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NPTE > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

APGAR Scoring

A

Appearance (color)
Pulse
Grimace (reflex irritability)
Activity (muscle tone)
Respiration

Each scored 2/2, for max score 10/10

Checked at 1 min, 5 min, 10 min of life (10 min only if needed)

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2
Q

APGAR score meaning

A

<6 = apnea or bradycardia; begin resuscitation

3-4/10 = bag and mask ventilation

5-7/10 = blow-by oxygen

8-10/10 = normal, typical for term newborrns

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3
Q

Gross motor development key points

A

Reflexes before cortex
General before localized response
Flexor tone before extensor tone
Antigravity/upright: extensor tone before flexor tone
Cephalic to caudal development
Proximal to distal development
Gross motor before fine motor

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4
Q

Ped milestones poem/pneumonic

A

3 I lift my head,
4 lay on my side
5 prone to supine
And at 6 I sit upright

7 quadruped,
At 8, can’t wait to cruise (9).
Creep, cruise, and stand alone at 9,
Then walk and stack two cubes.

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5
Q

Peds milestones: month 3

A

Prone on elbows
Can lift head in prone
Belly crawl (3-9 mo)

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6
Q

Peds milestones: month 3-4

A

Supine to sidelying

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7
Q

Peds milestones: months 5-6

A

Prone to supine
Pull to sit without head lag
Sitting with UE support
Feet to mouth

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8
Q

Peds milestones: months 6-7

A

Supine to prone
Quadruped
Independent ring sitting
Transfer objects between hands
Trunk rotation in sitting

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9
Q

Peds milestones: 9-10

A

Quadruped creeping
Cruises to sideways
Plantigrade (soles of feet on ground), pulls to stand
Improving grasping skills, pincer, three jaw chuck (10 mo)

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10
Q

Peds milestones: 10-15

A

Begins to walk unassisted
Transitions in/out of squatting (10 mo)
Controls grasp and release
Stacks two cubes

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11
Q

Integrated

A

When the reflex disappears to allow for normal development

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12
Q

Persistent

A

A reflex that has not integrated and indicative of CNS dysfunction

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13
Q

Flexor withdrawal reflex

A

Onset: 28 weeks gestation
Integrated: 1-2 months

Stimulus: Noxious stimulus (pinprick) to sole of foot

Response: Toes extend, foot dorsiflexes, LE flexes uncontrollably

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14
Q

Crossed extension reflex

A

Onset: 28 weeks gestation
Integrated: 1-2 months

Stimulus: Noxious stimulus to ball of foot of LE fixed in extension

Response: Opposite LE flexes, then adducts and extends

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15
Q

Rooting reflex

A

Onset: 28 weeks gestation
Integrated: 3 months

Stimulus:
Stroking the side of baby’s cheek

Response:
Head turns toward stimulus and mouth opens

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16
Q

Traction reflex

A

Onset: 28 weeks gestation
Integrated: 2-5 months

Stimulus:
Grasp forearm and pull up from supine into sitting position

Response:
Grasp and total flexion of the UE

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17
Q

Asymmetrical tonic neck reflex (ATNR)

A

Onset: Birth
Integrated: 4-6 months

Stimulus:
Rotation of the head to one side

Response:
Flexion of skull limbs, extension of
the jaw limbs, “bow and arrow” posture

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18
Q

Palmar grasp reflex

A

Onset: Birth
Integrated: 4-6 months

Stimulus:
Maintained pressure to palm of hand

Response: Maintained flexion of fingers

19
Q

Moro reflex

A

Onset: 28 weeks gestation
Integrated 5-6 months

Stimulus:
drop pt backward from sitting position

Response:
Extension, ABD of UEs, hand opening and crying followed by flexion, adduction of arms across chest

20
Q

Symmetrical tonic labyrinthine reflex (TLR/STLR)

A

Onset: birth
Integrated: 6 mo

Stim:
Prone or supine position

Response:
Prone - inc flexor tone of all limbs
Supine - inc extensor tone of all limbs

21
Q

Positive supporting reflex

A

Onset: birth
Integrated: 6 mo

Stim:
contact to the ball of the foot in upright standing position

response: rigid extension (co-contraction) of LEs

22
Q

Plantar grasp reflex

A

Onset: 28 weeks gestation
Integrated: 9 mo

Stim:
maintained pressure to ball of foot under toes

response:
maintained flexion of toes

23
Q

Symmetrical tonic neck reflex (STNR)

A

Onset: 4-6 mo
Integrated: 8-12 mo

stim:
flexion or extension of the head

response:
head flexion - flexion of UEs, extension of LEs

head extension - extension of UEs, flexion of LEs

24
Q

Startle reflex

A

Onset: birth
integrated: persists

stim
sudden loud or harsh noise

response
sudden ext or abd of UEs, crying

25
Q

Plagiocephaly

A

Cause:
prolonged asymm pressure on premature skull

occipitoparietal flattening and CL occipital bossing

ipsilateral front bossing and anterior displacement of ear

assess ROM, strength

educate on positioning, exercises, helmet, tummy time

26
Q

Torticollis

A

Tight SCM

Often occurs in tandem with plagiocephaly

tx: positioning; stretch SCM

27
Q

Classification of cerebral palsy

A

classification according to mvmt disorders

spastic
ataxic
dyskinetic

severity classified by GMFCS

28
Q

Spastic CP

A

Velocity dependent resistance of a muscle to stretch

Synergy patterns, contractures, crouched gait, toe walking

29
Q

Ataxic CP

A

Disorder of coordination, force, and timing, associated with cerebellar involvement

low tone, tremor, poor balance, wide BOS, nystagmus

30
Q

Dyskinetic CP

A

Disorder of basal ganglia, characterized by involuntary
movements that are slow and writhing

Poor stability, hand tremor, fluctuating tone, hypo becomes hyper

31
Q

Gross motor function classification scale: level 1

A

Level 1 - Patient will walk without restrictions but will have limitations in more advanced gross motor skills.

athleticism limited

32
Q

Gross motor function classification scale: level 2

A

Level 2 - Patient will walk without assistive device with limitations in walking outdoors and in the community.

limited terrain

33
Q

Gross motor function classification scale: level 3

A

Level 3 - Patient will walk with assistive device with limitations in walking outdoors and in the community.

AD > WC

34
Q

Gross motor function classification scale: level 4

A

Level 4 - Patient self mobility will be severely limited; children are transported or use power mobility outdoors and in the community.

WC > AD

35
Q

Gross motor function classification scale: level 5

A

Level 5 - Patient self mobility will be severely limited, even with the use of assistive technology, requires caregiver.

caregiver needed

36
Q

Down’s syndrome summary

A

Trisomy 21
Increased risk with inc age of mother

Precaution:
Forceful neck flexion and rotation activities should be limited due to laxity of odontoid ligament and potential for a subluxation of atlanto-axial joiint

Tx:
Encourage motor function and avoid hyperextension of elbows/knees during WB activities

37
Q

Down syndrome sxs

A

Hypotonia
Ligamentous laxity
Delayed motor milestones (running, jumping)
Deficits in memory/expressive language
Impaired postural control/coordination
Dec quad and hip ABD strength
Inefficient mvmt strategies due to hypotonia

38
Q

Autism spectrum disorder sxs

A

Social/communication skill limitations (esp non verbal)

Repetitive behaviors (routines, highly focused interests, spinning of hands)

Sensory processinig issues

Difficulty developing relationshiips

Hypo/hyper reactive to sensory input (sensory seeking or avoiding)

Dyspraxia (inability to imitate mvmt)

39
Q

Autism tx

A

Controlled, multi-sensory input
Behavioral interventions
Encourage motor development
Coordination
Visual supports (line on the floor for gait)
Verbal sequencing
Consistency

40
Q

Duchenne Muscular dystrophy

A

X-linked recessive
Males only
Destruction of mm. cells (missing dystrophin)
Pseudohypertrophy (collagen and adipose; large calves w/o strength)
Life expectancy < teenage

Exam:
Gower’s sign
Strength
ROM
Functional
Skeletal alignment
Respiratory** (will decline 2/2 restriction from inc adipose)
Adaptive equipment

Tx:
Maintain mobility as long as possible
Maintain joint ROM w/ active/passive
DO NOT OVERFATIGUE

41
Q

Scheuermann disease

A

Aka juvenile kyphosis; gymnast spine

exam:
Schmorl’s nodes
Angled/wedged thoracic spine
Pain w/ thoracic ext/rot
Agg w/ long standing/sitting or physical activity
Inc thoracic kyphosis and lumbar lordotic curve

Tx:
Schroth method (core/trunk ex for scoliosis)
stretch pecs
Strength thoracic extensors and scap stabilizers

42
Q

Erb’s palsy

A

C5-6
In babies

MOI: stretching head downward

Loss of mvmt: loss of shoulder ABD and ER

deformity: waiter’s tip

tx: immobilize, then gentle ROM

43
Q

Klumpke’s palsy

A

C8-T1
In babies

MOI: stretching of arm overhead

loss of mvmt: paralysis of intrinsics of the hand

deformity: claw hand

tx: immobilize, then gentle ROM

NPTE (40 decks)

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