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EC Physical Examination > Peds > Flashcards

Peds Flashcards

1
Q

Why are infants more susceptible to hypothermia?

A

bc of their large body surface area for weight ratio
thinner skin
limited ability to cope with cold stress

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2
Q

Most pain impulses are transmitted along the ___ ______ slower C fibers because myelination of the A delta fibers continues to develop after birth

A

non myelinated

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3
Q

Why are infants less abs to modify pain impulses?

A

because the descending pathways from the brain to the dorsal horn of the spinal cord are not fully developed at birth

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4
Q

What is the HR of a neonate?

A

may rate close to 200 bpm but can decrease to 120 at a few hours of age

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5
Q

When is pulse variation the greatest?

A

around the time of birth and more so if premature

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6
Q

What might be the first indication of infection or clue to an underlying cardiac rhythm disturbance in a neonate?

A

sustained tachycardia

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7
Q

What is the expected RR for a neonate?

A

40-60 bpm

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8
Q

Babies delivered by cesarean section may have ________ compared to babies delivered vaginally

A

a more rapid respiratory rate

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9
Q

What is an expected BP of a neonate?

A

60-96/30-62

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10
Q

What are possible indications of hypertension in a newborn?

A

thrombosis after the use of umbilical Cather, coarctation of the aorta, renal disorders congenital adrenal hyperplasia, or CNS disease

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11
Q

Can a very ill baby maintain a normal BP?

A

yes but they can quickly develop hemodynamic instability. therefore check capillary refill too!

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12
Q

What is an indication of very poor perfusion with capillary refill?

A

as long as 6-7 seconds

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13
Q

What is used to asses procedural pain in preterm and full term neonates between 28-50 weeks gestation?

A

Premature Infant Pain Profile (PIPP)

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14
Q

What does the PIPP measure?

A

physiologic signs (heart rate and oxygen saturation)
pain behaviors (brow bulge, eye squeeze, and nasolabial furrow)
gestational age
behavior state

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15
Q

What is used to assess procedural pain in preterm and full term infants up to 6 weeks of age by observing facial expression, cry, breathing pattern, arm and leg movements, and state of arousal are observed and scored?

A

Neonatal Infant Pain Scale

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16
Q

What is used to evaluate procedure and surgical pain in newborns and infants by wearing crying, expression and sleeplessness as well as O2 saturation, HR and BP?

A

CRIES scale

crying requires oxygen to sleep saturation above 95

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17
Q

Are PIPP, Neonatal Infant Pain Scale and CRIES deigned to measure pain intensity?

A

NO

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18
Q

How does 2mL of 24% sucrose solution help neonates with pain?

A

when in contact with the oral mucosa, the sucrose solution is believed to activate the endogenous opioid system

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19
Q

What is the HR of a newborn?

A

120-170

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20
Q

What is the HR of a 1 year old?

A

80-160

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21
Q

What is the HR of a 3 year old?

A

80-120

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22
Q

What is the HR of a 6 year old?

A

75-115

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23
Q

What is the HR of a 10 year old?

A

70-110

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24
Q

How much can the HR increase for each Celsius degree of temperature elevation?

A

10-14 bpm

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25
Q

What is the normal respiratory rate of a newborn?

A

24-50

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26
Q

What the normal respiratory rate of a 1 year old?

A

20-40

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27
Q

What is the normal respiratory rate of a 3 year old?

A

20-30

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28
Q

What is the normal respiratory rate of a 6 year old?

A

16-22

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29
Q

What is the normal respiratory rate of a 10 year old?

A

16-20

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30
Q

The cuff width should cover ____ of the distance between the acromion and the olecranon.

A

70%

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31
Q

The bladder length should be ___ to ____ of the upper arm circumference, and the bladder width should be at least ____ of the arm circumference at the midpoint of the acromion-olecranon distance

A

80-100%

40%

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32
Q

A Childs systolic and diastolic BP should be below the ____ percentile for age and height percentile.

A

90th

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33
Q

What might be the cause if systolic BP is elevated and diastolic is not?

A

anxiety

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34
Q

What is the most common cause of diagnosed htn in children?

A

renal disease

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35
Q

What are the categories of the FLACC Behavioral Pain Assessment?

A 
Face
Legs
Activity
Cry
Consolability
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36
Q

When is the FLACC Behavoiral pain assessment used?

A

asses acute pain associated with surgery in children between 2 months and 7 years of age

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37
Q

What can be used to rate pain in children 3 and older?

A

Wong/Baker Faces Rating Scale and the Oucher Scale

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38
Q

What behavior score of FLACC indicates mild discomfort?

A

1-3

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39
Q

What behavior score of FLACC indicates moderate pain?

A

4-6

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40
Q

What behavior score indicates severe discomfort or pain or both?

A

7-10

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41
Q

How should an infants cry sound?

A

should be loud and angry

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42
Q

What type of cry suggests a CNS deficit?

A

a shrill or whiny, high pitched cry or catlike screeching

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43
Q

When are cooing and babbling expected?

A

after 3-4 months of age

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44
Q

What can be used to evaluate articulation milestones in children 2.5-6 years old?

A

Denver Articulation Screening Exam (DASE)

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45
Q

At what age does a child have 1 or 2 words, such as “mama”, “dada” and “bye bye”?

A

10-12 months

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46
Q

At what age do children have 2 word combinations “want cookie”?

A

12 to 24 months

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47
Q

At what age does the child use 2-3 word sentences that are understood by family members?

A

24 to 36 months

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48
Q

At what age does the child make sentences of 4+ words, speech is understood by most people

A

36 to 48 months

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49
Q

At what age does a child say most sounds correctly except (L, S, R, V, Z, SH,TH)

A

48 to 60 months

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50
Q

What questionnaires can be completed as effective screening tools for developmental assessment?

A

Ages and stages

Parent’s evaluation of Developmental Status

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51
Q

What tool is useful for determining whether the child is developing fine and gross motor skills, language and personal-social skills as expected?

A

Denver II tool

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52
Q

When testing immediate recall at what age can a child repeat three digits or words?

A

4 years old

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53
Q

When testing immediate recall at one age can a child repeat 4 digits or words

A

5 years old

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54
Q

At what age should you test ‘recent memory’ by showing the child familiar objects and asking them to recall it after 5 minutes?

A

5 to 6 years

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55
Q

How is remote memory tested at 5 or 6 years old?

A

ask the child what they had for dinner the night before or address or nursery rhyme

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56
Q

What is a disorder with genetic component potentially affecting dopamine transport and reception

A

ADHD

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57
Q

What is a pervasive neurodevelopment disorder of unknown etiology that refers to a wide spectrum or disorders identified prior to age 3

A

autism

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58
Q

What has a strong genetic influence that inactivates areas of the genome that affect early brain development, potential intrauterine toxic insults leading to abnormal brain growth in the frontal, temporal, cerebellar and limbic areas

A

autism

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59
Q

When is macrocephaly apparent by 1 year of age

A

autism

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60
Q

During infancy growth of the ____ predominates.

A

trunk

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61
Q

What is the fastest growing part during childhood?

A

legs

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62
Q

Fat tissue increases slowly until what age? What happens at this time?

A

7, at which time a prepubertal fat spurt occurs before the true growth spurt

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63
Q

At what age is the individual 50% of ideal weight is gained, and the skeletal mass and organ systems double in size?

A

adolescence

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64
Q

When do females develop a wider pelvic outlet?

A

adolescence

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65
Q

What is the average lean body mass in males and females in adolescence?

A

males 90%

females 75%

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66
Q

Most babies born to the same parents will be within what range compared to their siblings?

A

within 6 ounces

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67
Q

Rapid weight gain than expected in early infancy is associated with what?

A

increased cardiovascular disease risk as an adult

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68
Q

When should infant length be measured in the supine position?

A

birth-24 months

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69
Q

What is the average length of a healthy term newborn?

A

45-55 cm

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70
Q

When are infant and children scaled in grams or kilograms?

A

to reduce medication errors because pet dosages are calculated per kg of body weight

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71
Q

What is the average weight of a term newborn?

A

2500-4000g (5lb 8oz to 8lb and 13 oz)

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72
Q

How long after birth will the infant regain the 10% they lost from birth weight?

A

regain that within 2 weeks

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73
Q

How much will a new born gain the first 3 months of age?

A

30 g (1oz) daily

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74
Q

When will infants triple their birth weight?

A

12 months

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75
Q

When can you stop measuring head circumference?

A

until 2-3 years

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76
Q

Where should you wrap the measuring tape to measure the point of largest circumference?

A

at the occipital protuberance and the supraorbital prominence

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77
Q

What is the expected head circumference of term newborns?

A

32.5-37.5cm

mean of 33-35cm

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78
Q

What might be present if there head circumference increases rapidly?

A

increased ICP

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79
Q

Although rare when is chest circumference useful?

A

comparison with the head circumference when a problem is suspected with head or chest circumference

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80
Q

How do you measure Chest circumference?

A

at the nipple line midway between inspiration and expiration

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81
Q

At what age might the head circumference equal the chest circumference or exceed it by 2 cm?

A

until 5 months of age

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82
Q

At what age does the chest circumference exceed the head circumference?

A

2 years age

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83
Q

What is an indicator of the newborns maturity?

A

gestational age

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84
Q

What is gestational age used for?

A

infants developmental progress
identify preterm newborns of appropriate size
term newborns who are small

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85
Q

What is the Ballard Gestational Age Assessment Tool?

A

It evaluates 6 physical and 6 neuromuscular newborn characteristics within 36 hours of birth or confirm the newborns gestational age

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86
Q

How accurate is the Ballard Gestational Age Assessment tool?

A

within 2 weeks of the assigned gestational age

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87
Q

When are the Ballard Gestational Age Assessment Tool scores more accurate?

A

when assessment occurs within 12 hours of birth

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88
Q

What is considered “term”?

A

37-41 weeks

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89
Q

What is the risk of small for gestational age infants who are full term?

A

increased risk for respiratory distress, hypoglycemia etc

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90
Q

What are the risks for large gestational age infants?

A

shoulder dystocia, respiratory distress syndrome, intraventricular hemorrhage and bronchopulmonary dysplasia

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91
Q

What is considered “underweight”

A

BMI for age under the 5th percentile

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92
Q

What is at risk for overweight?

A

BMI for age greater than the 85th percentile

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93
Q

What is considered “overweight”?

A

BMI for age greater than the 95th percentile

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94
Q

What percentage of children and adolescents (ages 2-19) are obese?

A

17%

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95
Q

At what age is there an increased rate of obesity?

A

12-19 years

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96
Q

What is the upper to lower segment ratio?

A

calculated when a child’s body may have inappropriate proportions between the head and trunk to the lower extremities

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97
Q

How do you calculate the upper to lower segment ratio?

A

divide the upper body by the lower body segment

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98
Q

What are the expected upper to lower ratios at birth?

A

1.7

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99
Q

What are the expected upper and lower ratios at 3 years of age?

A

1.3

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100
Q

What are the expected upper and lower ratios after 7 years of age?

A

1.0

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101
Q

What is a higher upper to lower body ratio associated with?

A

dwarfism and bone disorders

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102
Q

What should the arm span equal?

A

the Childs height or stature

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103
Q

What is an arm span that exceeds height associated with?

A

marfan syndrome

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104
Q

At what age do most girls start puberty?

A

9-12 with breast enlargement

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105
Q

When do most boys start puberty?

A

10-13 with testicular enlargement

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106
Q

What is the tanner stage associated with breast budding, areolar increases in diameter?

A

tanner 2

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107
Q

What is the tanner stage with great and areola enlargement but no contour separation?

A

tanner 3

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108
Q

What is the tanner stage with increased fat deposits and the areolar forms a secondary elevation above that of the breast

A

tanner 4

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109
Q

What is the tanner stage with scarily pigmented straight hair in females?

A

tanner 2

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110
Q

What is the tanner stage with sparse dark and visible curly pubic hair on labia?

A

tanner 3

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111
Q

What is the tanner stage with hair coarse and curly but less than an adult?

A

tanner 4

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112
Q

What is the tanner stage with lateral spreading in triangle?

A

tanner 5

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113
Q

What percentage of women will exhibit tanner 6 in which there is further extension laterally upward or dispersed hair?

A

10%

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114
Q

At what tanner stage is there enlargement of the scrotum and testes. The skin becomes redder, thinner and wrinkled?

A

tanner 2

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115
Q

At what tanner stage is there enlargement of the penis in length and further enlargement of testes and descent of scrotum

A

tanner 3

116
Q

What tanner stage has continued enlargement of the penis and sculpturing of the glans with increased pigmentation of the scrotum (not quite adult)

A

tanner 4

117
Q

What tanner stage does the penis reach to the bottom of the scrotum?

A

tanner 5

118
Q

What percentage of men have tanner 6 n which the hair spreads along the linea alba?

A

80%

119
Q

What can be assigned to determine the overall pubertal development?

A

a sexual maturity rating (SMR)

120
Q

At what tanner stage is the onset of puberty in girls?

A

breast or pubic hair stage 2

121
Q

At what tanner stage is puberty over in girls?

A

great stage 4 or pubic hair stage 5

122
Q

When does menarche usually occur?

A

SMR 4 or breast stage 3-4

123
Q

At what stage does ejaculation occur in males?

A

SMR 3 with semen appearing by 4

124
Q

What is sunsetting sign indicative of?

A

infantile hydrocephalus- paralysis of the upward gaze resulting from aqueduct stenosis

125
Q

What is classified as failure to thrive?

A

growth of an infant or child below the 3-5th percentiles on a growth chart OR a shower than expected rate of growth OR crossing down 2 percentile lines in a short period of time

126
Q

When does growth usually begin leaving off in a child with growth hormone deficiency?

A

9-12 months

127
Q

What is the onset of secondary sexual characteristics before 7 years in white girls and 6 years in black girls and 9 years in makes with progressive sexual maturation?

A

precocious puberty

128
Q

What is McCine-Albright syndrome associated with?

A

precocious puberty

129
Q

What covers the infants body at birth?

A

vernix-a mixture of sebum and cornfield epidermis

130
Q

Why are babies predisposed to hypothermia?

A

the subcutaneous fat layer is poorly developed

131
Q

What is lanugo?

A

fine silly hair that covers shoulders and back in newborns

132
Q

When us lanugo more common?

A

in preterm infants but is shed within 10-14 days

133
Q

At what age is newborn hair on their head shed?

A

2-3 months of age

134
Q

Why do children lack offense perspiration?

A

the eccrine sweat glands function the first month of life but the apocrine glands don’t function until puberty

135
Q

What gives the skin an oily appearance and predisposes adolescents to acne?

A

sebaceous glands increase sebum production in response to increased androgen levels

136
Q

What is carotenemia or xanthoderma?

A

common in facts who have started eating baby foods, is yellow pigmentation of the skinned increased beta carotene levels in the blood

137
Q

How can carotonemia be distinguished from jaundice?

A

carotonemia does not cause orange sclera

138
Q

When does the gentle pink color surface in newborns?

A

after the first day of birth

139
Q

What is acrocyanosis?

A

expected cyanosis of hands and feet of a newborn

140
Q

What is cutis marmorata?

A

expected transient mottling when infant is exposed to decreased temperature

141
Q

What is erythema toxicum?

A

expected pink papular rash with vesicles superimposed on thorax, back, buttocks and abdomen

142
Q

When does erythema toxicum appear and when does it resolve?

A

may appear in 24-48 hours and resolve after several days

143
Q

What is congenital melanocytosis?

A

expected irregular areas of deep blue pigmentation, usually in the sacral and gluteal regions in African. Native American, asian or latin descent

144
Q

What are salon patches?

A

“stork bites” are expected flat, deep pink localized areas usually seen on the mid forehead, eyelids, upper lip and back of neck

145
Q

What might be present mild in newborns after the first day of life and disappears by the 8-10th day but can persist as long as 3-4 weeks?

A

physiologic jaundice

146
Q

What are major risk factors for severe hyperbilirubinemia in infants >35 weeks or more?

A

total serum bilirubin greater than 75th percentile
jaundice observed in the first 24 hours
blood group incompatibility with positive direct antiglobin test or other known hemolytic diseases
gestational age 35-36 weeks
previous sibling received phototherapy
cephalohematoma or significant bruising
exclusive breast feeding (ecp if weight loss is excessive)
East Asian race

147
Q

Where an jaundice be detected more easily?

A

sclera of the eyes and oral mucosa

148
Q

What is faun tail nevus?

A

tuft of hair overlying the spinal column at birth, usually in the lumbosacral area and may be associated with spina bifida

149
Q

What is an epidermal verrucous nevi?

A

warty lesions in a linear or whorled pattern that may be pigmented or skin colors; present at birth or in early childhood may be associated with skeletal, CNS and ocular abnormalties

150
Q

What are cafe au lait macule?

A

flat, evenly pigmented spots varying in color from light to dark brown or black in dark skin, larger than 5mm may be associated with neurofibromatosis, pulmonary stenosis, temporal lobe dysrhythmia and tuberous sclerosis.

151
Q

What other skin finding might be indicative of neurofibrosis besides cafe au lait macule?

A

freckling in the axillary or inguinal area

152
Q

What is an ash leaf macule?

A

white macule present at both associated with tuberous sclerosis. occurs mostly on the trunk but may appear on the face and limb

153
Q

What is a facial portal wine stain?

A

when it involves the ophthalmic division of the trigeminal nerve and may be associated with ocular defects (glaucoma) or may be accompanied by angiomatous malformation of the meningitis (Sturge-Kalisher-Weber syndrome) resulting in atrophy and calcification of the adjacent cerebral cortex

154
Q

What is a port wine state of the limb or trunk associated with?

A

when accompanied by varicosities and hypertrophy of underlying soft tissues and bones it may be associated with orthopedic problems (Klippel-Trenaunay-Weber syndrome)

155
Q

What is a congenital lymphedema with or without transient hemangioma associated with?

A

gonadal dysgenesis caused by absence of an X chromosome, producing an XO karyotype (turners syndrome)

156
Q

What are supernumerary nipples associated with?

A

renal abnormalities especially in the presence of other minor anomalies particularly in whites

157
Q

What is a “hair collar” sign?

A

a ring of long, dark, coarse hair surrounding a midline scalp nodule in infants and usually an isolated cutaneous anomaly that may indicate neural tube closure defects of the scalp

158
Q

What is associated with a single transverse crease in the palm that may also be normal?

A

Down syndrome

159
Q

When is cutis marmorata most commonly seen?

A

premature infants, Down syndrome or hypothyroidism

160
Q

What is a true neoplasm which develop in the first 1-2 months of life and grow for 2-6 months and then regress over the next 5-10 years?

A

infantile hemangioma

161
Q

What are small whitish, discrete papule on the face commonly found during the first 2-3 months of life?

A

milia

162
Q

What is the Dennie-Morgan fold?

A

the allergic salute in children with atopic dermatitis or chronic skin changes involving the face will commonly rub their eyes leading to an extra crease or clear of skin below the eye

163
Q

What is caused by sweat retention from occlusion of sweat ducts during periods of high heat and humidity?

A

Miliaria rubra (Prickly heat)

164
Q

What is the presentation of Miliaria rubra?

A

irregular, red, macular rash usually covered areas of the skin

165
Q

What is the infectious agent of impetigo?

A

staph or strep infection or infection of the epidermis

166
Q

When does the lymphoid and immune system begin developing?

A

20 weeks of gestation but production of antibodies is still immature the first few months of life

167
Q

When does the mass of lymphoid tissue increase?

A

plentiful in infants but increases between 6-9 years of age and then regresses by puberty

168
Q

When should the umbilical cord drop off?

A

by 1-2 weeks after birth

169
Q

What might be indicated if umbilical cord separation is delayed?

A

leukocyte adhesion deficiency, an autosomal recessive disorder that causes recurrent infection.

170
Q

When does the thymus reach its greatest absolute weight?

A

at puberty then it involutes and is replaced with fat and becomes a rudimentary oran in the adult

171
Q

Why isn’t enlargement of the tonsils an indication of problems?

A

palatine tonsils and lymphoid tissue are the larger during childhood

172
Q

At what age can enlarged inguinal, occipital and post auricular lymph nodes be indicative of a problem?

A

after 2 years

173
Q

What lymph nodes are uncommon to palpation during the first year but more common in older children?

A

cervical and submandibular lymph nodes

174
Q

Does circumcision increase the likelihood of inguinal lymph nodes?

A

no

175
Q

What is characterized by somewhat painful swelling of the parotid glands unilateral or bilateral and occasionally by swelling and tenderness of the other salivary glands along the mandible?

A

mumps

176
Q

How can you differentiate between mumps and cervical adeninitis?

A

cervical adeninitis does NOT ordinarily obscure the angle of the jaw

177
Q

What might be indicative of an immune deficiency?

A

child who is not growing well with recurrent infection and unusual LN findings

178
Q

When does lymphadenopathy require further investigation in children and young adults?

A

localized supraclavicular lymphadenopathy or any lump that grows rapidly

179
Q

What can be complications of excessive enlargement of the palatine tonsils?

A

sleep apnea and pulmonary hypertension (rare)

180
Q

What might present with obvious cervical nodes, usually posterior rather than anterior?

A 
rubella
rubeola
varicella
Hepatitis A or B
Infectious mono
181
Q

What size nodes are not generally a cause for concern?

A

0.5cm

182
Q

When does ossification of the cranial bones occur?

A

starts around 6 years and is finished by adulthood

183
Q

When does the posterior fontanel ossify?

A

2 months

184
Q

When does the anterior fontanel ossify?

A

24 months of age

185
Q

Which child is most likely to experience torticollis?

A

first born

186
Q

What is the Pierre-Robin sequence triad?

A

micrognathia
glossoptosis
palatal clefting

187
Q

What are the features of Down syndrome?

A 
depressed nasal bridge
epicentral folds
monoloid slant of etes
low set ears
large tongue
188
Q

What are the facies of Hurler syndrome?

A

enlarged skull with low forehead
corneal clouding
short neck

189
Q

What is the subcutaneous edema over the presenting part of the head at delivery?

A

caput succedaneum

190
Q

What is the most common form of trauma to the scalp? where does it occur?

A

caput succedaneum- over occiput and crosses suture lines (feels soft and margins are poorly defined)

191
Q

What is a subperiosteal collection of blood and therefore bound by the suture lines

A

cephalhematoma

192
Q

What is the presentation of a cephalhematoma?

A

usually in the parietal region and NOT obvious at birth with firm well defined edges that do NOT cross the suture line

193
Q

What is brachiocephaly?

A

long narrow heads because their soft cranial bones become flattened with positioning and weight of the head (common in preterm infants)

194
Q

What is plagiocephaly?

A

flattened spot on the back or one side of the head that can result from premature fusion of one of the sutures (craniosynostosis)

195
Q

Positional plagiocephaly (external deformation) is more common when?

A

with torticollis

196
Q

What is bossing (bulging of the skull) of the frontal areas associated with?

A

prematurity
thalassemia
rickets

197
Q

The neck appears shirt during infancy and lengths by ______ to ____ years of age

A

3-4

198
Q

A cystic mass high in the neck may be what?

A

thyrogloassal duct cyst or a branchial cleft cyst

199
Q

A mass over the clavicle, changing site with crying or respiration suggests what?

A

cystic hygroma

200
Q

When are sutures long no longer palpable.

A

they will feel ridge like until 6 month of age

201
Q

When is it common to see molding with prominent ridges in an infant?

A

vaginally delivered from overriding sutures that generally disappears quickly. reassure parents symmetry is usually regained a week after birth

202
Q

What is a third fontanel?

A

the mastoid fontanel, located between the anterior and posterior fontanels may be expected but also common with Down syndrome

203
Q

In infants younger than 6 months, the anterior fontanel diameter should not exceed ____ to ____cm.

A

4-5

204
Q

At what age should the anterior fontanel close completely?

A

18-24 months

205
Q

What is expected when palpating the anterior fontanel?

A

slightly depressed and some pulsation expected

206
Q

A bulging fontanel with marked pulsations may indicate what?

A

increased cranial pressure

207
Q

What are craniotables?

A

“skull wasting”, a softening of the outer table of the skull. s snapping sensation

208
Q

What are cranotables associated with?

A 
prematurity
rickets
hydrocephalus
marasmus
syphilis 
thalassemia
209
Q

A mass in the lower third on the sternocleidomastoid muscle may indicate what?

A

hematoma

210
Q

The presence of a goiter may indicate what?

A

intrauterine deprivation of thyroid hormone

211
Q

When transilluminating the skull what is expected in all regions except the occiput?

A

a ring of 2cm or less beyond the rim

212
Q

What is expected when transilluminating the occiput?

A

less than 1 cm

213
Q

What is suggesting if transillumination goes beyond expected parameters?

A

excess fluid or decreased brain tissue in the skull

214
Q

How can you detect Macewen sign?

A

direct percussion of the skull with one finger

215
Q

What is Macewen sign?

A

percussion near the junction of the frontal, temporal, and parietal bones produces a stronger resonant sound. May indicate hydrocephalus or a brain abscess

216
Q

When are cranial bruits common in children?

A

up to 5 years of age or in children with anemia

217
Q

If there are cranial bruits present AFTER 5 years of age what does that suggest?

A

vascular anomalies or increased ICP

218
Q

What is the result of birth trauma or intrauterine malposition at birth?

A

torticollis (wry neck)

219
Q

What is the presentation of torticollis?

A

head tilted and twisted toward the affected SCM m with chin elevated and turned toward the opposite side. a firm mass may be felt in the muscle

220
Q

What is a neural tube defect with protrusions of brain and membranes that cover it thorough openings in the skull?

A

encephalocele

221
Q

What indicates microcephaly?

A

head circumference is 2-3 standard deviations below mean for age
associated with mental retardation

222
Q

What is the premature closing of one or more cranial sutures before brain growth is complete but not usually accompanied by mental retardation?

A

craniosynostosis

223
Q

When do the eyes develop?

A

during the first 8 weeks of gestation and may become malformed due to maternal drug ingestion or infection

224
Q

Term infants are ______, with a visual acuity of less than ______.

A

hyperopic

20/400

225
Q

_____ vision is full developed at birth and _____ vision matures later.

A

peripheral; central

226
Q

When do the lacrimal glands begin producing full volume of tears?

A

2-3 weeks of age

227
Q

When is binocular vision development complete?

A

3-4 months

228
Q

At what age can the infant differentiate colors?

A

6 months

229
Q

When is visual acuity achieved?

A

4 years of age as the globe of the eye grows

230
Q

Inability of one eye to reflect light properly may be indicative of?

A

retinoblastoma

231
Q

What indicates that an upward or Mongolian slant is present?

A

When the outer canti are above the medial canti

232
Q

What indicates that a downward, or antimongolian is present?

A

when the outer canti are below the line

233
Q

How can you detect sunsetting sign?

A

rapidly lower the infant from upright to supine position and look for sclera above the iris.

234
Q

When is sunsetting sign present?

A

may be expected variant in newborns but also infants with hydrocephalus and brainstem lesions

235
Q

What is hypertelorism? What is it associated with?

A

wide spacing between the eyes, craniofacial defects including mental retardation.

236
Q

When is pseudo strabismus seen?

A

the false appearance of strabismus caused by flattened nasal bridge or epicanthal folds which is an expected variant in asian, Native American and some whites

237
Q

When does pseudo strabismus disappear?

A

around 1 year of age

238
Q

How can you distinguish between strabismus and pseudo?

A

corneal light reflex-an asymmetric light reflex may indicate true strabismus or hypertelorism.

239
Q

Enlarged corneas may be a sign of______

A

congenital glaucoma

240
Q

What is ophthalmia neonatorum?

A

neonatal bacterial conjunctivitis (conjunctival inflammation and drainage)

241
Q

What is a coloboma?

A

a keyhole pupil associated with other congenital anomalies

242
Q

What are Brushfield spots and what do they suggest?

A

white specks scattered in a linear pattern around the entire circumference of the iris. suggest Down syndrome

243
Q

A funduscopic exam should be deferred until what age?

A

2-6 months unless there is concern about congenital eye abnormality, suspicion of physical abuse, trauma, or for assessment of retinopathy of prematurity

244
Q

How can visualization of the funds safely be achieved?

A

dilation of pupils with mydriatics (cyclopentolate hydrochloride). one drop for blue iris and second drop 5 minutes later if dark eyes

245
Q

When is visual acuity tested with the Snellen E game?

A

3 years (stand 20 feet away)

246
Q

What is the expected visual acuity of a 3-5 year old?

A

20/40

247
Q

What is the expected visual acuity of a 6 year old?

A

20/30

248
Q

What are the screening mechanisms of newborns-3months?

A

red reflex

inspection for constant strabismus

249
Q

What are the screening methods from 6 months to a year?

A

fix and follow with each eye
alternate occlusion
corneal light reflex
inspection for strabismus

250
Q

What are the screening method from 3 and older?

A 
visual acuity
corneal light reflex/cover-uncover
stereoacuity
red reflex
inspection
251
Q

A child with a two-line difference of visual acuity between the eyes, even in passing range….

A

needs to see specialist

252
Q

What is an embryonic malignant tumor arising from the retina?

A

retinoblastoma

253
Q

What is the initial sign of a retinoblastoma?

A

leukocoria, a white reflex or “cat eye reflex” rather than the usual red reflex
ill defined mass on funduscopic exam

254
Q

What is the disruption of normal progression of retinal vascular development in a preterm infant that results in abnormal proliferation of blood vessels

A

retinopathy of prematurity (ROP)

255
Q

What is seen on fundoscopy in ROP?

A

straight, temporally diverted blood vessels

256
Q

What are the S&S of ROP?

A

can be mild with no visual effects,
refractive error
amblyopia (lazy eye)
or progress to retinal detachment and blindness

257
Q

What happens in infant victims of shaken baby syndrome?

A

retinal hemorrhages in infancy

258
Q

What is it called when both eyes do not focus on an object simultaneously but can focus with other eye?

A

strabismus

259
Q

What is the pathophysiology of strabismus (4)?

A

paralysis of extra ocular muscles or their nerves
non paralytic with no primary muscle weakness
sign of increased intracranial pressure
cranial nerve III is particularly vulnerable to damage from brain swelling

260
Q

What is a positive cover-uncover test for strabismus?

A

when one eye is covered, the other one will move to focus on the object if the covered eye was the dominant one

261
Q

What are the features of Down syndrome?

A 
short palbebral eye fissues
flat nasal bridge
thin, flat upper lip
poorly formed groove at the center of the upper lip
microcephaly
262
Q

What are some physical findings of hydrocephalus?

A 
head enlargement
separation of cranial sutures
dilated scalp veins
sunsetting sign
increased muscle tone (spasticity)
macewen sign
263
Q

How is an infant Euchstachian tube different compared to adults?

A

relatively wider, shorter and more horizontal which allows easier reflux of nasopharyngeal secretions

264
Q

What happens to the Euchstachian tube as a child grows?

A

the tube lengthens and its pharyngeal orifice moves inferiorly

265
Q

What may occlude the Euchstachian tube and interfere with aeration of the middle ear?

A

adenoids

266
Q

What sinuses are present at birth, although very small?

A

maxillary and ethmoid

267
Q

At what age to the sphenoid and frontal sinuses begin to develop?

A

start at 3 years and complete in adolescent (can still get infected)

268
Q

When do 20 deciduous teeth usually erupt?

A

6-24 months of age (girls and blacks may be earlier)

269
Q

When do permanent teeth start forming IN the jaw?

A

6 months

270
Q

At what age to the permanent teeth erupt?

A

6 years and complete around 14 or 15

271
Q

What are risk factors for hearing loss? ((8)

A 
prenatal factors (infection, drug abuse, syphilis)
birth weight less than 1500g
severe hyperbilirubinemia
infection (bacterial meningitis, recurrent otitis media with effusion)
cleft palate
ototoxic meds
head trauma
hypoxic episode
272
Q

The tip of the auricle should cross the imaginary line between the ____ ____ and the prominent portion of the _____, varying no more than ____ degrees from vertical

A

inner Canthus of the eye
occiput
10 degrees

273
Q

What is associated with auricles that are poorly shaped or positioned too low?

A

renal disorders and congenital anomolies

274
Q

What is the position of the tympanic membrane in a newborn?

A

extremely oblique and does not becoming conical for several months, the light reflex may appear diffuse

275
Q

Why must nasal potency be assessed at birth?

A

newborns are nose breathers

276
Q

An obstruction of the nares might indicate what?

A

choanal atresia

stenosis or septal deviation

277
Q

Secretions that accumulate in the newborns mouth that need repeated sanctioning may be associated with what?

A

esophageal atresia

278
Q

When is drooling common?

A

6 weeks and 6 months of age. after 6 months it is attributed to teething

279
Q

What is edentulous?

A

without teeth

280
Q

How do you elicit the gag reflex?

A

touching the tonsillar pillars

281
Q

At what age can the Weber and RInne test be used?

A

3-4 years

282
Q

At what age are the maxillary sinuses developed?

A

4 years

283
Q

What what age are the frontal sinuses developed?

A

5-6 years

284
Q

At what age do tonsils enlarge to their peak size?

A

6 years

285
Q

What findings suggests a peritonsillar abscess?

A

tonsil pushed backward or forward, possibly displacing the uvula

EC Physical Examination (9 decks)

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