#1 Flashcards
1
Q
APGAR Score assesses ___ from birth and ___ to extrauterine life.
A
- -neurologic recovery
- -immediate adaptation
2
Q
When should APGAR Scores be taken?
A
1 and 5 minutes
3
Q
What does APGAR stand for?
A
Activity Pulse Grimace Appearance Respirations
4
Q
What is the APGAR Score for heart rate?
A
0 = absent 1 = <100 2 = >100
5
Q
What is the APGAR Score for respiratory effort?
A
0 = absent 1 = slow and irregular 2 = easy; good crying
6
Q
What is the APGAR Score for muscle tone?
A
0 = limp/flaccid 1 = some flexion 2 = active motion
7
Q
What is the APGAR Score for Reflex irritability?
A
0 = no response 1 = grimace 2 = vigorous cry
8
Q
What is the APGAR Score for color?
A
0 = blue/pale 1 = acrocyanosis 2 = pink
9
Q
What is a normal 1-minute APGAR score?
A
8-10
10
Q
What 1-minute APGAR score is associated w/ some nervous system depression?
A
5-7
11
Q
What 1-minute APGAR score is associated w/ severe depression, requiring immediate resuscitation?
A
0-4
12
Q
What is a normal 5-minute APGAR Score?
A
8-10
13
Q
What 5-minute APGAR Score indicates organ failure?
A
0-7
14
Q
Estimates gestational age based on specific neuromuscular signs and physical characteristics
A
Ballard scoring system
15
Q
Ballard Scoring System:
–Preterm = ?wks
A
Preterm = < 37 wks
Term = 37-42 wks
Postterm = > 42 wks
16
Q
What are the birthweight classifications for:
- -Low birth weight
- -Normal birth weight
A
Low birth weight = < 2500 g
Normal birth weight = > 2500 g
17
Q
What is the newborn classifications for:
- -Small for gestational age
- -Appropriate for gestational age
- -Larger for gestational age
A
SGA = < 10th percentile
AGA = 10-90th percentile
LGA = > 90th percentile
18
Q
Preterm AGA infants are more prone to what 4 pathologies?
A
- -Respiratory distress syndrome
- -Apnea
- -Patent ductus arteriosus
- -Infection
19
Q
What is believed to be a big cause of Preterm AGA infants?
A
Maternal smoking
20
Q
Larger for gestational age may present w/ what pathology shortly after birth?
A
Metabolic abnormalities
21
Q
When examining a newborn and having difficulty inspecting the eyes, what is a tip?
A
Dim lights and rock newborn
22
Q
What are 7 things of appearance to note during the newborn exam sequence?
A
- -Newborn’s color
- -Size
- -Body proportions
- -Nutritional status
- -Posture
- -Respirations
- -Head/extremities movements
23
Q
Most normal term newborns lie in what position?
A
Symmetric position, w/ limbs semi-flexed (frog leg)
24
Q
Where is the Apical pulse palpated?
A
3rd-5th IC space in the Midcalvicular line
25
Where is the Femoral pulse palpated at?
Halfway from the pubic tubercle to ASIS
26
What is a normal pulse for a newborn?
120-170
27
What is a normal pulse for a 1 year old?
80-160
28
What is a normal pulse for a 3 year old?
80-120
29
What is a normal pulse for a 6 year old?
75-115
30
What is a normal pulse for a 10 year old?
70-110
31
During respiration what body part will rise and fall for an infant?
Abdomen
32
During respiration what body part will rise and fall for a child?
Chest
33
What is the normal respiration rate for a newborn?
30-80
34
What is the normal respiration rate for a 1 year old?
20-40
35
What is the normal respiration rate for a 3 year old?
20-30
36
What is the normal respiration rate for a 6 year old?
16-22
37
What is the normal respiration rate for a 10 year old?
16-20
38
What technique is used to take blood pressure on infants?
Flush technique
39
When using the flush technique gradually diminish pressure until..
You see a sudden "flush" and return to usual color
40
At what age should take blood pressure in a child the same as you would in an adult?
After 2 years
41
To make sure you are using the correct cuff size, the width should cover how much of the upper arm?
2/3
42
What will happen to your reading if your cuff size is too wide?
Underestimate BP
43
What will happen to your reading if your cuff size is too narrow?
Artificially high BP
44
What are the 2 best spots to take temperature for an infant?
Rectal or axillary
45
When measuring infants heigh (birth to 24-36 months) what distances are you measuring?
Top of head to heel (dorsiflexed)
46
What tools are recommended to measure infant height?
Infant measuring mat or headrest paper
47
At what development state is it ok to measuring a child's height standing?
If able to stand w/out support
48
When measuring child height standing, what body parts should touch the wall?
Heels
Buttocks
Shoulders
49
When measuring a child's height, the outer Can thus of the eye should line up w/...
External auditory canal
50
What is the most accurate tool to measure infant weight?
Infant platform scale
51
What is the pp for the infant platform scale?
Sit or lie
52
Before placing infant on scale what should you do?
Place paper or blank under the infant and weight it out
53
When should head circumference measurements be taken?
Done at every health visit
54
Where should head circumference be taken at?
Occipital protuberance to Supra orbital prominence
55
Where should chest circumference measurements be taken at?
Around the nipple line
56
When recording measurements, you should chart appropriately for what 2 things?
Sex and age
57
What are average birth weights?
5.8 lbs - 8.13 lbs
58
What is the average length at birth?
18-22 inches
59
What is the average head circumference at birth?
13-14 inches
60
Most babies born to the same parents weight w/in how many ounces of each other at birth?
6 oz
61
If there is a lower birth weight what are 2 things to suspect?
- -Congenital abnormality
| - -Intrauterine growth retardation
62
What is the expected length growth in the 1st year of life?
50%
63
When should infant weight double and triple?
```
2x = 6 months
3x = 1 year
```
64
When should infant head be equal or exceed the chest by 2 cm?
Newborn to 5 months
65
When should the chest closely approximate the head circumference?
5 months to 2 years
66
When should the chest exceed head circumference?
> 2 years
67
What is the fastest growing body part during infancy?
Trunk
68
During infancy, fat increases until what age?
9 months of age
69
What is the fastest growing body part in children?
Legs
70
During childhood, fat increases slowly until what age?
7, then prepubertal fat spurt occurs
71
What is the fastest growing body part during adolescence?
Trunk and legs
72
What % of the ideal weight is gained during adolescence?
50%
73
What organ systems double in size during adolescence?
Skeletal mass and organ systems
74
What if head circumference increases rapidly or rises above percentile cureves?
Increased intracranial pressure
| --Hydrocephalus, etc.
75
What if head circumference grows slowly or falls off percentile curves?
Microcephaly
| --craniosynostosis, etc.
76
What are 3 physical manifestations associated w/ Turner syndrome?
- -Webbed neck w/ low hairline
- -Shield chest w/ widespread nipples
- -Abnormal ears
77
Transient puffiness of the hands, feet, eyelids, legs pubis or sacrum occurs in some newborns is not a concern if it disappears w/in how many days?
2-3 days
78
Some newborns are bald while other are born w/ an inordinate amount of head hair, when should it shed and be replaced w/ permanent hair?
2-3 months
79
Dark-skinned newborns do not always manifest the intensity of melanosis that will be readily evident in 2-3 months. What are 2 exceptions?
Nail beds and skin of the scrotum
80
What is transient mottling when infant is exposed to decreased temperature?
Curtis marmorata
81
What is cyanosis of hands and feet?
Acrocyanosis
82
Acrocyanosis is a common response to cold, and underlying cardiac defect if more persistent in...
In the feet than hands
83
Whitish, moist cheese like substance that covers the infants body at birth?
Vernix caseosa
84
Vernix caseosa is a mixture of what 2 things?
Sebum and skin cells
85
Fine, silky hair covering the newborn shoulders and back?
Lanugo
86
Lanugo should be shed w/in how many days?
10-14 days
87
Flat, deep pink, localized areas usually seen in back of neck?
Telangiectatic nevi
88
Irregular areas of blue/blue-gray pigmentation. Usually in sacral and gluteal regions.
Dermal melanocytosis "Mongolian spots"
89
Mongolian spots are seen predominantly in what 4 populations?
Africans, native Americans, asians, latins
90
Pink popular rash w/ vesicles superimposed on the thorax, back, buttocks, and abdomen?
Erythema toxicum
91
When do erythema toxicum spots appear and resolve
24-48 hrs after birth and resolves after several days
92
What 2 things should be examined in newborns for hyperbilirubinemia?
Oral mucosa and sclera
93
Hyperbilirubinemia starts where and becomes worrisome if?
Starts at face and worrisome if descends below the nipples
94
What are 5 risk factors for hyperbilirubinemia?
- -Breast feeding
- -Hemolytic disease
- -Infection
- -Cephalhematoma
- -Cutaneous or subcutaneous bleeds
95
Physiologic jaundice starts and usually disappears when?
Starts first day of life and disappears in 8-10 days
| --(may persist for up to 3-4 weeks)
96
If jaundice is present in the first 24 hours or it is intense and/or persistent, you must consider..
Pathological jaundice
97
What 4 infections cause pathological jaundice?
Toxoplasmosis
Rubella
Herpes
Syphillis
98
What are 2 things to look at when examining skin creases?
- -Asymmetrical creases on thighs
| - -simian line
99
What does asymmetrical creases on thighs indicate?
Possible hip dysplasia
100
Skin turner is best evaluated by gently pinching a fold of ____ skin.
Abdominal skin
101
What does tenting indicate?
Dehydration or malnutrition
102
What are 5 causes of clubbing of the nails?
```
Respiratory disease
CVD
Thyroid disease
Cirrhosis
Colitis
```
103
Place nail surface of corresponding fingers together to measure for clubbing?
Schamroth Technique
104
Small white discrete papules on the face and bridge of the nose?
Milia
105
What causes milia?
Plugged sebaceous glands
106
Milia is common during what age?
First 2-3 months
107
Heat rash is caused by...
Occlusion of sweat glands during periods of head and high humidity
108
What is miliaria?
Heat rash
109
What are common locations for eczamatous rash in young children?
Face, elbow, knees
110
What is seborrheic dermatitis?
Cradle cap
111
Scalp lesions are scaling, adherent, thick, yellow, and crusted?
Seborrheic dermatitis
112
When do strawberry hemangioma become noticeable?
1-2 months after birth
113
When do strawberry hemangioma's grow most rapidly?
1-6 months after birth
114
When do you expect strawberry hemangioma's to begin shrinking?
12-18 months
115
What is trichotillomania?
Pulling hair out
116
Tuft of hair overlying the spinal column usually in the lumbosacral area?
Faun tail nexus
117
What pathology is associated w/ faun tail nevus?
Spina bifida occulta
118
What are evenly pigmented patches present at birth or shortly thereafter?
Cafe au lait spots
119
If you note > 5 patches w/ diameters > 1 cm in a child under 5, what pathology is it?
Neurofibromatosis
120
Axillary freckling or inguinal freckling is associated w/ what pathology?
Neurofibromatosis
121
When a port-wine stain involves the opthalmic division of the trigeminal nerve it may be associated w/ what 2 things?
- -Sturge-Weber syndrome (seizures)
| - -Occular defects
122
Supernumerary nipples are associated w/ what organ abnormalities?
Renal abnormalities
123
What lymph nodes in the neonate react quickly to any mild stimulus?
Cervical and postauricular chains
124
Is the enlargement of the tonsils in children an indication of a problem?
No
125
When do palatine tonsils begin to peak?
Ages 3-5
126
What should normal lymph nodes feel like during the lymph exam?
Firm, discrete, moveable, < 5 mm
127
What is the normal lymph node size in the cervical and inguinal regions?
Up to 1 cm
128
You should investigate further if during the the lymph exam, they...
Grow rapidly or are fixed and immovable
129
It is normal for a supraclavicular lymph node to be enlarged?
No
130
At what age is uncommon for postauricular and occipital lymph nodes to enlarge?
> 2 years
131
When is it uncommon for cervical and submandibular lymph nodes to be enlarged?
< 1 year
132
What is the key initial symptom for infectious mono?
Fever
133
What lymph nodes will be enlarged during infectious mono?
Anterior and posterior cervical chains
134
Other than the cervical lymph nodes, what are 3 other exam findings for infectious mono?
Splenomegaly, hepatomegaly, rash
135
What are the 3 key symptoms for strep pharyngitis?
Headache, fatigue, and abdominal pain
136
What lymph nodes are enlarged for strep pharyngitis?
Anterior cervical nodes
137
What is needed to confirm strep pharyngitis?
Throat culture
138
What is the McIsaac Modification score?
Strep score
139
According to McIsaac Modification of the Centor Strep Score, what is the key symptom or sign for diagnosing strep?
Absence of cough
140
What 3 things should you look for when observing the head and neck?
Head control
Position
Movement
141
Expect the skull to resume a normal shape and size after vaginal birth by...
W/in 1 week
142
An edema of the scalp at teh neonates presenting part of the head. It often appears over the vertex of the newborn's head as a result of pressure against the mother's cervix during labor?
Capture succedaneum
143
What is a subcutaneous edema?
| --captured succendaneum or cephalhematoma
Caput succedaneum
144
What is a subperiosteal bleed?
| --caput succendaneum or cephalhematoma
Cephalhematoma
145
Which crosses sutures lines?
| --caput succedaneum or cephalhematoma
Caput succedaneum
146
Which has a firm, well-defined edges?
| --caput succedaneum or cephalhematoma
Cephalhematoma
147
Premature union of cranial sutures?
Craiosynostosis
148
What is a flat spot on a baby's head?
Plagiocephaly
149
Which has a palpable ridge?
| --Positional head deformity or craniosynostosis
Craniosynostosis
150
In which condition does the ear on flat side migrate forward?
--positional head deformity or cariosysnostosis
Positional head deformity
151
In which condition does the forehead protrude?
| --positional head deformity or craniosynostosis
Positional head deformity
152
In which condition is there no bald spot or central bald spot?
--Positional head deformity or craionsynostosis
Craniosysnostosis
153
What is one of the rarest types of craniosysnostosis?
Lamb Doud synostosis
154
When palpating the head the suture lines should have a slight groove up to what age?
6 months
155
When palpating the fontaneles, should you expect to see some pulsation?
Yes
156
When should the posterior fontanel close?
~2 months
157
When should the anterior fontanel close?
~24 months
158
What are 2 causes of a bulging fontanel?
Infection or increased intracranial pressure
159
What is the cause for a depressed fontanel?
Dehydration
160
The anterior fontanel should not exceed how many cm's?
4-5 cm's
161
Where should you transilluminate the skull at?
Midline frontal region and inch over the entire head
162
Observe the ring of illuminate, a ring of 2 cm's is expected on all regions of the head except...
Occiput (should be < 1 cm)
163
What is the procedure for inspecting the newborns neck?
Place infant supine and pickup from arms and let head fall back into extension
164
What 3 things should you palpate in the neck?
SCM, trachea, thyroid
165
What is the key sign of hydrocephalus?
Sclera visible above the iris
| --"Setting Sun Sign"
166
How do you detect the "Setting Sun Sign"?
Rapidly lower the infant from upright to supine position (look for sclera above the iris)
167
Softening of the skull, demonstrated by pressing the bone along the suture line...bone pops in and out.
Craniotabes
168
Craniotabes is associated w/ what 2 pathologies?
Rickets and hydrocephalus
169
Craniotabes is more common in what infants?
Premature
170
What's the Dx?
- -Eyelid will not close completely
- -Drooping corner of mouth
- -Loss of labonasial fold
Bell's palsy
171
What is the Dx?
- -Smooth Philtrum
- -Widespread eyes
- -Hirsute forehead
- -Short nose
- -Thin upper lip
Fetal alcohol syndrome
172
In the newborn eyelids may be swollen or edematous, accompanied by conjunctivial inflammation and drainage as a consequence of...
Routinely administered antibiotics
173
What is hypertelorism and what is it associated with?
Widely spaced eyes
| --mental retardation
174
What is the Dx?
- -Loss of functional pupil
- -Keyhole pupil
Coloboma
175
What is the Dx?
| --White specks in a linear pattern around the circumference of the iris?
Brushfield spots
| --(suggests Down syndrome )
176
If you suspect a strabismus, what 3 tests should you do?
- -Corneal light reflex
- -Cross-Cover Test
- -Cover-Uncover Test
177
Pseudostrabismus is common in what populations?
Asian and Native Americans
178
When should a pseudostrabismus disappear by?
By 1 yoa
179
What does an asymmetrical light reflex indicate?
Strabismus
180
What is the Dx?
| --During Cross-Cover Test: eye moves lateral to medial
Exotropic eye
181
What is the Dx?
| --During Cross-Cover Test: eye moves medial to lateral
Esotropic
182
What is the Dx?
| --Impairment of extraocular muscles or their nerve supply
Paralytic strabismus
183
What is the Dx?
- -No primary muscle weakness
- -Can focus w/ either eye but not both simultaneously
Nonparyltic strabismus
184
What is the Dx?
| --reduced vision in an eye that appears structurally normal
Amblyopia
185
What is the Dx?
| --A limited ability to move the eye inward toward the nose, outward toward the ear, or in both directions
Duane syndrome
186
Duane syndrome primarily affects what 2 structures?
Abducens nucleus/nerve and lateral recurs muscle
187
Expect the infant to focus and track through how many degrees?
60*
188
During the Optical blink reflex, shine a bright light at the infants eyes and note what 2 things?
Quick closure of the eyes and dorsiflexion of the head
189
At what age is it appropriate to test using a Snellen E Chart?
~3
190
What does a Snellen score of "20/25+2" mean?
Can real all on the 20/25 and 2 from the 20/20 line
191
A 2 line difference (20/50 and 20/30) may indicate...
Amblyopia
192
What is the anticipated visual acuity for a:
- -3 year old
- -4 year old
- -5 year old
- -6 year old
- -20-50
- -20-40
- -20-30
- -20-20
193
When should a red reflex be performed?
From birth on
194
What would cause an abnormal or "white" reflex?
- -Congenital cataracts
| - -Retinoblastoma
195
What is the required work up for congenital cataracts?
Metabolic, infectious, systemic and genetic workup's
196
What are common causes of congenital cataracts?
TORCH
- -Toxoplasmosis
- -Rubella (MC)
- -Cytomegalovirus
- -Herpes
197
Fundoscopic examination is difficult to perform on newborns and often deferred until what age?
2-6 months
198
What is the Dx?
- -Blood vessels are straightened and diverted temporally
- -Cicatricial changes may be severe
Retinopathy of prematurity
199
Retinopathy of prematurity will increase the risk of what 3 pathologies?
- -Retinal detachment
- -Glaucoma
- -Blindness
200
What will your retinal findings be if you perform a supine fundoscopic exam?
Upside down
201
When inspecting the infants ear the tip of the auricle should cross an imaginary line between what 2 structures?
Outer Can thus of eye and EOP
202
Low or poorly shaped auricle is associated w/ what organ problems?
Renal disorders
203
If during palpation, pain is present at the mastoid what should you suspect?
Mastoiditis
204
If during palpation, pain is present at the Travis what should you suspect?
Otitis External
205
How do you differentiate between crying/red reflex and infection of the ear?
--Crying/red reflex = red but moveable
--Infection = red but decreased mobility
206
What is an appropriate age to perform a Weber, Rinne, and Schwabach test?
3-4 years of age
207
At what age is normal to have the following expected hearing response?
--startle reflex, crying cessation of breathing or movement in response to sudden noise
Birth to 3 months
208
At what age is this considered a normal expected hearing response?
--turns head toward source of sound but not always recognize location of sound
4 to 6 months
209
At what age is this considered a normal expected hearing response?
--Responds to own name, and begins localizing sounds above and below
6-10 months
210
At what age is this considered a normal expected hearing response?
--Recognizes and localizes source of sound; imitates simple words and sounds
10-12 months
211
What is the most common infection in childhood?
Bacterial otitis media
212
What is the Dx?
| --sticking or cracking sound on yawning or swallowing; no signs of acute infection
Otitis media w/ effusion
213
Congenital nasal obstruction of the posterior nares?
Chantal atresia
214
What sinuses are present at birth?
Maxillary and ethmoid
215
When does the sphenoid sinus fully develop?
Puberty
216
At what age does the frontal sinus develop?
7-8 years
217
What are 3 characteristic signs of sinusitis?
- -Malodorous breath*****
- -cervical adenopathy
- -Intermittent painless morning eye swelling
218
The tongue should fit well in the floor of the mouth and protrude just beyond what structure?
Alveolar ridge
219
The frenulum usually attaches midway between the ventral surfaces of what 2 things?
Tongue and its tip
220
What is ankylglossia?
Tongue tied
221
Ankylosing is a ___ issue, ___ tongue problem, and believed to be caused by ___.
- -Tonicity
- -Anterior tongue
- -Nerve
222
What are the white "pearl-like" spots along the buccal of the gums?
Retention cysts
| --"Epstein Pearls"
223
When should retention cysts disappear?
1-2 months
224
How many deciduous teeth should there be?
20
225
When should teeth erupt by?
6-14 months
226
What teeth should erupt first?
Lower incisors ~ 6 months
227
When should the 2nd molars erupt?
~2nd year
228
Multiple brown caries on upper lower incisors?
Baby bottle syndrome
229
What is the Dx?
| --black or grey colored teeth
Pulp decay
230
What is the Dx?
| --mottled or pitted teeth
Enamel dysplasia
231
What is the Dx?
| --Flattened edges on the teeth
Bruxism- unconscious grinding of the teeth
232
How do you tell the difference between milk deposits and candidiasis?
Scrape any white patches w/ a tongue blade
- -Nonadherent = milk deposits
- -Adherent = candidiasis
233
A cleft extending through the lip and hard and soft palates to the nasal cavity?
Complete cleft
234
What are the 4 grades to describe tonsil sizes?
```
1+ = visible
2+ = halfway b/t to Tonsillar Pillars and Uvula
3+ = nearly touching the Uvula
4+ = touching each other
```
235
Infection of the tissue between the tonsil and pharynx?
Peritonsillar abscess
236
At what age should salvation increase and when should it stop?
Increases by 3 months
| --until swallowing is learned
237
If drooling persists past 12 months what should you consider?
Neuro problem
238
If drooling is acute in older children, what should you consider?
Epiglottis
239
What virus causes epiglottitis?
Haemophius influenza type B
240
When is epiglottitis most common?
3-7 years old
241
What is the general shape of the infants chest?
Round
242
What is the Dx?
| --smaller chest circumference compared to the head
Intrauterine growth retardation
243
What is the Dx?
| --relatively larger chest circumference
Poorly controlled gestational diabetes
244
If the "roundness" of a child's chest persists past the 2nd year, suspect a possible...
Chronic obstructive pulmonary problem
245
Is cystic fibrosis and autosomal recessive or dominate condition affecting the exocrine glands?
Autosomal recessive
246
What is the Dx?
- -salty tasting sweat
- -sticky, foul smelling stool
Cystic fibrosis
247
What should the distance between the nipples be?
1/4 chest circumference
248
What is the average respiratory rate for a newborn?
40-60 rpm
249
What should suspect if you observe asymmetric chest expansion?
Pneumothorax and diaphragmatic hernia
250
Should the diploid be mobile and prominent during rib/sternum palpation?
Yes
251
The chest wall is thinner and more resonant than adults, therefore breath sounds may sound ___, ___, and ___.
Louder, harsher, more bronchial
252
At what point in the breathing cycle should lung percussion be performed?
Followed by a deep breath
253
Why are crackles and ronchi not uncommon immediately after birth?
Fluid has not completely cleared
254
What is a stridor?
High pitched, piercing sound
255
Cartilage of the larynx is floppy (not fully developed) resulting in "noisy breathing"
Laryngomalacia
256
Is laryngomalacia a serious health concern?
No
257
Bronchiolitis is most common at what age?
< 6 months
258
What is the characteristic cough of bronchiolitis?
Comes in "fits" and tends to be harsh
259
Croup is most common in what ages?
Boys 1.5 to 3 years old
260
What is the characteristic cough of croup?
Harsh stridorous cough
| --"Bark of a seal"
261
How do you differentiate between the symptoms of acute bronchitis and chronic bronchitis?
Acute = fever and chest pain
262
Fetal circulation compensates for the non-functional fetal lung bypassing blood directly from the R to L atrium through...
Foramen oval
263
During fetal circulation the R ventricle pumps blood through...
Ductus are tedious s
264
At birth...functional closure of Foramen ovale and the ductus arteriosus closes w/in how many hours?
24-48
265
Blood flows through the ductus during systole and diastole and:
- -Increases pressure in the ___ circulation
- -Increased workload for the ___ ventricle
- -pulmonary circulation
| - -right ventricle
266
Patent ductus areteriosus creates what side of the heart problems?
Right sided
267
What is the key sign of right sided heart problems?
Exertion also dyspnea but no cyanosis
268
What type of murmur is this?
| --Harsh, loud, continuous murmur
Machinery
269
Where is a machinery murmur heard best?
1st-3rd ICS and lower sternal border
270
What is the key symptom of a patent foramen ovale?
May exhibit cyanosis w/ exertion
271
When should initial heart exams be performed?
First 24 hours and again at 2-3 days of age
272
A complete evaluation of the heart function includes what 3 other organs?
Skin, lungs, liver
273
How does congestive heart failure affect an infants liver?
Large, firm liver
274
What do the following colors mean when inspecting a newborns skin?
- -Pink
- -purple
- -ashy/white
- -Central cyanosis
- -Pink = normal
- -Purplish = polycythemia
- -Ashy, white = shock
- -central cyanosis = congenital heart disease
275
Severe cyanosis evident at birth or shortly after suggests...
Transportation of the great vessels
276
Tetralogy of Fallot that produces blue or pink cyanosis indicates what?
Blue = evident at birth
Pink = after neonatal period
277
Cyanosis that does not appear until after the neonatal period suggests what?
Pure pulmonic stenosis
278
What is the capillary refill time for children up to 2 years?
< 1 second = normal
279
If capillary refill time lasts more than 2 seconds what are 2 causes?
Significant dehydration or hypovolemic shock
280
Where is the apical impulse located on babies?
3rd-5th left ICS
281
Is the apex of the heart higher, and more horizontal in babies or adults?
Babies
282
What 2 conditions shift the apical impulse from the left to the right?
Diaphragmatic hernia or dextrocardia
283
What are 2 causes for a weak or thin brachial/radial pulse?
Decreased cardiac output or peripheral vasoconstriction
284
What are 2 causes for a palpable bounding pulse?
L to R shunt; PDA
285
What would cause a difference in pulse amplitude between femoral and radial pulses?
Coarctation of the Aorta
286
The heart rate is more variable which infants or children?
Both
287
A sinus arrhythmia is common. In which stage of breathing is it faster/slower?
Faster on inspiration
Slower on expiration
288
Are murmurs frequent in the first 48 hours?
Relatively
289
Innocent murmurs typically disappear w/in how many days?
2-3 days
290
Innocent murmers occur during what stage in the heart cycle?
Systolic
291
A murmur may not indicate a significant congenital anomaly, but you must investigate further if 1 of the following 5 things happens?
- -Persists beyond 2nd or 3rd day of life
- -Is intense
- -Fills systole
- -Occupies diastole to any extent
- -Radiates widely
292
How do you auscultate a venous hum on children?
Head turned up and away; auscultate supraclavicular space
293
A venous hum is a continuous low-pitched sound that is louder during..
Diastole
294
What causes a venous hum?
Turbulence of blood flow in the internal jugular vein
295
What % of hypertension is associated w/ the following categories:
- -Significant
- -Severe
Significant = 90th percentile
Severe = 95th percentile
296
If BP is consistently above the 95th percentile, dDx include what 3 things?
- -Kidney disease
- -Renal arterial disease
- -Coarctation of the aorta
297
What is a narrowing in a portion of the aorta?
Coarctation of the Aorta
298
Coarctation of the Aorta is most commonly found in the descending aortic arch near the origin of what 2 things?
Left subclavian artery and ligamentum arteriousum
299
When is recommended that a Coarctation of the Aorta be repaired?
Before age 10
300
What allows oxygenated blood to leak from the left atrium into the right?
Atrial septal defect
301
What allows oxygenated blood to leak front he left ventricle into the right?
Ventricular septal defect
302
What type of murmur is associated w/ a ventricular septal defect?
Holosystolic murmur
303
What 4 pathologies makeup the Tetralogy of Fallot?
- -Pulmonary valve stenosis
- -Rt Ventricular hypertrophy
- -Overriding aorta
- -VSD
304
What are 3 exam findings indicating tetralogy of Fallot?
- -Systolic ejection murmur heard over the 3rd ICS
- -Parasternal heave
- -Precordial prominence
305
What pathology is associated w/ Tet spells?
Tetralogy of Fallot
306
What is the Dx?
- -central cyanosis
- -paroxysmal dyspnea w/ loss of consciousness
Tet spells
307
Acute rheumatic fever is most common in children between what ages?
5-15 years of age
308
What hear valves are affected by acute rheumatic fever?
Mitral and aortic valves
309
Kawasaki Disease is most common in children under what ages?
Males under 5
310
What is the Dx?
- -rash on stomach, chest, and genitals
- -strawberry tongue
- -red eyes
- -edema of hands and feet
Kawasaki disease
