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peds special pops > neonate neuro test 2 > Flashcards

neonate neuro test 2 Flashcards

1
Q

what is a APGAR score!

A

Universal method to assess status of newborn after birth

Used to assess newborn response to transition/resuscitation

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2
Q

what is not do the score APGAR

A

Not used to predict morbidity and mortality

Not used to make diagnoses

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3
Q

what are the parts of the APGAR score

A

appearence (pink good +2)

pulse (fast good above 100 = +2)

grimace (cry good +2)

activity (flexed good +2)

respirations (cry good robust +2)

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4
Q

normal axillary temp

A

36.1°C - 37 °C or (97 °F - 98.6 °F)

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5
Q

normal respiratory rate

A

30 - 60 /min

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6
Q

Oxygen takes ____ to reach normal levels

A

10 minutes

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7
Q

heart rate awake?

A

120-160

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8
Q

fever?

A

Fever is ≥ 38°C (100.4°F) obtained rectally

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9
Q

heart rate alseep?

A

80-90

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10
Q

blood pressure?

A

Blood pressure varies by gestational age, birth weight, chronological age

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11
Q

what is the new ballard score!!!

A

used to estimate the gestational age of a newborn based on 6 physical and 6 neurologic criteria

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12
Q

how do you add up the score to equal gestational age?

A

score plus 2! so a score of 40 = 42 weeks

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13
Q

what is the physical criteria of ballard score (maybe to indepth)

A

skin, lanugo hair, plantar surface of the foot, breast, eyes and ears, and genitalia

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14
Q

What is the new ballard score neuro criteria (maybe to indepth)

A

posture, square window, arm recoil, popliteal angle, scarf sign and heel to ear

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15
Q

what do you measure with posture?

A

flexion

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16
Q

what do you measure with square window?

A

angle between palm of hand and forearm with wrist held in full flexion

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17
Q

what do you measure with arm recoil?

A

by the angle of flexion at the elbow created by the position that the forearm returns to from full extenstion

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18
Q

what do you measure with popliteal angle?

A

Flex thigh onto abdomen fully and then extend at knee. The score is determined by the angle of extension at the knee

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19
Q

what do you measure with Scarf sign?

A

The score is determined by the degree to which the elbow can be easily pulled across the chest toward the opposite shoulder:

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20
Q

what do you measure with heel to ear? (baby contortionist)

A

With infant supine, bring the anterior surface of the thigh toward the mattress alongside the infant’s trunk. Support the thigh with one hand, while using your other hand to stretch the foot toward the ipsilateral ear.

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21
Q

palpable ridge over a suture line that persists for longer than two to three weeks after birth is concerning for?

A

craniosynostosis

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22
Q

results from edema of the scalp due to pressure of the presenting part of the head against the cervix. Swelling crosses sutures lines. Resolves in day

A

Caput succedaneum

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23
Q

this is not associated with caput succedaneum

A

cranial bleeding

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24
Q

results from bleeding into the potential space between the periosteum and skull. Swelling does not cross suture lines. Resolves in weeks.

A

Cephalohematoma

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25
Q

what is torticollis

A

presents as the top of the head tilted toward one shoulder

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26
Q

what does torticollis cause

A

deformational plagiocephaly (cranial flattening from an infant always laying a particular way on her head)

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27
Q

how is torticollis treated

A

PT

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28
Q

what new deformity doesTurner Syndrome and Down Syndrome cause

A

Redundant skin/webbing. like the spitting dinosaur from Jurassic park

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29
Q

what does hemivertebra cause

A

Congenital scoliosis

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30
Q

what do you look for to indicate possible spinal biffida

A

sacral dimple, hemangioma, nevus, skin tag, or hair tuft

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31
Q

what is a sacral dimple not associated with if midline, located ≤2.5cm from the anus, visible base, less than 0.5 cm in diameter, no other midline skin lesion present

A

spina bifida occulta

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32
Q

what is spina bifida occulta

A

(vertebrae malformed)

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33
Q

what is meningocele

A

(vertebrae malformed and meningeal sac protruding

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34
Q

what is myelomeningocele

A

(vertebrae malformed and both the meningeal sac and spinal cord are protruding)

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35
Q

what are normal sacral findings (2 of them)

A

Lanugo hair and Mongolian spots (pigmented birth mark) are normal sacral skin findings

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36
Q

what are 4 abnormal levels of alertness

A

Mild stupor (lethargy)
Moderate stupor
Deep stupor
Coma

(diminished reaction to noxious stimuli)

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37
Q

what does to little of resistance to passive stretch indicate?

A

hypotonia

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38
Q

what does to much resistance to passive stretch indicate?

A

hypertonia

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39
Q

what do asymmetric movements indicate?

A

weakness

40
Q

what movements can be mistaken for seizure?

A

Non-sustained jitteriness and tremulousness

Choreoathetoid movements of the hands

Migrating myoclonus during sleep

Facial twitching during sleep

41
Q

how do we test muscle strength?

A

Ventral suspension

Vertical suspension

Stepping

42
Q

Stepping

A

(pelvic girdle strength)

43
Q

Vertical suspension

A

(shoulder girdle strength)

44
Q

Ventral suspension

A

(neck and back strength)

45
Q

Newborn can lift and plant her feet on a flat surface when held above it in a standing position

A

Stepping

46
Q

describe Ventral suspension

A

Newborn can lift his head and hip gurdle in line with his trunk for a couple of seconds while suspended ventrally

47
Q

– Newborn can be held upright by her axilla with no support for her feet without slipping through the examiner’s hands (A = normal strength, B = weakness)

A

Vertical suspension

48
Q

how to test CN XI (accessory nerve) – Sternocleidomastoid and trapezius muscle functions

A

cannot be assessed in newborns

49
Q

how to test CN VIII (vestibulocochlear nerve) –

A

Hearing is assessed by startling or blinking to a loud noise. Balance cannot be assessed in newborns

50
Q

how to test CN III, IV, VI (oculomotor, trochlear, and abducens nerves) –

A

Observe the spontaneous eye movements.

Assess eye muscle function using the Doll’s Eye Phenomenon (vestibular-ocular reflex).

51
Q

what is the Doll’s Eye Phenomenon (vestibular-ocular reflex).

A

Moving head to the right causes both eyes to deviate to the left, and vice versa. Can also be performed in the vertical direction. Eye movements should be conjugated and full

52
Q

t/f It is normal for newborns to intermittently cross their eyes,

A

t

53
Q

how far can they see

A

about 12 inches, the length needed to breastfeeding successfully.

blind as a bat or a mole, or well a blind person

54
Q

Successful feeding (sucking and swallowing) requires intact functioning of what CN’s

A

CN 5, 7, 9, 10, 12

55
Q

CN V (trigeminal nerve) – Facial sensation is tested how

A

assessed by the infant turning his head to the side of the face being stroked

56
Q

CN VII (facial nerve) – Facial motor function is assessed by

A

sucking ability (dylan has a very prominent facial nerve), symmetry of the nasolabial folds, and being able to tightly close the eyes while crying.

57
Q

what is CN IX and X (glossopharyngeal and vagus nerves) needed for

A

Both nerves are needed for normal swallowing, palatal movements and gag reflex.

58
Q

what is CN X needed for

A

normal vocalization and crying

59
Q

what is CN XII (hypoglossal nerve) needed for –

A

Responsible for normal tongue movements.

60
Q

Deviation of the tongue to one side indicates what?

A

ipsilateral CN 12 palsy.

61
Q

Atrophy and fasciculation of the tongue are seen in what?

A

Type 1 Spinal Muscular Atrophy

62
Q

what deep tendon reflexes do we check?

A 
Masseter reflex 
Biceps reflex
Brachioradialis reflex
Patellar reflex
Ankle clonus – 5 to 10 beats is normal
Extensor Babinski is normal
63
Q

how to test Masseter reflex –

A

Tapping the mandible just beneath the lower lip causes the open mouth to close

64
Q

how to test Patellar reflex –

A

Tapping the quadriceps tendon below the patella causes extension at the knee

65
Q

how to test Babinski

A

normally extensor in newborns (upgoing great toe and fanning of the other toes)

66
Q

how to test Brachioradialis reflex –

A

Tapping the radial aspect of the forearm causes slight flexion and radial deviation at the wrist and slight supination and flexion at the elbow

67
Q

how to test ankle clonus

A

5-10 beats of ankle clonus is normal in a newborn. Elicit ankle clonus by swiftly dorsiflexing the foot

68
Q

what are newborn reflexes controlled by?

A

basal ganglia, brainstem and spinal cord (there are so many cards!!!!)

69
Q

name all the reflexes

A 
Gallant reflex
rooting reflex
grasp reflex
sucking reflex
asymmetric tonic neck reflex
moro reflex
70
Q

when do reflexes start and stop

A

Present at birth and disappear by 4-6 months of age

inhibited by cerebrum

71
Q

is it normal for these reflexes to go past 6 months?

A

hellllll no…. not good

72
Q

describeMoro reflex –

A

Sudden dropping of the head in relation to the trunk causes abduction and extension of the arms and opening of the hands, followed by flexion

73
Q

describe Rooting reflex –

A

Tactile stimulation near the infant’s mouth causes the infant to turn her head and move the mouth in search of food

74
Q

describe Sucking reflex –

A

Infant will suck on objects placed in the mouth, including a gloved finger, which can be soothing to the newborn during the exam

75
Q

describe Asymmetric tonic neck reflex –

A

When the newborn is supine, turning her head results in ipsilateral extension of her arm and leg and contralateral flexion (a fencing posture

76
Q

describe Palmer grasp reflex –

A

Newborn’s hand reflexively closes on an object placed in the palm

77
Q

describe Gallant reflex –

A

Stroking the paraspinous muscles causes the infant’s trunk to curve toward the ipsilateral side

78
Q

what is seen with normal sensory function?

A

infant moves when lightly touched and withdrawals from painful or noxious stimuli

79
Q

what are the 5 s’s

A 
Suck
Swaddle
Shush 	
Swing
Side or stomach
80
Q

what is behavior an indication of?

A

cortical functioning

81
Q

how is behavior assessed?

A

Habituation

Consolability

82
Q

what is Habituation –

A

Newborns should stop startling to a loud noise repeated 4 or 5 times

83
Q

what is Consolability –

A

Upset newborns should be consoled by sucking, swaddling, shushing, swinging, side-lying or stomach position.
Newborns with neurologic dysfunction are difficult to console

84
Q

t/f APGAR is done at 1 and 5 minutes of life

A

true

85
Q

t/f 10 is the highest APGAR score

A

true

86
Q

acrocyanosis is normal?

what is acrocyanosis?

A

yes it is

blue hands and feet

87
Q

the next 6 questions are about new ballard:

how is skin ranked from low to high score

A

decreased translucency and increased wrinkling of the skin

88
Q

lanugo from low to high score

A

decreased lanugo

89
Q

foot from low to high score

A

more creases and size increases to greater than 50 mm

90
Q

breast tissue low to high score

A

larger and more well defined

91
Q

ear and eye low to high score

A

loss of fusion of the eyelids and firming of the pinna of the ear

92
Q

genital male low to high score

A

increased rugae and pendulousness of the scrotum

93
Q

genital female low to high score

A

formation of the labia minora and then the labia majora

94
Q

what are examples of noxious stimuli

A

gentle shaking ( but tell the parents no baby shaking) gentle pinching,
perioral stroking,
noise,
shining a light in the eyes (you dick)

95
Q

what are choreoathetoid movements and are they normal

A

circling at the wrist (invisible hand job)

yes invisible hand jobs are normal

96
Q

Biceps reflex

A

Tapping the biceps tendon causes flexion at the elbow elbow

peds special pops (8 decks)

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