Pediatrics History & Physical (H&P) Exam MASTERY GUIDE: 376 Expert-Verified Q&A with Clinical Vignettes, Diagnostic Reasoning & SOAP Note Examples (Latest Guidelines)

Neonatal period

28 days

early childhood

1-5

late childhood

5-12

Adolescence

12-18

infancy

first year of life

What order should the pediatric exam follow?

Least invasive first

Neonatal history

Sleeping, eating, peeing, pooping, milestones

Diet for first 4 months

breast milk and formula only (no food or water)

Recommendations for amount of formula or breast milk in first month

about 3 ounces every 3 hours

Most babies are satisfied with _________ per feeding during the first month, and increase that amount by ___ ounce per month until reaching ____ ounces

3-4 oz, 1 oz, 8 oz

How often should infants void?

6-8x a day

(6 is minimum)

Normal bowel movements

loose, seedy, yellow stool about 4 times a day

Vitamin D supplementation for exclusively breastfed infants

400 IU daily

BM in first 2-3 days old

4-5 black tarry stools every 24 hours

BM first 6 weeks

1-5 yellow stools every 24 hours

BM after 6 weeks

once every 3-4 days is okay

How should baby be placed to sleep?

on the back, without anything in crib, not co-sleeping

When should wellbeing of parents be assessed?

newborn through 2 month visits (at a minimum)

If parents refuse vaccines, what should you document?

WHY they refused

Month 1 developmental milestones

- eye tracking

- recognize parents voice

- smile

- support head

Month 6 developmental milestones

- babbles

- recognizes name and familiar people

- rolling over

- transfers objects from hand to hand

Month 9 developmental milestones

- crawling

- pincher grasp

- feeds self with fingers

- peek a boo

Month 12 developmental milestones

- strong parental attachment

- identifies people

- speaks a few words

- claps

- stands

- follows simple commands

15-18 month language

use 3-5 words

2 year old language

200+ word vocabulary

1-2 word phrases

3 year old language

1500+ word vocabulary

puts 5-6 words together

6 year old language

several thousand word vocabulary

full sentences

Breastfeeding or formula is the main source of nutrition until ________

1 year (then can transition to whole milk)

APGAR Score

Preform at one 1 minute and 5 minutes and continue until score 7+

Newborn bradycardia

under 100 bpm

APGAR 1-3

critical!!

APGAR 4-6

Low - resuscitation efforts

Ballard score

assesses gestational age

A complete newborn exam should be done within ____ hours of birth

24

preterm

under 34 weeks

late preterm

34-36 weeks

full term

37-42 weeks

post term

42+ weeks

Extremely low birth weight

less than 1000 g

Very low birth weight

less than 1500 g

Low birthweight

1500 - 2500 grams

Normal birthweight

2500+ grams

Normal newborn position

limbs semi flexed and hips abducted with spontaneous movements

When is the best time to examine a newborn

1-2 hours after feeding

Newborn fever

100.4+

Average newborn pulse

70-190 (not below 100 if AWAKE)

Newborn RR

30-60 (sleeping rate most reliable)

newborn apnea

more than 20 seconds

1 lb = ___ kg

.45

normal length newborn

19-21 inches (48-53 cm)

It is recommended to measure head circumference until the age of _______

3 (do it three times and take the largest measurement)

(normal is 12-14 inches)

High pitched shrill cry

Children born to drug addicted mothers

Increased intracranial pressure

Low pitched hoarse cry

Infrequent and low in intensity

Assoc. with hypothyroidism, hypocalcemic tetany

Cri du chat

associated with deletion of chromosome 5

Absence of crying

Suggests severe illness, vocal cord paralysis, profound cognitive disabilities

Vernex caseosa

coating on skin when child is born

NORMAL

Lanugo

fine peachfuzz all over body

NORMAL

Cutis marmorata

lacy network of small BV (vasospasm/dilation) in response to cold temps -- disappears when skin warms

NORMAL

Harlequin color change

transient erythema from blood pooling (positional)

(days 2-5)

NORMAL

Acrocyanosis

blue cast to hands and feet when exposure to cold

(NORMAL IN FIRST 48 hours, then abnormal)

Physiologic Jaundice

Normal between 48-96 hours due to increase in RBC production and bilirubin

Jaundice in the first _____ hours of life is NEVER NORMAL!

24

Bilirubin levels peak _________ after birth

3-10 days

Pathologic Jaundice

- before 24 hours

- after 2 weeks

If jaundice occurs in the first 24 hours suspect...

Rapid hemolysis

- ABO

- Rh incompatibility

If jaundice occurs after 2 weeks suspect...

biliary obstruction or severe infection

Pathologic jaundice is associated with....

lethargy, poor feeding, convulsions

Congenital Dermal Melanocytosis (Mongolian spots)

black and blue macules on back and butt usually resolving by age 2 (NORMAL)

Infantile seborrheic dermatitis

cradle cap

("NORMAL")

Miliaria rubra

heat rash (obstruction of sweat glands)

scattered vesicles

("NORMAL")

Erythema toxicum

3-5 days of life

small pustules on erythematous base

spontaneously resolve

("NORMAL")

pustular melanocytosis

small pustules on brown macule base

resolves in months

("NORMAL")

Milia

tiny white pearly pustules caused by blocked sebaceous glands

("NORMAL")

Cafe au lait spots

flat lat brown patches

(if they are large or more than 5 consider neurofibromatosis)

Nevus simplex (angle kiss)

flat, blanchable, often resolve by age 2

Infantile hemangioma (strawberry hemangioma)

- benign vascular tumor

- palpable bright red lesion

- develop in first 1-2 weeks

- rapidly enlarge during infancy

- resolve by age 10

Nevus Flammeus (port wine stain)

- usually unilateral

- darken over time and are permanent

- caused by capillary dilation

- present at birth

If a port wine stain involves the eye must evaluate for _______________

glaucoma

Sturge Weber Syndrome

- port wine stain in ophthalmic distribution of trigeminal nerve

- associated with seizures and glaucoma (TRIAD!)

- hemangiomas of brain and meninges

- risk of developmental delay, learning disability, and hemiparesis

- refer to neuro and ophthalmology

Anterior fontanelle

Measures 3-6 cm

90% close btwn. 7-19 mo.

Posterior fontanelle

Measures 1-1.5 cm;

Closes around 2 mo

Enlargement of anterior fontanelle my indicate:

Increased intracranial pressure

Down syndrome

Hypophosphatemia

Achondroplasia

Trisomy

Congenital hypothyroidism

Intracranial tumors/lesions

Small fontanelles often seen with __________________

microcephaly

Sunken fontanelles seen with ____________

dehydration

Dilated scalp veins indicate...

long-standing increased intracranial pressure

head molding

"cone head"

resolves in 2 days

Caput Succedaneum

Pitting edema of the scalp due to pressure from vaginal canal resolving in 2-3 days (supraperiosteum)

Caput Succedaneum crosses ______________________

suture lines

Cephalohematoma

Sub-periosteum edema

Due to an injury of blood vessels

May worsen 48 hours after birth and take 3-4 months to resolve

Often seen with forceps/vacuum delivery

Cephalohematoma increases risk of _____________________ and _________________

jaundice, sepsis

Cephalohematoma __________________ suture lines

DOES NOT CROSS!

Plagiocephaly

Misshapen head

Usually from laying in one position

Flattening of occiput with a prominence of frontal region on opposite side

Craniosynostosis

Premature fusion of 1 or more cranial sutures, often resulting in an abnormal head shape

Craniosynostosis cause

>20% caused by single gene mutation or chromosomal abnormalities

In Dolichocephaly the head is disproportionately _______________

long and narrow

Dolichocephaly isthe result of premature fusion of the _______________ suture

sagittal

Micrognathia

Lower jaw smaller than normal

Can interfere with breathing and feeding

Can correct itself as child grows

Micrognathia is often seen with _________________________

Trisomy 13 &18

Congenital hypothyroidism facies

Course facial features

Macroglossia

Goiter

Large fontanelles

T/F: congential hypothyroidism is part of all newborn screenings

true