Pediatrics Flashcards
(220 cards)
1
Q
What is the asymmetric tonic neck reflex?
When does it begin? When does it cease?
A
when you turn a baby’s head to one side, the arm of the same side will extend and the other arm will flex (fencer’s)
You will notice this reflex from 2 wks to 6 months
2
Q
What is the hand grasp reflex?
When does it begin? When does it cease?
A
When you put a finger in a baby’s hand, they will grasp it and the grasp will increase as the finger is withdrawn.
It begins at birth and stops at about 3 months
3
Q
What is the head righting reflex?
When does it begin? When does it cease?
A
When you lift a baby by their arms, their head will lag behind.
1 month- lag
2-3 months- no lag
5-6 months- anticipation so the head is before shoulders
4
Q
What is the Moro reflex?
When does it begin and when does it cease?
A
If you tilt the babies head back, they will abduct and extend their arms, and then flex and adduct.
Birth- 4 months
5
Q
What is the parachute response?
When does it begin and when does it cease?
A
If you have the child “free fall” while being held, they will extend extremities symmetrically
9 months- life
6
Q
What is the protective equilibrium response?
When does it begin and when does it cease?
A
If you have the baby sit up and then push it to one side, he will flex his trunk and extend an arm to catch himself.
This begins at 6 months (persists)
7
Q
What is the rooting reflex?
A
if you stroke the corner of an infants mouth, the lower lip will lower on the same side and the tongue will go to the same side
8
Q
When would a patient attend a pediatrician?
A
birth to 21
9
Q
What are the six parts of a pediatric history?
A
- birth history
- nutrition
- growth assessment
- developmental history
- immunizations
- social history (adolescents)
10
Q
What is included in a “birth history”?
4 pre, 4 post
A
Pre-natal Events -mother's health/illness - drug use -length of pregnancy - duration of labor/type of delivery Post-Natal events - birth weight - gestational age -condition at birth/ length of hopsitalization - complications
11
Q
What nutritional discussions need to be had for children 0-2 years?
A
- method of feeding (breast v. formula)
- Reasons for change in feeding
- Amount of juice given (BAD. SUGAR WATER)
- intro of solids, vitamins
12
Q
For a preschool age child, what is taken into account in the developmental history? (3)
A
- Milestones for age
- Behavior- personality, temperament, thumb-sucking
- Sleep pattern- nightmare/terrors, position, snoring
13
Q
For a school age patient, what is considered in the developmental history? (6)
A
- grades/ gradelevel
- social attitude
- temperament
- habits (exercise, sports, TV, sex)
- Behavior (thumb-sucking, nail-biting)
- Sleep habits (amount, quality, bedtime)
14
Q
What age children do you need to consider social history?
A
school-aged and adolescents
15
Q
What is the “HEADSS” assessment?
A
the assessment used for adolescents social history: H- home life E- education/employment A- activity level D- drugs/drinking S- sexuality S- suicide/depression/self-image
16
Q
When should a parent be asked to leave during the pediatric history?
A
before the social history of an adolescent
17
Q
What is involved in the anticipatory guide topics?
A
- healthy habits
- nutrition
- safety/injury prevention
- sex
- family/peer relationships
- emotional and mental health
- oral health
- prevention of risky behavior
- school acheivement
18
Q
Responses to stimuli proceed from ________ involving the entire body to ________ under cortical control by ____ months.
A
generalized reflexes to voluntary actions by 6 months
19
Q
Development in a child occurs from _______ to ______ and ______ to _______.
A
cephalic to caudal and proximal to distal
20
Q
The reported age of acheivement for a particular milestone occurs around the _____percentile
A
50%
21
Q
If a child is showing a red flag for developmental milestones, who should you contact if they are under the age of 3?
A
Early Childhood Intervention
22
Q
Development is affected by what four factors?
A
- physical
- disease-related
- social
- environmental
23
Q
What are the “primitive reflexes” seen in children?
When should they subside?
A
- hand grasp
- moro
- rooting
- asymmetric tonic neck reflex
These should subside by 6 months
24
Q
What are the postural reflexes?
A
- Head righting
- protective equilibrium response
- parachute reflex
25
What does the moro test allow you to test for?
| What would be written in the chart of a baby that has this primitive reflex?
It allows you to test for nerve palsy.
| If the baby is fine, you can write MAEW (moves all extremities well)
26
What does the hand grasp reflex test for?
Hypertonia if the baby still clenches the finger at 4 months
27
What does the head righting reflex test for?
If there is still head lag after 4 months = hypotonia
| If there is head righting before 2-3 months = hypertonia
28
For gross motor development, what should the baby be able to do by 6, 9, 12, 24 months?
6- sit w/o support
9- pull to stand
12- walk
24- run, kick, throw overhand
29
What is meant by fine motor development?
Use of upper extremities to engage and manipulate the environment
30
When should a baby be able to feed itself?
| When does it develop gross pincer and fine pincer skills?
24 months- feed
9- months gross pincer
12 months- fine pincer
31
What are the three major red flags of motor development?
4 months- no head control
9 months- sitting w/o assistance
18 months- walking
32
What are the two types of language?
1. receptive language- hearing/seeing and understanding the meaning being conveyed
2. expressive language- development of speech
33
What is the best predictor of intelligence?
language development
34
When should a baby be able to say one or two words?
a year
35
When should a baby be able to follow a one, two and three step command?
When should they be able to say a one, two and three word sentence?
one, two and three years
36
When should a child's speech be intelligible to a stranger?
4yrs
37
What is cognitive development?
ability to learn and deal with new situations, problem-solving, language, memory, representational competence, symbolism
38
When do children develop object permenance? What is object permenance and what can it lead to?
around 9 months and this means that they understand that things still exist even when they are not in sight. This leads to separation anxiety
39
When does symbolic thinking develop in children?
Early childhood (1-5)
40
What kind of thinking is present in late childhood?
Concrete operational. Can't really understand abstract thought
41
What type of thinking should be present in adolescence?
formal operational- abstract thought and reasoning
42
What is the first thing a doctor should do if the baby is thought to have slow language development?
have the hearing checked
43
What is social/emotional development?
The ability to understand themselves, bonding, attachment and trust
44
When do babies tend to develop stranger anxiety?
6 months
45
What are social/emotional red flags for 6, 9, 15, and 18 months?
6- lack of social smile
9- lack of reciprocal facial expression
15- lack of gesturing
18- lack of pretend play
46
When is a baby considered premature?
before 37 wks
47
What is Cushing's syndrome?
hyperadrenocorticism where there is increased adrenal steroids so the child will have:
1. increased adiposity
2. hypertension
3. diabetes mellitus
4. osteoporosis
48
What is Prader-Willi?
a chromosomal disorder where the infant will exhibit:
1. hypotonia
2. round face/almond eyes
3. strabismus (misaligned eyes)
4. hypogonadism
5. mental retardation
6. short stature and obesity
49
What are the three main factors that influence fetal growth?
1. maternal nutrition
2. uterine size/restriction
3. insulin and insulin-like GF
Surprisingly, NOT genetics. The mom can be tiny, but if she overeats, has diabetes, or has large uterine size, the baby will be BIG and then get smaller for age as life goes on
50
Describe what happens to the baby's growth in the first 2 weeks after birth.
Initially the baby will lose 10% of its weight because of diaeresis of lung fluid.
By 2 wks the baby should be back to normal birth weight and then grows at a logarithmic rate
51
When would a physician be able to identify genetic stature correction?
Starting at 4-5 months and complete by 15 months
52
What are the four major influences on growth rate during post-natal/infancy?
1. GH
2. thyroid hormone
3. insulin and insulin-like growth factor
4. nutrition
53
When does logarithmic growth cease after infancy?
After this point, what is the typical weight increase per year?
Height?
Babies stop rapid growth phase between 2 and 3 years.
They increase weight at a rate of 2-3 kg/yr and increase in height 5cm/yr
(5lbs, 5cm)
54
What is the largest influence on growth during childhood (3-puberty)?
1. nutrition
2. GH
3. thyroid horomone
55
Why do males tend to be taller/larger than females? (genetics aside)
Male puberty starts later, so they have extra years increasing 5cm/year before puberty.
56
What causes the rapid growth acceleration at puberty?
sex hormones
57
What is the typical age for females to hit puberty? males?
f-9 yrs
| m- 11 yrs
58
When is a baby considered to be "postmature"?
after 42 wks
59
SGA infants have _____________________ which cause their small size.
Intrauterine Growth Restrictions (IUGR)
60
What are the two most common strategies for determining the gestational age of the baby?
1. Maternal dates (when was the last period)
| 2. Ultrasound measurements to see specific features of the neonate
61
What are the cutoffs for SGA, AGA, and LGA?
SGA 90%
62
What is symmetric growth restriction and what are the common causes?
It is a proportional reduction in size/weight of all organs (including brain).
It is usually caused by INTRINSIC factors like:
malformations, chromosomal abnormalities, congenital infections
63
What is asymmetric growth restriction and what are the main causes?
When the brain retains normal size but the rest of the organs weight/size is restricted.
It is usually caused by compromised uteroplacental blood supply:
1. placental infarct
2. maternal hypertension, smoking
3. abnormal placentation
64
Which would occur earlier in gestation, symmetric growth restriction or asymmetric?
asymmetric
65
What are growth restricted babies at risk for in childhood?
1. hypoglycemia
2. hypothermia
3. neurological defects (learning disabilities)
66
What are growth restricted babies at risk for in adulthood?
1. diabetes
2. obesity
3. hypertesion
4. coronary artery disease
67
What are the three most prominent areas of postnatal growth that are evaluated?
1. length/height
2. weight
3. head circumference (FOC-frontal occipital)
68
How does one take a bone age?
x-ray an area of growth like the wrist and compare the epiphyseal center to a standard atlas to determine bone age
69
Growth velocity at puberty correlates closely to what?
bone age
70
What are the two ways that growth curves can be made?
1. longitudinally- following an individuals growth for years
| 2. cross-sectional - comparing an individual to a standardized population
71
What are the three broad categories for short stature?
1. Normal variant
2. Primary short stature
3. Secondary short stature
72
What are the two normal variants for short stature?
1. genetic short stature (normal bone age)
| 2. constitutional delay (delayed bone age)
73
What are the properties of genetic short stature?
- Both parents are 1.5 to 2 SD below avg height
| - Appropriate bone age
74
What is midparental height?
It is used to determine genetic probabilities of height.
Boys: ((father +(mom+5)/2) = height+/- 2
Girls subtract 5 from dad, avg with mom
75
What are the properties of constitutional delay? Who is typically affected?
- Boys are usually affected. Dad was usually a "late bloomer"
- Delayed bone age because they are still growing on the childhood growth rate of 5cm/yr until puberty starts
76
Both constitutional delay (normal) and secondary short stature have delayed bone age. How can you identify the difference?
Constitutional- the bone age progresses along the normal child growth rate of 5cm/yr
Secondary short stature- the growth of the bone delays significantly and falls of the childhood growth curve
77
Does primary short stature have normal or delayed bone age?
| What are 4 examples of primary short stature?
Normal bone age
1. Turner's syndrome
2. Down's syndrome
3. Noonan syndrome
4. Achondroplasia
78
A patient comes in with short stature, defective ovarian development, web neck, lyphedema (puffy hands, feet) and abnormal elbows.
What disorder do they most likely have and what causes it?
Turner's syndrome cause by chromosomal abnormality (45XO)
79
Why do males tend to be taller/larger than females? (genetics aside)
Male puberty starts later, so they have extra years increasing 5cm/year before puberty.
80
What causes the rapid growth acceleration at puberty?
sex hormones
81
What is the typical age for females to hit puberty? males?
f-9 yrs
| m- 11 yrs
82
When is a baby considered to be "postmature"?
after 42 wks
83
SGA infants have _____________________ which cause their small size.
Intrauterine Growth Restrictions (IUGR)
84
What are the two most common strategies for determining the gestational age of the baby?
1. Maternal dates (when was the last period)
| 2. Ultrasound measurements to see specific features of the neonate
85
What are the cutoffs for SGA, AGA, and LGA?
SGA 90%
86
What is symmetric growth restriction and what are the common causes?
It is a proportional reduction in size/weight of all organs (including brain).
It is usually caused by INTRINSIC factors like:
malformations, chromosomal abnormalities, congenital infections
87
What is asymmetric growth restriction and what are the main causes?
When the brain retains normal size but the rest of the organs weight/size is restricted.
It is usually caused by compromised uteroplacental blood supply:
1. placental infarct
2. maternal hypertension, smoking
3. abnormal placentation
88
Which would occur earlier in gestation, symmetric growth restriction or asymmetric?
asymmetric
89
What are growth restricted babies at risk for in childhood?
1. hypoglycemia
2. hypothermia
3. neurological defects (learning disabilities)
90
What are growth restricted babies at risk for in adulthood?
1. diabetes
2. obesity
3. hypertesion
4. coronary artery disease
91
What are the three most prominent areas of postnatal growth that are evaluated?
1. length/height
2. weight
3. head circumference (FOC-frontal occipital)
92
How does one take a bone age?
x-ray an area of growth like the wrist and compare the epiphyseal center to a standard atlas to determine bone age
93
Growth velocity at puberty correlates closely to what?
bone age
94
What are the two ways that growth curves can be made?
1. longitudinally- following an individuals growth for years
| 2. cross-sectional - comparing an individual to a standardized population
95
What are the three broad categories for short stature?
1. Normal variant
2. Primary short stature
3. Secondary short stature
96
What are the two normal variants for short stature?
1. genetic short stature (normal bone age)
| 2. constitutional delay (delayed bone age)
97
What are the properties of genetic short stature?
- Both parents are 1.5 to 2 SD below avg height
| - Appropriate bone age
98
What is midparental height?
It is used to determine genetic probabilities of height.
Boys: ((father +(mom+5)/2) = height+/- 2
Girls subtract 5 from dad, avg with mom
99
What are the properties of constitutional delay? Who is typically affected?
- Boys are usually affected. Dad was usually a "late bloomer"
- Delayed bone age because they are still growing on the childhood growth rate of 5cm/yr until puberty starts
100
Both constitutional delay (normal) and secondary short stature have delayed bone age. How can you identify the difference?
Constitutional- the bone age progresses along the normal child growth rate of 5cm/yr
Secondary short stature- the growth of the bone delays significantly and falls of the childhood growth curve
101
Does primary short stature have normal or delayed bone age?
| What are 4 examples of primary short stature?
Normal bone age
1. Turner's syndrome
2. Down's syndrome
3. Noonan syndrome
4. Achondroplasia
102
A patient comes in with short stature, defective ovarian development, web neck, lyphedema (puffy hands, feet) and abnormal elbows.
What disorder do they most likely have and what causes it?
Turner's syndrome cause by chromosomal abnormality (45XO)
103
Describe secondary short stature. Include information about bone age.
Secondary short stature occurs as a result of factors outside of the skeletal system. Basically, you get sick and your bones stop aging, but your chronological age advances.
In 2ndary short stature, you have delayed bone growth
104
What are 5 major causes of secondary short stature?
1. Major organ disease (heart, lung, renal)
2. Nutritional deficiency (protein, malabsorption, eating disorders)
3. Endocrine abnormalities
4. Metabolic disorders
5. medication (steroids)
105
What are the nutritional deficiencies commonly associated with secondary short stature?
1. protein calorie malnutrition
2. malabsorption (celiacs, IBD, cystic fibrosis)
3. fear of obesity (eating disorders)
106
What are the Tanner (G and A) stages for men?
1. nothing and nothing
2. enlarged testes/scrotum and light downy hair
3. larger and textured hair
4. larger and full adult pattern
5. larger and full adult pattern plus thighs
107
What is Cushing syndrome?
glucocorticoid excess which decreases growth velocity due to action on the growth plate
108
What is hypothyroidism?
The thyroid secretes GH so hypothyroidism will lead to decreased growth velocity with preserved weight relative to height
109
What are the metabolic disorders associated with secondary short stature?
1. Inborn errors of metabolism
2. Hypophosphatemic rickets
3. Renal Fanconi syndrome
110
What are normal variants for excessive height?
1. familial
2. early puberty (only excessively tall for childhood but then can end up shorter than normal because of missed year of 5cm/yr growth
111
What are endocrine causes of excessive height?
1. Precocious puberty
2. congenital adrenal hyperplasia- excess androgens
3. GH excess
112
What are chromosomal causes of excessive height?
1. Klinefelters-XXY, gynecomastia, small testes
2. XYY- dull mentally, acne, personality issues
3. Marfan's syndrome- long arm-to-height, optic lens, aortic disseciton
113
What is the definition of failure to thrive?
1. weight under the third percentile OR
2. inadequate weight gain resulting in crossing percentile lines OR
3. weight less than the 80th percentile for length
114
What are the 3 major causes of failure to thrivE?
1. Inadequate caloric intake
2. Malabsorption- CF, celiacs, IBD
3. Inappropriate utilization- need more cals than normal due to congenital heart defects, IBD, etc
115
What are pathological causes of obesity?>
1. Prader-Willi
2. Cushing's syndrome
3. hypothyroidism
116
When should vital signs be taken on a child? What is the rationale?
First in the exam so they do not become agitated and are still quiet
117
Why is it crucial to measure the head in infancy and early childhood?
It reflects the volume of the brain
118
What are the ranges for microcephaly, normal and macrocephaly?
micro= 38
119
What is macrocephaly?
when the FOC exceeds 2 SD (97%)
120
What is the most common cause of macrocephaly?
hydrocephalus- blockage where fluid is getting trapped in CSF
121
What are the two types of microcephaly?
1. Primary- familial, congenital infection,chromosomal abnormalities
2. Secondary- occurs at birth as the result of injury to the brain
122
What is it called when sutures fuse too soon?
craniosynostosis
123
What are the four major findings associated with FAS?
1. facial anomalies- ptosis, flat mid face, upturned nose, smooth philtrum, thin upper lip
2. Growth retardation- low birth weight, growth slowing despite nutrition
3. CNS neurodevelopment- microcephaly, brain abnormalities
4. Bahavioral abnormalities- learning disabilities, porr school performance, impulse control
124
When you are examining the newborns head, what should you be looking for?
the front and back fontanels should be soft and flat.
If they are bulging it is a sign of high intracranial pressure.
If they cave in, it is a sign of dehydration
125
Adolescence embraces the ________ changes but has broader ________ and _______ implications.
physical; psychological and social
126
What is the difference between gonadarche and adrenarche?
Gonadarche- changes in sexula characteristics dependent on HPG axis (hypothalamus->GnRH->pituitary-> LH and FSH-> ovaries/testes)
Adrenarche- adrenal androgen production (DHEAs = body hair, smell, acne)
127
Puberty is more closely linked with _____ age than _____ age,
bone age than chronological
128
If the baby has an asymmetrical head as an older infant, what could be the two possible causes?
1. plagiocephaly- flattening because of laying on one side
| 2. craniosynostosis- premature fusion of sutures
129
Why do you assess the patency of the nares during the respiratory exam? How do you do this?
You check patency of nares to rule out choanal atresia (make sure the back of the nasal passage is not blocked)
block one and look for "steam" in the other
130
What are the Tanner (G and A) stages for men?
1. nothing and nothing
2. enlarged testes/scrotum and light downy hair
3. larger and textured hair
4. larger and full adult pattern
5. larger and full adult pattern plus thighs
131
What is the general pattern of respiratory rates, heart rate and blood pressure as an infant progresses to childhood and adulthood?
Respiratory rate and heart rate slow with age.
| Blood prWhat essure increases with age
132
What are the average respirations for a newborn?
30-60 breaths a minute
133
What are the average respirations for 6 months to 1 year?
30-40
134
What are the average respirations from 2 to 4 years?
20-30
135
What are the average respirations from 5-8?
14-20
136
What are the average respirations from 9-12?
12-20
137
What are the average respirations for an adult?
12-20
138
What are the average heart rate for :
1. newborn
2. 6-1yr
3. 2-4
4. 5-8'
5. 9-12
6. adults
1. 120-160
2. 120-140
3. 100-110
4. 90-100
5. 80-100
6. 60-90
139
What is the avg systolic blood pressure for:
1. newborn
2. 6mon-1
3. 2-4
4. 5-8
5. 8-12
6. adult
1. 60/80
2. 70-80
3. 80-95
4. 90-100
5. 100-110
6. 110-120
140
When should vital signs be taken on a child? What is the rationale?
First in the exam so they do not become agitated
141
What is the general pattern of respiratory rates, heart rate and blood pressure as an infant progresses to childhood and adulthood?
Respiratory rate and heart rate slow with age.
| Blood prWhat essure increases with age
142
What are the average respirations for a newborn?
30-60 breaths a minute
143
What are the average respirations for 6 months to 1 year?
30-40
144
What are the average respirations from 2 to 4 years?
20-30
145
What are the average respirations from 5-8?
14-20
146
What are the average respirations from 9-12?
12-20
147
What are the average respirations for an adult?
12-20
148
What are the average heart rate for :
1. newborn
2. 6-1yr
3. 2-4
4. 5-8'
5. 9-12
6. adults
1. 120-160
2. 120-140
3. 100-110
4. 90-100
5. 80-100
6. 60-90
149
What is the avg systolic blood pressure for:
1. newborn
2. 6mon-1
3. 2-4
4. 5-8
5. 8-12
6. adult
1. 60/80
2. 70-80
3. 80-95
4. 90-100
5. 100-110
6. 110-120
150
When should vital signs be taken on a child? What is the rationale?
First in the exam so they do not become agitated
151
What is the general pattern of respiratory rates, heart rate and blood pressure as an infant progresses to childhood and adulthood?
Respiratory rate and heart rate slow with age.
| Blood prWhat essure increases with age
152
What are the average respirations for a newborn?
30-60 breaths a minute
153
What are the average respirations for 6 months to 1 year?
30-40
154
What are the average respirations from 2 to 4 years?
20-30
155
What are the average respirations from 5-8?
14-20
156
What are the average respirations from 9-12?
12-20
157
What are the average respirations for an adult?
12-20
158
What are the average heart rate for :
1. newborn
2. 6-1yr
3. 2-4
4. 5-8'
5. 9-12
6. adults
1. 120-160
2. 120-140
3. 100-110
4. 90-100
5. 80-100
6. 60-90
159
What is the avg systolic blood pressure for:
1. newborn
2. 6mon-1
3. 2-4
4. 5-8
5. 8-12
6. adult
1. 60/80
2. 70-80
3. 80-95
4. 90-100
5. 100-110
6. 110-120
160
When should vital signs be taken on a child? What is the rationale?
First in the exam so they do not become agitated
161
When do you start taking blood pressure in children?
age 3
162
How do you find an appropriate cuff size for taking the blood pressure of a child?
What is the drawback of the cuff being too small?
The cuff should be wide enough to be 2/3 of the upper arm.
| If the cuff is too small, it will give a falsely elevated blood pressure
163
If coarctation of the aorta is suspected, how should you take the child's blood pressure?
You should measure pressure in the upper and lower extremities and blood pressure will be elevated in the upper extremities
164
Where is temperature best measured in an infant or newborn?
Rectally or with an ear thermometer but you must be careful for earwax or vernix in a newborn
165
How long should you count respirations for a newborn? Why is this?
What technique should be used to count respirations?
You should count respirations for a full minute because newborns have periodic breathing
Respirations should be counted based on observation and palpation. Auscultation misses shallow breaths
166
What order should the newborn exam be done?
| What is the rationale?1
The order should be dictated by the baby to make them the most comfortable, however, lungs, heart and abdomen should be attempted first because that is necessary info.
Try to do the ears last because it is very uncomfortable
167
What are the six stages of alertness for a baby?
| Which are the most difficult for a physician to do an examination?
1. sleep
2. light sleep
3. drowsy
4. alert awake
5. active awake
6. crying
alert awake and crying are the most difficult
168
When you are examining the newborns head, what should you be looking for?
the front and back fontanels should be soft and flat.
| If they are bul
169
When do you start taking blood pressure in children?
age 3
170
How do you find an appropriate cuff size for taking the blood pressure of a child?
What is the drawback of the cuff being too small?
The cuff should be wide enough to be 2/3 of the upper arm.
| If the cuff is too small, it will give a falsely elevated blood pressure
171
If coarctation of the aorta is suspected, how should you take the child's blood pressure?
You should measure pressure in the upper and lower extremities and blood pressure will be elevated in the upper extremities
172
Where is temperature best measured in an infant or newborn?
Rectally or with an ear thermometer but you must be careful for earwax or vernix in a newborn
173
How long should you count respirations for a newborn? Why is this?
What technique should be used to count respirations?
You should count respirations for a full minute because newborns have periodic breathing
Respirations should be counted based on observation and palpation. Auscultation misses shallow breaths
174
What order should the newborn exam be done?
| What is the rationale?1
The order should be dictated by the baby to make them the most comfortable, however, lungs, heart and abdomen should be attempted first because that is necessary info.
Try to do the ears last because it is very uncomfortable
175
What are the six stages of alertness for a baby?
| Which are the most difficult for a physician to do an examination?
1. sleep
2. light sleep
3. drowsy
4. alert awake
5. active awake
6. crying
alert awake and crying are the most difficult
176
When you are examining the newborns head, what should you be looking for?
the front and back fontanels should be soft and flat.
| If they are bul
177
When does the anterior fontanel close?
| Posterior?
anterior- 1-2 years
| posterior- 2 months
178
It is perfectly normal for a newborn to have caput, molding or cephalohematoma when examining the head. What are these things and how did the baby get them?
Caput- swollen scalp caused by pressure during delivery
Cephalohematoma- sub-periosteal blood that does NOT cross suture lines due to birthing stress
Molding- misshapen head due to birthing
179
What is plagiocephaly and what causes it?
Plagiocephaly is the flattening of the face/head. It is caused by sleeping in the same position. It has become more common with the "back to sleep" to reduce SIDS.
GIVE KIDS TUMMY TIME
180
If the baby has an asymmetrical head as an older infant, what could be the two possible causes?
1. plagiocephaly- flattening because of laying on one side
| 2. craniosynostosis- premature fusion of sutures
181
When does the anterior fontanel close?
| Posterior?
anterior- 1-2 years
| posterior- 2 months
182
It is perfectly normal for a newborn to have caput, molding or cephalohematoma when examining the head. What are these things and how did the baby get them?
Caput- swollen scalp caused by pressure during delivery
Cephalohematoma- sub-periosteal blood that does NOT cross suture lines due to birthing stress
Molding- misshapen head due to birthing
183
What is plagiocephaly and what causes it?
Plagiocephaly is the flattening of the face/head. It is caused by sleeping in the same position. It has become more common with the "back to sleep" to reduce SIDS.
GIVE KIDS TUMMY TIME
184
If the baby has an asymmetrical head as an older infant, what could be the two possible causes?
1. plagiocephaly- flattening because of laying on one side
| 2. craniosynostosis- premature fusion of sutures
185
Why do you assess the patency of the nares during the respiratory exam? How do you do this?
You check patency of nares to rule out choanal atresia (make sure the back of the nasal passage is not blocked)
block one and look for "steam" in the other
186
Absence of breath sounds or bowel sounds heard of the chest may be a sign of what?
diaphragmatic hernia
187
If you hear muffled heart sounds on your newborn exam, what is this a sign of? How do you treat?
spontaneous pneumothoraces and they are common and relatively non-symptomatic
188
What eye test must you do in infants?
Red reflex- shine the opthalmascope in the eyes. Should be orange/red light showing that light is making it to the retina.
If there is no red reflex: glaucoma, cataracts, retinoblastoma
189
Until what age is disconjugate gaze normal?
2 months. After this they should be able to fixate and track an object
190
What is amblyopia? What is a common cause?
Amblyopia is reduced vision in an otherwise normal eye.
| It is commonly caused by stabismus (misalignment of the eyes)
191
When examining ears, how is the normal level determined?
an imaginary line is drawn from the canthus and it should intersect the auricle/pinna
192
Why is the tympanic membrane not typically checked in newborns?
Vernix (birth fluids) may be in the ears still
193
When examining the skin of babies, what 2 things do you typically see in cold environment?
1. acrocyanosis- blueish hands and feet
| 2. cutis marmorata- spotting of the skin
194
What is the most common rash seen on newborns?
erythma toxicum affects 50% of babies and is yellow papules surrounded by raised macule
195
When is seeing jaundice on a baby considered abnormal?
1. DOL1- (birthday)--> hemolytic anemia
| 2. after 2wks old--> liver damage
196
What is the most commonly fractured bone during the birthing process? How is it fixed?
clavicle. they heal without intervention
197
_____________ is not reliable for detecting meningitis in an infant.
Instead, check for _________.
Brudzinski sign is not reliable so check for irritability
198
If the baby has decreased motion of the neck and a mass near the SCM on the side of the head tilt, it is___________________.
congenital torticollis
199
How is hydrocele confirmed in a newborn?
The fluid can be illuminated with a pen light
200
Why might male and female babies have breast buds immediately after birth?
They have estrogen from the mother. This is also why females may have vaginal discharge
201
What organs are palpable when doing the abdomen exam on a baby?
B/c they lack abdominal muscle, you can palpate:
1. spleen
2. kidneys
3. liver
202
What are the three tests for developmental dysplasia of the hip?
1. Barlow- adduct and pull down
2. Ortalani- pop the hip back in. Hips and knees are flexed 90 degrees and palpate femur/acetebulum
3. Galleazzi- assess femoral shortening
203
When can you stop doing Barlow, Ortolani, and Galeazzi?
4 months when you switch to checking skin folds and symmetry until they can walk
204
You are examining a child and see dimples and lesions on the spine above the natal cleft. What are the two possibilities?
1. tethered cord
| 2. spinal dysraphism
205
When you inspect tone on a newborn, what would you expect to see?
If you don't see this, what could the underlying problems be?
hypertonia and symmetric flexing (primitive reflexes)
Hypotonia: premature, down's, illness
206
If the maternal history or ultrasound data are not present, how is the gestational age of a baby assessed?
Ballard Score
207
Kids who eat a lot of carrots can have yellow/orange skin. How do you differentiate this from jaundice?
look at the sclera of the eye
208
Where will edema first be seen in children?
eyelids
209
Lymph nodes are frequently palpable in children and are mobile/non-tender. Where is the one place a node would be concerning?
supraclavicular area
210
Delayed fontanel closing can be a sign for what three disorders?
1. rickets
2. down's
3. hypothyroidism
211
When would you see pseudo-strabismus? How can you tell the difference from strabismus?
Pseudo - the appearance of misaligned eyes due to epicantal folds or wide eyes.
Do the red (corneal light) reflex. It should be symmetrical in pseudo.
212
To test for stabismus in a child, you cover the eye and have them fixate on a faraway object. Then you remove the cover. What would you see if they have stabismus?
The eye that was uncovered will move if there is stabismus
213
When checking the ears in children, what tool should be used? What are you looking for?
A pneumatic otoscope. Lack of motion of the tympanic membrane during insufflation will show an effusion in the middle ear
214
How many primary and secondary teeth should there be?
primary- 20
| secondary-32
215
If you see a bifid uvula, what is this an indicator for?
soft cleft palate
216
White spots on the tongue or buccal mucousa can be one of two things. What are they and how can you tell the difference?
Thrush or milk. Milk can be scraped off
217
From infancy to childhood, how does the cardiac exam change?
infancy the PMI is at 4th intercostal and in childhood it is fifth
218
If a female has a labial fusion, how can it be treated?
It will resolve, but you can use estrogen creme and practice good hygeine
219
what is genu varum and genu valgum?
bow legs and knock knees (toddlers --> 3 to 5)
220
When are scoliosis screening recommended in females and males?
F- 10 to 12
| M- 13 to 14
