Jarvis Quiz 3 Flashcards
The fine downy hair of a newborn infant
Lanugo
The thick, cheesy white substance made up of sebum and sheds epithelial cells in newborns
Vernix caseosa
Describe a baby’s skin, compared to an adult’s skin.
More permeable, sebum is present for the first few weeks which may cause cradle cap and milia, poor temperature regulation, eccrine glands dont respond to heat until first few months.Skin cannot contract and shiver because subQ layer is ineffective, pigment system is inefficient
What happens to the child’s skin as they mature?
Epidermis thickens, toughens, and darkens. The skin becomes better lubricated. Hair growth accelerates. Apocrine and sebaceous glands respond to heat to form sweat, body odor, and acne. SubQ fat deposits increase
What are some additional assessments for infants and children r.t skin?
Birthmarks? Jaundice? Cyanosis? Rash/sores? Burns, bruises. Scabies, lice, impetigo? Habitual movements such as nail biting? How do you reduce the risk of sun exposure in your child?
What additional skin assessment should take place for an adolescent?
Acne, blackheads
Describe the Mongolian spot
Variation of hyperpigmentation in babies of different nationalities. Macular. Not to confuse with a bruise. Caused by deep dermal melanocytes. Usually goes away within a year.
Describe the cafe au lait spot
Normal, Round/oval patch of light brown pigmentation, usually present at birth. 6 or more of them indicates neurofibromatosis, an inherited neurocutaneous disease.
Why does a baby have a beefy red flush for the first day of life?
Vasomotor instability
What is the harlequin color change?
Occurs when baby is laying on its side. Lower Half of the body turns red, and the upper half blanches with a distinct demarcation line down the midline. Cause unknown.
What is erythema toxicum?
Common rash that occurs in the first 3-4days of life. Called flea bite rash or newborn rash. Tiny puncture macules and papules on cheeks, trunk, chest, back, and buttocks. Cause unknown,. No t(x) needed.
What is acrocyanosis?
Bluish color around the lips, hands, and fingernails, and feet and toenails. May last a few hours and disappear with warming.
What is cutis marmorata?
Mottling of the trunk and extremities in response to cooler room temperatures. Reticulated, red or blue pattern over the skin. Persistent or pronounced cases found with Down Syndrome or prematurity.
What does green-brown discoloration of the skin, nails and cord of an infant indicate?
Passing of meconium in utero, and fetal distress is present as a result
When does physiological jaundice usually occur in newborns? What causes the yellow discoloration? What may be indicative of jaundice during the first day of life? What about if it is present after 2wks?
After the 3rd or 4th day r/t increased number of RBCs that hemolyze after birth. Jaundice during day one could be a hemolytic disease. After two weeks, presence could indicate biliary tract obstruction.
What is carotenemia? What causes it? When/how does it go away?
Yellow-orange color in light skinned persons with NO yellowing of sclera or mucous membranes. R/t ingestion of large amount of foods containing carotene, vitamin A. inhanced by mashing/pureeing baby foods, and cooking. Will fade after 2-6wks once carotene rich foods are drawn from the diet
What may excessive sweating in children indicate?
Hypoglycemia, heart disease, and hyperthyroidism
What is milia?
Tiny white papules on the cheeks and forehead and nose and chin caused by sebum the occludes the opening for hair follicles. Tell the rents to not squeeze the lesions. Resolves spontaneously over a few weeks.
What is a stork bite?
Vascular birthmark. Flat, irregularly sapped red or pink patch found on the forehead, eyelid, or upper lip but mostly on the back of the neck. Fades usually during the first year.
Scalp hair may be lost in the first few weeks after birth, but
It will grow back slowly. Nail beds may be blue for the first couple hours.
What creates acne? What is a Whitehead called? what about a blackhead? Describe acne. When does it most commonly occur?
Sebaceous gland activity creates acne. Whitehead= closed comedones, blackhead= open comedone. Involves pustules, papules, and nodules. May appear 7-8y/o, peak at 14-16 in girls and 16-19 in boys
Talk about a strawberry mark. What is it also called?
Immature hemangioma: raised, bright red area with well-defined borders, 2-3cm in diameter. Does not blanch. Consists of immature capillaries, present at birth or develops in first few months and disappears by age 5-7 y.o. Requires no treatment
What is a cavernous hemangioma (mature)?
Reddish-blue, irregularly shaped and solid/spongy mass of blood vessels. May be present at birth and enlarge in first 10-15 mos. Does not involute on its own.
Describe diaper dermatitis
Red. Moist. Maculopapular patch with poorly defined borders in the diaper area. History of infrequent diaper change, or occlusive diapers. Inflammatory disease caused by skin irritation from ammonia, heat, moisture, and occlusion.
What is intertrigo also called? What is it?
Candidiasis. Scalding, red moist patches with sharply demarcated borders and some loose scales. usually in the genital area. Aggravated by urine, feces, heat and moisture. Candida fungus infects the superficial skin layers
Describe impetigo
Moist, thin roofed vesicles with thin, red base. Rupture to form honey colored crust. Highly contagious bacterial infection by direct contact.
What is another name for atopic dermatitis? Describe it.
Eczema. Erythematous papules and vesicles with weeping, oozing, and crusts. Itching involved. Family history of allergies
What is another name for cradle cap?
Seborrheic dermatitis. Thick, yellow-to-white greasy adherent scales with mild yellow erythema on scalp and forehead. Pruritis present. Looks like eczema, but greasy and not associated with family history of allergies.
What separates parts of the skull in youngsters? Talk about them
Sutures and fontanelles (soft spots). They allow for brain growth during the first year. The posterior triangle fontanel closes by 1-2mos. The anterior diamond fontanel closes between 9mos-2yrs.
Talk about head size in fetuses, infancy, and children.
Fetal head growth predominates. Head size is greater than chest circumference at birth. Head size grows during childhood, reaching 90% by 6 yo. Trunk growth predominates during infancy.
Describe the facial bones in toddlers
Nasal and jaw bones grow at varying rates. The mandible and maxilla are small, and the nasal bridge is set low.
Talk about child lymphoid tissue
Well developed at birth and frowns to adult size until 6yo. Exceeds growth of adults by age 10/11 y.o, and slowly atrophies after that.
Talk about the sequence of facial hair growth in adolescent males. What causes the voice to get deeper?
Above the lip, then on the cheeks and below the lip, and last on the chin. Thyroid cartilage enlarges and the voice deepens
How often should you measure a baby/child;s noggin? How big should a baby’s head be?
At each visit up to 2yrs of age, then annually up to age 6. Newborns head should be 32-38cm and is 2cm larger than chest circumference. Both chest and head should be the same by age 2.
What are frontal bulges of the skull called in babies? What might they indicate?
Bossing r/t prematurity or rickets
What is a cephalhematoma? What causes it? What are these babies at risk for?
A subperiosteal hemorrhage r/t birth trauma. Well defined over one cranial bone. Occurs several hours after birth, may last a few weeks, three months at most. Reassure parents of this. At risk for jaundice.
What is craniosynostosis? Should the rents be considered about head molding?
A severe deformity caused by premature closure of the sutures. Molding of the head is normal and should only last a few days/week.
What is positional molding also called? How is it cured?
Positional plagiocephaly. Cured by helmet or tummy time. Inspect from top of the head.
How should fontanels feel? How long until they close?
Firm, slightly concave, and well defined against the edges of the cranial bones. Light arterial pulsations are normal. increased pulsations could be increased intracranial pressure.Delayed closure or Large fontanels indicate Down syndrome, hypothyroidism, or rickets. Small fontanels or early closure may be microcephaly. Posterior closes at 1-2mos. Anterior closes at 9mos-2yrs.
What is the tonic neck reflex? When does it disappear? When is head control maintained?
When supine, head is turned to one side, extension of same arm and leg, flexion of opposite side arm and leg. Disappears at 3-4 mos. Head control maintained at 4 mos.
What might be indicated if the baby has th e tonic neck reflex at 5 months? What about if they have head lag after 4mos?
T.neck reflex after 5 months=brain damage
Head lag after 4mos= motor retardation
When does a baby’s neck lengthen?
3-4years
Talk about lymph nodes in an infant/child.
Infant: not normally palpable, thyroid hard to palpate
Child: Feel more prominent than an adults until after puberty. Should be discrete, move easily, and nontender. thyroid palpable`
What may resistence to neck flexion (nuchal rigidity) indicate when accompanied with pain?
Meningeal irritation: meningitis
What might you hear when percussing a babies head?
Cracked pot sound (Macewen sign) which is normal before closure of fontanels, but may indicate hydrocephalus
What if you hear a bruit in a child’s skull?
Normal finding in kids under 4/5yo. Or anemic kids. After this, they may indicate increased intracranial pressure, aneurysm, or arteriovenous shunting.
What is also associated with hydrocephalus?
Dilated scalp veins, frontal bossing, and setting sun eyes. Cracked pot percussion
What are the characteristics of Down syndrome?
Upslanting eyes, flat nasal bridge, thick protruding tongue, ear dysplasia, broad neck with webbing, small hand and simian crease
What is craniosynostosis?
Premature closing of one or more cranial sutures causing a deformed head. Surgery may be required.
What is atopic facies?
Morgan lines (crease on lower eyelids, open mouth, pallor, blue shadows below the eyes
What does FAS (fetal alcohol syndrome)look like
Epicanthial folds, low nasal bridge, flat mid face, short nose, thin upper lip, minor ear abnormalities, etc.
What is torticollis also called? What causes it?
Wryneck. A hematoma in one sternomastoid muscle, probably injured by fetal positioning. Requires treatment to avoid permanent limited ROM. Can cause visual problems r.t nonhorizontal eye position
Talk about infant eyesight
Peripheral vision intact in newborn. Macula is absent but develops by 4mos. Mature by 8mos. Has binocular vision by 3-4 mos. Usually farsighted until 7-8yo. Eyeball reaches adult size by 8yrs. Lens flattens with age. Iris shows little pigment
Who is the one most often to detect vision problems in a baby
The parent
How might you know a baby is blind?
No response to light reflex, especially after 3wks
From birth to 10 mos, what behaviors should you notice in a bby’s vision
Birth-2wks: refusal to open eyes after exposure to tlight. Infant may fixate on object
2-4wks: infant can fixate on object
1 month: infant can fixate and follow light or toy
6wks: infant makes some visual response to face
3-4mos: infant can fixate, follow, and reach toy
By 6-10mos: infant can fixate and follow toy in all directions
What is the Allen test for eyes? When should it be used? What about a Snellen E chard?
Allen: picture cards for 11mos-2yrs.
Snellen E chart from 3-6yrs.
Snellen letter by 7-8yrs.
20/20 should be reached by 6-7yrs
Who should you test for color blindness? What tool do you use>
Boys aged 4-8yo by Ishihara test: they should be able to see a pattern if they are not color blind
What is strabismus? When should you test for it?
Squint, cross eyed. 3-5yrs. Diagnosis after 6yrs has poor prognosis. Some corneal light asymmetry may be normal under 6mos of age.
What is the difference between phobia and tropia?
Phoria is a mild weakness noted only when fusion is blocked. Tropia is more severe- constant malalignment of the eyes
How do you get a babe to open their eyes
Hold them supine and gently lower the head.
OR hold the infant at arms length and turn them in one direction
What is dolls eyes? When does it disappear
When you turn a baby, and then stop turning, the eyes shift to the opposite direction after a few quick beats of nystagmus. Disappears at 2mos.
What is pseudostrabismus
When epicanthial folds give a false appearance of malalignment
What is conjunctivitis of a newborn called?When does it go away?
R/t instillation of silver nitrate, ophthalmia neonatorum is a purulent discharge that appears within first hour and lasts about a day after birth.
How long does it take to gain a permanent iris color?What are the iris spots called that are associated with Down syndrome
6-9mos for iris color. Brushfield spots with Down syndrome.
What is strabismus? Esotropia? Exotropia?
Strabismus: true disparity of eye axes
Esotropia: inward turning of eye
Exotropia: outward turning of eye
What does the ear start to develop in the fetus?
5th week gestation. Ear is posteriorly rotated and low set
Describe the infant’s Eustachian tube
Shorter, wider, more horizontal.
What are risk factors that cause OM in children?
Absence of breastfeeding for first 3mos of age, exposure to second hand smoke (SHS), daycare attendance, male sex, pacifier use, fall and winter seasons, bottle feeding while supine
What is the most important side effect of OM
Fluid in the middle ear after treatment which can impair hearing and cause delayed development
What are the two types of genetic variations of cerumen
Dry cerumen: gray and flaky in middle ear canal (Asians and indians)
Wet cerumen: honey brown and moist (Africans and americans)
How should the ear be positioned in a child
Top of pinna should match imaginary line extending from corner of eye to occiput. Ear should be within 10 degree vertical. Low set ears in Down syndrome,
How should you pull a child’s ear to assess it? What is atresia?
Straight down
Atresia is absence or closure of ear canal
Red eardrum may be common in newborns from crying
What is the best indicator of middle ear infection in a newborn?
No vibration with a pneumatic bulb attachment to test vibratility
How do you assess hearing acuity in babies, toddlers, and children
Newborn: Moro reflex with startling sound
3-4mos: acoustic blink reflect, baby stops to listen or starts to cry to sound
6-8mos: infant turns head to side of sound, responds to name
School age: screened with audiometry
When does the baby start to salivate? Talk about a drooling baby
Salivates at 3mos. Drools for a few months before learning how to swallow. Does not prevent the form of the first tooth like people think
How many deciduous teeth should a child have? In which order do they form? When are they lost?
20 teeth. Should appear between 6mos and 2yrs. (Take age in mos minus 6 to equal amount of teeth). Lost from ages 6-12. Central incisors are lost first and appear first. Permanent teeth grow quicker in girls and African Americans
When does the nose fully develop?
In adolescence. Full size by 16 in girls and 18 in males
What is torus palatines
Benign bony ridge running in middle of hard palate
What is leukoedema
Benign, milky white opaque appearance of buccaneers mucosa common in African Americans
What is bruxism
Grinding teeth
What can you indicate as the cause of the inability to pass a catheter through the nasal cavity.
Chantal atresia. Needs immediate intervention
What are Epstein pearls
Normal finding in newborn and infants. Small white pearly papules along hard palate and gums. Look like teeth
What may a high arched palate indicate
Turner syndrome, treachery Collins syndrome, mouth breathing, chronic allergies, ehlers-Danlos syndrome, Marian syndrome
What is Bernard aphthae and what causes it?
Traumatic areas or ulcers on the posterior hard palate on either side of the midline. From abrasions while sucking
Talk about tonsils in babes and kids
Baby tonsils are not visible, but gradually enlarge. Look larger in crying.
What are s.s of Chantal atresia
Airway obstruction, stridor, pink discoloration, paradoxical cyanosis
What commonly causes cleft lips and palates
Dilantin/phenytoin, maternal smoking or alcohol use, benzodiazepines, corticosteroids
What are koplik spots
Small blue white spots with irregular halo scattered over mucosa opposite the molars. An early sign and indicates measles
What is leukoplakia
Chalky white, thick raised patch with well defined borders on lateral edges of tongue. Not able to be scraped off. Occurs with heavy smoking and alcohol use
What is monilial infection?
Candidiasis: cheesy, curd like patch on the buccal mucosa and tongue. Scrapes off leaving the tongue raw and red. TErmed thrush in a newborn. Occurs with antibiotic use and corticosteroids in immunosuppressive people
What is ankyloglossia
Short lingual frenulum (tongue tied) difficulty pronouncing a,d,n
