Questions and Answers
What happens to the heart rate as a child ages from infancy to adolescence?
What is the normal range for blood pressure in children aged 4 to 12 years?
What method is recommended for taking the apical pulse in children up to 7 years?
When measuring blood pressure in children older than 3 years, where should the cuff be placed?
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How should respirations be observed in children up to 7 years old?
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What is the significance of Tanner stages in pediatric assessments?
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What is the correct description of downy hair in males during Stage 3 of development?
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At what age does the anterior fontanelle typically close?
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In infants, what is the primary breathing pattern until about 6-7 years of age?
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What indicates a positive Ortolani test in newborns?
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When assessing a child's PMI, where should you palpate in children under the age of 4?
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What defines abnormal central cyanosis in a newborn?
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How should you manipulate the ear during a pediatric assessment?
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What is the correct procedure for performing Barlow's test on a newborn?
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What indicates a positive Galeazzi sign?
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What is indicated by the Trendelenburg sign?
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What is the normal shape of an infant's abdomen?
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At what age does the normal Babinski reflex typically disappear in infants?
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Which condition is characterized by projectile vomiting and a palpable mass in the upper abdomen?
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What diagnostic test is used to assess for scoliosis?
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What should be done if an umbilical hernia does not require surgery?
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Which sign is associated with hip disease and entails weakness of the hip abductors?
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Study Notes
Pediatric Vital Signs Changes
- Heart rate (HR) and respiratory rate (RR) decrease with age, while blood pressure (BP) increases.
- Pediatric blood pressure norms:
- Newborn - 6 months: 65-90 / 45-65 mmHg
- 6 months - 3 years: 80-105 / 55-70 mmHg
- 4 - 12 years: 95-120 / 60-75 mmHg
- Over 12 years: 110-120 / 65-85 mmHg
Vital Signs Measurement Techniques
- Temperature: Use axillary or oral method; normal range is 97.9-99°F (36.6-37.2°C).
- Heart Rate: Use apical pulse in neonates, infants, young children, and those with cardiac issues. Listen for one full minute; warm the stethoscope first.
- Respirations: Observe full breaths for one minute. Children up to 7 years are diaphragmatic breathers, and those over 7 years are thoracic breathers.
- Blood Pressure: For children over 3 years, measure on the right arm with a cuff that covers 40% of arm circumference. Infants have BP measured on the leg.
Tanner Stages
- Tanner stages assess sexual maturity and identify premature puberty:
- Stage 1: No sexual hair present.
- Stage 2: Downy hair (males: sparse, pigmented; females: breast budding).
- Stage 3: Scant terminal hair, continued breast enlargement in females.
- Stage 4: Terminal hair fills the pubic triangle; females develop secondary mounds.
- Stage 5: Adult-type hair extends beyond the inguinal crease; females have mature breasts.
Cyanosis in Newborns
- Normal (Acrocyanosis): Cyanosis observed in extremities, resolves with warmth.
- Abnormal (Central Cyanosis): Cyanosis around mouth and torso, indicating lower oxygen levels in blood.
Fontanel Closure
- Anterior fontanelle closes by approximately 18 months.
- Posterior fontanelle closes between 2-3 months (6-8 weeks).
Ear Assessment Differences
- In pediatrics, the ear is assessed by pulling down and back, contrasting with the adult method of pulling up and back.
Breathing and PMI Assessment
- Children are abdominal breathers until 6-7 years; infants are obligate nose breathers.
- PMI location: under 4 years at the 4th intercostal space; over 4 years at the 5th intercostal space.
Hip Dysplasia Assessments
- Ortolani Test: Reduces a dislocated hip; positive if femoral head slips into the socket with a palpable clunk.
- Barlow’s Test: Attempts to dislocate the hip; positive if hip slides out of the acetabulum.
- Galeazzi Sign: Analyzes leg level with flexed knees.
- Unequal Skin Folds: Indicates hip dislocation.
Scoliosis Evaluation
- Adams forward bend test identifies scoliosis; a scoliometer measures lateral curvature, with 7 degrees or more requiring further evaluation.
Normal Findings in Infants
- Thoracic shape: Equal anterior/posterior and transverse diameters, with chest circumference equal to head circumference until age 1.
Abdominal Assessment of Newborns
- Normal findings: Rounded abdomen in infants, potbellied appearance in children up to 4 years.
- Abnormal findings may include distention (intestinal obstruction) or scaphoid shape (malnutrition).
- Common umbilical issues include hernias (self-resolve by 10 days to 3 weeks) and diastasis recti (also heals on its own).
Abnormal Conditions in Newborns
- Pyloric Stenosis: Thickening of the pylorus causing vomiting and a palpable mass.
- Intussusception: A medical emergency characterized by a sausage-shaped mass in the abdomen and current jelly stools.
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Description
Test your knowledge on the normal changes in pediatric vital signs from infancy to adolescence. This quiz covers heart rate, respiratory rate, and blood pressure norms for different age groups. Learn the correct methods for taking vital signs in pediatric patients.
