Exam 2 Flashcards
Blood test used to screen for risk of birth defects such as spina bifida?
Alpha-fetoprotein (AFP)
Your patient is 33 weeks pregnant. She has been having contractions and suspects that her water broke last night, though there was only a small amount of fluid. Which is NOT standard medical management?
A) Antihypertensives to stabilize her blood pressure**
B) Tocolytics to delay delivery
C) Antibiotics to min risk of infection
D) Corticosteroids to stim fetal lung development
Your patient is 35 weeks pregnant. Chief complaint:low back pain following a motor vehicle accident. Review of systems reveals; uterine pain and vaginal bleeding. You suspect?
Abprutio placentae
Your patient is 38 weeks pregnant. When updating your patient’s chief complaint, she mentions that she’s had headaches since the last visit and describes mild visual disturbances. When asked, she reports upper abdominal pain as well. You suspect and recommend?
pre-eclampsia
taking her blood pressure
____ is/are associated with slower 1st and 2nd stages of labor, increased use of piton, increased perineal tears, increased instrument-assisted deliveries, and increased rate of cesarean.
epidural analgesia
True/False? a “nuchal arm is the LEAST common type of compound presentation?
FALSE=most common
Your patient presents in your office 1 week after giving birth vaginally. She tells you that they had to induce her labor with Pitocin and that she chose to have an epidural. Forceps were used because the baby was stuck. In addition to wanting and adjustment, she reports frequent urges to urinate and some burning with urination. she does not have a fever and describes a normal lochia. your exam reveals suprapubic tenderness. You suspect?
urinary tract infection
T/F Mastitis is caused by milk stasis and cracked nipples?
true
T/F clinical presentation of mastitis may include fever, myalgias and warm, swollen, tender breast tissue?
true
T/F A mother with mastitis should discontinue nursing and avoid expressing milk?
false
T/F Conservative mastitis management may include moist heat and massage to reverse stasis
true
T/F PPT (Postpartum thyroiditis) includes signs of fatigue, palpitations, heat intolerance, and nervousness?
false (cold intolerance)
T/F Postpartum psychosis is a permanent condition in most cases?
false (duh)
When recording pediatric history, a number of people may provide you with historical data (parents, siblings, ect.). You must document the historian’s ?, __?__, and ?
name, relationship to patient, and reliability
T/F start pediatric exam with the otoscopic exam to get uncomfortable parts of the exam out of the way first?
false
Apgar scores are notes at 1 minute and again at 5 minutes. Which is associated with a high risk for subsequent CNS and other organ dysfunction?
1minute: 5
5minute: 6
Response to decreased temperature?
cutis marmorata
As a chiropractor, you may be the primary healthcare provider for some of your patient families. It will be important for you to understand expected growth patterns. Which of the following statements is true?
length should be increased by 50% in the first year
clubbing nails is assessed using ___ and is most likely related to ____?
schamroth technique
cardiovascular disease
T/F the apical pulse is found between the 3rd and 5th intercostal space and midclavicular line in a newborn exam?
true
a 6 day old infant presents to your office with jaundice that has appeared over the last 3 days. You assess it as ___ and which is commonly related to ___?
physiologic (pathologic if born with it)
breastfeeding
Saddle-shaped nose with a low bridge means what for the patient?
congenital heart anomaly
When examining a newborn head, you note a prominence over the left parietal bone. It is firm with well defined edges and does not appear to cross sutures. You suspect ___ which is caused by ___?
cephalhematoma
subperiosteal bleeding
T/F microsomnia is associated with hydrocephalus?
false
these are; dilated scalp veins, setting sun sign, craniotabes
Recommendation in class for inspection of infant’s neck?
to inspect the neck, lay them supine and elevate their shoulders letting the head fall gently into extension
Cross eyed child, what describes him best?
psuedostrabismus
symmetrical corneal light reflex
In a patient with a right isotropic strabismus, you would expect to see what?
cover-uncover test: the right eye moves medial
Multiple brown areas caries on the upper and low incisors are suspicious of?
baby bottle syndrome
Parents tell you their 11 month old daughter has been irritable and tugging at her right ear the past few days. Temp is 101.4. Upon examination of the right ear, you note a red, bulging tympanic membrane. You recommend pneumatic otoscopy to confirm your suspicion but your clinical impression is?
otitis media effusion
T/F this would be obstructive sleep apnea, 2 year old with tonsils graded as a +1 bilaterally?
false
The McIsaac Modification of the center strep score has been use to estimate the likelihood of strep. What increases the likelihood of strep?
temperature greater than 100.4, tender anterior cervical adenopathy, tonsillar swelling or exudates
NOT cough
Common findings with allergies?
allergic salute, grayish nasal membranes, dark circles under eyes
NOT otitis externa
Rarely seen is childhood sinusitis?
facial pain, headache
T/F a newborn with crackles throughout the lung fields shortly after birth is a sign of respiratory distress?
false
Laryngomalacia typical features include?
underdeveloped cartilage, noisy breathing, self-limiting with age
NOT coughing
A 3 year old boy presents with a harsh stridorous cough and labored breathing. Parents say that he went to bed find and woke up suddenly having difficulty breathing. This is the first time that he’s presented this way. You suspect?
croup
___ pathologies are common causes of secondary HPT in pediatric patients?
kidney
A 5 year old boy presents with a reddish-pink marginated rash complaining of pain in his hips and knees. When you ask about recent illness, his mother tells you that he has had a fever on and off for about 3 weeks and has complained of headache and abdominal pain. You suspect ____ and are concerned about _____?
rheumatic fever
cardiac valve involvement
T/F a soft, rounded abdomen is normal in an infant?
true
Parents present their 11 month old son for evaluation. They state that he has been vomitting all day and in obvious pain. No fever. When examining his abdomen, you note a sausage-shaped mass in the right upper quadrant. You suspect?
intussusception
the most common intraabdominal tumor of childhood is ____ and will present as a ____?
nephroblastoma
firm, non tender mass
A warm water bath should only be used when?
during active labor
Benefits of water birth?
reduce stress during birth and reduces fetal complications
What does a doctor want to avoid when administering an epidural?
does NOT want to pierce the dura
How can you prevent an episiotomy?
perineal massage and kegal exercises (kegals also help repair after)
This presentation at birth may cause intense back labor and cone head?
occiput posterior
Baby fell out? (which birth presentation?)
nuchal arm
Birth presentation common with pitocin and epidurals?
parietal presentation
Head forced into extreme lateral flexion, parietal bone of fetus against mom’s pubis (cephalohematoma***), traction/compression of brachial plexus
asynclitic
Vacuum extraction could cause?
caput succedaneum
Time from delivery of the placenta through first few weeks (when body returns to non-pregnant state**)
puerperium
Vaginal discharge (about 5 weeks)
lochia
What lochia is the most common?
type 1 (breastfeeding/lactating link)
type 3 lochia is what phase?
rubra phase
Women will start ovulating when after birth of a child if they are breastfeeding?
36 weeks
12 weeks if not breastfeeding
How do you rid retention of placental parts?
dilation and curettage
Maternal gestational history, all pregnancies and miscarriage and age of parents, review ____ on each side?
2 generations
How do you allow adolescents to write their own problems in a history?
ask open-ended questions
Apgar scores are subjective and ____?
qualitative
According to Ballard scoring, term weight is at how many weeks?
37-42 weeks
In a newborn exam, the most common way for an infant to lie is?
symmetric position with limbs semi-flexed and legs partially abducted
Normal newborn respiration is?
3-=80
When taking blood pressure, cuff should cover how much of the arm?
2/3 width of the arm
Doll-like appearance, not meeting milestones is what condition?
cornelia de large syndrome
Flat, deep pink “stork bite” MC on the back of the neck is called?
telangiectatic nevi
Irregular area of deep blue pigment MC near sacral/gluteal region (MC in African Americans and Asians)
mongolian spots
whats the difference between milia and miliaria?
milia-small white papules/plugged sebaceous glands
milaria-“heat rash”, occluded sweat ducts
Cows milk and IgE allergy is linked with what?
atopic dermatitis
Thick, yellow crusted “cradle cap” is called?
seborrheic dermatitis
Honey colored crust, staph or strep infection and is contageous
impetigo
Tuft of hair over spine (MC lumbosacral area) and is associated with spin bifida
Fawn tail nevus
Neurofibromatosis
cafe au lait
Supernumorary nipples and low set ears indications problems with what?
kidneys (renal issues)
T/F It is never normal to feel supraclavicular nodes
true
MC found on occiput, crosses sutures, subcutaneous edema
capur succedaneum
Fontanels should be closed by?
2 months
Increased transillumination may increase excess fluid causing?
hydrocephalus
Softening of the skill (may be normal) is called?
craniotabes
Corneal light reflex is also called?
Hirschberg’s test
White reflex indicates?
retinoblastoma or cataracts (MC from rubella)
What sinuses are present at birth?
maxillary and ethmoid
Grinding teeth is called?
bruxism
T/F bronchial and hyperresonance is common?
true
Innocent murmurs last how long?
2-3 days
Holosystolic murmur indicates?
ventricular septal defect
Kawasaki disease is most common in males or females?
males-strawberry tongue, conjunctivitis, lymphadenopathy
Another name for nephroblastoma (MC intra-abdominal tumor in children)
Wilm’s tumor
