Pediatric Health Care Quiz
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Questions and Answers

Which age group is defined as preschool age?

  • 0-2 years old
  • 3-6 years old (correct)
  • 6-12 years old
  • 12-18 years old

    • What is a key feature of children in the school age category?

  • Stable growth with developing intelligence (correct)
  • High incidence of diseases
  • Strong dependency on adult behavior
  • Rapid and inconsistent growth

    • What age-related factor significantly affects kidney function in children?

  • Increased renal blood flow
  • Higher concentration of electrolytes
  • Limited kidney's ability (correct)
  • Lower body fluid composition

    • During adolescence, which statement is true regarding health care?

    <p>Emphasize educational aspects and emotional regulation (C)</p> Signup and view all the answers

    Which of the following are common risks for infants due to decreased immunologic factors?

    <p>Respiratory and gastrointestinal infections (C)</p> Signup and view all the answers

    What is a characteristic feature of the infancy growth period?

    <p>Baby weight tripled from birth weight (A)</p> Signup and view all the answers

    What method can help infants older than 6 months feel more comfortable during a physical examination?

    <p>Using a calm demeanor and a toy as distraction (A)</p> Signup and view all the answers

    What does the examiner use to gain insight into a patient's condition upon entering the room?

    <p>Observation of general appearance (D)</p> Signup and view all the answers

    What is critical when administering pediatric drug doses?

    <p>Body weight or surface area should be used (D)</p> Signup and view all the answers

    What is crucial to perform in the health care of infants and children?

    <p>Planned immunization (C)</p> Signup and view all the answers

    Which method of temperature measurement is preferred for infants and young children?

    <p>Rectal temperature recordings (A)</p> Signup and view all the answers

    At what age do yearly blood pressure measurements typically begin in children?

    <p>At 3 years (B)</p> Signup and view all the answers

    What aspects influence blood pressure thresholds for children?

    <p>Age, sex, height (B)</p> Signup and view all the answers

    Which vital sign measurement should be counted for a full 60 seconds in infants and young children?

    <p>Respiratory rate (D)</p> Signup and view all the answers

    Which of the following conditions is NOT a reason to measure blood pressure in children under the age of three?

    <p>Injury to the arm (A)</p> Signup and view all the answers

    What is the preferred method of measuring body length in a child younger than two years?

    <p>Supine position (C)</p> Signup and view all the answers

    When should occipitofrontal circumference (OFC) be measured in children?

    <p>At each visit for children with developmental complaints (C)</p> Signup and view all the answers

    What is the normal closure time for the anterior fontanelle?

    <p>Between 10 and 24 months (A)</p> Signup and view all the answers

    What factors can affect the reliability of measuring head circumference in a newborn?

    <p>Caput succedaneum or cephalohematoma (A)</p> Signup and view all the answers

    What should be assessed regarding lymph nodes during a physical examination?

    <p>Size, tenderness, consistency, and mobility (B)</p> Signup and view all the answers

    Signup and view all the answers

    Flashcards

    Pediatric Vital Signs

    Heart rate, blood pressure, and lab results vary by age in children.

    Infant Immunology

    Infants face higher infection risks due to lower immune factors at 3-5 months.

    Rapid Illness Onset

    Children's illnesses can escalate quickly with atypical symptoms.

    Importance of Fluid Therapy

    Pediatric drug dosages and fluid therapy are crucial and age-related.

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    Stages of Child Growth

    Infancy features rapid growth; toddlerhood has slower growth and increased activity.

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    Preschool Age

    Period from 3 years until 6-7 years characterized by slower growth, mature intelligence, and imitating adult behavior.

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    School Age

    From 6-7 years until adolescence, marked by steady growth, increased knowledge, and fewer diseases.

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    Adolescence

    From the onset of secondary sexual characteristics to growth cessation, encompassing major psychological and emotional changes.

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    Health Care in Preschool

    Focuses on adequate nutrition, disease prevention, and accident prevention during preschool years.

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    Physical Examination Approach

    A calm, reassuring approach is critical for infants and toddlers during physical exams, observing their behavior for insights.

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    Vital signs

    Measurements that indicate the basic functions of the body, including temperature, pulse, respiration, and blood pressure.

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    Measurement technique varies by age

    The technique and site for measuring temperature and heart rate differ depending on the patient's age.

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    Respiratory rate assessment

    Count the respiratory rate for a full 60 seconds, varying by age and activity level.

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    Blood pressure in children

    Blood pressure should be measured yearly in children ages 3 and up; younger children only when there's concern.

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    Factors affecting blood pressure

    Blood pressure norms depend on age, sex, and height in children.

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    Body Length Measurement

    In children under two, measure body length while in a supine position.

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    Height Measurement in Children

    Height should be measured with the child standing in older children.

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    Occipitofrontal Circumference (OFC)

    Measure OFC in all children at health visits from birth to three years.

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    Fontanelle Closure Timing

    Posterior fontanelle closes by 2 months; anterior by 10-24 months.

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    Early Fontanelle Closure

    Early closure of fontanelles can indicate potential microcephaly risks.

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    Study Notes

    Physical Examination

    • A physical examination of a child varies based on age
    • Infants under six months and young children often need to be held by a caregiver.
    • Use a calm approach, a pleasant smile, and/or a toy for distraction
    • Children over 30-36 months typically are cooperative
    • General appearance assessment includes comfort level, state of health, activity level, and physical characteristics.

    Pediatric Characteristics

    • Heart rate, blood pressure, routine blood test results and composition of body fluids vary by age.
    • Limited kidney function in children can lead to electrolyte and acid-base disorders
    • Children are more susceptible to hypothermia, hypoglycemia, hypoxia, and dehydration.

    Respiratory Rates

    • Respiratory rates vary based on age.
    • Infant (birth-1 year): 30-60/minute
    • Toddler (1-3 years): 24-40/minute
    • Preschooler (3-6 years): 22-34/minute
    • School-age (6-12 years): 18-25/minute
    • Adolescent (12-18 years): 12-16/minute

    Pediatric Heart Rates

    • Heart rates vary based on age
    • Infant (birth-1 year): 100-160/minute
    • Toddler (1-3 years): 90-150/minute
    • Preschooler (3-6 years): 80-140/minute
    • School-age (6-12 years): 70-120/minute
    • Adolescent (12-18 years): 60-100/minute

    Immunology

    • Infants have diminished immunoglobulin and other immunologic factors and a decreased neutrophil function.
    • This puts them at higher risk for respiratory and gastrointestinal infections.

    White Blood Cell Counts (Leukocytes)

    • White blood cell counts (WBC) vary based on age in neutrophils, lymphocytes, monocytes, and eosinophils.
    • View table for details

    Pathology

    • Illness onset can be rapid in children
    • A typical presentation of a severe infection in a newborn includes weakness, apathy, refusal to feed, without fever or elevated WBC counts.

    Treatment

    • Pediatric medication dosages are based on body weight or surface area.
    • Fluid therapy is crucial in both quantity and makeup.
    • Nutritional support is essential.

    Prognosis

    • The clinical manifestations of childhood illnesses change rapidly.
    • Children typically have a good chance of recovery.
    • Prompt diagnoses and treatments are vital.

    Prevention

    • Preventative healthcare for infants and children is essential to the field of pediatrics.
    • Immunizations (vaccination)
    • Genetic counseling and screening
    • Injury prevention
    • Parenting counseling is necessary

    Stages of Children by Age

    • Children transition through various stages throughout life

    Infancy Period

    • Rapid growth period
    • Weight triples birth weight immediately
    • Height increases 1.5 times from birth.
    • Head circumference increases from 35 to 47 cm.
    • All organs, especially the brain, continuously develop.

    Toddler Period

    • Growth slows, but intelligence and contact with objects develop quickly
    • Identifying damage is more difficult

    Preschool Age

    • Growth slows, intelligence develops.
    • Children express a strong desire for knowledge, imitate adult behavior, and have difficulty identifying damage.

    School Age

    • Growth is relatively steady
    • More mature intelligence is developed
    • Increased desire for further knowledge
    • Fewer childhood diseases and illnesses occur.

    Adolescence

    • The second period of fastest growth and development
    • Neuroendocrine regulation isn't yet fully developed
    • Emotional and psychological issues can emerge
    • Good nutritional habits and education are important

    General Measurements

    • Height/Length and weight are measured at regular well-child visits.
    • Length measurement is preferable for children under two years old
    • Standing measurements are appropriate for older children.

    Head Circumference

    • Occipitofrontal circumference (OFC) is measured in infants and children up to three years of age (at each well-child visit).
    • Measured with neurologic/developmental concerns at all ages
    • OFC measurements may be unreliable in newborns due to factors like caput succedaneum, cephalohematoma, and molding

    Examining Body Systems and Organs

    • Assessment of skin, lymph nodes, HEENT (Head, Eyes, Ears, Nose, and Throat), and neck areas

    Skin

    • Skin texture, color, pallor, cyanosis, jaundice, temperature, subcutaneous fat turgor, pigmentation, rashes are checked.
    • Weight loss evidence and signs of injury/trauma are also assessed.

    Lymph Nodes

    • Cervical, occipital, post-auricular, axillary, epitrochlear, and inguinal lymph nodes are evaluated for size, tenderness, consistency, and mobility.

    HEENT (Head, Eyes, Ears, Nose, and Throat) - Head

    • Assess size, shape, fontanelles, sutures, and scalp and hair status.
    • Fontanelle closure time varies by gestational age.
    • Early or delayed closure can indicate potential developmental disorders.

    HEENT (Head, Eyes, Ears, Nose, and Throat) - Eyes

    • Assess general appearance (strabismus, palpebral fissures, hypertelorism), pupils response to light, conjunctiva, sclera, cornea, nasolacrimal ducts, and red reflex.
    • Recognize white reflex which is a symptom of retinoblastoma

    HEENT (Head, Eyes, Ears, Nose, and Throat) - Ears

    • Check ear position (low-set ears), tympanic membranes, and hearing.

    HEENT (Head, Eyes, Ears, Nose, and Throat) - Nose

    • Evaluate nasal septum, mucosa, and sinus tenderness, and any discharge

    HEENT (Head, Eyes, Ears, Nose, and Throat) - Throat

    • Evaluate the mouth (gingiva, teeth, buccal mucosa, salivary ducts, tongue, palate, tonsils, and uvula), ulcers, herpetic stomatitis, aphthous lesions, geographic tongue, and hard/soft palate defects.
    • Note tooth development, which starts around six months old

    Neck

    • Assess for masses, torticollis, rigidity, retraction, and webbing (associated with Turner syndrome)
    • Evaluate neck structures (vessels, thyroid, trachea) to find any distention or pulsation.

    Thorax and Lungs

    • Evaluate chest wall symmetry and diameter.
    • Look for any unusual deformities like pectus excavatum (funnel chest) or pectus carinatum (pigeon breast).
    • Examine respiratory rate, rhythm, and depth.

    Lungs Sounds

    • Clear, soft breath sounds are normal.
    • Atypical sounds like crackles, rhonchi, or wheezes suggest possible pulmonary disorders.
    • Upper airway congestion can produce coarse sounds, which may be mistaken for underlying lung issues.

    Lungs Sounds (Stridor)

    • High-pitched, inspiratory stridor suggests upper airway obstruction, due to croup-like illness, structural defects, masses, foreign bodies, or external obstructions.

    Lungs Sounds (Wheeze)

    • Musical sounds heard on inspiration, expiration, or both, are often due to airway narrowing/blockage in asthma, chronic obstructive lung disease and possibly to a foreign body or tumor.

    Lungs Sounds (Rhonchi)

    • Low-pitched, musical sounds heard on inspiration, expiration, or both; possibly due to fluid films rupturing or abnormal airway collapsibility. Also possible in cases with larger airways secretions.

    Lungs Sounds (Crackles)

    • Short, explosive, nonmusical sounds, often heard on mid-to-late inspiration; possibly due to interstitial lung issues, congestive heart failure, pneumonia

    Lungs Sounds (Coarse Crackles)

    • Short, explosive sounds often heard during all phases of breathing; typically associated with intermittent airway opening, possibly related to secretions, often in bronchitis cases.

    Lungs Sounds (Pleural Friction Rub)

    • Nonmusical, potentially biphasic sounds; commonly heard in basal regions, and associated with pleural inflammation or tumors.

    Lungs Sounds (Squawk)

    • Mixed sound, with musical components alongside crackles; often associated with distal airway issues in nonacute cases, suggesting interstitial lung disease, hypersensitivity pneumonia, or pneumonia in acute cases

    Heart

    • Assess general appearance for central and peripheral coloring, nutritional status, respiratory rate, and effort.
    • Determine the presence of sweating and chest contour.
    • Observe for jugular venous distention, peripheral edema, and signs of hepatic engorgement

    Heart (Cyanosis)

    • Central cyanosis occurs when systemic arterial concentration of deoxygenated hemoglobin exceeds 5 g/dL.
    • Peripheral cyanosis occurs when systemic arterial oxygen saturation is normal but oxygen extraction is increased.

    Heart (Apical Impulses)

    • Palpation identifies apical impulse, heaves, taps, and thrills.
    • In newborns, a palpable lift is best appreciated at the left lower sternal border.
    • In cases of left ventricular hypertrophy, a heave can be best detected on the right palm.

    Heart (Auscultation)

    • Auscultation using either bell or diaphragm of stethoscope helps determine heart rate and rhythm.
    • All precordial areas, along with the back, neck, and axillary areas should be auscultated using consistent technique.

    Heart (Heart Sounds)

    • S1 is produced by atrioventricular valve closure.
    • S2 is produced by the semilunar valve closure.
    • S3 (and S4) sounds may be associated with pathologic heart conditions

    Heart Murmurs

    • Murmur intensity is graded on a scale of 1-6.
    • Grade 4 or higher often creates a precordial thrill
    • Different murmurs (systolic and diastolic) may indicate specific heart conditions.

    Abdomen

    • Inspect abdomen for shape, symmetry, pulsations, peristalsis, vascular patterns, and skin markings.
    • Palpate for tenderness, rebound, guarding, liver, spleen, and kidneys (in newborns).

    Abdomen (Protrusions)

    • Common protrusions include umbilical hernias, which often resolve spontaneously, and diastasis recti.

    Abdomen (Auscultation)

    • Active bowel sounds are normal.
    • Decreased or absent bowel sounds may suggest gastroenteritis, appendicitis, or intestinal obstruction.

    Abdomen (Percussion)

    • Percussion detects mass lesions and organ size.
    • Solid/fluid-filled structures produce dull sounds; gas-filled loops produce tympany.

    Abdomen (Ascites)

    • Percussion helps diagnose ascites, which is characterized by a fluid-filled abdomen.

    Abdomen (Palpation)

    • Palpation aids in assessing liver, spleen, and kidney size and identifying masses.
    • Tenderness should be avoided until end of examination and technique may vary depending on a patient's anatomy (obese patients might need 2 hands).

    Splenomegaly

    • Splenomegaly is graded based on palpation, following Hackett's grading system.

    Genitalia (MALES)

    • Neonatal evaluation involves carefully inspecting penile length, foreskin, urethral meatus, scrotal morphology, and testes position.
    • Uric acid crystal precipitation in diapers could be mistaken for blood.

    Genitalia (MALES) (continued)

    • Empty scrotal sacs require checking each inguinal canal for retained testicular tissue.

    Genitalia (FEMALES)

    • Neonatal genitourinary examination focuses on anatomical inspection, ensuring proper visualization of the vulvar area.

    Genitalia (ADOLESCENT MALES AND FEMALES)

    • Tanner stages help assess secondary sexual characteristic development.

    Anus and Rectum

    • Anus and rectum examinations are typically routine, with inspection focusing on perianal area skin integrity, and symmetry.

    Musculoskeletal System

    • Evaluate back posture (lordosis, scoliosis, kyphosis).
    • Examine vertebral, costovertebral tenderness, hair tufts, dimples, and masses
    • Evaluate extremities for pulses, cyanosis, clubbing, edema, length, symmetry, and deformities.
    • Assess joint range of motion and tenderness.
    • Assess musculoskeletal features like tone, atrophy, and hypertrophy.

    Hips

    • Newborns demonstrate physiological hip laxity.
    • Evaluate hip stability in infants younger than three months using the Ortolani and Barlow maneuvers.

    Neurological System

    • Observe level of alertness (quiet sleep, active sleep, awake/drowsy, alert, or crying)
    • Assess developmental reflexes (Moro, asymmetric tonic neck, trunk incurvation, plantar grasp, rooting, and parachute reflexes).
    • Test cranial nerve functionality (olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, acoustic, glossopharyngeal, vagus, spinal accessory, and hypoglossal nerves).

    Gait

    • Observe walking pattern.
    • Circumduction of a limb, broad-based gait, a high steppage gait, or other atypical walking patterns could reveal underlying conditions.

    Signs of Meningitis

    • Evaluate for signs of meningeal inflammation, such as nuchal rigidity (stiff neck) and Brudzinski's sign (neck flexion eliciting hip and knee flexion).

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    Physical Examination - Pediatric Characteristics PDF

    Description

    Test your knowledge on pediatric health care concepts, including age classifications, growth periods, and vital sign assessments. This quiz covers essential topics that every health care professional should be familiar with when working with infants and children. Challenge yourself and enhance your understanding of child health!

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