Clin Skills Pediatrics

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bunhead321
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24972
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Clin Skills Pediatrics
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2010-06-27 13:54:13
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Pediatrics Physical Exam
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CS Peds Flashcards
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  1. What age is this?
    Pull to sit, but has head lag & a rounded back.
    Smiling responsively.
    Sstartled to sound.
    6 wks
  2. What age is this?
    Holding hands loosely and laughing.
    Lift head up 45-90 degrees.
    3 mo
  3. What age is this?
    No head lag & sit w/ a straight back.
    Start putting everything in their mouth.
    Reach for an object.
    5 mo
  4. What age is this?
    Bear full weight on their legs.
    Sit w/ support.
    Roll prone to supine.
    Palmar grasp w/ ulnar approach.
    6 mo
  5. What age is this?
    Roll supine to prone.
    Raking motion to pick up a pea.
    Babbling in single syllables (and combined syllables will be a month later).
    • 7 mo
    • Combined syllables at 8 mo
  6. What age is this?
    Sit steadily and lean forward, but cannot pivot.
    Stand by holding onto something.
    Pull themselves to stand.
    Inferior pincer grasp (scissor grasp).
    Localize sound @ 3 ft above & below ear level.
    Feed themselves w/ spoon occasionally.
    Look for fallen toys.
    Understand "no".
    9 mo
  7. What age is this?
    Pull self to sit.
    Able to let go of a cube in their hand.
    Wave "bye-bye".
    Play "pat-a-cake".
    10 mo
  8. What age is this?
    Creeping on all fours.
    Walking w/ 2 hands held.
    1 word w/ meaning.
    Plays "peek-a-boo".
    11 mo
  9. What age is this?
    Gets from lying to sitting to crawling to standing.
    Stands alone.
    Neat pincer grasp.
    2-3 words w/ meaning.
    1 yr (12 mo)
  10. What age is this?
    Creeping up stairs.
    Stooping for a toy and standing up w/o support.
    Tower of 2 cubes.
    Scribbling spontaneously.
    Continual jabber and jargon.
    Points to objects they want.
    Feeds self w/ cup & spoon (but spills).
    Putting everything in mouth stops.
    • 15 mo
    • Scribbling is 15-18 mo
  11. What age is this?
    Gets up & down stairs holding on to rail or w/ 1 hand held.
    Tower of 3 cubes.
    Handedness.
    Toilet trained.
    Uses spoon well.
    Points to 2-3 body parts.
    18 mo
  12. What age is this?
    Runs
    Able to throw & kick ball w/o falling.
    Tower of 6 cubes.
    Imitates cube of train w/ no chimney.
    Imitates straight line.
    2-3 word sentences.
    Puts on shoes, socks & pants.
    No wetting during the day.
    2 yrs
  13. What age is this?
    Tower of 8.
    Imitates train w/ chimney.
    Holds pencil well.
    Knows FULL name & sex.
    Names 1 color.
    2.5 yrs (30 mo)
  14. What age is this?
    Goes up stairs 1 foot per step & down stairs 2 feet per step.
    Rides a tricycle.
    Imitates a bridge w/ cubes.
    Copies a circle.
    Can count to 10.
    Names 2 colors.
    No more wetting at night.
    Plays w/ others.
    3 yrs (36 mo)
  15. What age is this?
    Skips on 1 foot.
    Hops on 1 foot.
    Names 3 colors.
    Fluent conversation.
    Attends to own toilet needs.
    Buttons clothes fully.
    4 yrs (48 mo)
  16. What age is this?
    Knows age.
    Names 4 colors.
    Tells time.
    Ties shoelaces.
    Dresses and undresses alone.
    Copies "X".
    5 yrs
  17. What age is this?
    Walks heel toe.
    Kicking, throwing, climbing.
    Copies diamond.
    Imitates or copies steps w/ 10 cubes.
    6 yrs
  18. 1 minute APGAR score is 8-10. 5 minute APGAR score is 8-10.
    This is normal
  19. 1 minute APGAR score is 5-7.
    Some nervous system depression.
  20. 1 minute APGAR score is 0-4.
    Severe CNS depression, requiring immediate resuscitation.
  21. 5 minute APGAR score is 0-7.
    High risk for subsequent CNS and other organ system dysfunction.
  22. APGAR stands for:
    • A - appearance (color)
    • P - pulse (heart rate)
    • G - grimace (reaction of suction of nares w/ bulb syringe)
    • A - activity (muscle tone)
    • R - respiration
  23. Heart rate or pulse during APGAR:
    0 -
    1 -
    2 -
    • 0 - absent
    • 1 - <100 bpm
    • 2 - >100 bpm
  24. Respiratory effort at APGAR:
    0 -
    1 -
    2 -
    • 0 - absent
    • 1 - slow and irregular
    • 2 - good and strong
  25. Muscle tone on APGAR:
    0 -
    1 -
    2 -
    • 0 - flaccid
    • 1 - some flexion of the arms & legs
    • 2 - active movement
  26. Reflex irritability / grimace / reaction to suction of nares w/ bulb syringe on APGAR:
    0 -
    1 -
    2 -
    • 0 - no response
    • 1 - grimace
    • 2 - crying vigorously, sneeze or cough
  27. Color on APGAR:
    0 -
    1 -
    2 -
    • 0 - blue, pale
    • 1 - pink body, blue extremities (acrocyanosis)
    • 2 - pink all over
  28. Newborn classifications (percentiles):
    SGA =
    AGA =
    LGA =
    • SGA = <10th
    • AGA = 10-90th
    • LGA = >90th
  29. Heart rates from birth to 1 year:
    Birth 0-2 average and range =
    0-6 mo average and range =
    6-12 mo average and range =
    • 140 and 90-190
    • 130 and 80-180
    • 115 and 75-155
  30. Which part of the blood pressure screening (systolic or diastolic) increases throughout childhood?
    Systolic
  31. Normal systolic pressure in males is __ mm Hg at birth, __ mm Hg at 1 mo, and __ mm Hg at 6 mo.
    • 70
    • 85
    • 90
  32. Rates of respirations per minute ranges between __ and __ in the newborn.
    30 and 60
  33. Body temp in infants and children is less constant than in adults. The avg rectal temp is higher in infancy and early childhood, usually above __F until after 3 yo. Body temp may fluctuate as much as __F during a single day, approaching __F in nL children, particularly in late afternoon and after vigorous activity.
    • 99
    • 3
    • 101
  34. For this technique, place the baby supine w/ the legs pointing toward you. Flex the legs to form right angles at the hips and knees, placing your index fingers over the 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 examining table. This tests for the presence of a posteriorly dislocated hip.
    • Ortolani Test
  35. For this test, press in the opposite direction w/ your thumbs moving down toward the table and outward, Feel for any movement of the head of the femur laterally. Normally there is no movement and the hip feels "stable". This tests for the ability to sublux or dislocate an intact but unstable hip.
    • Barlow Test
  36. What is this reflex?
    Place your fingers into the baby's hands and press against the palmar surfaces. The baby will flex all fingers to grasp your fingers.
    Palmar Grasp Reflex (birth to 3-4 mos)
  37. What is this reflex?
    Touch the sole at the base of the toes. The toes curl.
    Plantar Grasp Reflex (birth to 6-8 mos)
  38. What is this reflex?
    Hold the baby supine, supporting the head, back and legs. Abruptly lower the entire body about 2 feet. The arms abduct and extend, hands open, and legs flex. Baby may cry.
    Moro Reflex (Startle Reflex) (birth to 4 mos)
  39. What is this reflex?
    W/ the baby supine, turn head to 1 side, holding the jaw over the shoulder. The arms/legs on the side to which the head is turned extend while the opposite arm/leg flex.
    Assymetric Tonic Neck Reflex (birth to 2 mos)
  40. What is this reflex?
    Hold the baby around the trunk and lower until the feet touch a flat surface. The hips, knees and ankles extend, the baby stands up, partially bearing weight, and then sags after 20-30 seconds.
    Positive Support Reflex (birth or 2 mos until 6 mos)
  41. What is this reflex?
    Stroke the perioral skin at the corners of the mouth. The mouth will open and the baby will turn the head toward the stimulated side and suck.
    Rooting Reflex (birth to 3-4 mos)
  42. What is this reflex?
    Support the baby prone w/ 1 hand, and stroke 1 side of the back 1 cm from the midline, from shoulder to buttocks. The spine will curve toward the stimulated side.
    Trunk Incurvation (Galant's) Reflex (birth to 2 mos)
  43. What is this reflex?
    Hold the baby upright from behind as in positive support reflex. Have 1 sole touch the tabletop. The hip and knee of that foot will flex and the other foot will step forward. Alternate stepping will occur.
    Placing and Stepping Reflexes (birth [best after 4 days] and variable age to disappear)
  44. What is this reflex?
    Suspend the baby prone w/ 1 hand. The head will lift up, and the spine will straighten.
    Landau Reflex (birth to 6 mos)
  45. What is this reflex?
    Suspend the baby prone and slowly lower the head toward a surface. The arms and legs will extend in a protective fashion.
    Parachute Reflex (4-6 mos and doesn't disappear)
  46. BP in young and school-aged children (1-10):
    Normal =
    Prehypertensive =
    Hypertensive =
    • <90th percentile
    • 90th-95th percentile
    • >= 95th percentile
  47. Average HR of children at rest:
    1-2 yrs average and range =
    2-6 yrs average and range =
    6-10 yrs average and range =
    • 110 and 70-150
    • 103 and 68-138
    • 95 and 65-125
  48. Test for severe hip disease in a young or school aged child with its associated weakness of the gluteus medius muscle. Observe from behind as the child shifts weight from 1 leg to the other. A pelvis that remains level when weight is borne on the unaffected side is a negative sign. With an abnormal positive sign in severe hip disease, the pelvis tilts toward the unaffected hip during weight-bearing on the affected side. What test is this?
    • Trendelenburg Sign
  49. Early Adolescence -
    Middle Adolescence -
    Late Adolescence -
    • 10-14 yo
    • 15-16 yo
    • 17-20 yo
  50. Avg HR 10-14 yo =
    15 yo and older =
    • 85 (range 55-115)
    • 60-100
  51. This Tanner stage for girls is preadolescent. Elevation of nipple only.
    Stage 1
  52. This Tanner stage for girls is the breast bud stage. Elevation of breast and nipple as a small mound; enlargement of areolar diameter.
    Stage 2
  53. This Tanner stage for girls involves further enlargement of elevation of breast and areola, with no separation of their contours.
    Stage 3
  54. This Tanner stage for girls involves the projection of areola and nipple to form a secondary mound above the level of breast.
    Stage 4
  55. This Tanner stage for girls is the mature stage. Projection of nipple only. Areola has receded to general contour of the breast (although in some normal individuals, the areola continues to form a secondary mound).
    Stage 5
  56. This Tanner stage for boys is the preadolescent stage w/ no public hair except for the fine body hair (vellus hair) similar to that on the abdomen. The penis is the same size and proportions as in childhood. The testes and scrotum are the same size and proportions as in childhood.
    Stage 1
  57. This Tanner stage for boys involves sparse growth of long, slightly pigmented, downy pubic hair, straight or only slightly curled, chiefly at the base of the penis. There is slight or no enlargement of the penis. The testes are larger; scrotum is larger, somewhat reddened and altered in texture.
    Stage 2
  58. This Tanner stage for boys involves darker, coarser, curlier pubic hair spreading sparsely over the pubic symphysis. The penis is larger, especially in length. The testes and scrotum are further enlarged.
    Stage 3
  59. This Tanner stage for boys involves coarse and curly pubic hair, as in the adult; area covered greater than in earlier stages, but not as great as in the adult and not yet including the thighs. The penis is further enlarged in length and breadth, with development of the glans. The testes are further enlarged; scrotal skin is darkened.
    Stage 4
  60. This Tanner stage for boys involves pubic hair adult in quantity and quality; spread to the medial surfaces of the thighs but not up over the abdomen. The penis, testes, and scrotum are adult size and shape.
    Stage 5
  61. This Tanner stage for girls is preadolescent w/ no pubic hair except for the fine body hair (vellus hair) similar to that on the abdomen.
    Stage 1
  62. This Tanner stage for girls involes sparse growth of long, slightly pigmented downy hair, straight or only slightly curled, chiefly along the labia.
    Stage 2
  63. This Tanner stage for girls involves darker, coarser, curlier pubic hair, spreading sparsely over the pubic symphysis.
    Stage 3
  64. This Tanner stage for girls involves coarse and curly hair as in adults; area covered greater than in earlier stages, but not as great as in the adult and not yet including the thighs.
    Stage 4
  65. This Tanner stage for girls involves hair adult in quantity and quality, spread on the medial surfaces of the thighs, but not up over the abdomen.
    Stage 5
  66. These common yellow or white pustules are surrounded by a red base.
    Erythema Toxicum
  67. Red pustules and papules are most prominent over the cheeks and nose of some normal newborns.
    Neonatal Acne
  68. The salmon red, scaly eruption often involves the face, neck, axilla, diaper area, and behind the ears.
    Seborrhea
  69. Erythema, scaling, dry skin, and intense itching characterize this condition.
    Atopic Dermatitis (Eczema)
  70. Characteristic features include more than 5 café-au-lait spots and axillary freckling, both shown below. Later findings include neurofibromas and Lish nodules (not shown).
    Neurofibromatosis
  71. This bright red rash involves the intertriginous folds, with small “satellite lesions” along the edges.
    Candidal Diaper Dermatitis
  72. This irritant rash is secondary to diarrhea or irritation and is noted along contact areas (here, the area touching the diaper).
    Contact Diaper Dermatitis
  73. This infection is due to bacteria and can appear bullous or crusty and yellowed with some pus.
    Impetigo
  74. Although not present at birth, these appear within the first 24 hours from subperiosteal hemorrhage involving the outer table of one of the cranial bones. The swelling, as seen below, does not extend across a suture, though it is occasionally bilateral following a difficult birth. The swelling is initially soft, then develops a raised bony margin within a few days from calcium deposits at the edge of the periosteum. It tends to resolve within several weeks.
    Cephalohematoma
  75. In this disease, the anterior fontanelle is bulging, and the eyes may be deviated downward, revealing the upper scleras and creating the setting sun sign, as shown below. The setting sun sign is also seen briefly in some normal newborns.
    Hydrocephalus
  76. This is a condition of premature closure of one or more sutures of the skull. This results in an abnormal growth and shape of the skull because growth will occur across sutures that are not affected but not across sutures that are affected. The figures demonstrate different skull shapes associated with the various types of this condition. The prematurely closed suture line is noted by the absence of a suture line in each figure. Scaphocephaly and frontal plagiocephaly are most common. The blue shading shows areas of maximal flattening. The red arrows show the direction of continued growth across the sutures, which is normal.
    Craniosynostosis

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