Clinical Skills - Exam 5 (Peds)

Infancy 0-12 months

Physical Development

height, weight, head circumference

1 year weight and height

weight tripled

height inc by 50%

Infancy 0-12 months

Physical Development - 6 months

sits

rolls

bears weight on legs

Infancy 0-12 months

Physical Development - 12 months

walking

3-4 month cognitive

babbles and laughs aloud

6-12 months cognitive

monosyllables

12 months cognitive

few words

points

15 months cognitive

12+ words

social emotional at 0-12 months

5-6 weeks smiling

observe interaction w/ caregiver

growth 1-4 years

slows to 1/2 of infancy

18 month-2 years physical development

run

scribble

imitation

3 year milestone

peddles tricycle

4 year physical development

draw/copy circles

18 month cognitive

10-20 words

2-3 years old and 3 years old cognitive

2-3: sentences

3: why? songs and stories

4 year old cognitive

complex sentences

social/emotional 1-4 yo

independent

tantrums and NO

middle childhood

5-10 years

middle childhood cognitive

logical thinking

increased learning and language

right vs. wrong

1 minute APGAR results

8-10: normal

5-7: some decreased CNS function

0-4: severe CNS problems, resuscitate

5 minute APGAR results

8-10: normal

0-7: high risk CNS and other organ dysfunction

preterm

<37 weeks

late-term

34-36 weeks

term

37-41 weeks

post-term

>42 weeks

extremely low birth weight

<1000 g

very low birth weight

<1500 g

low birth weight

<2500 g

normal birth weight

>2500 g

BP progression

Systolic gradually increases

70 mmHg at birth

85 mmHg at 1 month

90 mmHg at 6 months

pulse progression

Very sensitive to illness

140 bpm at 1 month

130 bpm at 1-6 months

115 bpm at 6-12 months

newborn RR range

30-68/min

infants 6-12 months RR range

25-60/min

cutis marmorata

extreme mottling of trunk and extremities

cause of cutis marmorata

premies

hypothyroidism

down syndrome

harlequin dyschromia

marked erythematic changes on 1/2 body

acrocyanosis

blueish tint of palms and soles

cause of acrocyanosis

benign vs. congenital heart disease

mongolian spots

melanotic pigmentation in pt of color

fades w/ time, can be confused w/ a bruise

lanugo

fine hair covering premies

jaundice

physiological in 2-3d of life

in first 24 hrs is likely pathologic

carotenemia

orange discoloration from carotene in veggies

mostly palms and soles

milia

retention of sebum-white and raised

-first few weeks of life, resolves

milia rubra

red vesicles from obstructed sweat glands

nevus flammeus

stork bite or salmon patch

-proliferative capillaries fade in 1 yr

-nape of neck, forehead, eyes

port wine stain

do note fade

sturge-weber syndrome: port wine stains associated w/ seizures, paralysis, MR, and glaucoma

strawberry hemangioma

proliferative capillaries

-inc in size in 1st year then regress

-surgical internvention

craniosynstosis

premature closure of suture lines

craniotabes

softening of skull bones

ricketts and syphillis

caput succedaneum

swelling of occipitoparietal area after vacuum extraction

resolves in 1-2d

plagiocephaly

flattening of skull due to positioning

can be associated w/ torticollis

cervical torticollis

from tight SCM

"packaging problem" or birth injury

micrognathia

hypoplasia of jaw

can be associated with intrauterine pressure or other syndromes

cephalohematoma

bruise from birth injury

thyroglossal duct cyst

fistula from thyroid cartilage to skin

-from congenital cells after thyroid formation

brachial plexus palsy

birth injury from shoulder dystocia - clavicle fracture

transient or permanent paralysis

visual acuity milestones

3 years - 20/40

4-5 years - 20/30

6-7 years - 20/20

eyes 2-4 weeks

eyes are fixed

eyes 5-6 weeks

eyes coordinate and follow

eyes 3 months

freely focus

subconjunctival hemorrhage

birth in infants

older kids - trauma or coughing

brushfield spots

white specks on iris

normal or Downs

dacrosytenosis

narrowing of tear duct

lots of eye crusties

auditory atresia

congenital

normal auricle and canal atresia

in syndromes

fluorosis

too much fluoride

-cosmetic

fluoride dose 6mo-3yrs

0.25mg

fluoride dose 3-5 yrs

0.5 mg

fluoride dose 5-14 years

1mg

choanal atresia

mouth breathing child due to bony obstruction in nasal passage

cause of choanal atresia

birth injury that causes trauma or congenital obstruction

mucoceles

mucous retention cyst

benign

prominent frenulum

ankyloglossia "tongue tied"

may interfere with speech and feeding

oral candidiasis

thrush not easily removed w/ scraping

drooling

no teeth for barrier

lessens w/ tooth development

Epstein pearls

retention cysts on hard palate

laryngeal hoarseness

in hypothyroidism and hypocalcemia

shrill high-pitched cry

episodes of increased ICP or narcotic addiction

absence of cry or voice

paralysis

MR

severe illness

cleft palate

congenital lack of fusion in mid-maxillary area

associated lip involvement

umbilical cord

clean w/ alcohol

fall off in 2 weeks

look for infection

hydrocele

resolution @ 18 months

transilluminated, not reducible

increased potential of inguinal hernia

cryptorchidism

one testicle doesn't descent

-should descent by 12 months

-increase CA and infertility

first month of life - female genital

can have bloody discharge

labial adhesions female genitals

secondary to poor hygiene or trauma

vaginal discharge

physiological leukorrhea

FB

barlow's sign

evaluates for unstable hip joint

cause subluxation

ortolanti's sign

evaluate for hip dislocation

reduce dislocation

CN II

visual acuity

facial regard and tracking

CN II and III

response to light

pupils and blinking

CN III, IV, and VI

EOM

tracking

CN V

motor

rooting and sucking

CN VII

facial

crying

smiling

facial symmetry

CN VIII

acoustic

acoustic blink

track w/ sound

CN IX and X

swallow coordination and gag reflex

CN XI

spinal accessory

shoulder symmetry

CN XII

hypoglossal

swallow

suck

tongue thrust

reflex mouth opening when nostrils pinched

CN deficiency is concerning for

congenital anomaly

hemorrhage

Babinski reflex

fanning of toes is considered normal - up to 24 months

blinking reflex

eyes blink w/ light stimulus

acoustic blinking reflex

eyes blink in response to sound

goes away over time