatening abnormalities?

Back 374

serum eleectrolytes

Front 375

Do males or females more often present with abnormal genitalia?

Back 375

females

Front 376

Why are male infants at higher risk for SIDS?

Back 376

they do not develop ambiguous genitalia and thus their hyperkalemia is not detected as often

Front 377

What fraction of newborns present with hypospadias?

What is it important to note?

Why should you not circumcise these babies?

Back 377

1/250

note the location of the urethral meatus

Do not circumcise, as the foreskin is used for repair at approx. 1 year of age.

Front 378

Hydroceles are hernias are very common in newborn (males or females?)

Back 378

males

Front 379

If there is fluid in the scrotum, ______ is present

Back 379

a hydrocele

Front 380

If there is bowel in the scrotum, a ________ is present,

Back 380

hernia

Front 381

How are hydroceles characterized? They will usually resorb without surgery by age___?

Back 381

may fluctuate in size and transilluminate

They will usually resorb without surgery by age 18 months.

Front 382

Why are hernias always repaired when detected?

Back 382

due to the risk of bowel incarceration

Front 383

What is imperforate hymen? What will it present as?

Back 383

a thin white transparent hymenal membrane that blocks the vaginal outlet. It can be difficult to see. If there is vaginal bleeding it will present as a dark red bulge. This is a cause for delayed onset of menses.

Front 384

Labia minor adhesions are common in who? What are they caused by?

Back 384

common in prepubertal girls. They are caused by fusion of the labia minora from inflammation of the this vaginal mucosa that adheres in midline. Most lyse spontaneously.

Front 385

In children (esp. infants) a large part of the neurologic examination is obtained by careful observation of what?

Back 385

how the infant react to the environment

Front 386

What are all assessed in the neurologic examination? (8)

Back 386

positioning
degree of alertness
spontaneous movements
symmetry of movement
eye position and movements
cry and primitive reflexes
Deep tendon reflexes
Muscle tone and bulk

Front 387

What may increased or decreased muscle tone indicate?

Back 387

neurologic disease

Front 388

How should deep tendon reflexes be elicited?

Back 388

by tapping the biceps and patellar tendons

Front 389

How should the neurological examination be given in normal full-term newborns?

Back 389

lie in a symmetrical position with the limbs semi-flexed and the legs partially abducted at the hip.
The head is slightly flexed and positioned in the midline or turned to one side. Deviations from this position should be investigated.

Front 390

What are extremely important in picking up potential neurologic disease?

Back 390

developmental milestones

Front 391

It can be helpful to think of a child's development is broad categories. What are they (4)?

Back 391

gross motor
fine motor
speech
social skills

Front 392

What is a useful test when examining developmental milestones?

Back 392

Denver Developmental Screening Test

Front 393

What is the Denver Developmental Screening Test?

Back 393

provides a range of ages for expected developmental milestones. This is a highly specific screening test but not very sensitive. This means that many children with mild development delay may test as normal.

Front 394

A developmental quotient is one normative measure of development. It is equal to the ratio of what?

Back 394

the child's developmental age over their chronologic age x 100

Front 395

There should be no head lag by ____ months of age.

Back 395

4

Front 396

At __to __ an infant should be able to reach and grasp objects.

Back 396

5 to 6

Front 397

By ___ months an infant should be transferring objects from hand to hand.

Back 397

7

Front 398

By ____ months the infant should be sitting alone.

Back 398

7

Front 399

By ___ months an infant should be walking.

Back 399

14

Front 400

Speech development is extremely important to monitor. Mama and Dada should be present by ____ months of age. A specific word (ball, dog) should be present by ____months. Children should be speaking in two to three word sentences by age ___.

Back 400

Speech development is extremely important to monitor. Mama and Dada should be present by __9__ months of age. A specific word (ball, dog) should be present by __15__months. Children should be speaking in two to three word sentences by age __2 yrs_.

Front 401

A variety of primitive reflexes may be elicited in the newborn and infant. These reflexes result from a lack of what?

Back 401

lack or cortical inhibition on primitive reflexes by a nervous system that is not yet fully develop.

Front 402

What is the Babinski reflex characterized by? At what ages may this be normally present?

Back 402

by an upgoing toe in response to noxious stimulation of the S1 dermatome, may be normally present in infants and small children until 3 to 4 years of age.

Front 403

How is the Moro reflex elicited? How is it characterized? When it is present? When should it disappear?

Back 403

elicited by startling the pt.
is characterized by extension of the arms, following a flexion, clenching of the hands and flexion off the knees and hips. The infant then gives a loud cry. This reflex is present at birth and disappears normally ny about 4-5 months of age.

Front 404

A full term infant should ______ an object when placed in the palm of their hand. _______ is another reflex present at birth.

Back 404

A full term infant should _grasp_____ an object when placed in the palm of their hand. _Sucking______ is another reflex present at birth.

Front 405

The tonic neck reflex present between what ages? When does it disappear? What is tonic neck reflex describes as?

Back 405

2 weeks and 2 months of age

disappears by 4 to 6 months

when the infant's head turns to one side, the ipsilateral arm extends and the contralateral arm flexes

Front 406

What are indicators of neuromotor retardation? These may be the earliest clinical signs of cerebral palsy, neurologic problems or mental retardation.

Back 406

failure to achieve head control by 4 months of age, or the persistence of the tonic neck reflex by 6 months of age

Front 407

When is handedness decided?

Back 407

decided developmentally around 15 months of age.

Front 408

What does a definite handedness in children younger than 15 months suggests what?

Back 408

hemiparesis

Front 409

When is a cerebral thumb sign present? What disease is this a sign of?

Back 409

when the infant holds the thumb in the palm curled under flexed fingers. This is a sign of upper motor neuron disease.

Front 410

Back 410

Front 411

You are so wonderful!!!!!!!

Back 411

You are going to do great!!!!! Better than great!!!!!! You are going to do phenomenal!!!!!!!!!!!!!!