PANCE book - Exam of newborn Flashcards

1
Q

Ballard score

A

newborn assessment of activity, position, and tone to evaluate neuromuscular and physical maturity

rubric estimates gestational age

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2
Q

Causes of infant’s being small for gestational age

A

maternal drug use, chromosomal abnormality, viral infection, multiple birth, advanced maternal age, placental insufficiency, or lack of maternal weight gain

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3
Q

What is advanced maternal age?

A

> 35 yo

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4
Q

Most common cause of being large for gestational age

A

maternal diabetes

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5
Q

When should complete newborn exam be done?

A

within 24 hrs of birth

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6
Q

erythema toxicum

A

common rash in newborns 3-5 days old

small pustules with erythematous bases

spontaneous resolution in 1-2 wks

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7
Q

milia

A

common newborn rash

very small, white papules mostly on face

resolves w/o treatment in 1-2 months

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8
Q

miliaria

A

common newborn rash; “heat rash”

caused by blockage of eccrine sweat glands, resulting in flushed macular appearance

light clothing and decreased humidity speeds resolution

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9
Q

Mongolian spots

A

blue-black macule concentrated on back and buttocks of dark-skinned infants

most resolve in 4 yrs but may persist for life

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10
Q

craniosynostosis

A

premature fusion of one or more sutures

necessary to refer to neuro

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11
Q

Anterior fontanelle closes around _____ months and posterior fontanelle closes at _____ months.

A

10-26 mon

1-3 mon

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12
Q

If a third fontanelle is seen along sagittal suture this may be associated with ________.

A

Trisomy 21

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13
Q

caput succedaneum

A

fluid accumulation under scalp secondary to birth trauma

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14
Q

subgaleal hemorrhage

A

occurs beneath scalp; uncommon but results in enough blood loss to cause hemorrhagic shock!

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15
Q

How is hearing assessed in newborns?

A

auditory brain stem response or evoked otoacoustic emission testing

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16
Q

Absence of red reflex in infant may suggest what?

A

congenital cataracts, glaucoma, or retinoblastoma

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17
Q

Brushfield spots

A

gray/yellow spots at periphery of iris associated with Down syndrome

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18
Q

subconjunctival hemorrhages in newborns

A

benign finding associated with trauma of delivery; resolves with time

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19
Q

strabismus in newborns

A

“cross eyed”

almost always present in newborn period and is not pathologic unless persists past 4 months

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20
Q

choanal atresia

A
  • unilateral or bilateral nasal obstruction
  • bilateral results in respiratory distress as infants are obligate nasal breathers
  • obstruction confirmed with CT
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21
Q

esophageal atresia presents as..

A

excessive drooling

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22
Q

Epstein pearls

A

small, pearly nodules along midline of hard palate; benign cysts

23
Q

What indicates a submucosal cleft?

A

bifid uvula

24
Q

Mouth findings of trisomy 21 infants

A

large tongue

25
webbed or redundant skin of neck may suggest _________.
Turner syndrome
26
Midline/thyroid neck mass finding
thyromegaly; congenital hypothyroidism and requires immediate attention to prevent growth failure/cretinism
27
neck mass finding within sternocleidomastoid suggests ________.
Torticollis, hematoma
28
signs of respiratory distress
grunting, intercostal retractions, tachypnea (+60), cyanosis
29
finding with pneumothorax or diaphragmatic hernia
decreased breath sounds unilaterally | pneumothorax would also have mediastinal shift
30
Most common causes of respiratory distress in newborn
aspiration, congenital pneumonia, transient tachypnea
31
Concerning findings in heart exam
rapid heart rate, cyanosis, CHF, diminished peripheral pulses *murmurs may or may not be pathologic
32
Prune belly or absence of abdominal musculature may indicate what?
renal anomalies
33
What are prominent kidneys suggestive of?
hydronephrosis or cystic kidney disease
34
severely scaphoid belly + respiratory distress indicates?
diaphragmatic hernia
35
What may delayed stool production (+24 hrs) indicate?
Hirschsprung disease
36
signs of neurotubular defect or spina bifida on exam
gluteal cleft with pits, birthmarks, or tufts of hair
37
Normal HR at birth to 6 months
average 130-140, normal range up to 180-190
38
Avg HR 6-14 years old
90
39
respiratory rate at birth
30-60 bpm
40
respiratory rate 8-15 yrs old
15-25 (similar to adult)
41
When should testes descend?
usually at 3 months and 80% by 9 mon; if over 1 year refer to urologist
42
Concerns of prolonged empty scrotal sac?
testicular cancer and infertility; refer to endocrinologist
43
hydrocele
commonly observed (80% of newborns) collection of fluid in scrotum due to patency of vaginalis process
44
How is hydrocele mass differentiated from inguinal hernia?
transillumination
45
Which conditions are commonly associated with ambiguous genitalia?
``` chromosomal anomalies adrenal hyperplasia (affects testosterone) ```
46
How to treat vaginal adhesions in newborns?
estrogen or beclomethasone cream x 5-10 days | if doesn't resolve, refer to urologist
47
Exams to test for developmental hip dislocation
Barlow maneuver: adduct fully flexed hip while pushing thigh posteriorly; dislocation + test Ortolani maneuver: grasp medial aspect of flexed knee and fully abduct hip; feel for spasm or clunk
48
When should newborn's hip clicking need ultrasound and referral to pediatric ortho?
- If Barlow and/or Ortolani maneuvers are positive | - If hip click persists past 1 month old
49
sucking and rooting reflex
earliest reflexes | when face stroked the baby will turn head towards that side and if offered nipple or finger will suckle
50
Moro reflex
allow infant's head to drop 1-2 cm and observe for abduction of shoulders and elbows with spreading and extending of fingers; then adduction and flexion of same disappears by 3-4 months old
51
grasp reflex
placement of finger in palmar or plantar surface elicits grasping response disappears by 4 months old
52
Babinski reflex of infant
test is positive with upgoing plantar may exist until 2 yo
53
traction response
pull infant by arms to sitting position | observe initial head lag, coming briefly to midline, then falling forward
54
Placing reflex
when infant dangled over flat surface with toe barely touching, triggers stepping response or extremity flexion