Review set 4 Flashcards
Does IBS increase the risk of colon cancer?
NO
Hcg doubles every ____ ____ in the first trimester.
Urine pregnancy tests can detect pregnancy by the ___ week of conception
2nd
Physiologic changes in pregnancy:
Extra heart sound - ____ is common
S3
***Pregnancy results in a ________ state
hypercoagulable
Pregnancy:
Compression on the vena cava by the uterus decreases blood return esp when supine at 20 weeks and later. Position in _____ ____ ____ position.
left lateral decubitus
Premature rupture of membranes (placenta abruptio) is premature separation of a ***______ implanted placenta from the uterus. Risk factors are a hx of placenta abruption, HTN, smoking, African American, rheumatoid disease, cocaine use, trauma. Has tender & contracted uterus that is severely painful
normally
Placenta previa: _______ implanted placenta in the uterus and on top of the cervix. Sudden painless bright red bleeding in the 2nd to 3rd trimester.
abnormally
NSAIDs are contraindicated in the ____ trimester of pregnancy b/c they block prostaglandins
3rd
Women with no risk factors:
Screen for gestational diabetes at ___ - ___ weeks with a ___ gram 2-hr OGTT.
24 - 48
75
Gestational diabetes:
Continue to screen after baby is delivered at __ - ___ weeks, then every ___ ___.
6 - 12
3 years
Hypothyroidism in pregnancy:
If TSH is > ____, start treatment.
Recheck TSH and _____ levels every few weeks.
6
free T4
Cardiovascular changes in pregnancy include all of the following EXCEPT:
1 The enlarged uterus displaces the heart upward and to the center of the chest
2 Systolic ejection murmur
3 Mammary souffle
4 Blood volume and cardiac output increase in the third trimester
1 The enlarged uterus displaces the heart upward and to the center of the chest
Increased levels of progesterone during pregnancy is associated with:
1 N/V especially early in pregnancy
2 Delayed peristalsis in the GI tract with a delay in gastric emptying
3 Diarrhea due to an increase in peristalsis in the GI tract
4 An increase in the deposition of melanin in the skin
2 Delayed peristalsis in the GI tract with a delay in gastric emptying
Miscarriage (spontaneous abortion):
A loss of pregnancy before ____ weeks
Threatened abortion: Cervix is/ is not dilated?
Inevitable abortion: Cervix is / is not dilated?
20
is not
is
*** Naegele’s rule:
Using the date of the LMP, what do you do?
Add 9 months to the month and add 7 days to the date
A 28 year-old primigravida's LMP was on March 10, 2020. Using Naegele's rule, which of the following dates is correct for her expected date of delivery? 1 Nov 10, 2020 2 Nov 17, 2020 3 Dec 10, 2020 4 Dec 17, 2020
4 December 17, 2020
Uterine involution is completed by: 1 Four weeks 2 Six weeks 3 Eight weeks 4 Twelve weeks
2 Six weeks
Early term pregnancy: ___ to ___ weeks
Full term pregnancy: ___ to ___ weeks
Late term pregnancy: ___ weeks
Post-term pregnancy: ___ weeks
37 to 38
39 to 40
41
42
1st trimester: conception until ___ weeks
2nd trimester: __ weeks until ____ weeks
3rd trimester: ___ weeks until ___ weeks
12
13; 27
28; 40
Primary teeth (baby teeth): First tooth - lower \_\_\_\_ incisors come in at \_\_ to \_\_\_\_ months of age
central
6 to 10
Peds:
permanent teeth:
The first is the ____ ____ at age ___ to ___ years
central incisor; 6 to 7
Peds:
Permanent tooth avulsion transport:
Do NOT clean the tooth. Avoid touching the root.
Best way to transport is to use ______ ____.
cold milk
Infant weight:
***Infants lose up to ___% of body weight but will regain birth weight in ___ ____.
Double birth weight by ___ ___ of age.
Triple birth weight by ___ ____ of age.
7
2 weeks
6 months
12 months
Infant weight and length:
0 to 6 months: __ to ___ ounces per week and __ inch per month
6 to 12 months: __ to ___ ounces per week and __ inch per month
6 to 8; 1
3 to 4; 1/2
Peds:
If the child’s weight and/or length decelerates across ___ or more major percentiles, rule out failure to thrive.
Any child who is on the ___ to ___ percentile is considered as FTT.
The most common cause in primary care is ______.
Evaluate the child, including maternal bonding and depression.
2
3rd; 5th
undernutrition
Peds:
In infants, length (linear growth) is measured from birth to ___ ___. Starting at age ___, height is measured with child standing up.
24 months; 2
Newborns’ focus distance is __ to ___ inches. Eyes may appear crossed but this is normal up to 2 months of age
and is ____ strabismus.
Lacrimal ducts are developed by __ to __ months of age.
8; 10
pseudo
2 to 3
Visual acuity of kids:
Reaches 20/20 by the age of ___ years.
The ______ chart is for color blindness.
6
Ishihara
Age 3 to 5 years:
Distance vision - ______ / _____/ ____ chart
Tumbling-E; HOTV; LEA
Testing vision in Age 6 years or older:
Use the _______ chart
Snellen
*** If vision is 20/40, what does it mean?
the test subject sees at 20 feet what a person with normal vision sees at 40 feet.
Vision testing in kids:
Refer when the following is present:
Frequent headaches
Squinting
Strabismus
___-____ difference between each eye (even if passing range)
Vision worse than ___/___ in age > ____ years
two-line
20/30; 6
Baby eye color:
____ babies are born with dark blue or gray eyes, which can change in color.
______, ____, and some Hispanic groups are born with brown eyes which usually do not change in color.
Caucasian
African-American; Asians
\_\_\_\_\_\_\_ test (red reflex test): Use direct ophthalmoscope. Shine light \_\_\_\_\_\_\_\_\_ in both eyes. Look for \_\_\_\_\_\_ and round red glow from both eyes.
Bruckner
simultaneously
symmetrical
The Bruckner test (red reflex test) assesses for ______, opacities, strabismus, etc
retinoblastoma
_______ reflex (light reflex test):
Shine _______ on the child’s eyes. Look for light reflection on the center of each eye. Look for ______ light reflection (from cornea).
This is a screening test for ______.
Hirschburg
flashlight
symmetric
strabismus
Strabismus:
Refer for intermittent esodeviation (cross-eyes) at age __ _____ or older.
2 months
The cover/uncover test is a screening test for ________-.
Place fixation target so that the child/infant is looking _____.
Cover one eye/remove cover - observe unpatched eye immediately for deviation.
strabismus
forward
***A mother calls you and reports that her newborn female infant has a small amount of blood in her vagina. Which of the following is the appropriate response?
1 Advise the mother to bring her infant to the office as soon as possible
2 Tell the mother that this is a normal finding and is due to the maternal hormones in her system
3 Advise the mother to take the infant to the closest ER
4 Advise the mother that her infant needs hormonal treatment
2 Tell the mother that this is a normal finding and is due to the maternal hormones in her system
Fontanels:
Posterior fontanel: closes by _____ months
Anterior fontanel: closes by ____ - ___ months
3
12 - 18
Hearing screening:
Newborn, toddler, or pre-school and older?
1 Understands simple commands
2 Pure tone audiometry
3 Otoacoustic emissions (OMEs) or auditory brainstem evoked responses
1 Toddler
2 Pre-school and older
3 Newborn
The mother of a 5 week old infant is concerned that her infant’s eyes are crossed occasionally. The NP would:
1 Recommend referral to a pediatric ophthalmologist
2 Advise the mother that this is a normal finding in some infants up to 2 months of age
3 Recommend multivitamin supplements should be given to the infant daily
4 Educate her on how to patch the infant’s eye every 4 hours
2 Advise the mother that this is a normal finding in some infants up to 2 months of age
Newborn screening tests:
TSH - screen for hypothyroidism (can lead to ____/____ retardation).
PKU: Inability to metabolize phenylaline to tyrosine due to defective enzyme. Causes ____ ____ / severe ______ _______
mental / growth
brain damage
Test for PKU: After ___ to ___ hours feeding formula or breast milk. Can be a false negative if obtained under ___ hours of age.
24 to 48
48
Hemoglobin and hematocrit - Do or do not screen at birth?
Do not
Physiologic anemia of infancy:
Lowest H&H is at __ to ___ weeks of life - Hgb 11. Due to temporary shutdown of erythropoietin production.
8 to 12
Physiologic jaundice of infancy:
A ______ _____ (____) hyperbilirubinemia
Bilirubin is the breakdown product from old _____.
Jaundice appears when levels are __ or higher.
Jaundice first appears on the ____ and progresses downward.
transient unconjugated (indirect)
RBCs
5
head
Physiologic jaundice starts after __ - ___ days of life and resolves in ___ to ___ weeks. If before this, it is _______.
EVALUATE jaundice at the ____ day of life and when serum bilirubin level rises > ___ mg/day.
2 - 3 1; 2 pathologic 1st 5
Jaundice in the newborn:
________ is very high level of bilirubin and results in severe brain damage or death
Kernicterus
Conjunctivitis in the newborn:
The conjunctiva is the superficial membrane that covers the surface of the eyes. Neonatal eye infections are serious and may cause _______ if not treated ASAP.
_______ _______: All newborns should receive prophylaxis within 24 hours of birth.
blindness
ophthalmia neonatorum
Conjunctivitis in the newborn:
prophylaxis is with 5% ______ ophthalmic ointment
erythromycin
Appearance of conjunctivitis symptoms:
In the first 24 hours of life: Usually due to eye irritation from silver nitrate drops
From 2 to 4 days after birth: May have ______ infection of the eye. Look for purulent eye discharge and swollen eyelids. can cause blindness by corneal perforation. Treated with _______ IV plus treat for _______ infection.
From 4 to 10 days after birth: May have _______. Treat with PO or topical __________.
gonococcal
ceftriaxone; chlamydia
chlamydia
erythromycin
**Viral keratoconjunctivitis (pink eye)
Bright pink eye that is very _______ with ** _________ ________. Very contagious. Occurs in epidemics. More common in school-aged children.
Frequent handwashing advised.
Keep child out of school for __ _____.
itchy; PERIAURICULAR LYMPHADENOPATHY
1 week
From 0 to ___ weeks of age:
Strong primitive reflexes: Moro, rooting, blink, stepping, etc.
Cries without tears until about __ to ___ months of age.
Head lag
jerky uncontrolled arm and leg movements
breastfed babies should breastfeed ___ to ____ times per day, they may breastfeed every ____ to __ hours.
Newborns should not go on for more than ___ hours without feeding at night. If asleep, wake baby up to feed.
Sleeps about ____ hours per day.
4 2 to 3 8 to 12 1.5 to 3 4 16
Colustrum secreted in the first few days is high in _______ _______.
maternal antibodies
Breastfed infants need vitamin ___ drops
Avoid cow’s milk during the first year of life due to ___ ______.
Start with formula that is fortified with _____.
D
GI bleeding
iron
Neonate variants:
___________: Diffused edema of scalp due to intrauterine or vaginal pressure
CROSSES the midline
Due to prolonged labor - goes away in a few days
Caputsuccedaneum
*** To remember the crossing the midline or not identifier, think “PUT the CROSS” - caPUTsuccedaneum CROSSes
Neonate variants:
***___________: Swelling that DOES NOT cross the midline or suture lines.
Is a traumatic subperiostal hemorrhage.
Higher risk for ________.
Cephalohematoma
hyperbilirubinemia
\_\_\_\_\_\_ \_\_\_\_\_\_ (seen in 80% of neonates): Benign white to yellow cysts found on the gums and/or hard palate of neonates. May be mistaken for teeth in newborns.
Epstein’s pearls
_________:
Abnormal urethral opening. Urethral opening is located in the ventrum (lower aspect) of the glans or shaft of the penis. Refer to pediatric urologist for surgical repair
Hypospadias
______:
Abnormal urethral opening. Urethral opening is located in the dorsum (upper aspect) of the glans or shaft of the penis. Refer to pediatric urologist for surgical repair.
Epispadias
__________:
Undescended testicle. Infant testicle may be in the ______ area.
____ groin with infant ____ ____.
Increases the risk for testicular cancer.
Refer to pediatric urologist.
Cryptoorchidism
inguinal
Massage; sitting up
Asymmetry of thigh / gluteal folds:
Rule out congenital hip dysplasia by performing the ____ and ______ maneuvers.
Barlow; Ortolani
____ reflex:
Sudden loud noise or sudden head movement will cause symmetric abduction and extension of the arms followed by adduction and flexion of the arms over the body.
Disappears by 4 - 6 months.
Moro (startle reflex)
Placing/stepping reflex:
Hold baby upright and allow the dorsal surface of the foot to touch the edge of a table.
The baby will flex the ___ and ____ and place the stimulated foot on the tabletop in a stepping motion.
Absent in ____ and _____ births.
hip; knee
paresis; breech
_____ reflex:
Eyelids will close in response to bright light.
Disappears after 12 months.
Blink
____ ____ reflex:
Turning head to one side with jaw over shoulder causes the arm and leg on side where the head is turned to extend.
The arm and leg on the opposite side will ____.
Tonic neck
flex
_______ reflex:
Stroking a finger at the corner of the mouth causes mouth to open and baby to turn to stimuli.
Disappears by 3-4 months.
Rooting
Name the condition (Peds):
The thin membrane at the end of the nasolacrimal duct causes blockage.
Presents in the first few weeks of life.
Chronic tearing from the baby’s eyes.
Most cases resolve spontaneously within __ months.
Findings: Crusts in eyelashes, eyelids stuck together, mucopurulent discharge, persistent tearing, WORSE ON AWAKENING
Treatment is to massage the lacrimal sac by placing finger on it and massage downwards towards the mouth.
Repeat several times a day.
Congenital lacrimal duct obstruction
Breastfeeding - first 6 months of life:
Look for inadequate or delayed milk production. There should be no clicking sounds.
Look for wet diapers (__ to __) and loose seedy stools __ to __ times in 24 hours.
Look for _______ fontanelles and none to very few wet diapers.
Give iron at ___ months of age.
4 to 8
3 to 4
sunken
6
Lactational mastitis: More common in the 1st 3 months of breastfeeding. Occurs in 2-10% of breastfeeding women. Cause is \_\_\_\_\_, \_\_\_\_, or \_\_\_\_\_ \_\_\_\_\_. Labs include: Non-pharm treatment includes:
Pharm treatment includes: ________ or ______
Pharm treatment for MRSA (non-severe) is: _____ if NOT a newborn, or _______
staph; MRSA; strep pyogenes
C&S of milk
Cold compresses, NSAIDs, complete emptying of breast
dicloxacillin; Keflex
Bactrim
clindamycin
A new mother is breastfeeding her full-term 4-week old male infant. She wants to know whether she should give the infant vitamin supplements. You would tell her:
1 Since she is breastfeeding, the infant does not need any vitamin supplements.
2 Breastmilk contains all the vitamins and minerals that the child needs for the first 12 months of life.
3 All breastfed infants require Vitamin D supplementation
4 Breasfted infants require iron and vitamin B12 supplementation
3 All breastfed infants require Vitamin D supplementation
During a well-child visit, a new father wants to know if he can give fresh whole milk to his 6-month old son. The NP would recommend that:
1 He can start giving whole milk but not skim milk by 6 months of age
2 He should not give whole milk to his son until he is at least 12 months of age.
3 He can give whole milk to his son at any time
4 He should not give whole milk to his son without diluting it in water
2 He should not give whole milk to his son until he is at least 12 months of age.
Growth & development: What age is this?: STARTS to smile at people (social smile). Starts to coo. Turns head toward sounds. Can hold head up. Begins to follow things with eyes. Brings hands to mouth.
2 months
Growth & development:
At age ___ months, refer for floppy, lack of response to sounds, doesn’t smile at people
2
Growth & development:
What age is this?:
May roll from tummy to back
when lying on stomach, cab push up to elbows
Holds head steady
Smiles in response to others (social smile)
Starts to babble
4 months
Growth and development:
At age ____ months, refer for a baby that:
doesn’t smile at people, does not watch things as they move, can’t hold head steady, does not coo, does not push down with legs when feet are placed on a hard surface
4
Growth & development:
What age is this?:
Rolls in both directions
Begins to jabber (consonants such as “m”, “d”)
Imitates sounds such as “raspberries” (imitated fart sound or whatever)
Begins to sit without support
Passes objects from one hand to the other
*** Palmar grasp of objects
Reaches for toys (raking)
Starts to crawl
6 months
Growth and development:
At age ____ months, refer for a baby that:
Does not babble, does not respond to sounds, can’t roll, doesn’t laugh
6 months
Growth & development:
What age is this?:
Separation anxiety and stranger anxiety (“clingy”)
Plays peek-a-boo
Understands “no”
***Pincer grasp starts. Can pick up cereal with index finger and thumb. (fine motor)
Can pass things from hand to hand (fine motor)
Pulls to stand and “cruises” (holds furniture to move around a room) (gross motor)
9 months
Growth and development:
At age ____ months, refer for a baby that:
Absence of babble
Unable to sit alone
Still has strong primitive reflexes (Moro)
9
Growth & development:
What age is this?:
Follows simple one-step directions such as “pick up a toy”
Gross motor:
Walks idependently or holding one hand while walking
Growth rate slows down
12 months
Growth and development:
At age ____ months, refer for a baby that:
Absence of weight-bearing
Unable to transfer objects from hand to hand
12 months
12 month-old labs include:
___ and ____ ______
anemia; lead poisoning
The following are acceptable methods of birth control for breast-feeding mothers EXCEPT:
1 Diaphragm with spermicidal gel
2 Progesterone-only pills (Micronor)
3 Condoms
4 Low-dose oral contraceptives with at least 20 mcg estradiol
4 Low-dose oral contraceptives with at least 20 mcg estradiol - (NOT OK!)
A new mother who is on her fourth day of breastfeeding complains to the nurse practitioner of very sore breasts. The NP should:
1 Recommend a decrease in the number of times she breastfeeds her infant per day
2 Recommend that she stop breastfeeding and use infant formula for the next 48 hours
3 Educate the mother that this is normal during the first week or two of breastfeeding and the soreness will eventually go away
4 Recommend that she purchase plastic nipple pads for her nursing bra and use it daily
3 Educate the mother that this is normal during the first week or two of breastfeeding and the soreness will eventually go away
Infant colic: Rule of 3s:
Crying and irritability lasting a total of ___ hours per day. Occurs more than ___ days in a week.
Starts at birth and usually resolves by the age of ___ months.
Goal: Rule out _______ causes such as diaper rash, thrush, hair/fiber wrapped around a finger, toe, or penis, lactose intolerance.
3
3
3
physiologic
Down’s syndrome: Sports participation:
Must be screened for ________ (___-spine) instability.
Before participating in sports, must evaluate with _______ __-____ x-ray.
atlantoaxial (C-spine)
lateral C-spine
Down’s Syndrome:
High incidence of _____ ___ disease, thyroid disease, hearing loss etc.
Needs _____ and ____ x-ray in the first month of life
early onset Alzheimer’s disease
congenital heart
echo; chest
A newborn infant who is small for gestational age is noted to have microcephaly with short palpebral fissures, a smooth philtrum and a thin upper vermillion border. The infant is most likely to be diagnosed with the following: 1 Down syndrome 2 Fetal alcohol syndrome 3 Growth retardation 4 Osgood-Schlatter disease
2 Fetal alcohol syndrome
The safest place in the car for an infant/child is in the ______ of the ____ seat.
***Infants up to _____ pounds should be in ____-_____ seats
middle; back
20; rear-facing
AAP recommends that kids ride in the back seat until age ______.
13 years
***Leading cause of death:
0 - 12 months: ______/ ______ _______
age 1 year to 24 years: _______
developmental / genetic disorders
accidents
Toddlers:
2 years old:
_______ behavior
Builds towers of ___ or more blocks (** stacks __ cubes)
Draws ________ lines
Combines ___ to ___ word sentences intelligible mostly to family
Begins to run.
Climbs stairs up and down holding on railing or wall for support
Has security blanket or other transitional objects
Defiant
4; 6
straight
2 to 3
