Pediatric primary care burns exam 4
There are many illnesses that are less likely to occur if babe is breastfed, what are
these? ANSWERgastro, NEC, AOM, LRTIs, asthma, atopy, DM, SIDS, leukemia
At what age should birth wt be doubled? ANSWER5-6 months
At what age should birth wt be tripled? ANSWER1 yr
First few days, a neonate should void? ANSWER1-3 times
By day 4 the neonate should void? ANSWER4-6
Regular urine output of neonate is? ANSWER4-6 times per day
Stool output of typical neonate? ANSWER2-3
How much water loss can be life threatening to a child? ANSWER10%
What does sodium regulate in the body? ANSWERECF volume, osmolarity, acid-base
balance, membrane potential of cells
How is sodium lost out of body? ANSWERvomiting, diarrhea, perspiration
Role of potassium in the body? ANSWERhelps maintain intracellular homeostasis,
muscle contractility, transmission of nerve impulses
Severe deficit of potassium can cause? ANSWERcardiac dysrhythmias/death
What is the role of chloride in the body? ANSWERfunction with sodium to maintain
fluid/electrolyte balance
What is advice regarding comfort feeding? ANSWERavoid
How much exercise should a child have? ANSWER60 minutes mod/high per day
Benefits of vegetarianism ANSWERlower obesity, heart disease, and DM rates
What can be deficient in a vegan diet? What 2 are the highest? ANSWERprotein, B12,
iron, Ca++, zinc, riboflavin, vit D; B12, zinc
What can become of fetus with B12 and zinc deficiency? ANSWERpossible permanent
neuro damage
What BMI percentile is considered overweight? ANSWER85-95th
What BMI percentile is considered obese? ANSWER95th or higher
,Pediatric primary care burns exam 4
Primary goal of pediatric wt management? ANSWERnormalize, not reduce
Complications of obesity in children? ANSWERHypertension obstructive sleep apnea ,
OSA, orthopedic issues, depression, suicide
How long should a food recall or diary be kept for assessment? ANSWER3 days
Children aged 5 to 9 who have contact with same or opposite sexes, play sex games, or
idea about sex - parents should be? ANSWERparents should avoid being overly
alarmed if they witness this play.
*parents can redirect play*
At around what AGE do children giggle and learn more about SEX and sexuality?
ANSWERAge 8
At what age does self-stimulation as a result of sexual reflexes due to sexual fantasies,
behavior and relationships? ANSWER10-12 year olds
The biggest reason adolescents do not seek healthcare for sexual education is due to?
ANSWERConfidentiality
How should you ask an adolescent with concrete cognitive abilities about sexual
history? ANSWER"Have you ever had a romantic relationship with a boy or a girl"
"Define Sex"
Early Adolescents (age 12 to 14) are concrete thinkers and cannot get to the abstract
thought of "what if". How should sexual education be given to them? ANSWERUse
pictures and direct questions and statements
Use simple concert terms when counseling
Mid-adolescents (age 15 to 17) are starting to understand abstract concepts, but will
often refresh to concrete thinking in stressful situations. How should the provider speak
to them? ANSWERThey need to adjust the approach to mid-adolescents accordingly,
help them to identify the inconsistencies in their thought processes and guide them
through to the logical consequences.
how often should a helmet be replaced? ANSWERevery 5 years or sooner
For Preparticipation physical examination (PPE), what should the provider do if the
parent disagrees with the providers advise to refrain from participation? ANSWERobtain
a Signed Informed consent from the pt's guardian.
Which cardiac conditions may warrant an athlete to seek a cardiologist before
performing in Physical activity/sports? ANSWERPathologic murmur, EKG dysrhythmias,
hypertrophic cardiomyopathy, Coronary artery abnormalities, carditis, marfans, ehlers-
danlos, mitral valve prolapse.
,Pediatric primary care burns exam 4
How should diabetics monitor their glucose with physical activity? ANSWERbefore,
q30min during, and 15 min after exercise & Before bedtime
What should the Physical exam include? ANSWERThe musculoskeletal Examination
General Head to toe (generalized focus on Cardiac and Neuro)
What is the 90-second musculoskeletal exam? ANSWER+Standing Posture & shoulder
- acromioclavicular alignment
+ Cervical ROM
+ Shoulder Shrug/strength
+ Elbow ROM/strength
+ supination/pronation ROM & Hand clench test
+ Stand & bend at knee to chest
+ Squat test
+ Lumbar ROM/Scoliosis
+ Tip/Toe Calf Symmetry
What cardiovascular examinations should be done for sports physical? (4)
ANSWERAuscultate for heart murmur (sitting/lying/standing)
Femoral Pulses
Marfan's Sx's
Bilateral blood pressure
What occurs with people WITHOUT diabetes when they exercise? ANSWERexercise
leads to decreased plasma insulin levels and increased glucagon that triggers hepatic
glucose production.
What happens with Type 1 diabetics when they exercise? Pathophys?
ANSWERdiabetic individuals who have too little insulin in their system exercise can
trigger release of high levels of glucose and Keytone bodies, leading to hyperglycemia
and eventually DKA
What is the most concerning clinical issue with infectious mononucleosis?
ANSWERSplenomegaly
How long should nothing stay out for sports if they are diagnosed with infectious
mononucleosis? ANSWERThree weeks
About 15% of children with down syndrome can have what? ANSWERAtlantoaxial or
anlanto-occipital instability
*anomaly of the Cervical vertebrae at the space between C-1 and C-2
How are asymptomatic cases of Atlantoaxial Instability screen? ANSWERby obtaining
lateral radiographic views of the C-spine
, Pediatric primary care burns exam 4
What does the female athlete triad consist of? ANSWER1. Disordered eating patterns
2. Menstrual dysfunction (amenorrhea or oligomenorrhea)
3. Osteopenia or osteoporosis
Why is co-sleeping discouraged? ANSWERRisk of SIDS
What is the best sleeping position for infants? ANSWERSupine
At 6 months, infants are able to go how long with out eating over the night? ANSWER6
to 12 hours
at Ages 2 to 4 months, what should parents try doing with night time sleeping?
ANSWERTry to delay and then discontinue middle-of-the-night feedings.
Encourage self-soothing
How should parents manage Sleep-onset association disorders? ANSWERExtinction
and Graduated extinction.
When the child awakens and cries in the night, *the parent should go to them briefly
comfort and reassure them, but DO NOT hold, rock, or feed them*
How should sleep refusal be managed? ANSWERPositive routines.
Set limits on the child's demands for attention.
What are the 3 recommendations for sleep-cycle problems? ANSWER1. keep nighttime
routine, but awaken child earlier in 15 minute increments
2. Older child or Adolescent - better to go forward in time, have child remain awake until
the next evening & then go to bed at the desired hour, beginning the desired routine
from that point.
3. Keep a sleep log to document gradual change.
Normal newborn infants weight will do what in the first few days of life? ANSWERthey'll
lose 5-8% of their birthweight
One criterion for failure to thrive is? ANSWERLack of return
What should happen to infant weight by 6 months and 12 months? ANSWERDouble
and Triple in weight
What age should you introduce solid foods? ANSWER6 months
Which drugs should be avoided for breastfeeding that Inhibit Prolactin release? (3)
ANSWERAntihistamines
Estrogen
Ergot compounds (headache drugs)
There are many illnesses that are less likely to occur if babe is breastfed, what are
these? ANSWERgastro, NEC, AOM, LRTIs, asthma, atopy, DM, SIDS, leukemia
At what age should birth wt be doubled? ANSWER5-6 months
At what age should birth wt be tripled? ANSWER1 yr
First few days, a neonate should void? ANSWER1-3 times
By day 4 the neonate should void? ANSWER4-6
Regular urine output of neonate is? ANSWER4-6 times per day
Stool output of typical neonate? ANSWER2-3
How much water loss can be life threatening to a child? ANSWER10%
What does sodium regulate in the body? ANSWERECF volume, osmolarity, acid-base
balance, membrane potential of cells
How is sodium lost out of body? ANSWERvomiting, diarrhea, perspiration
Role of potassium in the body? ANSWERhelps maintain intracellular homeostasis,
muscle contractility, transmission of nerve impulses
Severe deficit of potassium can cause? ANSWERcardiac dysrhythmias/death
What is the role of chloride in the body? ANSWERfunction with sodium to maintain
fluid/electrolyte balance
What is advice regarding comfort feeding? ANSWERavoid
How much exercise should a child have? ANSWER60 minutes mod/high per day
Benefits of vegetarianism ANSWERlower obesity, heart disease, and DM rates
What can be deficient in a vegan diet? What 2 are the highest? ANSWERprotein, B12,
iron, Ca++, zinc, riboflavin, vit D; B12, zinc
What can become of fetus with B12 and zinc deficiency? ANSWERpossible permanent
neuro damage
What BMI percentile is considered overweight? ANSWER85-95th
What BMI percentile is considered obese? ANSWER95th or higher
,Pediatric primary care burns exam 4
Primary goal of pediatric wt management? ANSWERnormalize, not reduce
Complications of obesity in children? ANSWERHypertension obstructive sleep apnea ,
OSA, orthopedic issues, depression, suicide
How long should a food recall or diary be kept for assessment? ANSWER3 days
Children aged 5 to 9 who have contact with same or opposite sexes, play sex games, or
idea about sex - parents should be? ANSWERparents should avoid being overly
alarmed if they witness this play.
*parents can redirect play*
At around what AGE do children giggle and learn more about SEX and sexuality?
ANSWERAge 8
At what age does self-stimulation as a result of sexual reflexes due to sexual fantasies,
behavior and relationships? ANSWER10-12 year olds
The biggest reason adolescents do not seek healthcare for sexual education is due to?
ANSWERConfidentiality
How should you ask an adolescent with concrete cognitive abilities about sexual
history? ANSWER"Have you ever had a romantic relationship with a boy or a girl"
"Define Sex"
Early Adolescents (age 12 to 14) are concrete thinkers and cannot get to the abstract
thought of "what if". How should sexual education be given to them? ANSWERUse
pictures and direct questions and statements
Use simple concert terms when counseling
Mid-adolescents (age 15 to 17) are starting to understand abstract concepts, but will
often refresh to concrete thinking in stressful situations. How should the provider speak
to them? ANSWERThey need to adjust the approach to mid-adolescents accordingly,
help them to identify the inconsistencies in their thought processes and guide them
through to the logical consequences.
how often should a helmet be replaced? ANSWERevery 5 years or sooner
For Preparticipation physical examination (PPE), what should the provider do if the
parent disagrees with the providers advise to refrain from participation? ANSWERobtain
a Signed Informed consent from the pt's guardian.
Which cardiac conditions may warrant an athlete to seek a cardiologist before
performing in Physical activity/sports? ANSWERPathologic murmur, EKG dysrhythmias,
hypertrophic cardiomyopathy, Coronary artery abnormalities, carditis, marfans, ehlers-
danlos, mitral valve prolapse.
,Pediatric primary care burns exam 4
How should diabetics monitor their glucose with physical activity? ANSWERbefore,
q30min during, and 15 min after exercise & Before bedtime
What should the Physical exam include? ANSWERThe musculoskeletal Examination
General Head to toe (generalized focus on Cardiac and Neuro)
What is the 90-second musculoskeletal exam? ANSWER+Standing Posture & shoulder
- acromioclavicular alignment
+ Cervical ROM
+ Shoulder Shrug/strength
+ Elbow ROM/strength
+ supination/pronation ROM & Hand clench test
+ Stand & bend at knee to chest
+ Squat test
+ Lumbar ROM/Scoliosis
+ Tip/Toe Calf Symmetry
What cardiovascular examinations should be done for sports physical? (4)
ANSWERAuscultate for heart murmur (sitting/lying/standing)
Femoral Pulses
Marfan's Sx's
Bilateral blood pressure
What occurs with people WITHOUT diabetes when they exercise? ANSWERexercise
leads to decreased plasma insulin levels and increased glucagon that triggers hepatic
glucose production.
What happens with Type 1 diabetics when they exercise? Pathophys?
ANSWERdiabetic individuals who have too little insulin in their system exercise can
trigger release of high levels of glucose and Keytone bodies, leading to hyperglycemia
and eventually DKA
What is the most concerning clinical issue with infectious mononucleosis?
ANSWERSplenomegaly
How long should nothing stay out for sports if they are diagnosed with infectious
mononucleosis? ANSWERThree weeks
About 15% of children with down syndrome can have what? ANSWERAtlantoaxial or
anlanto-occipital instability
*anomaly of the Cervical vertebrae at the space between C-1 and C-2
How are asymptomatic cases of Atlantoaxial Instability screen? ANSWERby obtaining
lateral radiographic views of the C-spine
, Pediatric primary care burns exam 4
What does the female athlete triad consist of? ANSWER1. Disordered eating patterns
2. Menstrual dysfunction (amenorrhea or oligomenorrhea)
3. Osteopenia or osteoporosis
Why is co-sleeping discouraged? ANSWERRisk of SIDS
What is the best sleeping position for infants? ANSWERSupine
At 6 months, infants are able to go how long with out eating over the night? ANSWER6
to 12 hours
at Ages 2 to 4 months, what should parents try doing with night time sleeping?
ANSWERTry to delay and then discontinue middle-of-the-night feedings.
Encourage self-soothing
How should parents manage Sleep-onset association disorders? ANSWERExtinction
and Graduated extinction.
When the child awakens and cries in the night, *the parent should go to them briefly
comfort and reassure them, but DO NOT hold, rock, or feed them*
How should sleep refusal be managed? ANSWERPositive routines.
Set limits on the child's demands for attention.
What are the 3 recommendations for sleep-cycle problems? ANSWER1. keep nighttime
routine, but awaken child earlier in 15 minute increments
2. Older child or Adolescent - better to go forward in time, have child remain awake until
the next evening & then go to bed at the desired hour, beginning the desired routine
from that point.
3. Keep a sleep log to document gradual change.
Normal newborn infants weight will do what in the first few days of life? ANSWERthey'll
lose 5-8% of their birthweight
One criterion for failure to thrive is? ANSWERLack of return
What should happen to infant weight by 6 months and 12 months? ANSWERDouble
and Triple in weight
What age should you introduce solid foods? ANSWER6 months
Which drugs should be avoided for breastfeeding that Inhibit Prolactin release? (3)
ANSWERAntihistamines
Estrogen
Ergot compounds (headache drugs)
