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H & P 2 > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Neonate

A

Birth to 29 days

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2
Q

Infant

A

29 days to 1 year

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3
Q

Term infant

A

37-42 weeks

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4
Q

Birth weights

A

<10th percentile is too small

> 90th is large

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5
Q

APGAR

A 
Appearance (color)
Pulse
Grimace (reflex response to bulb syringe)
Activity (muscle tone)
Respiratory effort

1 and 5 minute interval

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6
Q

APGAR scoring

A

8 is normal

5-6 is mild depression
3-4 need resuscitative measures

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7
Q

Ballard assessment is…

A

Calculates GA of child within 1 week

Neurological and physical components evaluated

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8
Q

When do you aspirate stomach contents in an infant?

A

Meconium stained amniotic fluid

C section babies

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9
Q

Failure to pass NG tube, think…

A

Esophageal atresia associated with tracheoesophageal fistula

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10
Q

High frequency tremors normal until…

A

4 days old

If >4, consider CNS, PNS

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11
Q

Pulse of infant

A

115-140

<90 or >180 is a concern

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12
Q

Physiologic jaundice

A

3-4th day of life

96 hours, self limited

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13
Q

Erythroblastosis fetalis

A

Jaundice in first 24hours of life, can cause kernicterus

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14
Q

Vernix caseosa

A

Normal finding at birth, peely white skin/residue

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15
Q

Acrocyanosis

A

Benign, hands/feet cyanotic

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16
Q

Central cyanosis

A

Tongue and gum mucosa blue, not normal

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17
Q

Milia

A

Pinhead smooth, white raised areas

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18
Q

Miliaria rubra

A

Heat rash

Caused by obstructed sweat glands, vesicles with erythematous base

Resolves in 1-2 weeks

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19
Q

Erythema toxicum

A

Baby acne

2-3rd day of life

Red macules with central urticarial wheals

Spontaneously resolves in a week

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20
Q

Angel kisses

A

On forehead

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21
Q

Stork beak

A

On back of neck

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22
Q

Salmon patches

A

Small and pink, fade over time

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23
Q

Port wine stains/nevus flammeus

A

Most often on face, unlikely to go away and may get darker

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24
Q

Sturge Weber syndrome

A

Trigeminal V1, seizures, hemiparesis, mental retardation, glaucoma

Orbit, upper eyelid and forehead

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25
Q

Large posterior fontanelle, think…

A

Congenital hypothyroidism

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26
Q

Caput succedaneum

A

Crosses suture lines

Swelling/edema

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27
Q

Cephalhematoma

A

Bleeding, doesn’t cross suture lines

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28
Q

Macrocephaly and microcephalic

A

> 2 standard deviations above the mean

3 standard deviations below the mean

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29
Q

Pupils constricted for…

A

First 3 weeks of life

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30
Q

Nasolacrimal duct obstruction

A

Tears begin 2-3 months, not fully patent until 5-7 months

Parent complains of chronic tearing

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31
Q

Ocular motility

A

4 weeks- following in an arc
8 weeks- follow past midline with coordinated head movements
3 months- follow an object

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32
Q

Nystagmus common in infants…

A

Immediately after birth

After a few days, consider blindness

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33
Q

Doll’s eyes for infants…

A

First 10 days

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34
Q

Blue sclera in infants…

A

After 6 months its abnormal

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35
Q

Sucking reflex until…

A

9-12 months of age

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36
Q

Micrognathia

A

Pierre robin syndrome

Breathing problems, glossoptosis

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37
Q

Epstein pearls

A

On palate, white spots

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38
Q

Teeth in infants

A

First set at about 6 months, bottom front teeth

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39
Q

By 10 months, what teeth ?

A

Two upper, two lower central incisors

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40
Q

4 teeth added every…

A

4 months. 8 teeth by 14 months

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41
Q

Apnea definition

A

> 20 seconds

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42
Q

Shrill, high pitched cry

A

ICP, narcotic addiction

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43
Q

Hoarse cry

A

Hypocalcemic tetany, congenital hypothyroidism

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44
Q

Expiratory stridor

A

Airway obstruction, polyp, tracheomalacia

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45
Q

Absence of cry

A

Severe illness, vocal chord paralysis, profound brain damage

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46
Q

Femoral pulses in infant

A

Check 24-48 hours after birth to assess strong pulses after closure of PDA

Weakness- consider coarctation of aorta

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47
Q

Heart lie in infant

A

More horizontally, apex is higher

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48
Q

PMI of infant

A

4th ICS, left of MCL until age 7

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49
Q

Auscultating infants

A

PVCs more common

Louder sounds

S2 split sometimes

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50
Q

Systolic II/VI or less until…

A

PDA and PFO close in the first 48 hours

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51
Q

Transposition of great vessels

A

Must have additional heart defect to survive

Not compatible with life without intervention

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52
Q

Tetralogy of fallot

A

Pulmonary stenosis

Thickened right ventricle

Ventricular septal defect

Overriding aorta (over septal defect)

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53
Q

Tet PE findings

A

Parasternal heave

Systolic ejection murmur over third intercostal space

Radiation to left side of neck

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54
Q

Atrial septal defect

A

Systolic ejection murmur over pulmonic area

Loud, high pitched, harsh

Thrill and parasternal thrust possible

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55
Q

Ventricular septal defect

A

Holosystolic murmur

Best heard at left sternal border in 3rd to 5th intercostal spaces

Loud, coarse, high pitched

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56
Q

PDA

A

Dilated and pulsatile neck vessels

Harsh, loud, continuous murmur

1st to 3rd intercostal spaces and lower sternal border

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57
Q

Kawasaki disease

A

Inflammation of. Small and medium arteries, including coronary arteries

High fever
Conjunctivitis
Strawberry tongue
Rash, polymorphous and erythematous

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58
Q

Umbilical stump

A

Falls off in 10-14 days

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59
Q

Umbilical hernia

A

Typically resolves spontaneously by age 2

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60
Q

Duodenal atresia

A

Double bubble sign

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61
Q

Ambiguous genitalia

A

Congenital adrenal hyperplasia is MCC

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62
Q

Concave abdomen

A

Diaphragmatic hernia

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63
Q

Bladder percussed at level of…

A

Umbilicus

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64
Q

Pyloric stenosis

A

Inspect during feeding in supine position

Olive mass

Projectile vomiting

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65
Q

Intussusception

A

Drawing up knees

Vomiting bile

Sausage mass

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66
Q

Obstruction

A

High pitch/frequency bowel sounds

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67
Q

Omphalocele

A

Incomplete closure of abdominal wall, midline defect with spleen, liver and stomach

Hypotensive baby, large exposed bowel, risk for sepsis

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68
Q

Hirschsprung’s disease

A

Congenital megacolon
Midline suprapubic mass
Failure to pass meconium

69
Q

Colic

A

Excessive crying
>3 hours a day, >3 days a week for >3 weeks

Sudden onset, same time of day

First month, resolves by 3 months but may persist

High pitched intense crying, flushed face, furrowed brow

70
Q

Metatarsus varus

A

Pigeon toe

Forefoot is adducted in relation to hindfoot

Resolves spontaneously in first few years of life

71
Q

Talipes equinovarus

A

Club foot

Entire foot is deviated midline- forefoot adduction, fixed hindfoot inversion, Achilles’ tendon is foreshortened

72
Q

Clavicle fx

A

Distal 1/3, crepitus

73
Q

Ortolani

A

Index finger on greater trochanter, thumbs on lesser trochanter

Abduct hips, hear clicks or feel clunks

74
Q

Barlow

A

Index fingers on greater troachanters and thumbs medially over lesser trochanter

Thumb presses backward and outward to feel for slip, index finger move forward and inward

Instability

75
Q

Only test sensory in infant if…

A

Palsy or spina bifida expected

76
Q

Meningiomyelocele

A

Severe spina bifida, massive and obvious

Spinal chord and nerves in the outpouching

77
Q

Abdominal reflexes absent until…

A

6 months old

78
Q

Rooting

A

Until 3-4 months

Touching mouth or cheek and head will turn to that side

79
Q

Blinking/dazzle reflex

A

Eyelids close in response to light

1 year

80
Q

Acoustic blink/cochleopalpebral reflex

A

Both eyes blink at sharp noise

81
Q

Palmar grasp

A

3-5 months lasts

Hand will grasp finger

82
Q

Moro startle reflex

A

Intact CNS, dead drops a few centimeters and arms spread wide

Disappears after 3-5 months

83
Q

Gallant’s

A

One side of back stroked 1 cm from the midline, and lateral curving to the stroked side

Disappears after 2-3 months

84
Q

Perez’s reflex

A

Thumb on sacrum and extend to head, causes flexion of knees and extension of neck, emptying bladder

Disappears after 2-3 months

85
Q

Tonic neck reflex/fencing

A

Turn head to one side, holding jaw over babies shoulder

Arm and leg extend on the side the head turns, other side is flexed

Disappears at 6 months

86
Q

Placing response

A

Foot lightly allowed to place on table

Hip and knee flex and then put their foot down

Disappears at 2-5 months
Test at 4-5 days of life

87
Q

Stepping response

A

Both feet placed and should see alternate movement

Disappears at 2-5 months, test 4-5 days of life

88
Q

Water less than…

A

120 degrees

89
Q

Breast milk or formula only for…

A

First 4 months

90
Q

Transient tachypnea of newborn and retained fetal lung fluid

A

Tachypnea, grunting, flaring, retracting

Excess fetal lung fluid from delayed clearance in C section

91
Q

Klumpke’s paralysis

A

Brachial plexus trauma of wrist and hands

92
Q

Erb’s palsy

A

Brachial plexus trauma at birth

93
Q

Length of pregnancy

A

40 weeks

94
Q

Nagele’s rule

A

9 months plus 7 days from last menstrual period

95
Q

1-200 risk at age…

A

35

96
Q

1-20 risk at age…

A

44

97
Q

Over 5 parity increases risk for…

A

Placenta previa or accreta

98
Q

Quickening

A

Around 20 weeks

99
Q

8th week breast changes

A

Increased pigmentation and size of Arellano and nipple

Nipple more erect, Montgomery tubercles more prominent

100
Q

16th week breast changes

A

Colostrum produced, may be expressed

101
Q

Chadwick’s sign

A

Bluish/violet color change of vagina

102
Q

Ph in pregnancy of vagina

A

More acidic

103
Q

Uterus increases in weight from…

A

2 ounces to 2 pounds over 40 weeks

104
Q

12-14 weeks, uterus shifts from…

A

Pelvic organ to abdominal organ

105
Q

Hegar’s sign

A

6-8 weeks, softening of the isthmus

106
Q

Cervical signs in pregnancy

A

Red velvet mucosa at cervical os

107
Q

Goodel’s sign

A

Softening of cervix at 4-6 weeks

108
Q

HTN after 24 weeks

A

PIH

109
Q

What kinds of murmurs are not uncommon in pregnancy?

A

Soft, blowing murmurs

110
Q

How many weeks to get fundal height same as GA

A

20 weeks

111
Q

HR location

A

Midline/lower abdomen at 12-18 weeks

112
Q

Heart rate of baby

A

160s early pregnancy

120-140s nearing term

113
Q

When do you begin Leopold maneuvers?

A

28 weeks GA

114
Q

Attitude

A

Fetal head when it is presenting

Flexed, hyperextended, etc.

115
Q

Station

A

Presenting part and relationship to ischial spine

At ischial spine is zero, above or below, below is positive numbers

116
Q

Effacement

A

Thinning, shortening and drawing up of cervix, measured in percentage from 0-100%

Documented in centimeters

117
Q

Bishop score

A

Pre labor score to determine if induction of labor is necessary

118
Q

Low BMI <19.8 weight gain

A

28-40 lbs

119
Q

Obese BMI weight gain

A

Around 15 pounds

120
Q

Early pregnancy bleeding

A

Implantation
Ectopic
Threatened abortion

121
Q

Late pregnancy bleeding

A

Cervical changes
Placenta previa
Placenta acreata
Placental abruption

122
Q

PIH

A

HTN after 24 weeks pregnanct

123
Q

Pre eclampsia

A

HTN plus protein in the urine!!

Plus edema

124
Q

Eclampsia

A

Pre eclampsia plus seizures

Can lead to death and HELLP syndrome

125
Q

Placenta previa

A

Placenta lies low in uterus and partially or completely covers cervix

Painless bleeding in third trimester

126
Q

Placental abruption

A

Most common pathological cause of bleeding in late pregnancy

Painful bleeding
0-3 scale

127
Q

Premature rupture of membranes

A

High risk if it occurs preterm or if labor does not begin within 12 hours

Passage of fluid, nitrazine paper and fern leaf pattern

128
Q

Ectopic pregnancy

A

Bleeding, pain on one side

If rupture- tachycardia, hypotension

Tenderness, adnexal mass, CMT

129
Q

Myomas

A

Heavy menses, pelvic discomfort, can effect bowel patterns

Nodules on uterus, can prevent implantation and growth of an embryo

130
Q

Geriatric

A

Over the age of 65

131
Q

ADL versus IADL

A

Activities of daily living are more relevant like dressing, bathing, eating, walking

IADL are things they want to do, like housework, take meds, drive, laundry, shopping, cooking

132
Q

Urge incontinence

A

Need to urinate comes quickly and can’t defer it

Stoke, MS, spinal chord injury

133
Q

Overflow incontinence

A

Dripping of urine

Bladder obstruction, BPH

134
Q

Stress incontinence

A

Leaking of urine with increased pressure, like laughing or running

Incompetent sphincter

135
Q

Functional incontinence

A

Normal control but issues physically making it to the bathroom

136
Q

Medications in elderly key points

A

Have them bring the bottles

Know prescription versus OTC

137
Q

Leading cause of injury related to death in elderly?

A

Falls !

138
Q

Temp in elderly

A

May not elevate in infection

139
Q

BP inelderly

A

Systolic HTN, diastolic can level off between 50-60

140
Q

Weight loss in elderly

A

If 5-10% in 12 months, work it up

141
Q

Senile purpura

A

Purple/blue coloring on hands in elderly

142
Q

Actinic keratosis

A

Face, neck, trunk and hands

Can develop into squamous cell carcinoma

143
Q

Seborrheic keratosis

A

Face, chest, shoulders and back

Waxy, scaly and slightly elevated

MCC non cancerous lesion in elderly

144
Q

Solar lentigines

A

Back of hands, forearms

Sun exposed areas, light brown to light flat macules

145
Q

Sebaceous gland hyperplasia

A

Forehead or nose

3 mm with central pore andyellowish in color

146
Q

Decubitus ulcers

A

Prolonged pressure over a bony prominence

147
Q

Decubitus ulcers staging

A

1- nonblacnhing erythema of intact skin

2- partial thickness skin loss of epidermis

3- full thickness skin loss, damage or necrosis to subQ

4- significant damage or necrosis with muscle and or bone involvement

148
Q

Headaches in elderly

A 
Temporal arteritis (70)
HTN
149
Q

Eyes in elderly

A

Presbyopia- common vision changes with age, lens starts to harden

Need readers to focus on near objects

150
Q

Senile ptosis

A

Drooping of eyelid, usually bilateral

151
Q

Arcus senilis

A

Common over age of 60

Blue, grey, white

Disposition of lipids

152
Q

Macular degeneration

A

Central vision loss
Progressive and painless
Amsler grid to evaluate

153
Q

Cataracts

A

Opacities of lens, cloudy look

154
Q

Medications contributing to hearing loss

A

Furosemide
Salicylate
Gentamicin
Aminoglycoside S

155
Q

Cerumen impaction

A

Conductive hearing loss

MCC of hearing loss in elderly

More sudden

156
Q

Presbycusis

A

50% of patients over 75

Slow, progressive hearing loss, sensorineural

Bilateral, high frequency sound

157
Q

Otosclerosis

A

Gradual conductive hearing loss
Initially low pitched sounds and whispers
Hardening of bony growth of stapes

158
Q

Xerostomia

A

Dry mouth

159
Q

Oral cancer

A

> 40
Tobacco abuse

Leukoplakia and erythroplakia are pre malignancy

160
Q

Colonoscopy

A

50-75 for USPSTF, every 10 years

50 every 10 years for ACS, annual guiac

161
Q

Diverticulosis

A

Predisposed for diverticulitis

Fever, LLQ pain, guarding

162
Q

UTI symptoms in elderly

A

Atypical, can be dementia

163
Q

Osteoarthritis

A 
Crepitus
Asymmetrical 
Joint stiffness in morning andimproves within 30 minutes
DIP joints, heberden nodes (women) 
Degenerative loss of cartilage
164
Q

Polymyalgia rheumatica

A

Symmetric pain worse in the morning

Neck, shoulders, lower back, pelvic girdle

UE and pelvis are tender with palpation

165
Q

Taste diminished…

A

Bitter and sour first

166
Q

Analogies

A

Similarities and differences

167
Q

Abstract reasoning

A

Shapes and patterns

168
Q

Calculations

A

Serial 7s

169
Q

Situational judgement

A

What if’s

H & P 2 (3 decks)

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