Term
| Immunizations at birth, 2-18 mos, and 11-12 years |
|
Definition
Birth: Hep B
2-18 mos: Rotavirus, DTaP, Hib (hemophilus influenza B), PCV (pneumococcal), IPV (inactivated polio virus), influenza yearly, MMR (12 mos), Varicella (12 mos), Hep A (2 doses at 12 mos)
11-12 years: Tdap, HPV, MCV4 (meningococcal) |
|
|
Term
| ___ is used to assess neonates adaptation to extrauterine life. done at 1 min and then again at 5 min. observations are done in 5 min intervals until a score >7 is reached. |
|
Definition
|
|
Term
| Apgar scoring system: signs and scores |
|
Definition
Everything scored 0, 1, or 2
HR: absent, <100, >100
Resp effort: absent, slow and irregular, good and strong
muscle tone: flaccid, some flexion of arms and legs, active movement
reflex irritability: no response, grimace, crying vigorously and sneezing/coughing
color: blue or pale, pink body and blue extremities, pink all over
|
|
|
Term
| What are "normal" apgar scores at 1 and 5 min? |
|
Definition
1 min: 8-10
5-7 is some nervous system depression
0-4 is severe depression requiring immediate resuscitation
5 min: 8-10
0-7 is high risk for subsequent cns and organ dysfunction |
|
|
Term
| The ___ system estimates gestational age to within 2 weeks. |
|
Definition
|
|
Term
Newborn classifications:
___ is <10th percentile
___ is 10-90th percentile
___ is >90th percentile |
|
Definition
|
|
Term
| what are some concerns with preterm SGA infants? |
|
Definition
asphyxia
hypoglycemia
hypocalcemia |
|
|
Term
| what are some concerns with preterm AGA infants? |
|
Definition
respiratory distress syndrome (RDS)
apnea
patent ductus
arteriosus with left to right shunt
infection |
|
|
Term
| what are some concerns with LGA infants? |
|
Definition
common in mothers with DM
prone to birth difficulties
metabolic abnormalities shortly after birth
congenital abnormalities |
|
|
Term
abnormal enlargement of the infant head that is not present at birth but appears in <24 hours from subperiosteal hemorrhage involving outer table of one of the cranial bones.
swelling does not extend across a suture, it is occasionally bilateral following a difficult birth
swellingi s initially soft, then develops a raised bony margin within a few days from calcium deposits
tends to resolve in several weeks |
|
Definition
|
|
Term
| This cause of abnormal enlargement of infant head is when the anterior fontanelle bulges and the eyes may be deviated downward, revealing the upper scleras and creating the SETTING SUN SIGN, which is also seen briefly in some normal newborns |
|
Definition
|
|
Term
a cause of abnormal enlargement of an infants head: a condition of premature closure of one or more sutures of the skull. results in abnormal growth and shape fo the skull
scaphocephaly - saggital
frontal plagiocephaly - unilateral coronal
trigonocephaly - metopic
brachycephaly - coronal, metopic
occipital plagiocephaly - unilateral lamboid |
|
Definition
|
|
Term
THe ____ is a standard for measuring developmental milestones and detecting developmental delays in children ranging from birth to 6 y/o. it looks at 4 domains: ___, ___, ___, and ___.
this is NOT a measure of intelligence. expect delays in premies. |
|
Definition
denver developmental screening tool
personal-social, fine motor-adaptive, langauge, gross motor |
|
|
Term
|
Definition
birth-1 mon: fixes/follows, head control, responds to sounds, smiles/regards face
1-2 mos: squeals
2-3 mos: rolls over, grasps rattle, imitates speech sounds, works for toy, smiles in response to faces
4-5 mos: feeds self (holds bottle)
5-7 mos: sits up, thumb-finger grasp, says dada/mama
7-8 mos: pulls to standing position, indicates wants
9-10 mos: crawls, stands, says 2 words, imitates activities, stranger apprehension
11-12 mos: walks, 3 words, uses spoon
1 year: walks, 2-3 words, plays peek a boo, scribbles
2 year - throws, 2-3 word phrases, imitates activities,
3 years : jumps, balances on 1 foot, sentences, feeds self, asks why, telling illogical stories
4 years: hops, pedals tricycle, speech is understandable, sings, imaginative, copy circles
5 years: skips, balances, copies figures, defineswords, dresses self, plays games |
|
|
Term
| typical ages of puberty for boys and girls |
|
Definition
|
|
Term
Which tanner stage?
• No pubic hair
• Penis is same size as in childhood
• Testes and scrotum same size as in childhood |
|
Definition
|
|
Term
Which tanner stage?
•Sparse growth or long, straight pubic hair at the base of penis
•Slight or no enlargement of penis
•Testes and scrotum larger, somewhat reddened and altered in texture |
|
Definition
|
|
Term
which tanner stage?
• Darker, coarser, curlier hair spreading sparsely over pubic symphysis
• Penis is larger, especially in length
• Testes and scrotum are further enlarged |
|
Definition
|
|
Term
which tanner stage?
•Coarse and curly pubic hair over greater area than stage 3, but not as seen in adult or reaching the thighs
•Penis is larger in length and width and the glans is developed
•Testes and scrotum further enlarged and scrotal skin is darkened |
|
Definition
|
|
Term
wihch tanner stage?
• Hair is quantity and quality of adult, spread to the things but not up over the abdomen
• Penis is adult size and shape
• Testes and scrotum are adult size and shape |
|
Definition
|
|
Term
which tanner stage?
• Elevation of nipple only
• No pubic hair |
|
Definition
|
|
Term
which tanner stage?
• Breast bud stage – elevation of breast and nipple as a small mound
• Sparse, downy hair growth, chiefly along labia |
|
Definition
|
|
Term
Which tanner stage?
• Further enlargement of elevation of breast and areola – no separation of their contours
• Darker, coarser, curlier hair, spreading sparsely over the pubic symphysis |
|
Definition
|
|
Term
which tanner stage?
• Projection of areola and nipple to form a secondary mound above level of breast
• Coarse and curly hair as in adults – not yet on thighs |
|
Definition
|
|
Term
which tanner tage?
• Mature – projection of nipple only
• Hair in adult quantity and quality, on thighs but not up over abdomen |
|
Definition
|
|
Term
| what test assesses for scoliosis |
|
Definition
adam's bend test
plumb line
|
|
|
Term
| 12 step MSK sports eval for kids |
|
Definition
1. stand straight facing fwd - asymmetry or swelling of joints?
2. neck ROM
3. shrug hsoulders against resistance - trap
4. hold arms out against resistances - deltoid
5. hold arms out to side with elbows at 90 deg, raise and lower arms. ext rotation and glenohumeral joint
6. hold arms out completely bet and elbows straight
7. arms down, bent at 90 deg and pronate and supinate
8. make fist and spread fingers
9. duck walk
10. stand straight - look for scoliosis or leg length discrepency
11. adam's bend test
12. stand on heels and rise to toes |
|
|
Term
| ___ & ___ signs check for dislocation of hips in newborns |
|
Definition
|
|
Term
___ test:
- tests for presence of a posteriorly dislocated hip
- pt supine
- flex legs to form right angles at hips and knees, placing index fingers over greater trochanter of each femur and your thumbs over the lesser trochanters
- abduct both hips simultaneously until the lateral aspect of each knee touches the exam table
a palpable movement of femoral head back into place is a positive test |
|
Definition
|
|
Term
___ test:
- test for ability to sublux or dislocate an intact but unstable infant hip
- supine, with legs flexed to right angles
- press in opposite directions with your thumbs moving down toward the table and pushing the thumbs outward as you adduct the hip
- feel for lateral movement of femur
head of femur slipping out of posterior acetabulum - positive test
pos test indicates laxity of hip, not a diagnosis of dysplasia. just means baby should be followed |
|
Definition
|
|
Term
| Pos babinksi reflex can be seen in kids up to how old? |
|
Definition
|
|
Term
|
Definition
• Mental Status- assess when infant is alert
o Should be able to regard faces, turn to voices, quiet in the presence of singing, track colorful objects, and respond to touch
• Motor Function and Tone
o Look at position at rest
o Test resistance to passive movement and note spasticity or flaccidity
• Sensory Function
o Flick palm or sole with finger and look for withdrawl, arousal, and change in facial expression
o Do not use a pin to test for pain- duh!!!
• Deep tendon reflexes
o May be exaggerated or absent- this is normal
o Looking for change since previous test or extreme response
o Use index finger instead of reflex hammer
o Triceps, brachioradialis, and abdominal hard to elicit prior to 6 months
o Should have anal reflex- if not, then suspect spinal cord lesion
o (+) Babinski can be seen in normal babies up to age 2
o Ankle clonus may be present
• Primitive Reflexes (see other objective for list of these)
o Abnormalities suggest neurologic disease and indicate further evaluation
• Bates says to assess their cry- I guess just noting if it is appropriate to the situation, if |
|
|
Term
| Red flags for infant neuro exam |
|
Definition
extreme irritability
persistent asymmetry of posture
persistent extension of extremities
constant turning of head to one side
marked extension of head, neck, and extremities
severe flaccidity
limited response to pain |
|
|
Term
| how do you test CN in infants? |
|
Definition
acuity: look for baby to notice faces
light reflex (II and III): shine light in eye and look for baby to blink (optic blink reflex)
V: rooting and sucking reflexes
VII: baby's facial expressions when crying
VIII: acoustic blink reflex: blinking of both eyes in response to loud noise
IX, X: observe coordination and swallowing, test for gag reflex
XI: observe symmetry of shoulders
XII: coordination of sucking, swallowing, tongue thrusting
|
|
|
Term
| how do you test CN V in babies? |
|
Definition
|
|
Term
Red flags in pediatric neuro exam
1. spacticity, scissoring, clenched fist = ____
2. uncoordinated gait - determine __ or ___
3. weakness = ____
4. increased tone or hyperreflexia = ____ |
|
Definition
spacicity, scissoring, clenched fist - spastic diplegias
uncoordinated gait - determine ortho from neuro reason
weakness - muscular dystrophy
increased tone or hyperreflexia - cerebral palsy
peform DDST to look for developmental delays |
|
|
Term
| 2 important questions for assessing alcohol use |
|
Definition
have you ever had a drinking problem?
when was your last drink? |
|
|
Term
|
Definition
have you ever felt the need to Cut down on drinking?
have you ever feld Annoyed by criticism of your drinking?
Have you ever felt Guilty about drinking?
have you ever taken a dirnk first thing in the morning (Eye opener)?
|
|
|
Term
|
Definition
lack of child-parent bonding
stories that don't match injuries
evasive or overly defensive parents |
|
|
Term
| Indications of sexual abuse |
|
Definition
possible indications:
- marked and immediate dilation of anus in knee-chest position
- hymenal notch or cleft that extends greater than 50% of inf hymenal rim
- condyloma acuminata in child older than 3
- bruising, abrasions, lacerations, or bite marks of labia or perihymenal tissue
- herpes of anogenital area beyond neonatal period
- purulent or malodorous vaginal discharge in a young girl
strong indications:
- lacerations, ecchymoses, and newly-healed scars of the hymer or posterior fourchette
- no hymenal tissue from 3-9 o'clock
- healed hymenal transections between 3-9 o'clock
- perianal lacerations extending to external sphincter |
|
|
Term
| advance care planning includes?? |
|
Definition
end of life information
invoking pts preferences (DNR status, durable power of attorney)
identifying proxy decision makers
conveying empathy and support |
|
|
Term
| The goal of ___ care is to relieve suffering and improve quality of life for pts wtih advanced illnesses and their families throguh specific knowledge and skills, including communications with pts, family members, management of pain, psychosocial, spiritual, and bereavement support, and coordination of an array of medical and social services |
|
Definition
|
|
Term
| Kubler-Ross's 5 stages of dying |
|
Definition
denial and isolation
anger
barganing
depression/sadness
acceptance |
|
|
Term
| ___ - process that requires humility as individuals continually engage in self-reflection and self-critique as lifelong learners and reflective practitioners |
|
Definition
|
|
Term
| 3 dimensions of cultural humility |
|
Definition
self awareness
respective communication
collaborative partnerships |
|
|
Term
| ___ - the capacity to fxn effectively as an individual and an organization within the context of the cultural beliefs, behaviors and needs |
|
Definition
|
|
Term
Building blocks of professional ethics in pt care:
____: first do no harm. giving info that is incorrect or not releated to the pts problem can be harmful. avoid relevant topics or create barriers to open communication can also do harm
___: clinician needs to do good for pt. be motivated by pts best interests
___: pts have right to determine what is in their best interest. relationship should be consistent collaboration, not parental.
___: keep pt info confidential |
|
Definition
nonmaleficence or primum non nocere
beneficience
autonomy
confidentiality |
|
|
Term
Tavistock principles - ethical principles for guiding health care behavior
___: pt have a right to health and health care
___: care of pt is central but the health of population is also our concern
___: in addition to treating the illness, we have an obligation to ease suffering, minimize disability, prevent disease, and promote health
___: improve health care
___: do no harm
___: be open, honest, and trustworthy |
|
Definition
rights
balance
comprehensiveness
cooperation
improvement
safety
opennes |
|
|
Term
| Physiologic changes of aging: |
|
Definition
BP: decreases - orthostatic hypotension
HR and rhythm: maximal HR declines due to decreased # of pacemaker cells. more likely to have benign arrhythmias
Temperature: control decreases, more likely to be hypothermic
Skin: gets wrinkly
Eyes: lots of changes
Ears: higher pitches lost first
Submandibular glands: become more prominent
Lungs: mass declines, chest wall stiffer
Heart: carotid bruits, S4 normal, S3 indicates CHF,
Breasts: lose glandular tissue to fat |
|
|
Term
| average age of menstruation: |
|
Definition
|
|
Term
| what cuases the sx of menopause? |
|
Definition
|
|
Term
___ syndromes have the following features:
multifactorial origin
older and frail adults
precipitated by acute event
episodic
followed by fxnal decline
examples? |
|
Definition
geriatric
delirium, cognitive impairment, falls, dizziness, depression, incontinence, fxnal impairment |
|
|
Term
presentaiton of ___ in older adults
___: CP likeliness decreases, SOB, syncope, stroke, confusion
___: fatigue, weight loss, tachycardia
___: fatigue and weakeness are common |
|
Definition
MI
hyperthyroidsim
hypothyroidism |
|
|
Term
__% of older adults have at least 1 chronic disease and take at least 1 Rx
__% report adverse drug reactions causing hospitalization. |
|
Definition
|
|
Term
| ___ is #1 modifiable risk for falls in elderly |
|
Definition
|
|
Term
| for underweight indivuals (which most older adults are), ___ is the independent risk factor for all causes of mortality |
|
Definition
|
|
Term
| most pain in older adults is from ___ causes |
|
Definition
|
|
Term
| most common causes of acute and chronic pain in elderly |
|
Definition
acute: post surgery, trauma, headache
chronic: arthritis, CA, claudication, leg cramps, neuropathy, radiculopathy |
|
|
Term
detection of ____ in older adults:
memory loss, cognitive impairment, depression, anxiety, neglect of hygiene, nutritional deficits, sleep disruption, HTn refractory to tx, blood sugar control problems, seizure refractory to tx, impaired balance, falls, recurrent gastritis and esophagitis, difficulty managing warfarin dose |
|
Definition
|
|
Term
| immunization recommendations for elderly |
|
Definition
pneumococcal after age 65
tetanus every 5 years |
|
|
Term
| cancer screening for elderly |
|
Definition
annual or biennial mammography til 75 y/o, then every 2-3 years if life expectancy
pap smears: until 65-70
colonoscopy: every 10 yeras at age 50
check for skin and oral cancer |
|
|
Term
| a positive response to "do you feel sad or depressed?" is about ___% sensitivie for depression |
|
Definition
|
|
Term
| Dementia affects __% of people over 65 |
|
Definition
|
|
Term
| risk factors for elder abuse |
|
Definition
depression
dementia
malnutrition |
|
|
Term
| components of 10 minute geriatric screener |
|
Definition
10 minute Geriatric screener (Bates p914)
Vision
2 parts
1. Ask “do you have difficulty driving, watching TV, reading, or doing any of your daily activities because of your eyesight?
2. IF YES TO PREVIOUS: test each eye with a Snellen Eye chart (with glasses if they wear them): + if yes and inability to read greater than 20/40 on Snellen
Hearing
Use audioscope set at 40 dB. Test hearing using 1,000 and 2,000 Hz
+ if inability to hear 1,000 or 2,000 in both ears or either one in one ear.
Leg Mobility
Time patient asking them to “rise from your shair, walk 20 feet briskly, turn, and walk back to chair and sit down” + if unable to perform task in less than or equal to 15 sec.
Urinary Incontinence
2 parts
1. Ask “in the past year have you ever lost your urine and gotten wet?”
2. IF YES: Ask “Have you lost your urine on at lease 6 separate occasions?”
+ if yes to both questions
Nutrition/ Weight loss
2 Parts
1. “Have you lost 10 or more pounds in the last 6 months without trying to do so?”
2. Weight the patient
+ if yes to question or weight >100 lbs
Memory
Three item recall + if unable to recall all three items after 1 minute
Depression
“Do you often feel sad or depressed?” + if they answer yes
Physical Disability
6 questions “are you able to...”
1. “Do strenuous activities like walking fast or bicycling?”
2. “Do heavy work around the house like washing windows, walls, or floors?”
3. “Go shopping for groceries or clothes?”
4. “Get to places out of walking distance?”
5. “Bathe, either sponge bath, tub bath, or shower?”
6. “Dress, like putting on a shirt, buttoning and zipping, or putting on shoes?”
+ is yes to any of the questions |
|
|
Term
____- identifies the proportion of people who test positive in a group of people known to have a disease or condition, or the proprotion of people who are true positives compared with the total number of people who actually have the disease.
___ - identifies the proportion of people who test negative in a group of people known to be without a given disease or condition, or the proportion of people who are "True negatives" compared with the total # of people without the disease. Used to RULE IN disease.
___ - the probability of a disease in a pt with a positive (abnormal) test, or the proportion of the true positives out of the total population tested
___ - the probability of not having a condition or disease the when the test is negative or normal. or the proportion of true negatives. |
|
Definition
sensitivity
specificity
positive predictive value
negative predicitive value |
|
|
Term
infancy is divided into two periods:
___ is the first 28 days
___ is day 29 through 1 year |
|
Definition
|
|
Term
| typical sequence for newborn PE |
|
Definition
observation of parent-infant interaction
head, neck, heart, lungs, abdomen, GU
lower extremities, back
ears, mouth
eyes (whenever they're open)
skin as you go alone
neuro
hips |
|
|
Term
| a comprehensive newborn exam (NOT apgar), should be done within what period of time after birth? |
|
Definition
first day, preferrably first 8 hours
preferably 1-2 hours after feeding |
|
|
Term
| components of comprehensive newborn exam |
|
Definition
color
size
body proportions (head should be bigger)
nutritional status
posture (should be flexed)
respirations
movements
spontaneous motor activity
parent and infant interactions
head, neck, lungs, etc
|
|
|
Term
| neurological development in babies progresses in what manner? |
|
Definition
| central to peripheral -- head control before trunk control before arm control before hand control |
|
|
Term
| at what ages should infant assessment take place? |
|
Definition
first week
1, 2, 4, 6, 9, and 12 mos |
|
|
Term
| what may be a cause of projectile vomiting in the first year? |
|
Definition
|
|
Term
normal HR for babies:
0-2 mos
2-6 mos
6-12 mos |
|
Definition
0-2: 90-190 bpm
2-6: 80-180
6-12 mos: 75-155 |
|
|
Term
| normal resp rate in babies |
|
Definition
30-60
(50 is upper limit past 2 mos) |
|
|
Term
|
Definition
| soft down hair over whole body. younger gestational age = more lanugo |
|
|
Term
1. dark or bluish pigmentaiton over buttocks and lower lumbar regions. often seen in african, asian, and mediteranean descent.
2. pigmented light-brown lesions (<1-2 cm at birth)
3. blue cast to hands and feet that persists past birth
4. lattice-lick bluish mottled appearance prominent in premature infants with congenital hypothyroidism and down syndrome |
|
Definition
mongolian spots
cafe-au-lait spots
acrocyanosis
cutis marmorata |
|
|
Term
| ___ - twitching/tetanus of the masseter in response to a tap on the angle of the jaw. sign of hypocalcemia |
|
Definition
|
|
Term
| thick epicanthal folds, small head, thick tongue, low ears, short fingers, hypotonia, curving of 5th finger, brushfield spots. signs of... |
|
Definition
|
|
Term
| thin upper lip with smooth filtrum, flat face, and wideset eyes |
|
Definition
|
|
Term
|
Definition
| pupil that isn't centered |
|
|
Term
| usual development of teeth |
|
Definition
| one tooth per month from 6-26 mos until 20 teeth |
|
|
Term
| central cyanosis without acute respiratory symptoms suggests ___ dz in an infant |
|
Definition
|
|
Term
| raspberry color in infants suggests |
|
Definition
|
|
Term
2 benign murmurs in newborns:
____: transient, soft, ejection at upper lsb
___: soft, slightly ejectile, systolic to left of upper lsb and in lung fields and axillae |
|
Definition
closing ductus
peripheral pulmonary flow murmur
have NO associated findings if they are benign |
|
|
Term
| feeling an "olive" in RUQ wtih deep palpation on a baby is likely waht? |
|
Definition
|
|
Term
| most common severe congenital foot deformity is ____ |
|
Definition
| talipes equinovarus (club foot) |
|
|
Term
|
Definition
palmar grasp
startle reflex
plantar grasp
tonic neck
gallant - stimulate one side of back, that side will flex
walking reflex/standing reflex
rooting reflex
parachute reflex |
|
|
Term
| what part of childhood do you see goal-directed exploration of the world and achievement by trial and error? |
|
Definition
| middle childhood - 5-10 yrs |
|
|
Term
childhood BMI:
underweight: less than __ percentile
healthy: _-_ percentile
overweight: __-__ percentile
obese: ___ percentile or greater |
|
Definition
|
|
Term
| ___ is number 1 reason for high bp in kids |
|
Definition
|
|
Term
| #1 reason adolescents see health care providers |
|
Definition
|
|
Term
| at what age do sinuses form? |
|
Definition
maxillary: 4
sphenoid: 6
frontal: 6-7 |
|
|
Term
| child with sore throat, difficulty swallowing saliva, and sitting up in a "tripod" position. What should you NOT do? |
|
Definition
open their mouth
it's probably epiglottitis |
|
|
Term
___ an upper airway disease characterized by swelling of trachea, prolonged inspiration, and stridor/cough/ronchi (seal bark cough)
___ a lower airway disease characterized by prolonged experiation, cough and wheezing, increased work of breathing. |
|
Definition
|
|
Term
3 benign murmurs of childhood
___: grade 1-2 musical vibratory, early and midsystolic at mid/lower LSB
____: soft, hollow, continuous, under clavicle and eliminated with maneuvers that affect venous return
___: early and midsystolic. usually louds at left. elminitaed with carotid compression |
|
Definition
still's murmur
venous hum
carotid bruit |
|
|
Term
| ___ is a benign murmur in adolescents that is grade 1-2/4 soft ejection in timing at left upper sternal border |
|
Definition
|
|
Term
| ___ test will approximate liver size in children |
|
Definition
|
|
Term
| testes should be descended by age __ |
|
Definition
|
|
