Exam 3 Flashcards
(169 cards)
1
Q
Neonate
A
Birth to 29 days
2
Q
Infant
A
29 days to 1 year
3
Q
Term infant
A
37-42 weeks
4
Q
Birth weights
A
<10th percentile is too small
> 90th is large
5
Q
APGAR
A
Appearance (color) Pulse Grimace (reflex response to bulb syringe) Activity (muscle tone) Respiratory effort
1 and 5 minute interval
6
Q
APGAR scoring
A
8 is normal
5-6 is mild depression
3-4 need resuscitative measures
7
Q
Ballard assessment is…
A
Calculates GA of child within 1 week
Neurological and physical components evaluated
8
Q
When do you aspirate stomach contents in an infant?
A
Meconium stained amniotic fluid
C section babies
9
Q
Failure to pass NG tube, think…
A
Esophageal atresia associated with tracheoesophageal fistula
10
Q
High frequency tremors normal until…
A
4 days old
If >4, consider CNS, PNS
11
Q
Pulse of infant
A
115-140
<90 or >180 is a concern
12
Q
Physiologic jaundice
A
3-4th day of life
96 hours, self limited
13
Q
Erythroblastosis fetalis
A
Jaundice in first 24hours of life, can cause kernicterus
14
Q
Vernix caseosa
A
Normal finding at birth, peely white skin/residue
15
Q
Acrocyanosis
A
Benign, hands/feet cyanotic
16
Q
Central cyanosis
A
Tongue and gum mucosa blue, not normal
17
Q
Milia
A
Pinhead smooth, white raised areas
18
Q
Miliaria rubra
A
Heat rash
Caused by obstructed sweat glands, vesicles with erythematous base
Resolves in 1-2 weeks
19
Q
Erythema toxicum
A
Baby acne
2-3rd day of life
Red macules with central urticarial wheals
Spontaneously resolves in a week
20
Q
Angel kisses
A
On forehead
21
Q
Stork beak
A
On back of neck
22
Q
Salmon patches
A
Small and pink, fade over time
23
Q
Port wine stains/nevus flammeus
A
Most often on face, unlikely to go away and may get darker
24
Q
Sturge Weber syndrome
A
Trigeminal V1, seizures, hemiparesis, mental retardation, glaucoma
Orbit, upper eyelid and forehead
25
Large posterior fontanelle, think...
Congenital hypothyroidism
26
Caput succedaneum
Crosses suture lines
Swelling/edema
27
Cephalhematoma
Bleeding, doesn't cross suture lines
28
Macrocephaly and microcephalic
>2 standard deviations above the mean
3 standard deviations below the mean
29
Pupils constricted for...
First 3 weeks of life
30
Nasolacrimal duct obstruction
Tears begin 2-3 months, not fully patent until 5-7 months
Parent complains of chronic tearing
31
Ocular motility
4 weeks- following in an arc
8 weeks- follow past midline with coordinated head movements
3 months- follow an object
32
Nystagmus common in infants...
Immediately after birth
After a few days, consider blindness
33
Doll's eyes for infants...
First 10 days
34
Blue sclera in infants...
After 6 months its abnormal
35
Sucking reflex until...
9-12 months of age
36
Micrognathia
Pierre robin syndrome
Breathing problems, glossoptosis
37
Epstein pearls
On palate, white spots
38
Teeth in infants
First set at about 6 months, bottom front teeth
39
By 10 months, what teeth ?
Two upper, two lower central incisors
40
4 teeth added every...
4 months. 8 teeth by 14 months
41
Apnea definition
>20 seconds
42
Shrill, high pitched cry
ICP, narcotic addiction
43
Hoarse cry
Hypocalcemic tetany, congenital hypothyroidism
44
Expiratory stridor
Airway obstruction, polyp, tracheomalacia
45
Absence of cry
Severe illness, vocal chord paralysis, profound brain damage
46
Femoral pulses in infant
Check 24-48 hours after birth to assess strong pulses after closure of PDA
Weakness- consider coarctation of aorta
47
Heart lie in infant
More horizontally, apex is higher
48
PMI of infant
4th ICS, left of MCL until age 7
49
Auscultating infants
PVCs more common
Louder sounds
S2 split sometimes
50
Systolic II/VI or less until...
PDA and PFO close in the first 48 hours
51
Transposition of great vessels
Must have additional heart defect to survive
Not compatible with life without intervention
52
Tetralogy of fallot
Pulmonary stenosis
Thickened right ventricle
Ventricular septal defect
Overriding aorta (over septal defect)
53
Tet PE findings
Parasternal heave
Systolic ejection murmur over third intercostal space
Radiation to left side of neck
54
Atrial septal defect
Systolic ejection murmur over pulmonic area
Loud, high pitched, harsh
Thrill and parasternal thrust possible
55
Ventricular septal defect
Holosystolic murmur
Best heard at left sternal border in 3rd to 5th intercostal spaces
Loud, coarse, high pitched
56
PDA
Dilated and pulsatile neck vessels
Harsh, loud, continuous murmur
1st to 3rd intercostal spaces and lower sternal border
57
Kawasaki disease
Inflammation of. Small and medium arteries, including coronary arteries
High fever
Conjunctivitis
Strawberry tongue
Rash, polymorphous and erythematous
58
Umbilical stump
Falls off in 10-14 days
59
Umbilical hernia
Typically resolves spontaneously by age 2
60
Duodenal atresia
Double bubble sign
61
Ambiguous genitalia
Congenital adrenal hyperplasia is MCC
62
Concave abdomen
Diaphragmatic hernia
63
Bladder percussed at level of...
Umbilicus
64
Pyloric stenosis
Inspect during feeding in supine position
Olive mass
Projectile vomiting
65
Intussusception
Drawing up knees
Vomiting bile
Sausage mass
66
Obstruction
High pitch/frequency bowel sounds
67
Omphalocele
Incomplete closure of abdominal wall, midline defect with spleen, liver and stomach
Hypotensive baby, large exposed bowel, risk for sepsis
68
Hirschsprung's disease
Congenital megacolon
Midline suprapubic mass
Failure to pass meconium
69
Colic
Excessive crying
>3 hours a day, >3 days a week for >3 weeks
Sudden onset, same time of day
First month, resolves by 3 months but may persist
High pitched intense crying, flushed face, furrowed brow
70
Metatarsus varus
Pigeon toe
Forefoot is adducted in relation to hindfoot
Resolves spontaneously in first few years of life
71
Talipes equinovarus
Club foot
Entire foot is deviated midline- forefoot adduction, fixed hindfoot inversion, Achilles' tendon is foreshortened
72
Clavicle fx
Distal 1/3, crepitus
73
Ortolani
Index finger on greater trochanter, thumbs on lesser trochanter
Abduct hips, hear clicks or feel clunks
74
Barlow
Index fingers on greater troachanters and thumbs medially over lesser trochanter
Thumb presses backward and outward to feel for slip, index finger move forward and inward
Instability
75
Only test sensory in infant if...
Palsy or spina bifida expected
76
Meningiomyelocele
Severe spina bifida, massive and obvious
Spinal chord and nerves in the outpouching
77
Abdominal reflexes absent until...
6 months old
78
Rooting
Until 3-4 months
Touching mouth or cheek and head will turn to that side
79
Blinking/dazzle reflex
Eyelids close in response to light
1 year
80
Acoustic blink/cochleopalpebral reflex
Both eyes blink at sharp noise
81
Palmar grasp
3-5 months lasts
Hand will grasp finger
82
Moro startle reflex
Intact CNS, dead drops a few centimeters and arms spread wide
Disappears after 3-5 months
83
Gallant's
One side of back stroked 1 cm from the midline, and lateral curving to the stroked side
Disappears after 2-3 months
84
Perez's reflex
Thumb on sacrum and extend to head, causes flexion of knees and extension of neck, emptying bladder
Disappears after 2-3 months
85
Tonic neck reflex/fencing
Turn head to one side, holding jaw over babies shoulder
Arm and leg extend on the side the head turns, other side is flexed
Disappears at 6 months
86
Placing response
Foot lightly allowed to place on table
Hip and knee flex and then put their foot down
Disappears at 2-5 months
Test at 4-5 days of life
87
Stepping response
Both feet placed and should see alternate movement
Disappears at 2-5 months, test 4-5 days of life
88
Water less than...
120 degrees
89
Breast milk or formula only for...
First 4 months
90
Transient tachypnea of newborn and retained fetal lung fluid
Tachypnea, grunting, flaring, retracting
Excess fetal lung fluid from delayed clearance in C section
91
Klumpke's paralysis
Brachial plexus trauma of wrist and hands
92
Erb's palsy
Brachial plexus trauma at birth
93
Length of pregnancy
40 weeks
94
Nagele's rule
9 months plus 7 days from last menstrual period
95
1-200 risk at age...
35
96
1-20 risk at age...
44
97
Over 5 parity increases risk for...
Placenta previa or accreta
98
Quickening
Around 20 weeks
99
8th week breast changes
Increased pigmentation and size of Arellano and nipple
Nipple more erect, Montgomery tubercles more prominent
100
16th week breast changes
Colostrum produced, may be expressed
101
Chadwick's sign
Bluish/violet color change of vagina
102
Ph in pregnancy of vagina
More acidic
103
Uterus increases in weight from...
2 ounces to 2 pounds over 40 weeks
104
12-14 weeks, uterus shifts from...
Pelvic organ to abdominal organ
105
Hegar's sign
6-8 weeks, softening of the isthmus
106
Cervical signs in pregnancy
Red velvet mucosa at cervical os
107
Goodel's sign
Softening of cervix at 4-6 weeks
108
HTN after 24 weeks
PIH
109
What kinds of murmurs are not uncommon in pregnancy?
Soft, blowing murmurs
110
How many weeks to get fundal height same as GA
20 weeks
111
HR location
Midline/lower abdomen at 12-18 weeks
112
Heart rate of baby
160s early pregnancy
120-140s nearing term
113
When do you begin Leopold maneuvers?
28 weeks GA
114
Attitude
Fetal head when it is presenting
Flexed, hyperextended, etc.
115
Station
Presenting part and relationship to ischial spine
At ischial spine is zero, above or below, below is positive numbers
116
Effacement
Thinning, shortening and drawing up of cervix, measured in percentage from 0-100%
Documented in centimeters
117
Bishop score
Pre labor score to determine if induction of labor is necessary
118
Low BMI <19.8 weight gain
28-40 lbs
119
Obese BMI weight gain
Around 15 pounds
120
Early pregnancy bleeding
Implantation
Ectopic
Threatened abortion
121
Late pregnancy bleeding
Cervical changes
Placenta previa
Placenta acreata
Placental abruption
122
PIH
HTN after 24 weeks pregnanct
123
Pre eclampsia
HTN plus protein in the urine!!
Plus edema
124
Eclampsia
Pre eclampsia plus seizures
Can lead to death and HELLP syndrome
125
Placenta previa
Placenta lies low in uterus and partially or completely covers cervix
Painless bleeding in third trimester
126
Placental abruption
Most common pathological cause of bleeding in late pregnancy
Painful bleeding
0-3 scale
127
Premature rupture of membranes
High risk if it occurs preterm or if labor does not begin within 12 hours
Passage of fluid, nitrazine paper and fern leaf pattern
128
Ectopic pregnancy
Bleeding, pain on one side
If rupture- tachycardia, hypotension
Tenderness, adnexal mass, CMT
129
Myomas
Heavy menses, pelvic discomfort, can effect bowel patterns
Nodules on uterus, can prevent implantation and growth of an embryo
130
Geriatric
Over the age of 65
131
ADL versus IADL
Activities of daily living are more relevant like dressing, bathing, eating, walking
IADL are things they want to do, like housework, take meds, drive, laundry, shopping, cooking
132
Urge incontinence
Need to urinate comes quickly and can't defer it
Stoke, MS, spinal chord injury
133
Overflow incontinence
Dripping of urine
Bladder obstruction, BPH
134
Stress incontinence
Leaking of urine with increased pressure, like laughing or running
Incompetent sphincter
135
Functional incontinence
Normal control but issues physically making it to the bathroom
136
Medications in elderly key points
Have them bring the bottles
Know prescription versus OTC
137
Leading cause of injury related to death in elderly?
Falls !
138
Temp in elderly
May not elevate in infection
139
BP inelderly
Systolic HTN, diastolic can level off between 50-60
140
Weight loss in elderly
If 5-10% in 12 months, work it up
141
Senile purpura
Purple/blue coloring on hands in elderly
142
Actinic keratosis
Face, neck, trunk and hands
Can develop into squamous cell carcinoma
143
Seborrheic keratosis
Face, chest, shoulders and back
Waxy, scaly and slightly elevated
MCC non cancerous lesion in elderly
144
Solar lentigines
Back of hands, forearms
Sun exposed areas, light brown to light flat macules
145
Sebaceous gland hyperplasia
Forehead or nose
3 mm with central pore andyellowish in color
146
Decubitus ulcers
Prolonged pressure over a bony prominence
147
Decubitus ulcers staging
1- nonblacnhing erythema of intact skin
2- partial thickness skin loss of epidermis
3- full thickness skin loss, damage or necrosis to subQ
4- significant damage or necrosis with muscle and or bone involvement
148
Headaches in elderly
```
Temporal arteritis (70)
HTN
```
149
Eyes in elderly
Presbyopia- common vision changes with age, lens starts to harden
Need readers to focus on near objects
150
Senile ptosis
Drooping of eyelid, usually bilateral
151
Arcus senilis
Common over age of 60
Blue, grey, white
Disposition of lipids
152
Macular degeneration
Central vision loss
Progressive and painless
Amsler grid to evaluate
153
Cataracts
Opacities of lens, cloudy look
154
Medications contributing to hearing loss
Furosemide
Salicylate
Gentamicin
Aminoglycoside S
155
Cerumen impaction
Conductive hearing loss
MCC of hearing loss in elderly
More sudden
156
Presbycusis
50% of patients over 75
Slow, progressive hearing loss, sensorineural
Bilateral, high frequency sound
157
Otosclerosis
Gradual conductive hearing loss
Initially low pitched sounds and whispers
Hardening of bony growth of stapes
158
Xerostomia
Dry mouth
159
Oral cancer
>40
Tobacco abuse
Leukoplakia and erythroplakia are pre malignancy
160
Colonoscopy
50-75 for USPSTF, every 10 years
50 every 10 years for ACS, annual guiac
161
Diverticulosis
Predisposed for diverticulitis
Fever, LLQ pain, guarding
162
UTI symptoms in elderly
Atypical, can be dementia
163
Osteoarthritis
```
Crepitus
Asymmetrical
Joint stiffness in morning andimproves within 30 minutes
DIP joints, heberden nodes (women)
Degenerative loss of cartilage
```
164
Polymyalgia rheumatica
Symmetric pain worse in the morning
Neck, shoulders, lower back, pelvic girdle
UE and pelvis are tender with palpation
165
Taste diminished...
Bitter and sour first
166
Analogies
Similarities and differences
167
Abstract reasoning
Shapes and patterns
168
Calculations
Serial 7s
169
Situational judgement
What if's
