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Paediatrics > NIPE > Flashcards

NIPE Flashcards

1
Q

When is the new-born assessment carried out?

A

Within 72 hours of birth

Repeated at 6-8 weeks

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2
Q

What is the purpose of the new-born assessment?

A

Screen for congenital abnormalities

Make referrals for further tests as necessary

Provide reassurance to parents

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3
Q

Where should the new-born assessment take place?

A

Private area
Baby on changing mat
Parents present
Natural light

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4
Q

What preparation needs to be done?

A

Wash hands
Introduce self
Explain and gain consent

Ask parents to undress baby down to nappy

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5
Q

What questions should you ask the parents?

A

Maternal history

  • delivery date/time
  • method of delivery
  • risk factors for neonatal infections
  • any abnormalities on antenatal scans
  • family history

New-born history

  • feeding pattern
  • passed meconium?
  • urination
  • parental concerns
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6
Q

What is the significance of the baby being breech at 36 weeks or earlier?

A

Increased risk of developmental dysplasia of the hip

Refer for ultrasound

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7
Q

What measurements should be take and plotted?

A

Weight
Length
Fronto-occiptal circumference

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8
Q

What are you looking for on general inspection?

A

Colour

  • pallor
  • cyanosis
  • jaundice
  • rashes

Cry

Posture

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9
Q

What should you be assessing as you exam the infant?

A

Tone

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10
Q

How are hypotonic infants said to feel?

A

Like a rag doll

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11
Q

What do you assess with the head?

A

Size
- measure + plot circumference

Shape

  • shape of head
  • inspect sutures

Fontanelles
- anterior fontanelle

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12
Q

What is microcephaly?

A

Head that is smaller than expected

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13
Q

What can microcephaly indicate?

A

Reduced brain size

Atrophy

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14
Q

What is macrocephaly?

A

Head that is larger than expected

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15
Q

What can macrocephaly indicate?

A

Hydrocephalus
Cranial vault abnormalities
Genetic abnormalities

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16
Q

What is caput succedaneum?

A

Diffuse subcutaneous fluid collection with poorly defined margins (crossing suture lines)

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17
Q

What causes caput succedaneum?

A

Pressure on presenting part of the brain during delivery

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18
Q

When does caput succedaneum resolve?

A

First few days

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19
Q

What is cephalhaematoma?

A

Subperiosteal haematoma that does not cross suture lines

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20
Q

What should be monitored if presence of cephalhaematoma?

A

Bilirubin

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21
Q

What is a subgaleal haemorrhage?

A

Haemorrhage aponeurosis of the scalp and periosteum

Forms large fluctuant collection which crosses suture lines

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22
Q

What is craniosynostosis?

A

Condition in which one or more the sutures fuses prematurely

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23
Q

What is the result of craniosynostosis?

A

Raised ICP
Damage to intracranial structures

Surgical intervention required

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24
Q

What does a tense bulging fontanelle suggest?

A

Raised ICP

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25
Q

What does a sunken fontanelle suggest?

A

Dehydration

26
Q

What should be looked for on the skin?

A

Colour

Bruising/lacerations (documented

Birthmarks/other marks

Vernix

27
Q

What is a Mongolian spot?

A

Benign flat birthmark with irregular shape usually over sacrum

28
Q

What is nevus simplex also known as?

A

Stork bite

Salmon patch

29
Q

What is a nevus simplex?

A

Congenital capillary malformation most commonly on the eyelid/glabella/back of neck

30
Q

When does nevus simplex normally resolve be?

A

First year

31
Q

What is naevus flammeus?

A

Vascular malformation that does not regress

32
Q

What is naevus flammeus also known as?

A

Port wine stain

33
Q

What is looked for on the face?

A

Appearance

Asymmetry

Trauma

Nasal patency

34
Q

What is looked for in the eyes?

A

Erythema
Discharge

Sclera inspection

Position + shape

Red reflex

Subconjunctival haemorrhages

35
Q

How do you assess for the red reflex?

A

Use ophthalmoscope

36
Q

What does an absence of the red reflex suggest?

A

Congenital cataracts

Retinoblastoma

37
Q

What is looked for in the ears?

A

Pinna symmetry + shape

Ear position

38
Q

What is looked for in the mouth?

A

Cleft palate
- use torch + tongue depressor

Evidence of tongue-tie

39
Q

What is looked for in the neck?

A

Length of neck
Neck webbing
Neck swellings
Clavicular fracture

40
Q

What is looked for in the upper limbs?

A

Symmetry

Count fingers

Inspect palms
- 2 palmar creases

Palpate brachial pulses

41
Q

What does one single palmar crease indicate?

A

Down’s syndrome

42
Q

What is looked for in the chest?

A

Chest wall deformities
Chest wall expansion

Ausculate

  • heart sounds
  • air entry

Pre + post ductal pulse oximetry

43
Q

What should be looked for in the abdomen?

A

Abdominal distension

Hernias

  • inguinal
  • umbilical

Palpate

  • liver
  • spleen
  • kidneys
  • bladder

Umbilicus

44
Q

What is looked for in the genitalia?

A

Any ambiguity

45
Q

What is looked for in male genitalia?

A

Position of meatus
Size of penis
Hydrocele

Palpate scrotum for 2 testes

46
Q

What is looked for in female genitalia?

A

Inspect labia

Inspect clitoris

47
Q

What is assessed in the anus?

A

Patency

Position

48
Q

What is looked for in the lower limbs?

A

Symmetry
Tone
Movement

Palpate femoral pulses

Count toes

49
Q

What tests are conducted on the hips?

A

Barlow’s test

Ortolani’s test

50
Q

What is Barlow’s test?

A

Adduct the hips while applying light force to the knees pushing them posteriorly

51
Q

What is a positive Barlow’s finding?

A

Dislocation of the hip

Positive = bad

52
Q

Why is Ortolani’s test done?

A

Confirm posterior dislocation of the hip joint

53
Q

What is Ortolani’s test?

A

Flex hips + knees

Place anterior pressure on greater trochanters and abduct the hips

54
Q

What is a positive Ortolani’s finding?

A

‘Clunk’ hears as hip relocates

55
Q

What is looked for in the spine?

A 
Scoliosis 
Hair tufts
Naevus 
Abnormal skin patches
Birthmarks
Sacral pits
56
Q

What reflexes are tested?

A 
Palmar grasp reflex
Suckling reflex
Rooting reflex
Stepping reflex
Moro reflex
57
Q

What is the palmar grasp reflex?

A

When an object is placed in an infants hand, fingers will grasp it in the palm

58
Q

What is the sucking reflex?

A

Child will suck anything that touches the roof their mouth

59
Q

What is the rooting reflex?

A

Child will turn its head towards anything that strokes it cheek or mouth

60
Q

What is the stepping reflex?

A

When the soles of their feet touch a flat surface, they will appear to walk

61
Q

What is the moro reflex?

A

Warn parents first

Support the infants upper back with one hand, then drop back once or twice onto other hand

Legs + head extend, arms jerk up with fingers extended

Arms then brought together and hands clench into fists and infant cries

62
Q

How do you complete the new-born examination?

A

Thank parents
Share results with parents

Offer to help redress child

Wash hands

Document findings

Paediatrics (40 decks)

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