Peds General Exam Review PDF

WEEK 1+2 When does the step reflex disappear in a newborn? -​ 4-8 weeks When does the suck reflex disappear in a newborn? -​ 2 to 5 months When does the rooting reflex disappear in a newborn? -​ 3 months When does the moro reflex disappear in a newborn? -​ 4 months When does the tonic n...

WEEK 1+2 When does the step reflex disappear in a newborn? -​ 4-8 weeks When does the suck reflex disappear in a newborn? -​ 2 to 5 months When does the rooting reflex disappear in a newborn? -​ 3 months When does the moro reflex disappear in a newborn? -​ 4 months When does the tonic neck reflex disappear in a newborn? -​ 4 months When does the palmar grasp reflex disappear in a newborn? -​ 9 months When does the babinski reflex disappear in a newborn? -​ 12 months When does the pincer grasp reflex appear in a newborn? -​ 10 months When should weight double in a newborn? Triple? -​ Double by 6, triple by 12 How much should the height of a newborn increase by 1 year? -​ 50% How much should the head circumference of a newborn increase by 1 year? -​ 33% When should a newborn be able to distinguish faces? -​ 6 months When should a newborn develop binocularity? -​ 6 weeks, when eyes work together -​ Established by 4 months When should vision be established in a newborn? -​ 4 months When should depth perception be established in a newborn and when should it be fully developed? -​ 7 to 9 months, fully developed at 2 to 3 years -​ Increased risk of falls during this period When should a newborn turn their head towards noise? -​ 2 to 3 months When would not walking in a child be of concern? -​ 18 months When should head lag be minimal in a newborn? -​ 4 months When is crawling established in a newborn? -​ 6 to 7 months When is creeping established in a newborn? -​ 9 months When is walking with assistance established in a newborn? -​ 11 months When is walking without assistance established in a newborn? -​ 12 months When does object permanence develop in a newborn? -​ 8 to 12 months When does stranger fear, separation anxiety, and temperament develop in a newborn? -​ 8 months When should a newborn be able to say “mama” and “dada” without meaning? -​ 9 to 12 months When should a newborn respond to their name? -​ 4 to 5 months When should a toddler be able to ride a tricycle and stack 9-10 cubes/blocks? -​ 36 months When should a toddler be able to run, kick a ball, stand on their tip toes, stack 6 blocks? -​ 24 months When should a toddler climb stairs with assistance, pull toys while walking, stack 4 cubes/blocks? -​ 18 months When should a toddler understand 100-150 words, repeat words, and babble in sentences? -​ 15 months -​ Understand at 15 but can’t say at 15 When should a toddler understand no, 200 words, and SAY 5-20 words -​ 18 months, can start saying When should a toddler begin to say “my” or “mine” and say 40-50 words? -​ 24 months When should a toddler follow two-part commands and say 150-300 words? -​ 30 months When should a toddler be able to understand most sentences, use 3 to 4 word sentences, understand 1000 words, and use pronouns and plurals? -​ 36 months When does separation anxiety reemerge in toddlerhood? -​ 18 to 24 months When does parallel play develop? -​ Toddlerhood What are some examples of developmental delay at 18, 24, and 36 months? -​ 18: Not walking or speaking 15 words, does not understand function of common household objects  -​ 24: Does not use two word sentences, does not imitate actions, cannot push a toy with wheels -​ 36: Difficulty with stairs, frequently falling, tower round belly from toddlerhood goes away What type of play develops in preschool? -​ Associative play When should a pediatric individual be aware of sex? -​ 1.5 to 2.5 years Is stuttering common in the 2 to 5 age group? -​ Yes What are some signs of developmental delay in preschool? -​ 4 yrs: Cannot jump in place or ride a tricycle, cannot stack 4 blocks, cannot throw ball overhand, no fantasy play, resists using toilet, dressing, sleeping -​ 5 yrs: Unhappy or sad often, cannot use plurals or past tense, rarely engages in fantasy play, cannot build tower of six to eight blocks, easily distracted When does the shedding of first deciduous teeth occur? -​ 6 yrs When does the acquisition of final permanent teeth occur?  -​ 12 yrs, puberty When does puberty start? -​ 12 in girls, 14 in boys When should an infant be able to transfer objects between their hands? -​ 7 months When should an infant be able to remove objects from a container? -​ 11 months When should an infant be able to build a tower of two blocks? -​ 12 months What food should you not give infants? -​ Honey, increased risk for botulism How often should you introduce baby foods at a time? -​ At 6 months, 3 to 5 days for allergies What are some developmental red flags in infants? -​ Poor weight gain, lack of response to loud noises/bright lights, doesn’t focus on near object -​ Does not smile by 3 months -​ No head control by 4 months, extreme floppiness or stiffness -​ Does not make sounds/babble by 4 months -​ Cannot sit with assistance by 6 months, failure to crawl by 12 months, cannot stand with support at 12 months Describe growth in a toddler: -​ Rounded abdomen, weight increase slows down, adult height will be double the height at 2 years old Describe what a 12-15 month old child should be able to do regarding their motor skill development. -​ Walks independently, uses fingers to eat, points Describe what an 18 month old child should be able to do regarding their motor skill development. -​ Climb stairs with assistance, build 4 blocks, turn pages of a book, pull toy while walking, take off shoes and socks Describe what a 24 month old child should be able to do regarding their motor skill development. -​ Run, kick a ball, stand on tiptoes, climb onto furniture, knows left and right, stack 6 cubes/blocks, copies vertical and circular motion, scribbles and draws, turn a doorknob Describe what a 36 month old child should be able to do regarding their motor skill development. -​ Climb easily, rides a tricycle, stack 8/9 blocks, copies circles, undresses self, holds pencil appropriately, can turn page of book one at a time, screws/unscrews lids, walks up and down stairs with alternating feet Describe language development in a 12 month old child. -​ Understands common words, follows one step command w gesture, points at what they want, imitates goodbye Describe language development in a 15 month old child. -​ Understands 100-150 words, repeats words, babbles sentences Describe language development in an 18 month old child. -​ Understands 200 words, say 5-20 words, understands no Describe language development in a 24 month old child. -​ Begins to say my or mine, says 40-50 words Describe language development in a 30 month old child. -​ Follows two-part commands, says 150-300 words Describe language development in a 36 month old child. -​ Follows three-part command, says 1000 words, understands most sentences, uses 3 to 4 word sentences, uses pronouns and plurals WEEK 3 When doing a nutritional assessment for a pediatric patient, what is the easiest way? -​ 24 hour recall -​ Food diary, 3 day intake record > 2 weekdays, 1 weekend When taking the length and weight in an infant, how would you measure? -​ Recumbent lying before 2 years At what age do you assess the general growth of a pediatric patient standing up? -​ > 2 years old At what age do you take a pediatric patient’s BMI? -​ > 2 years old -​ Growing at a constant rate, would be inaccurate before 2 years Up to when do you measure the head circumference of a pediatric patient? -​ Less than 36 months -​ After 36 months you do not need to measure, unless abnormal What is considered underweight in a pediatric patient? -​ Less than 5% BMI What is considered overweight in a pediatric patient?  -​ 85-89% BMI What is considered obesity in a pediatric patient? -​ >95% BMI When taking the temperature for a pediatric patient, which route do we use? -​ Axillary until 5 years old -​ Oral > 5 -​ If tympanic, >2 years old -​ Rectal only if ordered but contraindicated in infants, must be lubricated When and where should you take the pulse of an infant? -​ Apical is best when asleep -​ Branchial for young child At what age should you take the blood pressure of a pediatric patient? How would you confirm HTN in a pediatric patient? -​ >3 years old -​ Confirm HTN through 2 different measurements 2 different times Asymmetry in a pediatric patient’s head could be indicative of what? -​ Craniosynostosis, indicative of premature suture closing When should head lag be absent in a pediatric patient? -​ 4 months When do the posterior fontanels close? Anterior? -​ Posterior first, 6-8 weeks -​ Anterior later, 12-18 months Weak range of motion in the neck could be indicative of what? -​ Torticollis, injury to the SCM At what age is a pediatric patient’s neck similar to an adult neck? When palpating the lymph nodes of a pediatric patient, what would you expect as normal? What would be considered abnormal? -​ Normal: detects strabismus -​ Cover test -​ Snellen test, peripheral vision -​ Color vision > Ishihara test When inspecting the ears of an infant, how would you inspect their ear? Toddler? -​ Infant + Toddler: Down and back -​ >4: Up and back, insert otoscope , 5th ICS lateral to MCL How would you test capillary refill in a pediatric patient? -​ Forehead or hand What do you hear when auscultating Erb’s point in a pediatric patient? -​ S1 + S2 What could intense S1 in a pediatric patient indicate? -​ Anemia, exercise, fever In pediatric patients, is S3 normal? -​ Yes Where could peristaltic waves be seen in a pediatric patient? -​ Very thin pt -​ Hypertrophic pyloric stenosis A mother of a 2 year old patient reports seeing herniation in the umbilicus. What would you educate the mother? -​ May require surgery but resolves by 3 to 5 years Who is inguinal hernia more common in? -​ Males, always requires surgery Should you retract the skin of a circumcised pediatric patient? -​ No What are you palpating for a pediatric male patient’s genitals? -​ Cremasteric reflex > if absent issue with testicles -​ Retracts testicles, stop via tailor position (which is basically frog leg) -​ Block inguinal canal A stiff and resistant neck could be indicative of what in a pediatric patient? -​ Nuchal rigidity What age range is best to inspect the hips of a pediatric patient? -​ 0-3 months When should you refer a pediatric patient that has bowleg? -​ If unilateral, asymmetric in a child 2-3 years old Is a knock knee normal? -​ In age range 2-7 A mother reports brisk DTR in their 3 month old child. What do you educate to the mother? -​ Is normal -​ Will decrease to normal DTR by 5 months When should a positive Babinski reflex be absent? -​ 12 months, if hyperactive could indicate cerebral injury At what age should an infant be able to hold their head up steadily? -​ 4 months At what age should an infant/toddler walk without assistance? -​ 12-18 months, >18 contact HCP At what age should an infant speak their first word with meaning? -​ 9-10 months When is rectal contraindicated? -​ 50-60 mins  -​ Temp: 101 degrees -​ Cough > 2 days -​ Refusal to eat + poor sleep pattern What classifies apnea in a pediatric patient? -​ Child holding breath for > 20 seconds How would you stimulate a pediatric patient who is going through apnea? -​ Rub their back, flick their foot -​ Rescue breathing next -​ Apnea monitor may be necessary, may need caffeine and theophylline to stimulate respirations What can cause apnea in a pediatric patient? -​ Sepsis, respiratory infection, hypothermia, hypoglycemia, infection What are some differences between allergies and the cold in a pediatric patient? -​ Allergies: Seasonal, itchy ears and eyes -​ Cold: Not seasonal, everything stated above What will tonsillitis present as in a pediatric patient? -​ White patches on tonsils, difficulty breathing and swallowing, bad breath -​ Cough if a viral infection How would you manage a pediatric patient with tonsilitis? -​ Saltwater gargles (but only if pt is old enough to understand to spit out water) -​ Soft and warm food -​ Acetaminophen for pain What is a contraindicated pain medication for pediatric children under the age of 10?  -​ Codeine, has different S/E depending on each child, may accidentally OD child How would you care for a pediatric patient who has just undergone a tonsillectomy? -​ Educate to not do anything that stresses throat like coughing, sipping on straws, clearing your throat -​ Swallowing is ok, ice chips and water -​ Do not drink red liquids, may confuse w blood A pediatric patient who has just undergone a tonsillectomy 10 days ago presents with constantly swallowing. What could this be indicative of? -​ Hemorrhage/bleeding, pt is swallowing blood What characterizes strep throat over tonsillitis in a pediatric patient? -​ Group A beta-hemolytic streptococcus, has NO COUGHING, a bacterial swab through a throat culture How would you manage strep throat in a pediatric patient? -​ Saline gargles (if old enough), penicillin oral (for 10 days) /IM not IV, after infection is gone change toothbrush -​ Educate: Pt can go back to school 24 hrs after taking abx What are some complications associated with strep throat? -​ Glomerulonephritis (bacteria travels down to the kidneys), rheumatic fever (exacerbation of strep, inflammation across body particularly in joints and heart lining), impetigo (patches) What is the treatment plan for a patient with infectious mononucleosis? -​ Treat symptoms, the disease is self limiting What age group is most likely to have infectious mononucleosis? -​ indicative of blocking of upper airways -​ If pt has inspiratory stridor, associated with suprasternal retractions, cough, hoarse voice, possible cyanosis, apnea When do symptoms of croup usually occur? -​ Night time > air is cooler, make it harder for pt to breathe If a patient with croup syndrome needs medical treatment, what would be recommended for the pediatric patient? -​ Corticosteroid + nebulized epinephrine and cool mist What should you have near a patient with acute epiglottitis? -​ A crash cart, epiglottitis is an emergency What are the trademark symptoms of acute epiglottitis? -​ Pt drooling, high fever, pt in tripod positioning, high RR/HR due to struggling to breathe, tongue protrusion What do you not do for a patient who has acute epiglottitis? -​ DO NOT ASSESS THE MOUTH esp not with a tongue depressor > may cause area to spasm and close off airway How would you treat a patient with acute epiglottitis?  -​ Decrease anxiety, give oxygen, child is agitated so no mask use a blow-by What is the hallmark symptom of bacterial tracheitis? -​ Thick purulent secretions which can clog the airway -​ May require intubation -​ Has a fever due to it being bacterial -​ 5 to 7 years old In a pediatric patient with the flu, what medication would you not give them? -​ Aspirin > Reye’s Syndrome When is bronchiolitis most severe? -​ The younger a patient is 70 breaths per minute What drugs do you not use for bronchiolitis? -​ Bronchodilators (the issue is with inflammation not about lungs opening up, treat inflammation first), and steroids (??????) What drugs do you use to treat bronchiolitis? -​ Epinephrine, -mab drugs -​ Cool-humidified O2, suction, nasal drops What pneumonia is most common? -​ Viral, bacterial is worse to have What are some hallmark symptoms of pneumonia? -​ Cough, hypoxemia, fever, accessory muscle usage When would you call the doctor for a patient with pneumonia? -​ Really high fever > 101 degrees F, tachypnea (50-60 per min), coughing for more than 2 days What are the three causes of respiratory difficulty in a patient with asthma? -​ Muscle tightness, swollen lining, and excess mucus production What are some signs and symptoms of asthma in a pediatric patient? -​ Wheezes, retractions, prolonged expiratory phase (breathing out slower bc airways are so narrow) Asthma that is unresponsive to normal treatments and goes into respiratory failure is known as what? -​ Status Asthmaticus (medical failure) What management for asthma sees how bad asthma exacerbation is? -​ Peak flow meter What system is mostly affected in a patient with cystic fibrosis? -​ Pancreas and respiratory tract -​ Affects mucus gland secretion of any gland  -​ Can also affect reproductive system and skin, gallbladder ​ What are some signs and symptoms of cystic fibrosis in a pediatric patient? -​ Salty sweat (positive if sweat contains high levels of chloride), steatorrhea (fat in poop), failure to thrive (body can not absorb any nutrients), CBAVD (vas deferens doesn’t develop) What are some management strategies for a pediatric patient with cystic fibrosis? -​ Fat supplements, Vitamin supplements (DrAKE), high calorie + high protein diet, care for bone health, insulin maybe bc if pancreas enzymes cannot make it out insulin cannot either) For eyes and ears: Look at ur notes