PD3- Final Flashcards
pain, temp, crude touch
lateral spinothalamic tract
light/fine touch
anterior spinothalamic, posterior column tracts
proprioception, vibratory sense, discriminative touch?
posterior column tract
motor pathways?
corticospinal tract
serial 7s test?
attention
illusions and hallucinations?
perception
MMSE- normal?
27-30
spell world backwards
months of year forwards/backwards
series of digits
attention
logic, relevance, organization, coherence
thought process
delusions, obsessions, compulsion, phobias
thought content
pose a simple problem
judgment
quantity/rate/rhythm/volume
speech
inability to speak or understand language; lesion in dominant cerebral hemisphere
aphasia
difficulty in articulation; lesions of tongue and palate
dysarthria
difficulty in phonation, lesions of palate and vocal cords
dysphonia
difficulty speaking/comprehending
dysphasia
ask pt to read, write, and name objects
language
must speak in loud voice, delayed response
lethargic
drowsy/somnolent, shake pt, cloudy
obtunded
marked reduction in mental and physical activity, vigorous stimuli needed
stupor
reflex to assess brainstem?
if that is abnormal move to? (pt is rarely conscious in this)
oculocephalic reflex
oculovestibular reflex
? can be the only Sx in a stroke
vertigo
wake up w/ HA or pain w/ valsalva
increased ICP
intermittent jabbing pain ?
trigeminal neuralgia
OCP, amlodipine, viagra, primary pulmonary htn ?
causes of HA
1 sided blindness?
optic neuritis
optic neuritis common sign in?
MS
pituitary tumor?
bitemporal hemianopsia
> 1mm difference in pupil size?
CN III compression
> 2 mm difference pupil size?
anisocoria
sluggish pupil résponse?
Adie’s tonic pupil
afferent input in affected eye, pupils fail to constrict fully
marcus gunn pupil
lyme dz, guillan barre, MS, ALS, tumors, syphilis, polio
palsies can be secondary to these
ALS, polio seen w/
hypoglossal damage
MCC cause of atrophy
lack of use
cerebellar function assesses? 4
motor, sensory, cerebellar, vestibular
prenatal pd?
1st 28 days of life
early child hood? middle?
1-4, 5-10
assess GA by scoring against ? and ?; name?
New Ballard or Dubowitz score, physical and neuro
developmental screening test - Denver II, PEDS, CDI; most used? measures ? not ?; can miss a ?
denver II, dev. attainment, intelligence, language delay
oral health start at ?
12 months
fever is ?
100.4
fever can be good bc?
body’s way of fighting
APGAR- acronym? 3 points scale- 1 point (0-2 scale) for each ?
activity (muscle tone)- arms and legs flexed pulse- <100 grimace- grimace appearance- pink body/blue extremities respiration- slow/irregular
newborn exam- first one in?
first 24 hours
apgar
1 min- resuscitate? depression? normal?
5 min- high risk? nl
1 min- 0-4, 5-7, 8-10
5 min- 0-7, 8-10
well child exam - do w/ in ?
2 days of birth
newborn most responsive ? after meals
1-2h
? exam last .. kids hate it
ear; do LESS invasive FIRST
stranger anxiety at ?
9-15 months
middle childhood - parents stay in exam through age?
11
length measurement
<2 yo.. take length ? position
supine
short stature consider ? and ? dz
endocrine, GI
weight infants directly on scale w/out ? toddlers ?
diaper
standing, w/ just undies
head circumference measured ?
first 2 yrs of life
newborn- 6 mo. - head is ? than chest; same size as chest at ?
2 cm larger; 6mo-2yrs
associated w/ macrocephaly? 4
macroencephaly, autism, hydrocephalus, fragile X
at birth bpm is?
age 2?
140bpm
~100bpm
palpate ? or auscultate heart
femoral arteries
respirations
- newborns
- early childhood
- middle childhood
- adult rate at ?
30-60/min newborns
20-40
15-25
age 15 yo
rr - during ? is more accurate
sleep (in newborns)
observe RR for how long?
full 60s (so variable)
rapid resp ? w/ grunting/nasal flaring/ acc muscle use = ? or ?
> 40/min, bronchiolitis, pneumonia
temp- ? preferrable; ? if less than 2 months- insert ? mm
ear canal, rectal temp, 2-3mm (in anal sphincter)
begin BP measurements at age?
2
acrocyanosis on ? and ? normal; BIG PROBLEM if on ? or ?
skin NOT health determinant
face, digits
lips, mucous membranes
cutis marmorata ('marbled skin')
typically first few mo., worse when ?infant is cold (immature nerve supply to superficial capillary bv)
MC over butt/lumbar region; predominant in asians, mediterranean, african descent?
mongolian spots
fine downy hair in PREMATURE that disappear in a few weeks
lanugo
pinhead sized smooth white raised areas on nose, chin, forehead; erythema?
milia; NO erythema
acne neonatorum- papules, pustules
- from?
- MC in ?
- usually dev at ?
- tx?
maternal estrogen
males
3 weeks but can present at birth
self limiting
milaria rubra aka ?
- scattered vesicles on ?
- heat rash common on ?
- obstructed sweat glands
prickly heat
erythematous base
face/trunk
erythema toxic
- erythematous macules with ?
- scattered diffusely over ?
- etiology? tx?
central pinpoint vesicles ENTIRE BODY (to diff from milaria rubra) unknown, self limiting
small vesiculopustures over BROWN macular BASE (to differentiate from milia)
pustular melanosis
phys jaundice peaks on?
day 3/4
nevus flammeus (port wine stain)- persists ?; typically appear on ?, vascular birthmark consisting of superficial and deep dilated capillaries in skin -Tx?
throughout life, face/extremities
topical/intralesional c/s
skin exam of infants same as adult when?
after 1st year
post font closes at ?
2 mo
ant font closes at ?
4-26 mo
asymmetry of cranial vault?
- from lack of ? while sleeping
- asymmetry from ?
plagiocephaly
tummy time (avoid sleeping on back)
-torticollis
caput succedaneum
- capillary distension/extravasation of blood from ?
- usually resolve in ? w/o comp
- scalp swelling extends across ? and over suture lines
- caused by?
- vaccuum effect of ROM
- first few days
- midline
- pressure of presenting part of scalp against dilating cervix (tourniquet effect of cervix)
cephalohematoma
- tearing of ?
- more common w/ ?
- suspect ? if fx crosses midline
- aka ? under scalp
veins
forceps/vaccuum delivery
skull fx
water balloon
hydrocephaly, rickets, congenital syphilis: PE findings?
pliable/springy bones upon palpation
percussion- RESONANT when ? or ?
location?
sign? aka ?
hydrocephalus, abscess
junction of frontal, parietal, and temporal bones
MacEwen’s sign, ‘cracked pot’
GA appropriate?
10th-90th %ile
LEADING preventable cause of mental and physical birth defects in US?
FAS
special characteristics of FAS?
flattened cheekbones, indistinct filtrum, poor fine motor skills, lack of imagination/curiosity
thick/coarse hair, LARGE tongue, ? hernias ?
congenital hypothyroidism, umbilical
short neck, upward slanting eyes, ? crease, widely separated ?
simian, 1st and 2nd, DOWN syndrome
infancy, lymphad?
childhood?
rare
more common- viruses
VA blinks, may regard face fixes on objects coordinated eye movements eyes converge, baby reaches acuity around 20/50
birth 1 month 2 months 3 months 12 months
blinks in response to sudden, sharp sound
acoustic blink reflex
infants only have ? sinuses
ethmoid
sinuses
maxillar at age?
sphenoid?
frontal?
4
6
6-7
thorax/lungs best to listen?
from front!
central cyanosis ALWAYS?
abnormal
high risk for SIDS?
> 20s or <20s w/ Sx
? easiest to palpate but do ? in infants
brachial, FEMORAL
MC heart ban in infants?
PSVT and PAT
infants- S3? S4?
normal, uncommon
MC murmur in preschool?
adolescents?
still’s murmur
pulmonary flow
infants:
bowel sounds?
liver extends 1-2 cm below?
HYPERactive
right costal margin
male genital
- urethral meatus and foreskin fully separate until?
- 2/3 cryptoorchidism descend by ?
10 yo
12 months
infant rectal- don’t check patency if ?
defecating normally
at birth hands are ?
clenched
most newborns are born ? (MS) and it will disappear at ~?
bowlegged, 18 months
toeing in or out of foot disappears w/ ?
-if can’t be turned out on PE?
weight bearing
congenital abn
absent reflexes/retention of reflex signals ?
dev abnormality
rooting reflex goes away at
4 mo
sucking reflex goes away at
3 yrs
test CNXII w/ sucking/swallowing ability and tongue position w/ ?
pinch test
if neuro exam abn, expand to include ? 3
sensory fxn
CN
less common primitive reflexes
newborns ? are tactile regions
cheeks
exploratory mouthing begins w/ grasping and stops around
6 months
temp- more sensitive to ?
cold
lack of realization of pain can be
congenital abn
hearing- by D3 prefers ?
voices (over pure tones)
vision- prefers to see ? at 3 months
faces
VA is ? at 6 months
20/100
intermodal perception- recognizes ? in mouth by ?
shapes, 1 month
NORMAL: babinski positive until ?
2 yo
palmar grasp goes away at
3 mo
plantar grasp goes away at
1 yo
moro reflex goes away at
6 mo (flexed legs, abducted arms, open hands)
asymmetric tonic reflex from?
turn head to one side w/ jaw over shoulder- same side? other?
birth to 6 mo
arm & leg extends, other side flexes
stepping reflex till 4w and reappears at ?
1-2 yo
reflex from tapping on forehead? if blinking persists (ban)?
gabellar reflex
Myerson’s sign
positive support reflex from ? to ?
3/4mo till thruout life
turning of shoulder and trunk in direction of head; goes away at?
righting reflex, 4 mo
when infants head pushed DOWN, legs drop down into FLEXION?
landau reflex aka SUPERMAN pose
Gross Motor Skills
walk by?
run well by?
pedal tricycle/jump by?
15 mo
2 yrs
3 yrs
eye exam begins at ?
refractive errors more common in?
3
middle childhood/adolescence
assess mobility of TM w/ ?
pneumatic otoscope- use insufflator
hearing
-under age 4? over 4?
whisper test, full acoustic screening
mouth/pharynx
one tooth for ? between 6-26 mo; up to ?
each month, 20 primary teeth
breast exam- onset ?, first sign of?
8-13 yo, puberty (male first sign of puberty: 9-13.5)
liver size determined by ? spleen typically ?
percussion, palpable
female- pubic hair before 7 =
precocious puberty
MS early childhood
normal = increased? and decreased?
lumbar concavity, thoracic convexity
neuro- ? not routinely tested in young children
DTR
baby sleeping during day and awake at night - NORMAL; usually first ?
4-8 weeks; train w/ cycled lighting, feeding schedules, dec stimulation at night
umbilical cord falls off at
2 weeks
bathe babies ?
1x/week
baby pooping
once every 5 days to 5 times a day
face car seat BACKWARDS until ? or ?
1 yr or 20 lbs
colic disappears at ?
3-4 months
after 6 mo only use pacifier when? wean pacifier and stop altogether at ?
falling asleep, 10 months
breast milk can store in freezer up to ? and in fridge?
3 mo, 48 hours
honey dang if less than
2 yrs
throw bottle away at ? NO NEED TO WEAN
9 months
irregular/unequal pupils; weak/absent reaction to light? can be from?
argyll robertson pupil
neurosyphilis
