Physical Assessment Flashcards
(144 cards)
1
Q
routine examination of the newborn
A
within 24 hours of birth
2
Q
Significant Congenital Anomalies
A
congenital heart disease, hypospadias, down syndrome
3
Q
order of examination
A
The exact sequence in which the newborn is examined is flexible so long as the entire body is examined at some stage
4
Q
general observation
A
weight, length, head circumference, GA, general observation, movement and tone
5
Q
head and face
A
fontanelle, facial appearance, and dysmorphic features
6
Q
eyes
A
cataract, red eye reflex
7
Q
mouth
A
cleft lip and palate, central cyanosis
8
Q
Upper limbs
A
digits, palmar creases
9
Q
chest
A
RR, retraction, heart sounds and murmurs
10
Q
pulses
A
femoral
11
Q
genitalia and anus
A
hypospadias, undescended testes, ambiguous genitalia, anus-position and appearance
12
Q
back
A
midline defects
13
Q
abdomen
A
abdominal distention, enlarged liver, spleen, kidneys or mass
14
Q
hips
A
developmental dysplasia of the hips
15
Q
lower limbs
A
talipes-positional, equinovarus
16
Q
CDC/WHO full term female weight
A
2.7-3.85kg
17
Q
CDC/WHO full term male weight
A
2.8-4kg
18
Q
head circumference female
A
32-35cm
19
Q
head circumference male
A
33-36cm
20
Q
central cyanosis
A
best observed on the tongue
21
Q
asymmetric crying face
A
congenital absence of the depressor anguli oris muscle
22
Q
neonatal urticaia
A
2-3 day of day, rash; white pinpoint papules at the center an erythematous base, EOSINOPHILS; migrates to other sites, resolved by day 5
23
Q
neonatal pustular melanosis
A
birth; NEUTROPHILS; readily removed by wiping, can be mistakem for staphylococcal infection
24
Q
Milia
A
bening white cyst; nose and cheeks; retention of keratin and sebaceous material
25
harlequin color change
reddening and blanching; last for few minutes, due to vasomotor instability
26
Mongolian blue spots
base of spine /buttocks
27
Cafe au lait spots
common, more than 6 underlying disorder
28
capillary hemangiomas/stork bites
pink macules, caused by distention of dermal capillaried; upper eyelids, mid forehead, nape of the neck; fade over teh first year
29
port-wine/nervus flammeus
unilateral or segmental, do not cross midline; do nto fade will grow with child and become darker; evaluate infant for glaucoma and brain lesions (intracranial vasular anormalities)
30
most common benigh tumor of infancy
strawberry nevus/infantile hemangiomas; RX: propranolol
31
tense fontanelle
increased intracranial pressure: HUS; meningitis: LP
32
caput succedaneum
bruising and edema of the presenting part of the head
33
cephalohematoma
bleeding between peristeum and skull bone, confine within margins of the skull sutures, parietal bone, does not cross midline
34
subgaleal hemorrhage
bleeding between galea aponeurosis and periosteum; vacuum extractions; "wave sign"; potencial for large blodo loss causing hypovolemic shock
35
craniosynostosis
premature fucion of one or more cranial sutures; might restrict brain growth
36
coloboms
defect in a normal eye tissue
| CHARGE syndrome
37
normal ears
the top third of the ear is level with a line drawn from the inner to the outer canthus of the eye
38
preauricular tags
ear skin tag
39
webbed neck, lymphydema of the feet
Turner syndrome
40
normal periodic breathing
up to 10 sec
41
HR
120-160
42
heart murmur
reflect directly for ECHO
43
single umbilical artery
asymptomatic renal abnormalities
44
micropenis
less than 2cm, suggests congenital hypopitutarism
45
hypospadias
urethral meatus is in abnormal position
46
polydactyly
extra digits
47
syndactyly
fused gigits
48
clinodactyly
bend digits
49
Trisomy 21
single palmar transverse creases
50
Clavicle fractures
supportive care only, immobilization for comfort
51
talipes equinovarus
feet turned inward from intrauterine compression/clubfeet
52
Ortolani manouver
when the posteriorly dislocated femoral head can be returned to the acetabulum
53
Barlow manouver
when the femoral head is in the acetabulum at rest but is dislocatable posteriorly out of the acetabulum,
54
developmental reflexes
rooting, sucking, palmar grasp, moro responses
55
Ballard examination
GA, 6 neurological, and 6 physical
56
CCHD AAP recomendations
Any oxygen saturation (SpO2) is less than 90%.
Oxygen saturation is less than 95% in both extremities on three measures, each separated by 1 hour.
There is a greater than 3% absolute difference in oxygen saturation between the right hand and either foot on 3 measures, each separated by 1 hour.
57
Erythema and Abrasions
dystocia, forceps delivery; self resolving within several days
58
Petechiae
head, neck, upper portion of the chest, and lover portion of the back at birth after a difficult delivery, self resolving
59
Ecchymoses/bruising
traumatic or breech deliveries; may cause increase in bili; resolve in 1 week
60
subcutaneous fat necrosis
rare form of panniculitis seen mostly in term or post-term infants characterized by well-circumscribed, indurated lesions of the skin and underlying tissue; associated with perinatal asphyxia and may be associated with hypercalcemia
61
Lacerations
inflicted with a scalpel during cesarean section
62
caput succedaneum
frequently, vaquely demarcated area of edema over presenting portion of the scalp; serum or blood; may extend across the midline of the skull; diminished 48-72 hours post delivery; EXTERNAL to periosteum
63
cephalhematoma
infrequent subperiosteal collection of blood overlying a cranial bone; mechanical trauma, rupture of diploic blood vessels that traverse from skull to periosteum; limitation to one bone; no overlying discoloration; later swelling, longer time of resolution: 3-4 weeks; BENEATH the periosteum
64
subgaleal hemorrhage
collection of blood in soft tissue between the galea aponeurotica and periosteum of the skull; midforceps and vacuum extractions; fluctuating mass straddling cranial sutures, fontanelles, or both; signs of hypoperfusion and falling hematocrit; Prompt restoration of blood volume with fresh frozen plasma or blood is essential;
65
skull fractures
uncommon; forceps delivery(depressed fractures) or difficult; most fractures are linear; labor
66
linear fracture
soft tissue changes and cephalhematoma
67
depresses fractures
visible, palpable indentations in the smooth countour of the skull, ping-pong ball
68
Facial Nerve Palsy
spontaneous recovery; compression of the peripheral portion of the nerve by forceps or maternal sacral promontory; paralysis;
69
clavicle fracture
greenstick type, but occasionally the fracture are complete
70
liver rupture
most frequently injured abdominal organ during the birth process
71
maxilla, lacrimal bones, and nose fractures
may present with respiratory distress and warrant emergent surgical attention
72
Duchenne-Erb palsy
mechanical trauma to the spinal roots of the fifth cervical through the first thoracic nerves (D-E: 5th and 6th cervical roots)
73
congenital anomaly
an internal or external structural defect that is identifiable at birth
74
malformation
primary structural defect in tissue formation (neural tube defect, congenital heart defect); genetic or teratogenic factor
75
deformation
abnormal mechanical forces acting on otherwise morphologically normal tissues; clubfoot, altered head shape
76
disruption
destruction nor interruption of intrinsically normal tissue
77
single gene / mendelian
limb anomalities
78
chromosomal
Downs Syndrome
79
subconjunctival hemorrhage
blood absorbed in 1-2 weeks
80
phrenic nerve paralysis
injuries are unilateral and are associated with ipsilateral upper brachial plexus palsy; ultrasonographic examination; The infant should be positioned on the involved side, and oxygen should be administered for cyanosis or hypoxemia.
81
torticollis
more of inuretro positioning; shortened sternocleidomastoid muscle; The head tilts toward the involved side, and the chin is somewhat elevated and rotated toward the opposite shoulder. The head cannot be moved passively into normal position.
82
dysmorphisms
anomalous external physical features
83
association
multiple congenital anomalities: VATER, CHARGE
84
syndrome
recognized pattern of anomalities with specific, usually heritable cause: Holt-Oram syndrome, The Cornelia de Lange syndrome
85
etiology of malformations broad categories
genetic(multifactorial, single gene/Mendelian, or chromosomal), environmental/teratogenic, and unknown
86
genetic complex examples
congenital heart defects, neural tube defects, cleft lip and palate, clubfoot, congenital hip dysplasia; usually genetics and environmental
87
single gene/Mendelian examples
limb anomalities, Smith-Lemli-Opitz syndrome;
88
chromosomal examples
down syndrome/trisomy 21; trisomy 18, and trisomy 13; aneuplodidies of the sex chromosomes (Klinefelter syndrome or Turner syndrome)
89
chromosomal aberrations testing
karyotype, FISH, chromosomal microarray (SNP); WES
90
teratogen
anything external to the fetus that causes a structural or functional disability in prenatal or postnatal life
91
common teratogens
alcohol, anticonvulsants, some altered metabolic states in the mother, (DM, phenylketonuria), infections (TORCH(toxoplasmosis, syphilis, rubella, cytomegalovirus, and herpes simplex
92
congenital anomalities goal of the physical examination
to determine whether an anomaly is isolated or to detect a recognizable pattern of malformation so that a specific etiologic determination can be made
93
genetics skin
trisomy 21, hypothyroidism, cornelia de Lange syndrome-marbling pattern called cutis marmorata; Cafe-au-lait spots_neurofibromatosis
94
genetics hair
sparse hair: ectodermal dysplasia; hirsutism: cornelia de lange syndrome, FAS
95
genetics head
macrocephaly, microcephaly
96
dolichocephaly
increase in anteriorposterior diameter
97
brachycephaly
decrease in anteriorposterior diameter
98
plagiocephaly
assymetric head shape
99
hypotelorism
eyes too close together
100
hypertelorism
eyes too far apart
101
holoprosencephaly
trisomy 13
102
epicanthal folds
normal, but also in trisomy 21
103
coloboma
defect in eyelid margins; CHARGE syndrome
104
synophrys
fusion of the eyebrowns in the midline
105
microstomia
small mouth
106
macrostomia
large mouth
107
omphalocele
abdominal contents protrude through the umbilical opening
108
gastroschisis
isolated disruption in which the abdominal contents protrude through the periumbilical abdominal wall
109
APGAR
heart rate, respiratory effort, muscle tone, reflex irritability, color
110
BALLARD neurological
posture, square window, arm recoil, popliteal angle, scarf sign, heel to ear
111
BALLARD physical
skin, lanugo, plantar surface, breast, ear/eye, genitalia
112
sucking reflex
birth, develop 33-36 weeks GA
113
rooting reflex
stroke the cheek and the corner of mouth
114
palmar grasp
tighting grasp, apparent at 28 weeks, strong by 36 weeks
115
tonic neck reflex
supine, head to the side, upper extremity extended on the side head is turned, fencing position
116
moro reflex
response to the sensation of loss of support, spreading movement of arms and hands, appears at 24-26 weeks, evolves throught 38
117
stepping refles
neonate held upright, alternating stepping movements
118
truncal incurvation reflex
ventral suspension, pressure parallel to the spine and thoracic area
119
babinski reflex
sole of the foot, plantar flexion, positive is normal: extension of toes, up to 18 months
120
Alpha-Fetoprotien Level
15-18 weeks pregnancy; neural tube defects
121
Aminocentesis
for MOB with known hereditary disorders, over 35 years old, Rh disease for optical density; trisomy 21; 18-20 weeks; later for fetal lung maturity
122
Assessment of Fetal Activity
kick count by MOB; 28+ weeks; 4 fetal movements per hour
123
Biophysical Profile
US and nonstress test; includes: AF index, fetal breathing, gross and fine movement, fetal tone
124
Chorionic Villus Sampling
chromosomal or biochemical defects; transabdominal or transcervical; 10-12 weeks, results in 24 hours;
125
Contraction Stress Test
FHR to uterine contractions; positive test (needs follow up) shows late decelerations in FHR
126
Doppler Velocimetry
blood flow in the umbilical arteries during diastole; placental perfusion; used in twin to twin transfusion in utero
127
Fetal Fibronectin Levels
"glue" , positive predictor of preterm labor and impending birth
128
Human Placental Lactogen Levels
low levels indicate uteroplacental insufficiency in maternal HPT;
129
Lecithin-Sphingomyelin Ration
L/S ration determines fetal lung maturity is done on AF; ; risk for many false high levels: blood, mec, vaginal seccretions
130
Lung Profile
L/S ration and PG levels; increase PG indicate mature lungs;
131
Maternal Serum Estriol Levels
increase as pregnancy advances; sharp or progressive decrease indicates fetal compromise;
132
Noninvasive Prenatal Screening NIPS
cell-free DNA analysis; Trisomies; MOB blood testend of first trimester
133
Nonstress Test
tests placental function that assesses FHR acceleration and variability; monitor MOB for 20-60 minutes increase of FHR by 15 bpm
134
Shake Test
AF for lung maturity indicated by a complete ring of bubbles in dilution of AF and ethanol
135
Ultrasound
GA, altered or abnormal growth, malformations; Placenta GRADE 0-III; Amniotic fluid volume (AFV); trisomy 21 (nuchal fold)
136
Unconjugated Estriol and Human
| Chorionic Gonadotropin Levels
trisomy 21 and 18;
137
Cord Blood Gases
for low apgar scores,
138
FHR monitoring
120-160 bpm normal; early decels: benign; variable decels: umbilical cord compressions; late decels: fetal hypoxemia
139
pH of umbilical and/or fetal Scalp Blood
compared with APGAR scores; 7.27-7.28
140
Brazelton Scale
"cost of attention" amount of energy the infant must expend to maintain interaction; evaluates baby reflexes, muscle tone, state changes, and responsiveness to physical and social stimuli
141
dolichocephaly
premature infant; flattened one side of the head without craniosynotosis
142
craniotabes
soft or thinning bone; "ping-pong ball"; vitamin D deficiency
143
ankyloglossia
tonge tie
144
cystic hygroma
neck mass
