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Flashcards in Well Child 2 Deck (46)
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1

Abdomen

  • What are the vessels of the umbilical cord?
  • Definition: develops at base of navel, pink granulation tissue formed during the healing process

  • Cord: 2 umbilical arteries, 1 umb vein
  • Umbilical granuloma

2

What is this?

Umbilical Granuloma

  • develops at base of navel
  • pink granulation tissue formed during healing process

3

Male GU

  • Presence of testes, size of penis, appearance of scrotum
  • 30% of pre term male infants are born w/ what?
  • Definition: abnormal ventral placement (check before what?)
  • Definition: abnormal dorsal placement (uncommon)

  • 30%: undescended testicle
  • Hypospadias (Hypo-below)
  • Epispadias (Epi-eye)

4

Male GU

  • What are 2 common scrotal masses in newborns?
  • What side are they most common on?

 

  • hydroceles & inguinal hernias
  • RIGHT

5

Which mass?

  • Overlie the testes & spermatic cord
  • Not reducible 
  • Can be transilluminated
  • Usually resolves by __ months
  • Refer to urology to r/o what?

Hydrocele

  • 18
  • hernia

6

Which mass?

  • Separate from the testes
  • Usually reducible
  • Often DO NOT transilluminate
  • Do not resolve

Hernias

7

Female GU

  • Often a milky white discharge present, but what may be present?
  • Labial adhesions
  • What may be noted at birth?

  • Blood tinged
  • imperforate hymen

8

Anus / Spine

  • Imperforate anus is not always obvious. Cannot assume until baby passes what? Usually passes within how many hours?
  • If there is a sacral dimple, must get what test?

  • Meconium / 48 hours
  • US (to check for spina bifida)

9

Extremities

  • Count fingers/toes
  • Check for what 2 things?

  • Syndactyly (webbed or conjoined fingers or toes)
  • Palmar crease (single palmar crease - simian crease associated w/ trisomy 21)

10

Hip

  • Evaluation for what condition?

Developmental dysplasia of the hips (DDH)

11

5 risk factors for Developmental Dysplasia of the Hips (DDH)

  • breech
  • caucasian
  • 1st born female
  • family hx
  • prematurity

12

Hip

  • What would prompt a further work up of DDH?
  • Which tests for ability to sublux or dislocate an intact, but unstable hip? (IN)
  • Which tests for posteriorly discolated hip? (OUT)
  • What other finding is suggestive of DDH?

  • Audible "click" heard w/ maneuvers
  • In: Barlow
  • Out: Ortolani
  • Asymmetry of leg creases

13

Tx for DDH?

  • Ortho eval & pavlik harness
  • If untreated can lead to degenerative hip disease

14

Palmar Grasp 

  • Primitive Reflex
  • Place your finger into baby's hand and press (baby will flex all fingers to grasp your finger)
  • What age?

  • Birth - 3/4 months

15

Plantar Grasp Reflex

  • Primitive Reflex
  • Touch sole at base of toes
  • Toes will curl
  • Age?

  • Birth - 6/8 months

16

What reflex?

  • Hold baby supine while supporting head, back, legs
  • Abruptly lower entire body about 2 feet
  • --> arms should abduct & extend
  • --> hands open & legs flex (baby may cry)
  • Age?
  • Persistence beyond what age suggests what?
  • Asymmetric response indicates what?

Moro Reflex (Startle Reflex)

  • birth - 4 months
  • 6 months --> neurological dz: CP
  • Fx of clavicle or brachial plexus injury

17

Which primitive reflex?

  • with baby supine, turn head to one side, holding jaw over shoulder
  • the arms/legs on side to which head is turned extend (think bow & arrow)
  • the opposite arm/leg flex
  • What age?
  • Persistence beyond this age suggests what?

Asymmetric Tonic Neck Reflex

  • Birth - 2 months
  • asymmetric central nervous system development

18

Which reflex?

  • Hold the baby around the trunk & lower until the feet touch a flat surface
  • the hips, knees & ankles extend & baby stands up, partially bearing weight, sags after 20-30sec
  • What age?
  • Lack of reflex = hypotonia or flaccidity

Positive Support Reflex

  • Birth - 2/6 months

19

Which reflex?

  • stroke the perioral skin at the corners of the mouth
  • the mouth will open & baby will turn the head toward the stimulated side
  • Age?

Rooting Reflex

  • Birth - 3/4 months

20

Which reflex?

  • Support the baby prone w/ one hand
  • stroke one side of the back 1cm from midline, from shoulder to buttocks
  • the spine will curve TOWARD the stimulated side
  • Age?
  • Absence suggests what?

Trunk Incurvation (Galant's Reflex)

  • Birth - 2 months
  • Transverse spinal cord lesion or injury

21

Which reflexes?

  • hold baby upright from behind (as in positive support reflex)
  • have one sole touch the tabletop
  • the hip & knee of that foot will flex & the other foot will step forward
  • alternate stepping will occur
  • What age?

Placing & Stepping

  • Birth (best after 4 days) - variable age to disappear

22

Vision

  • Always check for what?
  • Ages 3-5: 20/40
  • Ages 6+: 20/30
  • The AAP recommends annual photo screening between what ages?
  • What is the MC cause of childhood blindness?

  • Red reflex
  • 1 - 3 yrs
  • Amblyopia

23

Hearing Screening

  • AAP recommends universal hearing screening before when?

Before leaving the hospital

24

Blood Pressure

  • Start checking at what age? 
  • Check before this age if pt has risk factors:
    • Kidney disease, prematurity, congenital heart disease, recurrent UTIs, hematuria, proteinuria
    • Other conditions associated w/ HTN: neurofibromatosis, tuberous sclerosis)

  • 3 yrs

25

Additional Screening

  • Check what level to screen for iron deficiency at 9 months or 12 months?
  • CDC recommends universal screening of what for children age 1-2 yrs old?
  • Autism screening at what ages?
  • STI testing for high risk adolescents

  • Iron def: Hemoglobin
  • 1-2 yrs: Lead (targeted screening  for those in communities w/ high risk = homes before 1950)
  • Autism: 18mo & 24mo

26

Lipid Panel

  • Fasting lipid screening is recommended for children between what ages?
  • (if what 6 certain RF are present?)
  • Controversial if need to screen if pt/adolescent has no RF or Fam hx

  • 2 - 10 yrs
  1. Fam hx of HLD
  2. Fam hx of early CV disease
  3. Obesity
  4. Overweight
  5. HTN
  6. DM

27

Dental

  • Wash gums/teeth prior to 1st dental visit
  • 1st dental visit between what ages?
  • Brush 2x/day
  • Floss 1x/day
  • Dental visit how often?

  • 1st: 12mo - 3yrs
  • Every 6 months

28

Dental: Baby Teeth eruption ages: UPPER

  • Central incisor
  • Lateral incisor
  • Canine

  • Central: 8-12 months
  • Lateral: 9-13 months
  • Canine: 16-22 months

29

Dental: Baby Teeth eruption ages: UPPER

  • 1st molar:
  • Second molar:

  • 1st: 13-19 months
  • 2nd: 25-33 months

30

Dental: Baby Teeth eruption ages: LOWER

  • 1st molar:
  • 2nd molar:
  • Canine:
  • Lateral incisor:
  • Central incisor:

  • 1st molar: 14 - 18 mo
  • 2nd molar: 23 - 31 mo
  • Canine: 17-23 mo
  • Lateral incisor: 10 - 16 mo
  • Central incisor: 6 - 10 mo