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Physical Diagnosis 2A > History and Physical Examination of the Newborn > Flashcards

History and Physical Examination of the Newborn Flashcards

1
Q

How many times should a full term newborn be examined b/n birth and discharge?

A

At least 2 times, preferably 3 times.

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2
Q

Where and when should the newborn be examined b/n birth and discharge?

A
  1. Delivery room- immediately at birth
  2. Nursery/ rooming-in area- within 12h of birth
  3. Upon discharge, with the mother
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3
Q

During physical exam, where should be the attention directed?

A
  1. Wether any congenital anomalies are present
  2. Wether the infant has made a successful transition from fetal life to air breathing
  3. To what extent gestation, labor, delivery or anesthetics have affected the newborn
  4. Wether the infant has any sign of infection or metabolic diseases
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4
Q

What principles/ techniques should be included in the neonatal physical exam?

A
  1. Inspection
  2. Palpation
  3. Auscultation
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5
Q

In neonatal physical exam, what characters/ skills are required?

A
  1. Patience
  2. Gentleness
  3. Procedural flexibility
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6
Q

What examination should be done first if the infant is quiet and relaxed at the beginning?

A

Auscultation of the chest, and palpation of the abdomen.

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7
Q

Patterns of activity of the newborn for the first 15 to 30 minutes of birth

A
  1. Immediate tachycardia- 160 to 180bpm, gradual drop to 100 to 120bpm
  2. Irregular respiration, tachypnea 60 to 80bpm, brief moments of apnea
  3. Moist-sounding lung fields, transient grunting and retractions
  4. Awake, moving, alert, easily startled, crying, transient tremors
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8
Q

Patterns of activity of the newborn for the next 60 to 90 minutes

A
  1. Sleepy or sleeping, somewhat unresponsive
  2. Heart rate of 100 to 120 bpm, transient tachycardia
  3. Resp rate of 50 to 60 bpm, transient tachypnea
  4. Usually, passage of meconium
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9
Q

Patterns of activity of the newborn for the next several hours

A

Again, awake, alert, easily startled, crying, easily stimulated and reactive

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10
Q

I. General Appearance

The newborn should be ** when being examined

A

Naked

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11
Q

I. General Appearance

Things to observe in the inafant?

A
  1. Posture
  2. Skin color
  3. Activity
  4. Muscle tone
    Gross congenital abnormalities
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12
Q

II. VITAL SIGNS

What are the vital signs to be monitored?

A
  1. Temperature
  2. Respiratory Rate
  3. Type of Respiration
  4. Cardiac
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13
Q

II. VITAL SIGNS

How often should you monitor vital signs?

A

Every 30 minutes after birth, for 2 hours or until stable

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14
Q

II. VITAL SIGNS
A. TEMPERATURE
True or False:
Neonates USUALLY develops fever except in response to env’tal temp.

A

FALSE- UNUSUAL

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15
Q

II. VITAL SIGNS
A. TEMPERATURE
When should you obtain a rectal temperature

A

If the neonate’s skin temp is 38C and remains elevated even the envnt returns to normal

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16
Q

II. VITAL SIGNS
A. TEMPERATURE
A temp obtaining technique that is less likely to be affected by the environment.

A

Rectal Temperatue

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17
Q

II. VITAL SIGNS
A. Temperature
Hypothermia is more likely to be observed in?

A

Premature infants

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18
Q

Normal respiratory rate?

A

40 to 60 bpm

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19
Q

How to obtain RR of the infant?

A

Looking at the upper abdomen for a full minute

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20
Q

When obtaining RR, what happens as soon as the infant is touched?

A

Respiratory rate and depth changes.

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21
Q

True or False:

All infants are regular rather than periodic breathers.

A

FALSE- All infants are periodic rather than regular breathers.

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22
Q

Normal Cardiac Rate

A

120 to 160 bpm

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23
Q

Increased heart rate is seen when the baby is?

A

Crying, active, or breathing rapidly.

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24
Q

Decreased HR is seen if the infant is?

A

Quiet and breathing slowly.

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25
Q

Describe the HR of preterm infants at rest

A

Resting HR is at the higher end of the normal range

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26
Q

Describe the resting HR of occasional term or postterm infants

A

may have a HR below 100bpm

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27
Q

Tachycardia with a rate persistently greater than 160 bpm may indicate?

A

CNS irritability, CHF, sepsis, anemia, fever

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28
Q

True or False:

Measuring BP is a ROUTINE part of the vital signs in the newborn

A

FALSE- not a routine part in the vital signs of the newborn

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29
Q

What circumstances should you measure/ include BP in newborn?

A
  1. Infants requiring special care

2. Evaluating coarctation of the aorta, and CHD

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30
Q

Blood pressure correlates directly with?

A
  1. Gestational Age
  2. Postnatal Age
  3. Birth Weight
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31
Q

2 important elements for obtaining accurate BP

A
  1. Quiet infant

2. Properly sized cuff

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32
Q

Proper size of cuff?

A

Width 2/3 the length of the upper arm

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33
Q

Method for obtaining mean pressure

A

Flush Method

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34
Q

BP Method easier in active infants

A

Flush Method

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35
Q

BP Method that that requires only Sphygmomanometer

A

Flush Method

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36
Q

Describe the techniques in Flush Method?

A
  1. Wrap the cuff on the arm/leg
  2. Inflate enough to blanch the skin
  3. Lower pressure slowly until there is flush of color, at which point the pressure is read
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37
Q

Flush of color at which the pressure is read indicates the?

A

Estimated Systolic Pressure

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38
Q

BP Method that provides both Systolic and Diastolic pressure

A

Doppler Method

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39
Q

Doppler Method requires:

A

Electronic equipment and a quiet infant

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40
Q

Blood Pressure Values in the Newborn Accdg to Birthweight

A

Refer to page 47

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41
Q

III. Anthropometric Measurements

Describe the proper technique in obtaining Head Circumference

A

Place the tape measure around the head, above the glabella, and the occipital area.

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42
Q

What do you call if the head circ. is obtained around the head, above the glabella, and the occipital area?

A

OCCIPITO-FRONTAL CIRCUMFERENCE

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43
Q

Normal occipito-frontal circumference in term infants.

A

32-36 cm

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44
Q

Used in weight and percentile

A

Infant weighing scale

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45
Q

Weight of infant is recorded in? (Measurement)

A

Kilograms

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46
Q

Where do you plot infant weight?

A

Lubchenco chart

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47
Q

Birthweight below the 10th percentile

A

Small for Gestational Age (SGA)

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48
Q

When do you consider a newborn as SGA

A

Birthweight below the 10th percentile

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49
Q

SGA with an onset early in gestation

A

Symmetric

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50
Q

Describe the brain size as to the body size in Symmetric SGA

A

Brain size corresponds to the Body size

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51
Q

Etiologic factors for Symmetric SGA

A
  1. Environmental- smoking or drugs
  2. Genetics- small maternal size, or chromosomal disorders (trisomy 13, 28, and 21 syndromes)
  3. Intrauterine infections (TORCH, and metabolic disorders)
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52
Q

Onset of Symmetric SGA

A

Early in gestation

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53
Q

SGA with onset late in gestation

A

Asymmetric SGA

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54
Q

Effect of Asymmetric SGA in brain?

A

No or minimal effects on fetal brain growth

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55
Q

Onset of Asymmetric SGA

A

Late in gestation

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56
Q

Etiology of Asymmetric SGA

A

Uteroplacental insufficiency with chronic fetal hypoxia

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57
Q

Birthweight between the 10th and 90th percentile

A

Appropriate for Gestational Age (AGA)

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58
Q

When to consider the infant as AGA

A

Birthweight between the 10th and 90th percentile

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59
Q

Birthweight above the 90th percentile

A

Large for Gestational Age (LGA)

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60
Q

When to consider infant as LGA

A

Birthweight above the 90th percentile

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61
Q

LGA infants have increased incidence of?

A
  1. Perinatal Asphyxia and birth injuries
  2. Respiratory Distress Syndrome
  3. Hypoglycemia
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62
Q

Most LGA infants are born to?

A

Diabetic mothers

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63
Q

Posture of the baby during the length measurement

A

Lies supine on a recumbent length table or measuring board

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64
Q

In measuring length, the crown of the head should touch the?

A

Stationary vertical headboard

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65
Q

Steps in obtaining the length

A
  1. Crown of the head should the vertical stationary board

2. The legs should remain flat on the table and shifts the movable board against the heel

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66
Q

Length is recorded in?

A

To the nearest 0.1 cm

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67
Q

Length is plotted on?

A

Lubchenco Chart

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68
Q

Deep, rosy red, ruddy color

A

Plethora

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69
Q

Color more common in infants with polycythemia

A

Plethora

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70
Q

Plethora

A

Deep, rosy red, ruddy color

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71
Q

Where can you see Plethora

A
  1. More common in infants with Polycythemia
  2. Overoxygenated
  3. Overheated infants
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72
Q

Jaundice

A

Yellowish- secondary to Indirect Hyperbilirubinemia

Greenish- secondary to Direct Hyperbilirubinemia

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73
Q

Level of bilirubin at which Jaundice is noted

A

> 5mg/dL

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74
Q

May be secondary to Anemia, Birth Asphyxia, shock or PDA

A

Pallor

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75
Q

Pallor may be 2dary to?

A

Anemia, Asphyxia, Shock or PDA

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76
Q

Blue skin including tongue and lips

A

Central Cyanosis

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77
Q

Central Cyanosis is caused by?

A

Low oxygen saturation in the blood

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78
Q

Bluish hands and feet only

A

Acrocyanosis

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79
Q

Cause of Acrocyanosis

A

May be normal to newborn bec of vasomotor instability and peripheral circulatory sluggishness

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80
Q

Lacy red pattern

A

Mottling

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81
Q

Mottling is seen in?

A
  1. Normal infants
  2. Cold stress
  3. Hypovolemia
  4. Sepsis
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82
Q

Persistent mottling

A

Cutis Marmorata

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83
Q

Where can you find Cutis Marmorata?

A

Down Syndrome, trisomy 13, and 18

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84
Q

Greasy white substance that covers the skin

A

Vernix caseosa

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85
Q

Vernix caseosa covers the skin up to?

A

38th week of gestation

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86
Q

Purpose of vernix caseosa

A

Provide moisture barrier

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87
Q

Tiny, sebaceous retention cysts, whitish, pi-head sized concretions, seen in nose, chin, forehead and cheeks, resolves weeks after birth

A

Milia

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88
Q

Small areas of red skin with yellow-white papule in the center

A

Erythema toxicum

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89
Q

When does erythema toxicum erupts

A

Noticeable 48 hours after birth, but can be seen as late as 7 to 10 days

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90
Q

Non-inflammatory pinpoint clear vesicles that erupt in profusion over large areas of the body surfaces.

A

Miliaria Crystallina

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91
Q

Leaves a brawny desquamation on healing

A

Miliaria Crystallina

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92
Q

Benign, self-limiting condition which requires no specific therapy, characterized by 3 stages

A

Transient pustular melanosis

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93
Q

3 stages of transient pustular melanosis

A
  1. Pustules
  2. Ruptured vesicopustules with scaling or typical halo appearance
  3. Hyperpigmented macules
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94
Q

True vascular nevus

A

Macular Hemangioma

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95
Q

Stork bite

A

Macular Hemangioma

96
Q

NORMALLY Seen in occipital area, eyelids, and glabella

Disappear spontaneously within the 1st year of life

A

Macular Hemangioma

97
Q

Usually seen at birth, does not blanch with pressure, and does not disappear in time

A

Port-wine stain / Nevus Flammeus

98
Q

Dark-blue, or purple, bruise-like macular spots

A

Mongolian spots

99
Q

Mongolian spots are usually seen in the?

100
Q

Most common birthmark

A

Mongolian spots

101
Q

Things to check on Phys Exam of the head?

A
  1. General shape
  2. Cuts, bruises 2dary to forceps or fetal monitor leads
  3. Micro/Macrocephaly
102
Q

Head circumference is greater than 2 standard deviations above the mean

A

Macrocephaly

103
Q

Macrocephaly is a manifestation of?

A

Hydrocephalus

Skeletal Disorders

104
Q

Head circum less than 3 standard deviations below the mean

A

Microcephaly

105
Q

Microcephaly is seen in?

A

Familial with autosomal recessive or dominant inheritance
Infections
Trisomy 13 and 18

106
Q

Diamond shape fontanel b/n coronal and sagittal suture

A

Anterior Fontanel

107
Q

When does the anterior fontanel closes?

A

9 to 18 months

108
Q

Intersection of the occipital and parietal bones

A

Posterior fontanel

109
Q

When does posterior fontanel closes?

A

At birth or admits the tip of the finger till 2 to 4 months

110
Q

Large Anterior Fontanel

A

Hypothyroidism

Chromosomal abnormalities

111
Q

Small anterior fontanel

A

Hyperthyroidism
Microcephaly
Craniosynostosis

112
Q

Bulging fontanel

A

Increased intracranial pressure
Hydrocephalus
Meningitis

113
Q

Seen in prolonged labor secondary to the accumulation of blood or serum above the periosteum, poorly demarcated swelling that crosses the suture lines

A

Caput Succedaneum

114
Q

When does caput succedaneum resolves

A

Within days

115
Q

Rupture of blood vessels that traverses the skull to periosteum, well demarcated swelling that does not cross the suture lines

A

Cephalhematoma

116
Q

Cephalhematoma resolves

A

2 weeks to 3 months

117
Q

Temporary asymmetry of the skull due to the birth process, seen in prolonged labor or vaginal delivery

118
Q

Molding resolves in?

A

Within 1 week

119
Q

Noted during PE of the face

A

General shape of the nose, mouth and chin

120
Q

Eyes widely separated

A

Hypertelorism

121
Q

Compression of the facial nerve against the sacral promontory or by trauma caused by the use of forceps during delivery

A

Facial Nerve Palsy

122
Q

When do you see facial nerve palsy

A

1st to 2nd day of life

123
Q

Characteristics seen in facial nerve palsy

A

Corner of the mouth droops and absent nasolabial fold on the paralyzed side. Unable to close the eyes, move the lips, and drool on the side of paresis

124
Q

Symmetric facial palsy due to the absence or hypoplasia of the 7th nerve nucleus

A

Moebius Syndrome

125
Q

More useful for inspecting the eyes than forcing the lids apart

A

Doll’s eye maneuver

126
Q

Doll’s eye maneuver is a result of

A

Labyrinthine and neck reflexes

127
Q

Normal RED ORANGE REFLEX

A

No dulness and no irregularities

128
Q

White pupil aka?

A

Cat’s eye reflex

129
Q

Cat’s eye reflex denotes?

A

Abnormalities in the lens, vitreous, fundud

130
Q

Most common presenting sign of cataract

A

White pupillary reflex or Leukocoria

131
Q

Usually benign eye abnormality and usually resolves by 2 weeks of age

A

Subconjunctival hemorrhages

132
Q

PE of the nose

A 
Size
Shape
Patency
Presence of nasolacrimal duct inflammation
Size of the Philtrum
Nasolabial folds definition
133
Q

If suspected, do nasal patency

A

Unilateral or Bilateral Choanal Atresia

134
Q

How to assess nasal patency

A

Pass a nasogastric tube in each nose into the stomach

135
Q

PE of the ear

A

Size
Shape
Position
Presence of canal, and tags or pits

136
Q

How to determine the position of the ears

A

Draw a horizontal line from the inner and outer canthi of the eyes across the face, perpendicular to the vertical axis of the head

137
Q

When to consider ears as Low Set

A

If the helix of the ear is below the horizontal line

**congenital abnormalities

138
Q

Hairy ear is seen in

A

Infant of diabetic mothers

139
Q

True or false

Otoscopic exam is performed because the ears of the infant is clear

A

FALSE

Because the ear of the infant is full of amniotic debris

140
Q

PE of Mouth

A

Hard and soft palate clefts
Gum clefts
Deciduous teeth

141
Q

Should be visualized in mouth PE

A

Tongue, buccal surface, palate, back of the mouth

142
Q

Palpated with gloved finger

A

Gum and hard palate

143
Q

Keratin-containing cyst

A

Epstein Pearls

144
Q

Where can you find Epstein pearls?

A

Hard and soft palates

145
Q

Cystic swelling at the floor of the mouth

146
Q

Small lesions on oral mucosa due to the trauma of salivary gland ducts

147
Q

Natal teeth

A

Low incisors

148
Q

Loose, roots are absent or poorly formed

Extracted to prevent aspiration

A

Predeciduous teeth

149
Q

True teeth that erupt early, not extracted

A

True Deciduous teeth

150
Q

Enlarged tongue

A

Macrglossia

151
Q

Macroglossia seen in

A

Beckwith’s Syndrome

Congenital Hypothyroidism

152
Q

Quadrad of Beckwith’s Syndrome

A

Macroglossia
Gigantism
Omphalocoele
Severe Hypoglycemia

153
Q

Reflex that cause the baby to turn the head

A

Rooting reflex

154
Q

Palpated in the neck

A

Sternocleidomastoid- hemorrhages

Thyroid- enlargement and thyroglossal cysts

155
Q

Most common fracture in the newborn

A

Clavicular Fracture

156
Q

Irregularities in the clavicle

157
Q

PE of the CHEST

A

Check for symmetry

158
Q

Tachypnea with retractions

A

Respiratory Distress

159
Q

Barrel chest

A

Meconium Aspiration Pneumonia

-due to hyperaeration and air trapping

160
Q

Normally seen due to compliant chest walls

A

Mild subcostal and intercostal retractions

161
Q

Because diaphragm is the primary muscle for breathing, quiet breathing is

162
Q

Normal breast measurement

163
Q

Enlarged breast (3 to 4 cm)

A

Due to Maternal Estrogen

164
Q

Extra nipples and are normal

A

Supernumerary nipples

165
Q

A white discharge from infant’s ( male or female) breasts

A

Witch’s milk

166
Q

Absent or unequal breath sounds

A

Pneumothorax and Atelectasis

167
Q

Absent breath sounds with the presence of bowel sounds

A

Congenital Diaphragmatic Hernia

168
Q

True or False

Newborn lung sounds are more vesicular than bronchial

A

False

More bronchial than vesicular due to better transmission of large airway sounds through a thin chest wall

169
Q

Heart PE

A 
Precordial activity
Rate
Rhythm
Quality of heart sounds
Absence or presence or murmurs
170
Q

Normal heart rate

A

120 to 160

Resting term infant can have a heart rate below 90

171
Q

If heart rate does not increase upon appropriate stimulation

A

Check for serum electrolytes and obtain ECG

172
Q

Obtain ECG to rule out?

A

Heart Block

173
Q

Most common among infants whose mothers have SLE

A

Heart Block

174
Q

Heart block is common among infants whose mothers have?

175
Q

Most common murmur in immediate newborn

A

Flow murmur

176
Q

Flow murmur is due to

A

Transition from fetal to neonatal circulation

177
Q

Murmurs persisting after 12 hours of life

A

Structural abnormalities

178
Q

Normal Abdomen on PE

A

Globular and soft on palpation

179
Q

Intestines covered with peritoneum

Umbilibus situated centrally

A

Omphalocoele

180
Q

Intestines NOT covered with peritoneum

A

Gastroschisis

181
Q

Scaphoid abdomen may indicate

A

Congenital diaphragmatic hernia

182
Q

Normal infant bowel sounds

A

Relatively inactive bowel sounds

183
Q

Process of abdominal palpation

A

Stand on the right side of the infant
Left hand lifts the leg, slightly elevate the pelvis to relax abdominal muscles
Use right hand fingerpads to palpate
Palpate starting from the umbilicus in both side, then proceed towards the diaphragm

184
Q

Where is liver can be plapated?

A

2 cm below the costal margin

185
Q

Where is spleen tip can be palpated?

A

At the costal margin

186
Q

Hepatomegaly can be seen in?

A

Congestive heart failure
Hepatitis
Sepsis

187
Q

Splenomegaly may indicate?

A

CMV or Rubella infection

Sepsis

188
Q

Which side of kidney can be palpated

A

Right Kidney

189
Q

Enlarged kidney may indicate

A

Polycystic disease, renal vein thrombosis, hydronephrosis

190
Q

Discharge, redness, or edema around the base of the cord may signify

A

Patent Urachus/ Omphalitis

191
Q

Umbilicus have how many blood vessels.

A

2 arteries

1 vein

192
Q

Presence of only 2 vessels (1 artery 1 vein) of the umbilicus may indicate

A

Renal or genetic defects

193
Q

Normal color of umbilicus

A

Translucent

194
Q

Greenish-yellow umbilicus

A

Meconium stain- respiratory distress

195
Q

Male Genitalia PE

A

Dorsal Hood
Hypospadias
Epispadias
Chordee

196
Q

Normal newborn penile length

A

Greater than 2 cm

197
Q

True or False

Newborn males ALWAYS HAVE a marked phimosis

198
Q

Abnormally small penis

A

Reduced androgen effector reduced growth hormone action during the 2nd and 3rd trimesters

199
Q

True or False

Hydrocoeles are COMMON and usually disappear by 1 year

200
Q

Female genitalia PE

A

Labias, clitoris, meatus, vaginal opening, relation of the posterior fourchette to the anus

201
Q

True or False

All female newborns have redundant hymenal tissue

202
Q

Extension of hymenal tissue

A

1 to 15 mm beyond the rim of the hymen

203
Q

Discharge from the newborn genitalia usually blood tinge

A

Pseudomenses

204
Q

Pseudomenses are due to

A

Maternal estrogen withdrawal

205
Q

Clitoromegaly indicates

A

Masculinization
Virilizing tumor
Increased maternal androgen production
Materbal drug use

206
Q

TRUE OR FALSE

Ambiguous genitalia is a MEDICAL EMERGENCY

207
Q

Should be established if there is ambiguous genitalia

A

Adrenal and pituitary integrity

208
Q

Hips PE

A

Congenital hip dislocation/

Developmental dysplasia of the hips

209
Q

Ortolani Maneuver

A

Abduct
Middle finger
Inward upward pressure
Greater Trochanter

210
Q

Barlow maneuver

A

Adduct hip
Thumb
Outward and background pressure
Inner thigh

211
Q

Absence of pulses

A

Poor cardiac output or

Peripheral vasoconstriction

212
Q

Absence of femoral pulses

A

Coarctation of the aorta

213
Q

Abnormal fusion of the digits

A

Syndactyly

214
Q

Syndactyly happens in what digits?

A

3rd and 4th finger

2nd and 3rd toes

215
Q

Supernumerary digits

A

Polydactyly

216
Q

One transverse crease on the palm

A

Simian crease

217
Q

Simian crease most common in

A

Down syndrome

218
Q

Clubfoot
Foot turned downward and inward
Sole directed medially

A

Talipes equinovarus

219
Q

Talipes more common in

220
Q

Adduction of foot

A

Metatarsus varus

221
Q

Tufts of hair over the lower back

A

Occult spina bifida

222
Q

Sacral or pilonidal dimple

A

Small meningocele

223
Q

Passage of meconium

A

Within 48 hours of birth

224
Q

Gestational age prenatally can be determined by?

A
  1. Date of last menstrual period
  2. Date of the first reported fetal activity
  3. Ultrasound
225
Q

Quickening is first seen during

A

16 to 18 weeks

226
Q

Ultrasound is most accurate

A

Before 20 weeks

227
Q

Determine posnatal gestational age

A

New Ballard Score

228
Q

When to perform ballard score?

A

ASAP after stabilization

12 hours after birth

229
Q

2 parts of Ballard score

A

Neuromuscular maturity

Physical maturity

230
Q

Avoid when handling newborn

A

Primitive reflexes (tonic neck, plantar and palmar grasp reflex)

231
Q

Posture

Arms and legs extended

232
Q

Posture

Arms extended, knees and hips beginning flexion

233
Q

Sticky transparent skin

234
Q

Lanugo hair on the lumbosacral only

235
Q

Lanugo hair on the scapular area only

236
Q

Loosely fused eyelids, gentle traction opens

237
Q

Scrotum touches examining surface

Physical Diagnosis 2A (2 decks)

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