Exam 2 Flashcards
3 Risk factors for hydatidiform moles?
Teens
Women over 35 y.o
Previous miscarriage
What is the most common presenting symptom of hydatidiform moles?
Vaginal bleeding
What does a hydatidiform mole appear as on ultrasound?
snowstorm pattern
Where is the most common side of an ectopic pregnancy: Cervix, ovary, tube, or abdomen?
Tube (97%)
What condition presents with abdominal tenderness along with vaginal bleeding?
Ectopic pregnancy-likely ruptured
What is the term for a pregnancy complicated by bleeding before 20wks gestation?
Threatened abortion
What constitutes someone to have ‘recurrent spontaneous abortions’?
3 or more consecutive pregnancy losses
What accounts for 49% of spontaneous abortions (loss of preg. before 20wks)?
Chromosomal abnormalities
What is it called when the woman has a dilated cervix prior to the 20wk gestation mark?
Inevitable abortion
What is the term for implantation of the placenta over or near the internal os?
Placenta previa
Bright red, painless bleeding that occurs after 27wks gestation is most likely ___ ____.
Placenta Previa
What condition studied is NOT diagnosed via ultrasound?
Abruptio placentae
What is abruption placentae?
Separation of placenta after 20wks gestation; accompanied by bleeding, abdomen or back pain
What is the most common cause of abruption placentae?
Maternal hypertension (44%)
With twins, are you more likely to see oligohydramnios or polyhydramnios?
Polyhydramnios
T/F: Fetal ballottement is easier to perform with polyhydramnios.
True
What is gestational hypertension?
Blood Pressure: Over 140/90 mmHg
After 20wks gestation
NO PROTEIN IN THE URINE
If they have 140/90mmHg BP, after 20wks, with protein in the urine it is called ____.
Preeclampsia
Preeclampsia affects ___% of pregnancies?
5-7%
T/F: C-section is preferred if diagnosed with preeclampsia.
False: Vaginal is preferred unless there is physiological stress
What is HELLP?
Associated with preeclampsia; Hemolysis, Elevated Liver enzymes, Low Platelet count
New seizures in a woman with preeclampsia is called what?
Eclampsia
What are the two forms of treatment for eclampsia?
Magnesium sulfate,
Antihypertensive meds
Preterm labor is cervical effacement &/or dilation before __ wks of gestation.
37
What is the greatest risk factor for preterm labor?
Having a previous preterm delivery
What does tocolytic therapy do for preterm labor?
Slows down or halts uterine contractions
What do corticosteroids do with regards to preterm labor?
Enhance pulmonary maturity of baby
What is the definition of post-term pregnancy?
Pregnancy that reaches 42+ wks gestation
What is gestational diabetes?
A glucose intolerance that begins during pregnancy
T/F: Gestational diabetes increases your chances of having Type 2 diabetes later on.
True
What is the diet recommendation for gestation diabetes patients?
Diet that meets the needs of pregnancy but restricts carbs to 35-40% of daily calories
What is the most common complication of gestational diabetes?
Shoulder dystocia (which Google tells me is when the baby’s head is delivered but the shoulders get stuck)
What is puerperium?
Time from placenta delivery–>1st few weeks post-delivery
Most of uterine reduction in size and weight will occur when?
First 2 weeks; process called INVOLUTION
Lochia rubra, lochia serosa, lochia alba??
Vaginal discharge post partum, red (rubra) 1-3wks, brown-red (serosa), yellow (alba).
What is uterine atony?
Lack of uterine contracture to close spiral arteries and venous sinuses; may lead to hemorrhage of mom
What is the condition with painful, warm, swollen breasts usually accompanied by a fever and chills?
Mastitis
What is PPT?
Postpartum Thyroiditis; transient, destructive lymphocytic thyroiditis w/in 1st year postpartum
T/F: The majority of PPT moms will have permanent thyroid dysfunction.
False: only 10-30% have permanent damage
T/F: 50-70% of new mothers experience postpartum depression.
False: 50-70% experience postpartum BLUES…only 10-15% actually experience postpartum DEPRESSION.
T/F: Postpartum psychosis only lasts 2-3 months.
True; it’s postpartum depression that lasts 3-6months
What is the age bracket for toddlers?
1-2yrs. Below 1 yr=infant. Above 2 yrs=child
What is the difference between neonates and postneonates?
1-28 days=neonate
29 days-1 yr=postneonate
What does APGAR stand for?
activity, pulse, grimace, appearance, respirations
When is the APGAR done?
1 min after birth, and 5 min after birth
T/F: Maternal diabetes is a risk factor for having a preterm infant.
False: …risk factor for having a large for gestational age baby.
Where is the apical pulse found on an infant?
3rd-5th intercostal space in midclavicular line
Where is the femoral pulse found on an infant?
Halfway between pubic tubercle and ASIS
What is the ‘flush technique’?
A means of taking blood pressure on an infant
Where should you take an infants temperature?
Axilla; correlates well to core temp b/c small body mass
Length of infant increases by __% in the 1st year of life.
50%
Weight of an infant should double by __months and triple by one year.
6 months
When is it normal for the head circumference to be equal or larger than chest circumference?
5 months and under
T/F: From 5 months to 2 years the chest and head circumference should be about equal.
True
If the head circumference increases rapidly or rises above the percentile curves, what should we be concerned about?
Incr. intracranial pressure; such as hydrocephalus
Word associations with Turners Syndrome?
Short stature, webbed neck, lack sexual traits, fall below the growth curve
What is Cornelia de Lange Syndrome?
Microcephaly, low hairline, arched eyebrows, short upturned nose, developmental delay
What is cutis marmorata?
Transient mottling of skin when exposed to cold temps
The term for cyanosis of hands and feet as a response to the cold?
Acrocyanosis
What is vernix caseosa?
Protective mixture of sebum and skin cells covering the infants body at birth; may look like whitish cheese-like substance
The name for the fine, silky hair covering a newborn that usually sheds 10-14 days postpartum?
Lanugo
Other names for telangiectatic nevi?
Stork bites, salmon patches
Where is telangiectatic nevi typically seen?
Nape of the neck
Bluish-gray discoloration seen over the sacral area of a newborn, what is it?
Dermal melanocytosis; aka Mongolian spots
T/F: Erythema toxicum is a serious rash of a newborn that requires immediate attention.
False: pink popular rash with vesicles that will resolve after several days
Anatomically, when is jaundice worrisome?
If the jaundice descends below the nipples; indicates more than 12mg/dl of bilirubin
Time-wise, when is jaundice worrisome?
If it’s present the first 24 hrs; may indicate patholocial jaundice usually from a more serious problem
What is the most common disorder associated with a simian line?
Down Syndrome
Tenting of the skin when testing turgor can be indicative of what 2 things?
Dehydration or malnutrition
What is the Schamroth Technique?
Placing the back of the fingers together to look for clubbing of the nails.
What is milia?
Plugged sebaceous glands leading to small white papules on the face of infants between birth and 3 months
What is the fancy name for a heat rash?
Miliaria
Where are you likely to see an eczematous rash in a young child?
Face, elbows, knees
What is seborrheic dermatitis?
Thick, yellow, crusty scalp lesions; may spread down ear and neck. AKA Cradle Cap
Word association for honey-colored crusts?
Impetigo; highly contagious staph or strep infection
What is the most common vector of ring worm affecting kids?
Pets
T/F: Strawberry hemangiomas usually begin to shrink within 12 to 18 months post partum.
True
What is trichotillomania?
Pulling out own hair; may be related to stress or OCD
Tuft of hair overlying the lumbosacral area is called what and associated with what condition?
Faun tail nevus; Spina bifida occulta
Café au lait spots and axillary freckling may be related to what disorder?
Neurofibromatosis
A port wine stain over the ophthalmic division of the trigeminal nerve may be associated with what 2 problems?
Sturge-Weber Syndrome (seizures); ocular defects
Supernumerary nipples are associated with defects of what organ?
Kidney
T/F: Kids with excessively large palatine tonsils may develop sleep apnea.
True
What are the red flags when regarding lymph noses?
Fixed and immoveable, growing quickly, larger than 2-3cm
T/F: It’s common to find lymph node enlargement of cervical and occipital nodes after 2 years of age.
False: Postauricular and occipital node enlargement is uncommon after 2 yrs
T/F: It’s never normal to find enlarged supraclavicular nodes.
True
The Epstein-Barr virus causes what condition?
Infectious mononucleosis; most commonly affecting teens
What are some symptoms of mono?
Pharyngitis, fever, fatigue, (spleno or hepatomegaly, & rash may also be noted)
What is cranial molding?
During a vaginal birth, cranial bones may shift and overlap; normal-shaped skull should resume within 1 wk.
What condition has subcutaneous edema on the skull and may feel like a water balloon to the touch?
Caput Succedaneum
What is cephalhematoma?
Subperiosteal blood that doesn’t cross suture lines most commonly affecting the parietal region.
Where is caput succedaneum most likely to occur?
Over the occiput area with poorly defined margins
T/F: Premature union of the cranial sutures is usually accompanied by mental retardation.
FALSE
How is a positional head deformity different than craniosynostosis?
Ears migrate forward, heads shaped like parallelogram, bald spot on side of flattening for positional head deformity
When does the posterior fontanel close by? Anterior fontanel?
Post-2 months
Ant-2 YEARS
What condition is associated with the ‘setting sun sign’?
(Sclera visible above the iris but below that superior lid) associated with hydrocephalus
What is craniotabes and what causes it?
Softening of the skull; may be normal finding but associated with rickets and hydrocephalus
What are some common features of Down Syndrome?
Epicanthal folds, low set ears, depressed nasal bridge, upturned eyes, large tongue
Smooth philtrum, widespread eyes, short nose, thin upper lip…name that syndrome?
Fetal Alcohol Syndrome
T/F: A coloboma is a loss of functioning pupil usually seen with other abnormalities.
True: aka Keyhole Pupil
Brushfield spots, white specks in linear pattern around iris of the eye, suggests what syndrome?
Down Syndrome
What is the Hirschberg’s Test looking for?
Asymmetry indicating strabismus; (Hirschbergs aka Corneal Light Reflex)
If an eye moves lateral to medial during a cross-cover test, it is an _____eye.
Exotropic eye; esotropic moves medial to lateral
Duane Syndrome affects what part of the ocular system?
Abducens nucleus and the lateral rectus muscle.
What is amblyopia?
Reduced vision in an eye that appears structurally normal
At what age should a child be able to see 20/20?
6 yrs.
If you see an abnormal ‘white’ reflex in the eye, you should suspect what 2 problems?
Congenital cataracts
Retinoblastoma
What are some common causes of congenital cataracts?
Infectious diseases (TORCH), hypoglycemia, trisomies, prematurity
T/F: Retinoblastoma is a benign eye condition typically affecting kids.
False: Malignant tumor affecting kids under 2 years
How do you pull the ear when performing an otoscopic exam of a infant?
Downward b/c short, upward-curving auditory canal
How is the Eustacian tube different in kids?
It’s wider, shorter and more horizontal
Low set ears are frequently associated with which organ disorders?
Kidney
Why can the red reflex be seen in normal infants?
Crying causes dilation of blood vessels; don’t assume infection right away
Would you expect to see tympanic membrane redness with middle ear effusions?
NO, that’s otitis media. Effusions have retracted membranes & yellowish color
Nasal crease is usually seen with which common condition?
Allergies; also may have mouth breathing, allergic shiners, allergic salute (which causes the nasal crease)
What is choanal atresia?
Congenital nasal obstruction of the posterior nares; leads to respiratory distress and difficulty feeding
T/F: Don’t depress the tongue of an infant b/c it stimulates the tongue thrust reflex which will make mouth visualization difficult.
True
What is ankyloglossia?
Short frenulum, ‘tongue-tied’; may lead to feeding and eventual speech difficulties
Are retention cysts normal?
Yes, (AKA Epstein Pearls); pearl-like cysts along gums that should disappear in 1-2 months
How many deciduous teeth are there?
20; should appear between 6 months-2 years
What is natal teeth?
Teeth in a newborn, usually removed to reduce risk of aspiration
What is baby bottle syndrome?
Multiple cavities on upper/lower incisors due to putting the kid to bed with a bottle of milk/juice
What is bruxism?
Unconscious grinding of teeth giving them flattened edges
If the tonsils were observed halfway between tonsillar pillars and the uvula, how would you grade their size?
Grade 2+; (3+ nearly touching the uvula, 4+touching each other)
What is epiglottitis?
Life-threatening condition from Haemophilus influenza B, common 3-7 y.o; S/S high fever, drooling, can’t swallow, tripod position, croupy cough
Would you further inspect with a tongue blade if you suspected epiglottitis?
NO, could irritate further and hasten airway closure
Word association with salty kiss?
Cystic fibrosis; due to a salt loss in the sweat
What other organs are affected by cystic fibrosis?
Lungs; thick mucus with frequent pulmonary infections, Pancreas so they have sticky, foul smelling stools
The distance between the nipples should be ___ of chest circumference,
1/4
When is periodic breathing a concern?
If apneic episodes are prolonged or baby becomes cyanotic
T/F: Crackles and ronchi may be heard after birth b/c fluid hasn’t completely cleared.
True
What is laryngomalacia?
Floppy larynx cartilage resulting in noisy breathing, inspiratory stridor, wheezing; usually self limited w/ age
What condition common under 6 months old is caused by respiratory syncytial virus?
Bronchiolitis
A seal-like cough, not associated with fever common to very young kids (especially boys)?
Croup; if they had a fever think epiglottitis
In fetu, blood passes directly from the r. atrium to the l. atrium via the __ ___.
Foramen ovale
Both the foramen ovale and the ductus arteriosus should close within - hours.
24-48 hours
A patent ductus arteriosus would present with what type of murmur?
Machinery; harsh, loud and heard throughout
T/F: A patent foramen ovale is usually asymptomatic w/ occasional cyanosis upon exertion.
True
If the baby appears purplish, what condition are you thinking?
Polycythemia
Adult heart position is reached by age __.
7
Where would you find the apical impulse on a case of dextrocardia?
The right
What is different between dextrocardia and sinus invertus?
Dextro-only heart is on right
Sinus invertus-heart and stomach on right, liver on left
What are some red flags when discussing murmurs?
Lasts longer than 2nd-3rd day of life
Fills systole
Any diastole involvement
Intense or radiates widely
T/F: You should never hear a venous hum over the internal jugular vein in kids.
False: quite common in kids
If blood pressure is read high multiple times on a kid, what 3 dDx are you thinking?
Kidney Dz
Renal arterial Dz
Coarctation of the aorta
Where would the high blood pressure be found in coarctation of the aorta?
High in upper extremities
Low in lower extremities
What are the 4 components of Tetralogy of Fallot?
- Rt. Ventricle Hypertrophy
- Pulmonary Valve Stenosis
- VSD
- Overriding aorta
Where would the murmur be heard in Tetralogy of Fallot?
Systolic ejection murmur heard over the 3rd intercostal space
Acute rheumatic fever is a complication of strep that may involve what valves?
Mitral or aortic
Migratory polyarthritis, erythema marginatum, and a fever could be indicative of what?
Acute rheumatic fever
Who is most commonly affected by Kawasaki Disease?
Boys under the age of 5
What are the S/S of Kawasaki Disease?
Long lasting fever, red eyes, red tongue, rash, chapped lips
T/F: Toddlers may have a normal ‘pot-belly’.
True; if past toddler age be suspicious of organ enlargement, feces, or other masses
What is an umbilical hernia?
Protrusion of omentum & intestine thru umbilical opening
What is the treatment for an umbilical hernia?
Generally close spontaneously by 1-2 years
T/F: Diastasis recti can occur in kids and should be fixed surgically.
False: can occur but shouldn’t need surgery unless a herniation occurs. Otherwise diastasis recti resolve around 6 y.o
Another name for Wilms Tumor?
Nephroblastoma
What is the most common intraabdominal tumor of childhood?
Nephroblastoma, malignant
What is Hirschsprung Disease?
No parasympathetic ganglion cells leading to no peristalsis
What would you suspect if you found a sausage-shaped mass in the left or right upper quadrant?
Intussesception
What age group does intussesception most commonly affect?
3-12 months
How would pyloric stenosis palpate?
Olive-shaped mass in the right upper quadrant immediately after the infant projectile vomits
What is congenital obstruction or absence of some or all of the bile duct system called?
Biliary atresia
What are some S/S of biliary atresia?
Jaundice apparent @ 2-3wks, hepatomegaly, abdomen distention, light colored stools, dark urine, itchy
What condition is due to meconium hardening in the lower intestion leading to blockage and distention?
Meconium Ileus
What is omphalocele?
Intestine present in umbilical cord or protruding thru the umbilical area
What inflammatory disease of the GI mucosa is associated with prematurity?
Necrotizing Enterocolitis
