Term
| when you first walk into the room what are the three general things you should do before begining the exam? |
|
Definition
ease the child's fears, be gentile and patient
greed mother first then child, keep eye contact with mom
observe child while interviewing mother for anxiety, apathy, deformities, distress, ill look, etc |
|
|
Term
| wha are the different categories of history you should get in a pediatric exam (4) |
|
Definition
| perinatal/prenatal, routine questions, HPI, see if routine screenings are current |
|
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Term
| what questions should you ask about the perinatal/prenatal history (9) |
|
Definition
maternal health in pregnacy
gestational age
mode of delivery
birth weight
duration of hospital stay
jaundice history
breast or bottle fed
nutrition of mother
infection history |
|
|
Term
| why do we ask about the maternal health in pregnacy |
|
Definition
| complications or drug usage can cause effects on the child |
|
|
Term
| post term: qualification, what complications are there |
|
Definition
after 42 weeks
big baby can be difficult to deliver, shoulders get stuck, neck stretches, brachial plexus damage, hypoglycemia, fractures, baby poo in delivery, aspiration |
|
|
Term
| premature: wualification, complications |
|
Definition
before 37 weeks
underdeveloped baby especially lun surfactant |
|
|
Term
| why do we ask about mode of delivery |
|
Definition
| changes health of baby if there was complications. placenta seperation in utero can cause oxygen deprivation and brain damage |
|
|
Term
| why do we ask about breast of bottle feeding |
|
Definition
| breast feeding can have decreased caloric intake so you need to watch the baby's weight |
|
|
Term
| what are the rotuine questions you ask in a pediatric exam (8) |
|
Definition
developmental milestones
immunization status
behavorial problems
past medical history
hospitalizations
past surgical history
allergies
medications |
|
|
Term
| in what general order does child development occur |
|
Definition
|
|
Term
| why do we ask about behavorial problems |
|
Definition
| issues can show signs of autism, retardation, learning dissabilities, teen drug use or sex |
|
|
Term
| why do we ask about hospitalizations |
|
Definition
| shows if they are taking care of their disease and the severity of it |
|
|
Term
| why do we ask about past surgical history |
|
Definition
| we need to know if they have all their organs or if their issue is a surgical complication |
|
|
Term
| if pt says they have pain what do you ask |
|
Definition
| site, radiation, severity, timing, character, reliving factors |
|
|
Term
| if pt says they have vomitting what do you ask |
|
Definition
| frequency, color (blood or bile), amount to indicate fluid loss |
|
|
Term
| if pt says they have diarrhea what do you ask |
|
Definition
| frequency, amount, consistency, blood or mucous, odor, relation to food, is it just from breast feeding |
|
|
Term
| if pt says they have constipation what do you ask |
|
Definition
| frequency, medications, pellets, hard, infrequent |
|
|
Term
| if pt says they have jaundice what do you ask |
|
Definition
| duration, color of feces or urine, itchiness of skin, contacts, recent transfusion or injection |
|
|
Term
| if pt says they have SOB what do you ask |
|
Definition
| at rest of exhalation, relation to posture,cough or wheeze, chest pain, worse when laying down (heart indication), worse when sitting up |
|
|
Term
| if pt says they have headaches what do you ask |
|
Definition
| location, duration, severity, aggrivating or relieving factors, medications, associated features |
|
|
Term
| why is asking about appetite so important |
|
Definition
| kids loose appetite really fast, it shows they are pretty sick |
|
|
Term
| what type of screening labs or testing should be done (or made sure they were done as a newborn)(9) |
|
Definition
| newborn metabolic screening, Hb electrophoresis, hearing evaluation, vision evaluation, anemia screening, lead screening, TB testing, cholesterol testing if indicated, STD testing if indicated |
|
|
Term
| what is tested in a newborn metabolic screening |
|
Definition
| PKU, galactosemia, congenital hypothyroidism, maple sugar urine disease, cystic fibrosis |
|
|
Term
| how does cystic fibrosis testing work |
|
Definition
| tests for immunoractive trupsinogen (IRT). not definitive, need a DNA test if positive |
|
|
Term
| what does Hb electrophoresis do, why do we make sure kids have it done |
|
Definition
| tests for hemoglobinopathies because they increase the risk for infection and anemia complications |
|
|
Term
| how are newborn hearing evaluations done and when |
|
Definition
performed before nursery discharge
sounds played into headphones and electrodes measure response |
|
|
Term
| how do you screen hearing in an infant or toddler |
|
Definition
ask parents to examine speech and language
behavorial audiology: reaction to sound frequency and intensity |
|
|
Term
| how to you screen hearing in a 3 yo+ |
|
Definition
ask family about concerns
at age 4 child can identify sounds |
|
|
Term
| how do you screen for vision in an infant and toddler |
|
Definition
| evaluate gross motor skills, referral to pedatric opthalmologist if concerned |
|
|
Term
| how do you screen for vision in a 3 yo+ |
|
Definition
ask family about concerns
do a vision screen every 3-6 months to monitor |
|
|
Term
| why is it important that infants get anemia screen, when is it done |
|
Definition
anemic infants do not develop well
birth, 12 mo, and 4 mo if risk like low birth weight or premature baby |
|
|
Term
| why do we screen kids for lead, where do they come in contact with it |
|
Definition
lead intoxication can cause irreversable developmental and behavorial abnormalities at 5-10 ug/dL
at 20 ug/dL a enivornmental investigation is done
found in old homes with peeling paint, industrial exposure, foreign medications, pottery |
|
|
Term
| when do we screen for lead, how is it done |
|
Definition
collect blood from veins because arteries give false positives
12 and 24 mo |
|
|
Term
| when do you first test a child for TB and by what method, how is it determined positive |
|
Definition
tested at 1 yo via intradermal PPD
if size is >10 mm in 48-72 h it is positive
if >5mm in HIV pt it is positive |
|
|
Term
| why would a child get a cholesterol check, what are normal levels |
|
Definition
if family history of cardiovascular disease or parent with high cholesterol
lipid fasting profile normal is 170-199 mg/dL |
|
|
Term
| when should kids start to get STD testing, what qualifications |
|
Definition
at 12yo+ get a confidential physical exam and sexual history, order STD tests yearly if positive for sexual history
girls should get HPV testing 3 years after vaginal intercourse or at 21 |
|
|
Term
| what are the parts of a well visit dental exam |
|
Definition
identify cariees, inflammation, malocclusion, apply dental varnish
education: see dentist every 6 mo, instruct on brushing and flossing |
|
|
Term
| what is the nutrition assessment of well exam |
|
Definition
plot growth on chart
evaluate dietary history for nutrition deficits |
|
|
Term
| what should anticipatory guidance should be given during the educational part of a well visit |
|
Definition
| injury prevention, violence prevention, sleep positioning counseling |
|
|
Term
| what should be done on the general part of the physical exam |
|
Definition
| height, weight, temp, hr, respiratory rate, bp, head circumference |
|
|
Term
| why do we check head circumference, what does it mean if it is too small or big |
|
Definition
too big: CSF hydrocephalus
too small: fusion early which could lead to herniation, small brain
measure for 3 years |
|
|
Term
| what are the 6 parts of the general objective exam that should come just before the hands on physical exam |
|
Definition
mood: agitation, distress, iritability
affect: depression, mood
deformities or disability
gair
speech
hydration status |
|
|
Term
| physical exam of head: what do you look for and what does it mean |
|
Definition
shape: smooshed after delivery is temporary, could indicate bleed, permament fusion
frontanelles: sunken means dehydration, bulging means increased icp, seen for 1.5 years
sutures open or closed |
|
|
Term
| physical exam eyes: what do you look for and what does it mean |
|
Definition
peerla, eom, alignment
red reflex: tests for cataracts, tumor |
|
|
Term
| physical exam ears: what do you look for and what does it mean |
|
Definition
location: low set in down syndrome
shape: malformation could indicate renal cyst
canal and membranes |
|
|
Term
| physical exam nose, throat, pharynx |
|
Definition
| discharge, turbinates, throat, pharynx |
|
|
Term
|
Definition
| stiff, masses, swellings, thyroid |
|
|
Term
|
Definition
| shape, respiration/muscle tone, cardiac thrills, percussion, focal fermentus, ascultation lungs, |
|
|
Term
| what are the signs of respiratory distress |
|
Definition
| grunting, flare of nostrils, retraction of subcostal area |
|
|
Term
|
Definition
identify heart sounds, murmmur, and thrills
peripherial pulses |
|
|
Term
|
Definition
| shape, masses, tenderness, bowl sounds, rectal exam, liver, spleen, rebound tenderness, ascultation |
|
|
Term
|
Definition
|
|
Term
| physical exam extremities and spine |
|
Definition
| deformities, shape, swelling, rom, scolosis |
|
|
Term
|
Definition
| gait, balance, cn, reflexes, cerebellar signs |
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