History and Physical Examination of the Newborn Flashcards
(237 cards)
1
Q
How many times should a full term newborn be examined b/n birth and discharge?
A
At least 2 times, preferably 3 times.
2
Q
Where and when should the newborn be examined b/n birth and discharge?
A
- Delivery room- immediately at birth
- Nursery/ rooming-in area- within 12h of birth
- Upon discharge, with the mother
3
Q
During physical exam, where should be the attention directed?
A
- Wether any congenital anomalies are present
- Wether the infant has made a successful transition from fetal life to air breathing
- To what extent gestation, labor, delivery or anesthetics have affected the newborn
- Wether the infant has any sign of infection or metabolic diseases
4
Q
What principles/ techniques should be included in the neonatal physical exam?
A
- Inspection
- Palpation
- Auscultation
5
Q
In neonatal physical exam, what characters/ skills are required?
A
- Patience
- Gentleness
- Procedural flexibility
6
Q
What examination should be done first if the infant is quiet and relaxed at the beginning?
A
Auscultation of the chest, and palpation of the abdomen.
7
Q
Patterns of activity of the newborn for the first 15 to 30 minutes of birth
A
- Immediate tachycardia- 160 to 180bpm, gradual drop to 100 to 120bpm
- Irregular respiration, tachypnea 60 to 80bpm, brief moments of apnea
- Moist-sounding lung fields, transient grunting and retractions
- Awake, moving, alert, easily startled, crying, transient tremors
8
Q
Patterns of activity of the newborn for the next 60 to 90 minutes
A
- Sleepy or sleeping, somewhat unresponsive
- Heart rate of 100 to 120 bpm, transient tachycardia
- Resp rate of 50 to 60 bpm, transient tachypnea
- Usually, passage of meconium
9
Q
Patterns of activity of the newborn for the next several hours
A
Again, awake, alert, easily startled, crying, easily stimulated and reactive
10
Q
I. General Appearance
The newborn should be ** when being examined
A
Naked
11
Q
I. General Appearance
Things to observe in the inafant?
A
- Posture
- Skin color
- Activity
- Muscle tone
Gross congenital abnormalities
12
Q
II. VITAL SIGNS
What are the vital signs to be monitored?
A
- Temperature
- Respiratory Rate
- Type of Respiration
- Cardiac
13
Q
II. VITAL SIGNS
How often should you monitor vital signs?
A
Every 30 minutes after birth, for 2 hours or until stable
14
Q
II. VITAL SIGNS
A. TEMPERATURE
True or False:
Neonates USUALLY develops fever except in response to env’tal temp.
A
FALSE- UNUSUAL
15
Q
II. VITAL SIGNS
A. TEMPERATURE
When should you obtain a rectal temperature
A
If the neonate’s skin temp is 38C and remains elevated even the envnt returns to normal
16
Q
II. VITAL SIGNS
A. TEMPERATURE
A temp obtaining technique that is less likely to be affected by the environment.
A
Rectal Temperatue
17
Q
II. VITAL SIGNS
A. Temperature
Hypothermia is more likely to be observed in?
A
Premature infants
18
Q
Normal respiratory rate?
A
40 to 60 bpm
19
Q
How to obtain RR of the infant?
A
Looking at the upper abdomen for a full minute
20
Q
When obtaining RR, what happens as soon as the infant is touched?
A
Respiratory rate and depth changes.
21
Q
True or False:
All infants are regular rather than periodic breathers.
A
FALSE- All infants are periodic rather than regular breathers.
22
Q
Normal Cardiac Rate
A
120 to 160 bpm
23
Q
Increased heart rate is seen when the baby is?
A
Crying, active, or breathing rapidly.
24
Q
Decreased HR is seen if the infant is?
A
Quiet and breathing slowly.
25
Describe the HR of preterm infants at rest
Resting HR is at the higher end of the normal range
26
Describe the resting HR of occasional term or postterm infants
may have a HR below 100bpm
27
Tachycardia with a rate persistently greater than 160 bpm may indicate?
CNS irritability, CHF, sepsis, anemia, fever
28
True or False:
| Measuring BP is a ROUTINE part of the vital signs in the newborn
FALSE- not a routine part in the vital signs of the newborn
29
What circumstances should you measure/ include BP in newborn?
1. Infants requiring special care
| 2. Evaluating coarctation of the aorta, and CHD
30
Blood pressure correlates directly with?
1. Gestational Age
2. Postnatal Age
3. Birth Weight
31
2 important elements for obtaining accurate BP
1. Quiet infant
| 2. Properly sized cuff
32
Proper size of cuff?
Width 2/3 the length of the upper arm
33
Method for obtaining mean pressure
Flush Method
34
BP Method easier in active infants
Flush Method
35
BP Method that that requires only Sphygmomanometer
Flush Method
36
Describe the techniques in Flush Method?
1. Wrap the cuff on the arm/leg
2. Inflate enough to blanch the skin
3. Lower pressure slowly until there is flush of color, at which point the pressure is read
37
Flush of color at which the pressure is read indicates the?
Estimated Systolic Pressure
38
BP Method that provides both Systolic and Diastolic pressure
Doppler Method
39
Doppler Method requires:
Electronic equipment and a quiet infant
40
Blood Pressure Values in the Newborn Accdg to Birthweight
Refer to page 47
41
III. Anthropometric Measurements
| Describe the proper technique in obtaining Head Circumference
Place the tape measure around the head, above the glabella, and the occipital area.
42
What do you call if the head circ. is obtained around the head, above the glabella, and the occipital area?
OCCIPITO-FRONTAL CIRCUMFERENCE
43
Normal occipito-frontal circumference in term infants.
32-36 cm
44
Used in weight and percentile
Infant weighing scale
45
Weight of infant is recorded in? (Measurement)
Kilograms
46
Where do you plot infant weight?
Lubchenco chart
47
Birthweight below the 10th percentile
Small for Gestational Age (SGA)
48
When do you consider a newborn as SGA
Birthweight below the 10th percentile
49
SGA with an onset early in gestation
Symmetric
50
Describe the brain size as to the body size in Symmetric SGA
Brain size corresponds to the Body size
51
Etiologic factors for Symmetric SGA
1. Environmental- smoking or drugs
2. Genetics- small maternal size, or chromosomal disorders (trisomy 13, 28, and 21 syndromes)
3. Intrauterine infections (TORCH, and metabolic disorders)
52
Onset of Symmetric SGA
Early in gestation
53
SGA with onset late in gestation
Asymmetric SGA
54
Effect of Asymmetric SGA in brain?
No or minimal effects on fetal brain growth
55
Onset of Asymmetric SGA
Late in gestation
56
Etiology of Asymmetric SGA
Uteroplacental insufficiency with chronic fetal hypoxia
57
Birthweight between the 10th and 90th percentile
Appropriate for Gestational Age (AGA)
58
When to consider the infant as AGA
Birthweight between the 10th and 90th percentile
59
Birthweight above the 90th percentile
Large for Gestational Age (LGA)
60
When to consider infant as LGA
Birthweight above the 90th percentile
61
LGA infants have increased incidence of?
1. Perinatal Asphyxia and birth injuries
2. Respiratory Distress Syndrome
3. Hypoglycemia
62
Most LGA infants are born to?
Diabetic mothers
63
Posture of the baby during the length measurement
Lies supine on a recumbent length table or measuring board
64
In measuring length, the crown of the head should touch the?
Stationary vertical headboard
65
Steps in obtaining the length
1. Crown of the head should the vertical stationary board
| 2. The legs should remain flat on the table and shifts the movable board against the heel
66
Length is recorded in?
To the nearest 0.1 cm
67
Length is plotted on?
Lubchenco Chart
68
Deep, rosy red, ruddy color
Plethora
69
Color more common in infants with polycythemia
Plethora
70
Plethora
Deep, rosy red, ruddy color
71
Where can you see Plethora
1. More common in infants with Polycythemia
2. Overoxygenated
3. Overheated infants
72
Jaundice
Yellowish- secondary to Indirect Hyperbilirubinemia
| Greenish- secondary to Direct Hyperbilirubinemia
73
Level of bilirubin at which Jaundice is noted
>5mg/dL
74
May be secondary to Anemia, Birth Asphyxia, shock or PDA
Pallor
75
Pallor may be 2dary to?
Anemia, Asphyxia, Shock or PDA
76
Blue skin including tongue and lips
Central Cyanosis
77
Central Cyanosis is caused by?
Low oxygen saturation in the blood
78
Bluish hands and feet only
Acrocyanosis
79
Cause of Acrocyanosis
May be normal to newborn bec of vasomotor instability and peripheral circulatory sluggishness
80
Lacy red pattern
Mottling
81
Mottling is seen in?
1. Normal infants
2. Cold stress
3. Hypovolemia
4. Sepsis
82
Persistent mottling
Cutis Marmorata
83
Where can you find Cutis Marmorata?
Down Syndrome, trisomy 13, and 18
84
Greasy white substance that covers the skin
Vernix caseosa
85
Vernix caseosa covers the skin up to?
38th week of gestation
86
Purpose of vernix caseosa
Provide moisture barrier
87
Tiny, sebaceous retention cysts, whitish, pi-head sized concretions, seen in nose, chin, forehead and cheeks, resolves weeks after birth
Milia
88
Small areas of red skin with yellow-white papule in the center
Erythema toxicum
89
When does erythema toxicum erupts
Noticeable 48 hours after birth, but can be seen as late as 7 to 10 days
90
Non-inflammatory pinpoint clear vesicles that erupt in profusion over large areas of the body surfaces.
Miliaria Crystallina
91
Leaves a brawny desquamation on healing
Miliaria Crystallina
92
Benign, self-limiting condition which requires no specific therapy, characterized by 3 stages
Transient pustular melanosis
93
3 stages of transient pustular melanosis
1. Pustules
2. Ruptured vesicopustules with scaling or typical halo appearance
3. Hyperpigmented macules
94
True vascular nevus
Macular Hemangioma
95
Stork bite
Macular Hemangioma
96
NORMALLY Seen in occipital area, eyelids, and glabella
| Disappear spontaneously within the 1st year of life
Macular Hemangioma
97
Usually seen at birth, does not blanch with pressure, and does not disappear in time
Port-wine stain / Nevus Flammeus
98
Dark-blue, or purple, bruise-like macular spots
Mongolian spots
99
Mongolian spots are usually seen in the?
Sacrum
100
Most common birthmark
Mongolian spots
101
Things to check on Phys Exam of the head?
1. General shape
2. Cuts, bruises 2dary to forceps or fetal monitor leads
3. Micro/Macrocephaly
102
Head circumference is greater than 2 standard deviations above the mean
Macrocephaly
103
Macrocephaly is a manifestation of?
Hydrocephalus
| Skeletal Disorders
104
Head circum less than 3 standard deviations below the mean
Microcephaly
105
Microcephaly is seen in?
Familial with autosomal recessive or dominant inheritance
Infections
Trisomy 13 and 18
106
Diamond shape fontanel b/n coronal and sagittal suture
Anterior Fontanel
107
When does the anterior fontanel closes?
9 to 18 months
108
Intersection of the occipital and parietal bones
Posterior fontanel
109
When does posterior fontanel closes?
At birth or admits the tip of the finger till 2 to 4 months
110
Large Anterior Fontanel
Hypothyroidism
| Chromosomal abnormalities
111
Small anterior fontanel
Hyperthyroidism
Microcephaly
Craniosynostosis
112
Bulging fontanel
Increased intracranial pressure
Hydrocephalus
Meningitis
113
Seen in prolonged labor secondary to the accumulation of blood or serum above the periosteum, poorly demarcated swelling that crosses the suture lines
Caput Succedaneum
114
When does caput succedaneum resolves
Within days
115
Rupture of blood vessels that traverses the skull to periosteum, well demarcated swelling that does not cross the suture lines
Cephalhematoma
116
Cephalhematoma resolves
2 weeks to 3 months
117
Temporary asymmetry of the skull due to the birth process, seen in prolonged labor or vaginal delivery
Molding
118
Molding resolves in?
Within 1 week
119
Noted during PE of the face
General shape of the nose, mouth and chin
120
Eyes widely separated
Hypertelorism
121
Compression of the facial nerve against the sacral promontory or by trauma caused by the use of forceps during delivery
Facial Nerve Palsy
122
When do you see facial nerve palsy
1st to 2nd day of life
123
Characteristics seen in facial nerve palsy
Corner of the mouth droops and absent nasolabial fold on the paralyzed side. Unable to close the eyes, move the lips, and drool on the side of paresis
124
Symmetric facial palsy due to the absence or hypoplasia of the 7th nerve nucleus
Moebius Syndrome
125
More useful for inspecting the eyes than forcing the lids apart
Doll’s eye maneuver
126
Doll’s eye maneuver is a result of
Labyrinthine and neck reflexes
127
Normal RED ORANGE REFLEX
No dulness and no irregularities
128
White pupil aka?
Cat’s eye reflex
129
Cat’s eye reflex denotes?
Abnormalities in the lens, vitreous, fundud
130
Most common presenting sign of cataract
White pupillary reflex or Leukocoria
131
Usually benign eye abnormality and usually resolves by 2 weeks of age
Subconjunctival hemorrhages
132
PE of the nose
```
Size
Shape
Patency
Presence of nasolacrimal duct inflammation
Size of the Philtrum
Nasolabial folds definition
```
133
If suspected, do nasal patency
Unilateral or Bilateral Choanal Atresia
134
How to assess nasal patency
Pass a nasogastric tube in each nose into the stomach
135
PE of the ear
Size
Shape
Position
Presence of canal, and tags or pits
136
How to determine the position of the ears
Draw a horizontal line from the inner and outer canthi of the eyes across the face, perpendicular to the vertical axis of the head
137
When to consider ears as Low Set
If the helix of the ear is below the horizontal line
| **congenital abnormalities
138
Hairy ear is seen in
Infant of diabetic mothers
139
True or false
| Otoscopic exam is performed because the ears of the infant is clear
FALSE
| Because the ear of the infant is full of amniotic debris
140
PE of Mouth
Hard and soft palate clefts
Gum clefts
Deciduous teeth
141
Should be visualized in mouth PE
Tongue, buccal surface, palate, back of the mouth
142
Palpated with gloved finger
Gum and hard palate
143
Keratin-containing cyst
Epstein Pearls
144
Where can you find Epstein pearls?
Hard and soft palates
145
Cystic swelling at the floor of the mouth
Ranula
146
Small lesions on oral mucosa due to the trauma of salivary gland ducts
Mucocele
147
Natal teeth
Low incisors
148
Loose, roots are absent or poorly formed
| Extracted to prevent aspiration
Predeciduous teeth
149
True teeth that erupt early, not extracted
True Deciduous teeth
150
Enlarged tongue
Macrglossia
151
Macroglossia seen in
Beckwith’s Syndrome
| Congenital Hypothyroidism
152
Quadrad of Beckwith’s Syndrome
Macroglossia
Gigantism
Omphalocoele
Severe Hypoglycemia
153
Reflex that cause the baby to turn the head
Rooting reflex
154
Palpated in the neck
Sternocleidomastoid- hemorrhages
| Thyroid- enlargement and thyroglossal cysts
155
Most common fracture in the newborn
Clavicular Fracture
156
Irregularities in the clavicle
Crepitus
157
PE of the CHEST
Check for symmetry
158
Tachypnea with retractions
Respiratory Distress
159
Barrel chest
Meconium Aspiration Pneumonia
| -due to hyperaeration and air trapping
160
Normally seen due to compliant chest walls
Mild subcostal and intercostal retractions
161
Because diaphragm is the primary muscle for breathing, quiet breathing is
Abdominal
162
Normal breast measurement
1cm
163
Enlarged breast (3 to 4 cm)
Due to Maternal Estrogen
164
Extra nipples and are normal
Supernumerary nipples
165
A white discharge from infant’s ( male or female) breasts
Witch’s milk
166
Absent or unequal breath sounds
Pneumothorax and Atelectasis
167
Absent breath sounds with the presence of bowel sounds
Congenital Diaphragmatic Hernia
168
True or False
| Newborn lung sounds are more vesicular than bronchial
False
| More bronchial than vesicular due to better transmission of large airway sounds through a thin chest wall
169
Heart PE
```
Precordial activity
Rate
Rhythm
Quality of heart sounds
Absence or presence or murmurs
```
170
Normal heart rate
120 to 160
| Resting term infant can have a heart rate below 90
171
If heart rate does not increase upon appropriate stimulation
Check for serum electrolytes and obtain ECG
172
Obtain ECG to rule out?
Heart Block
173
Most common among infants whose mothers have SLE
Heart Block
174
Heart block is common among infants whose mothers have?
SLE
175
Most common murmur in immediate newborn
Flow murmur
176
Flow murmur is due to
Transition from fetal to neonatal circulation
177
Murmurs persisting after 12 hours of life
Structural abnormalities
178
Normal Abdomen on PE
Globular and soft on palpation
179
Intestines covered with peritoneum
| Umbilibus situated centrally
Omphalocoele
180
Intestines NOT covered with peritoneum
Gastroschisis
181
Scaphoid abdomen may indicate
Congenital diaphragmatic hernia
182
Normal infant bowel sounds
Relatively inactive bowel sounds
183
Process of abdominal palpation
Stand on the right side of the infant
Left hand lifts the leg, slightly elevate the pelvis to relax abdominal muscles
Use right hand fingerpads to palpate
Palpate starting from the umbilicus in both side, then proceed towards the diaphragm
184
Where is liver can be plapated?
2 cm below the costal margin
185
Where is spleen tip can be palpated?
At the costal margin
186
Hepatomegaly can be seen in?
Congestive heart failure
Hepatitis
Sepsis
187
Splenomegaly may indicate?
CMV or Rubella infection
| Sepsis
188
Which side of kidney can be palpated
Right Kidney
189
Enlarged kidney may indicate
Polycystic disease, renal vein thrombosis, hydronephrosis
190
Discharge, redness, or edema around the base of the cord may signify
Patent Urachus/ Omphalitis
191
Umbilicus have how many blood vessels.
2 arteries
| 1 vein
192
Presence of only 2 vessels (1 artery 1 vein) of the umbilicus may indicate
Renal or genetic defects
193
Normal color of umbilicus
Translucent
194
Greenish-yellow umbilicus
Meconium stain- respiratory distress
195
Male Genitalia PE
Dorsal Hood
Hypospadias
Epispadias
Chordee
196
Normal newborn penile length
Greater than 2 cm
197
True or False
| Newborn males ALWAYS HAVE a marked phimosis
TRUE
198
Abnormally small penis
Reduced androgen effector reduced growth hormone action during the 2nd and 3rd trimesters
199
True or False
| Hydrocoeles are COMMON and usually disappear by 1 year
TRUE
200
Female genitalia PE
Labias, clitoris, meatus, vaginal opening, relation of the posterior fourchette to the anus
201
True or False
| All female newborns have redundant hymenal tissue
True
202
Extension of hymenal tissue
1 to 15 mm beyond the rim of the hymen
203
Discharge from the newborn genitalia usually blood tinge
Pseudomenses
204
Pseudomenses are due to
Maternal estrogen withdrawal
205
Clitoromegaly indicates
Masculinization
Virilizing tumor
Increased maternal androgen production
Materbal drug use
206
TRUE OR FALSE
| Ambiguous genitalia is a MEDICAL EMERGENCY
TRUE
207
Should be established if there is ambiguous genitalia
Adrenal and pituitary integrity
208
Hips PE
Congenital hip dislocation/
| Developmental dysplasia of the hips
209
Ortolani Maneuver
Abduct
Middle finger
Inward upward pressure
Greater Trochanter
210
Barlow maneuver
Adduct hip
Thumb
Outward and background pressure
Inner thigh
211
Absence of pulses
Poor cardiac output or
| Peripheral vasoconstriction
212
Absence of femoral pulses
Coarctation of the aorta
213
Abnormal fusion of the digits
Syndactyly
214
Syndactyly happens in what digits?
3rd and 4th finger
| 2nd and 3rd toes
215
Supernumerary digits
Polydactyly
216
One transverse crease on the palm
Simian crease
217
Simian crease most common in
Down syndrome
218
Clubfoot
Foot turned downward and inward
Sole directed medially
Talipes equinovarus
219
Talipes more common in
Males
220
Adduction of foot
Metatarsus varus
221
Tufts of hair over the lower back
Occult spina bifida
222
Sacral or pilonidal dimple
Small meningocele
223
Passage of meconium
Within 48 hours of birth
224
Gestational age prenatally can be determined by?
1. Date of last menstrual period
2. Date of the first reported fetal activity
3. Ultrasound
225
Quickening is first seen during
16 to 18 weeks
226
Ultrasound is most accurate
Before 20 weeks
227
Determine posnatal gestational age
New Ballard Score
228
When to perform ballard score?
ASAP after stabilization
| 12 hours after birth
229
2 parts of Ballard score
Neuromuscular maturity
| Physical maturity
230
Avoid when handling newborn
Primitive reflexes (tonic neck, plantar and palmar grasp reflex)
231
Posture
| Arms and legs extended
0
232
Posture
| Arms extended, knees and hips beginning flexion
1
233
Sticky transparent skin
-1
234
Lanugo hair on the lumbosacral only
Sparse
235
Lanugo hair on the scapular area only
Thinning
236
Loosely fused eyelids, gentle traction opens
-1
237
Scrotum touches examining surface
4
