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Sasha: Module 12 Pediatrics > CA powerpoint -- Evaluation of a newborn > Flashcards

CA powerpoint -- Evaluation of a newborn Flashcards

1
Q
  • Estimated Gestational Age
  • Prenatal Care/Ultrasounds

–Risk factors? Abnormalities?

  • Fetal growth, advanced maternal age, polyhydramnios, oligohydramnios, echogenic cardiac focus, echogenic bowel, hydronephrosis
  • Maternal Labs

–GBS, Hepatitis B & C, syphilis, rubella, HIV, STIs, blood type and Rh antigen, Glucose tolerance test

•Exposures

–Medications, tobacco, alcohol, illicit drugs

  • Family History
  • Social History
  • Feeding plan
  • Duration of ruptured membranes: water broke longer than 18 hours risk of infections
  • Maternal fever
  • Clear amniotic fluid or meconium?
  • Fetal heart rate tracings
  • Presentation: vertex or breech?
  • Apgars
A

Prenatal history

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2
Q

–Tone, Color, Respiratory effort, Heart rate, Reflex Irritability

A

Apgars score

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3
Q

normal HR

normal RR

normal temp… rectally?

A

–HR: 120-160

–RR: 40-60

–T: 36.5 – 37.5 rectally

dont forget to look at their tone and color!

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4
Q

2 different types of words to describe babies weight

A

Small for gestation (SGA)

Large for gestation (LGA

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5
Q

what are you looking at in head exam ((3 things))

A

fontanelles

suture lines

molding/brusiing/scalp probe

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6
Q

what is this

A

Caput succadaneum: soft tissue swelling, will corss suture lines

soft and boggy, resolves in 24 hours

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7
Q

whats going on here?

A

Cephalohematoma: blood collection underneath the periosteum, DOES NOT cross suture lines

can put at risk for jaundice

localized to one bone at a time

can stick around for a few months

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8
Q

and here?

A

Subgaleal hemorrhage: larger potential space where blood can accumulate

medical emergency

extremely rare!! life threatening

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9
Q

and here they all are

A

yah gooooo peds!

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10
Q

Eye exam what are we looking for?

and if not present or unequal what could be going on

A

•Red reflex

–If not present or unequal: ? Congenital cataracts, optho consultation

should be present in both eyes if not contact eye doctor

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11
Q

often no conjugate until ____-____ months

A

4-6 months

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12
Q

what is this?

A

Dysconjugate gaze

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13
Q

what is going on here?

A

Subconjunctival hemorrhage: non painful, due to birthing trauma

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14
Q

whats this?

A

Dacryostenosis: sclera and conjunctiva not injected

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15
Q

and this?

A

Gonococcal conjunctivitis: rare!

eryrthromycin given to all babies to prevent this stuff

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16
Q

two things we are looking at on nose exam

A

–Patency?

–Deformity?

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17
Q

Ear exam…

what is a position of the ear to be looking for?

what can there be an association with?

what type of abnormalities? syndromes?

A

low set, posteriorly rotated ears

association with renal anomalies and hearing loss

chromosonal abnormalities, genetic syndromes

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18
Q

how is this ear?

A

normal

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19
Q

how is this ear?

A

Preauricular Tag

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20
Q

what is going on with this ear?

A

Preauricular Pit

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21
Q

Ankyloglossia

A

tongue tied

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22
Q

what is this a picture of?

A

•Oral candidiasis (thrush)

cannot brush away

and there is some firability when it is wipped away

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23
Q

what is this?

A

Bohn’s nodules: benign

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24
Q

whats this?

A

Epstein Pearls: Benign

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25
Q

what’s going on here?

A

cleft lip/palate

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26
Q

this is

A

normal jaw position

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27
Q

this is…

A

Micrognathia :

  • ? Underlying chromosomal abnormality
  • Feeding difficulty
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28
Q

4 things you do while examining neck, clavicles, and chest

A
  • Palpate clavicles
  • Inspect for symmetry
  • Check neck folds
  • Breast buds
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29
Q

•Fetal circulation

where does shunting happen and

where does oxygenation occur

A

–Shunting through foramen ovale and ductus arteriosus

–Oxygenation occurs via the placenta

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30
Q

what happens during transition to infant with cardio physiology

–> pulomonary vascular resistance _______, sysetmic pressure ________

–> __________ closes

–> ______________ constricts when oxygenation increases

A

–Pulmonary vascular resistance decreases, systemic pressures increase

–Foramen ovale closes

–Ductus arteriosus constricts when oxygenation increases

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31
Q

•Auscultation of murmurs

–Continuous “washing-machine” PDA murmur

–Systolic vs. diastolic murmurs

  • Observation of skin color
  • Assess perfusion
  • Assess respiratory effort
  • O2 sats (pre and post-ductal)
A

other things in the cardio PE

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32
Q

2 things that we do when examining lungs and the 4 key points under the second bullet point!!!

A
  • Auscultation
  • Observe respiratory effort

–Retractions

–Grunting

–Nasal flaring

–Rate

33
Q
  • Transient tachypnea of the newborn: within first 6 hours of life until 24 hours… retained lung fluide… to tachypnic to feed.. diffuce source picture and fluid within the fissures
  • Neonatal pneumonia
  • Meconium aspiration syndrome
  • Pneumothorax
  • Respiratory distress syndrome (hyaline membrane disease)
A

more studd we are looking for in lung PE

34
Q

what is this an x-ray of?

A

transient tachypnea

35
Q

what about this one?

A

FOcal pneumonia…

i hate x-rays!

36
Q

HOW ABOUT HERE?

A

PNEMOTHORAX!

great job!

37
Q

and how about here?

A

hyaline membrane ds.

38
Q

this?

A

Maconium aspirations

39
Q

3 things to look at during abdominal exam!?

  1. _____
  2. _____ (how many vessels?)
  3. ______ (3 things that are chategorized under here)
A
  • Palpate
  • Umbilical cord – 3 vessels
  • Abdominal wall defects

–Diastasis recti

–Omphalocele, gastroschisis

40
Q

GU exam

Female

what 2 things may be present

A

•Vernix and discharge may be present

41
Q

GU

male

what do you palpate

and what are you checking

A
  • Palpate testes
  • Check urethral meatus position
42
Q

what’s this condition?

and how common?

A

•Hypospadias

–(1/250 males)

Below

43
Q

what’s this condition?

A

epispadias : ontop

44
Q

what is this?

A

chordee (tethering)

45
Q

what is this?

A

inguinal hernias

  • bowel sounds
  • dont illuminate
46
Q

what is this?

A

hydroceles

47
Q

whats going on here?

A

•Descending and undescended testes

48
Q

baby should have a stool in the first ____ hours

A

24

49
Q

what is this?

A

meconium stool

50
Q

what is this?

A

transitional stool

51
Q

what is this?

A

sacral dimple

52
Q

what is this picture showing?

A

imperforate anus

53
Q

hip exam.

what are the two tests to Screen for Developmental Dysplasia of the Hip

A

Barlow test

and

ortolani test

54
Q

The maneuver is easily performed by adducting the hip (bringing the thigh towards the midline) while applying light pressure on the knee, directing the force posteriorly.[2] If the hip is dislocatable - that is, if the hip can be popped out of socket with this maneuver - the test is considered positive. The Ortolani maneuver is then used, to confirm the positive finding (i.e., that the hip actually dislocated).

A

barlow test

55
Q

It relocates the dislocation of the hip joint that has just been elicited by the Barlow maneuver.[citation needed]

It is performed by an examiner first flexing the hips and knees of a supine infant to 90 degrees, then with the examiner’s index fingers placing anterior pressure on the greater trochanters, gently and smoothly abductingthe infant’s legs using the examiner’s thumbs. A positive sign is a distinctive ‘clunk’ which can be heard and felt as the femoral head relocates anteriorly into the acetabulum:[2]

Specifically, this tests for posterior dislocation of the hip.[citation needed]

A

ortolani test

56
Q

GALEAZZI

A

lay prone..hips flexed.. make sure knees are at symmetric level!

57
Q

WHAT REFLEX IS THIS?

A

moro reflex:

The Moro reflex is an infantile reflex normally present in all infants/newborns up to 4 or 5 months of age as a response to a sudden loss of support, when the infant feels as if it is falling. It involves three distinct components:

spreading out the arms (abduction)

unspreading the arms (adduction)

crying (usually)

The primary significance of the Moro reflex is in evaluating integration of the central nervous system.

58
Q

what reflex is this?

A

rooting reflex:

A reflex that is seen in normal newborn babies, who automatically turn the face toward the stimulus and make sucking (rooting) motions with the mouth when the cheek or lip is touched. The rooting reflexhelps to ensure successful breastfeeding.

59
Q

what reflex is this?

A

Galant reflex:

It is elicited by holding the newborn in ventral suspension (face down) and stroking along the one side of the spine. The normal reaction is for the newborn tolaterally flex toward the stimulated side.

This is one of the reflexes tested in newborns to help rule out brain damage at birth.

60
Q

What reflex is this?

A

Grasp reflex

Palmar grasp reflex (sometimes simply called grasp reflex) is a primitive reflex. It appears as early as 16 weeks in utero and persists until five or six months of age. When an object is placed in the infant’s hand and strokes their palm, the fingers will close and they will grasp it with a palmar grasp. The grip is strong but unpredictable; though it may be able to support the child’s weight, they may also release their grip suddenly and without warning. The reverse motion can be induced by stroking the back or side of the hand.

all of these relfex summaries are from wiki…. BTW

61
Q

_______ vs _______

A

normal tone vs. hypotonia

62
Q

what is going on here?

A

Erythema toxicum: common rash, eosinophils in there

normal during 1st week of life

63
Q

whats going on here?

A

Cutis Marmorata (Mottling): normal baby that is cold– if gray not well perfused

64
Q

what about here?

A

peeling

65
Q

and here….

A

Acroncyanosis

66
Q

what is this?

A

Linea Nigra

67
Q

and here?

A

Nevus simplex (salmon patch)

common

68
Q

what about here?

what’s this?

A

Nevus simplex (stork bite)

69
Q

and here?

A

Slate grey patches (Mongolian spots)

common in darker skin individuals

70
Q

Skin exam

Jaundice

Risk Factors: (5)

A

Risk Factors:

    • Prematurity
    • Breastfeeding
    • Illness/Sepsis
    • ABO incompatibility
    • G6PD deficiency
71
Q

what is one thing we can do if jandice

A

phototherapy and then feed them because that is how they clear it!

72
Q

Preterm: < ___ weeks

Late Preterm: __-___ weeks

Term: ___- ___ weeks

Post-term: > _____ weeks

A
  • Preterm : < 35 wks
  • Late Preterm : 35-36 6/7 wks
  • Term : 37- 42 wks
  • Post-term : > 42 week
73
Q
  • Skin texture, lanugo, plantar markings
  • Joint mobility
  • Eyes/ears
  • Genitalia & breast development
  • Tone and posture
A

part of the Gestational Age Assessment

74
Q

BALLARD SCORE

Neuromuscular maturity

A

BALLARD SCORE

physcial maturity

75
Q

6 things that are part of the Newborn Screening!

A
  1. Hearing
  2. Hyperbilirubinemia
  3. Metabolic state screen
  4. Critical Congenital Heart Disease
  5. Infection
  6. Hypoglycemia (SGA, LGA, prematurity, infant of diabetic mothers, sepsis, maternal beta-blocker use[HTN during pregnancy] )
76
Q

sorry, this card sucks….

•Biotinidase Deficiency

•Cystic Fibrosis

•Galactosemia

•Endocrine Disorders:

–Congenital Adrenal Hyperplasia (CAH)

–Congenital Hypothyroidism

•Hemoglobinopathies

•Amino Acid Disorders:

–PKU (Phenylketurnia)

–MSUD (Maple Syrup Urine Disease)

–HCU (Homocystinuria)

–Tyr I (Tyrosinemia I)

–Tyr II (Tyrosinemia II)

•Urea Cycle Disorders:

–ASS (Citrullinemia)

–ASL (Argininosuccinic Aciduria)

–Argininemia

–HHH Syndrome Hyperammonemia Hyperornithinemia Homocitrullinemia

•Organic Acid Disorders:

–GA I (Glutaric Acidemia I)

–IVA (Isovaleric Acidemia)

–MMA (Methylmalonic Aciduria)

–PPA (Propionic Acidemia)

–HMG (HMG CoA Lyase Deficiency)

–MCC (B-Methyl Crotonyl Carboxylase)

–B-KT (B-Ketothiolase Deficiency)

–MCD (Multiple Carnitine Deficiency)

•Fatty Acid Oxidation Disorders:

–MCAD (Medium-Chain Acyl Co-A Dehydrogenase Deficiency), LCAD, LCHAD, VLCAD, SCAD

–CPT II Carnitine Palmitoyl Transferase deficiency Type II (CPT Deficiency)

–GA II (Glutaric Acidemia II)

–CUD (Carnitine Uptake Deficiency)

–TFP (Tri-functional Protein Deficiency)

A

Maine Newborn Bloodspot Screening Program

77
Q

what are the billions of things we see with sepsis… there are 11 thing listed :)

A
  1. Tachycardia
  2. Tachypnea
  3. Respiratory distress
  4. Low tone
  5. Poor feeding
  6. Hypoglycemia
  7. Apnea
  8. Lethargy
  9. Temperature instability
  10. Hyperbilirubinemia
  11. Pallor
78
Q

DONE … GREAT JOB!

now go enjoy spring break!!!!

A

hfdsoahivdsbavjkdsbavuisdbaviudsbauvsdbavkdsbakvibdas

Sasha: Module 12 Pediatrics (4 decks)

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