Pediatrics Immersion Flashcards

1
Q

Red reflex

A

Use an opthalmoscope and visualize the retina in the back of the eye. There should be red coloration due to red blood vessels.

If you don’t see a red reflex, it may suggest a mass or something blocking the view of the retina, or cataracts.

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2
Q

Signs of respiratory distress in a baby

A
  • Cyanosis
  • Grunting
  • Nasal flaring
  • Tachypnea (>60 bpm)
  • Subcostal or intercostal retractions (highly visible ribs)
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3
Q

Normal RR for an infant

A

40-60 breaths/min

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4
Q

Normal HR for an infant

A

Varys w/ age, but anywhere from 80-170 bpm

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5
Q

Acrocyanosis

A

A normal finding

Lips are not cyanosed, so this is not dangerous. May persist for several months, particularly in colder areas.

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6
Q

Scaphoid abdomen

A

Often suggests diaphragmatic hernia

Abdomen does not contain as many organs! You can hear bowel sounds over the chest where herniated intestines are.

Requires immediate surgery.

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7
Q

Syndactyly

A
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8
Q

Kleinodactyly

A
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9
Q

Babinski reflex presence is normal until age __.

A

Babinski reflex presence is normal until age 2.

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10
Q

Nephrotic syndrome is often mistaken for ___ in pediatrics.

A

Nephrotic syndrome is often mistaken for allergy in pediatrics.

The eyes become puffy first, and it tends to occur around the same time seasonally (since it can be triggered by a URI)

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11
Q

When an infant is relaxed, you can take advantage for the purposes of your physical exam by. . .

A
  • Reviewing facial features when facial muscles are not contracted
  • Look at exposed skin
  • Examine breathing (rate/pattern)
  • Listen for murmur/breath sounds
  • Assess red reflex if eyes are open
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12
Q

Anterior fontanelle

A

If an infant has high intracranial pressure, this fontanelle will be very wide.

In older children, it will be bulging.

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13
Q

When you are examining an infant, especially when you are removing coverings to look at skin, it is very easy for the baby to become. . .

A

. . . cold!!!!

Whenever possible, use warming lights overhead to keep the infant warm, and keep this in mind throughout your exam.

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14
Q

Moulding of sutures

A

May cause bumps along the cranial suture lines on an infant’s head.

Usually due to pressure during delivery. Resolves over time.

Completely benign.

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15
Q

Neonatal extracranial and intracranial birth injuries

A
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16
Q

Caput

A

Edema under the skin, but above the fascia and periosteum. Causes swelling/bulging. Crosses suture lines. Usually present at birth.

Totally benign. Resolves usually within 48 hours. Just put a hat on the baby.

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17
Q

What to ask when examining an infant’s head bulge

A
  1. Does it cross suture lines?
  2. Is there pitting edema?
  3. Is there fluid wave?
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18
Q

Cephalhematoma

A

Major risk factor is vacuum-assisted deliveries.

Presents 12-24 hours after delivery. Does NOT cross suture lines. No fluid wave.

Not serious, but may cause some jaundice within ~ 1 week of appearance. Monitor carefully for jaundice development.

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19
Q

Subgaleal hemorrhage

A

Above the skull, but beneath the periosteum. Blood witihn the external periosteal space. Presents soon after birth and does NOT cross suture lines. Fluid wave is PRESENT.

Potentially serious. Can be so much blood loss into this space that the baby loses significant circulating volume. This requires transfer to NICU and administration of plasma or cryoprecipitate to facilitate clotting.

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20
Q

Subdural hematoma

A

Not visually apparent on exam, but may present as seizures. Quite serious.

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21
Q

Why is it important to check for cleft lips and palate on infantile exam?

A

Babies with cleft lips or palates may have difficulty feeding due to muscle coordination, and so they must be fed with specialized nipples that are designed to make this easier for them.

Otherwise, it could lead to malnutrition/failure to thrive.

Clefts may also be found in certain syndromes and may be an early clue to identifying a more serious pathology.

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22
Q

Why do babies grunt when they are in respiratory distress?

A

Babies “grunt” (Ehhh, ehhh, ehhh) reflexively by constricting their larynx. This maintains a positive end expiratory pressure in their lungs, holding the alveoli open, much like PEEP on a ventilator.

If you see this with a newborn, you should think of a surfactant problem.

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23
Q

Where is the best place to look for significant cyanosis on an infant?

A

The tongue!!!

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24
Q

All newborns have __ in the first couple minutes of life.

A

All newborns have low oxygen saturation (~65%) in the first couple minutes of life.

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25
Q

What is going on in this picture?

A

An umbilical hernia.

No treatment needed. This will resolve on its own.

26
Q

What’s going on in this picture?

A

Diaphragmatic hernia

Contents of abdomen are in the chest. Very rare, but quite serious. Bowel sounds may be heard in chest.

27
Q

Male newborn genitourinary exam

A
28
Q

Female newborn and anal genitourinary exam

A
29
Q

Hypospadias

A

Opening of the penile urethra is on the ventral surface of the penis.

30
Q

Epispadias

A

Opening of the penile urethra is on the dorsal surface of the penis

31
Q

Why is it important to identify hypospadias and epispadias?

A

They are not pathological conditions per-se, but, they may predispose to genitourinary infection later in life, and we want to prevent circumcision of these individuals as infants because the tissue that is circumsized is used in the surgical repair of the condition later in life.

32
Q

What is going on in this image?

A

Classic hydroceles. Fluid collection in the scrotal sac.

Not pathological necessarily, will go away over time. But, if it persists or if it dramatically increases, intervention will be made. Families should be informed to let physicians know if this happens.

33
Q

Types of hydrocele

A

Non-communicating hydroceles are benign, frequently present at birth, and go away over time on their own.

Communicating hydroceles will not resorb on their own, and the fluid can back up into the abdomen. Smaller early in the day, larger in the evening if child is upright all day.

34
Q

What is going on in this image?

A

Testicular torsion.

Note the slight blue discoloration and decreased volume of the right scrotal sac. Often occurs in utero.

A flow-resolved ultrasound should be performed right away to establish whether or not there is good perfusion. This is an emergency and the infant should be transferred to the operating room ASAP.

35
Q

Risk factors for infantile hip abnormalities

A
  • Females are at slightly higher risk
  • Breech infants (baby’s buttocks or feet are positioned to be delivered first instead of the head)
  • Firstborn infants
36
Q

Hip displasias are not always. . .

A

. . . present at birth

They may develop. Keep this in mind when evaluating infants joints.

37
Q

Barlow test

A
38
Q

Ortolani test

A

Performed after Barlow test (dislocation test)

39
Q

Infants with hip dysplasia will require. . .

A

. . . a harness to realign the joint.

Or, alternatively, later in life this can be corrected by surgery. However, it is best if we can pick up on this early and treat with a harness so we can avoid invasive procedures, which is the point of doing newborn screening for hip dysplasia.

40
Q

Hypotonia

A

Hypotonia is indicative of serious pathology and these infants should be brought to the NICU.

41
Q

Sucking reflex

A

Reflex for all infants, even premies. Self-explanatory. Note the strength and symmetry of the sucking.

42
Q

Palmar grasp reflex

A

If you put your finger in the middle of their hand, they should reflexively grasp it.

43
Q

Plantar grasp reflex

A

If you stroke up the middle of the foot (not the side, which would trigger the babinski reflex), the infant should curl their toes inward as if to grasp your fingers.

Very similar to palmar grasp reflex.

44
Q

Babinski reflex

A
45
Q

Moro reflex

A
46
Q

Asymmetric tonic neck reflex

Aka the Fencer reflex

A
47
Q

Congenital dermal melanocytosis

A
48
Q

What is going on in this picture?

A

Infantile jaundice

May or may not be concerning. Concerning if it is just only hours after birth, as the placenta should have removed all bilirubin.

However, if this occurs days after birth and is not present on lower extremities, it is not concerning.

49
Q

Nevus simplex

A
50
Q

Erythema toxicum

A

Pustules of all eosinophils. Comes and goes within minutes. Most common in term infants.

51
Q

Complications of advanced varicella in children and infants

A
  • Extreme Strep pyogenes infections (ie, necrotizing fascitis)
  • Encephalitis
52
Q

Hemangioma

A

Generally benign, but large ones may be dysfiguring or cause mass effect, which indicates treatment.

53
Q

What is going on in these individuals?

A

Measles!

Reddened conjuncitvae and red spots that also appear on the hands, as well as in the oral mucosa.

54
Q

What is going on in these individuals?

A

Neisseria meningitidis.

Neisseria often affects older, sexually active young adults, however it can present in children as well and is very serious. Presents with significant skin manifestations as well as, of course, meningitis in some cases.

55
Q

What is going on in these individuals?

A

Epiglottitis, in this case caused by Haemophilus influenzae B.

Used to be a common cause of childhood ER visits, but nowadays preventable by vaccination.

56
Q

When are children given the bulk of their vaccinations in the US?

A

During the first two years of life

57
Q

What is going on in this infant?

A

Turner’s syndrome (45, X)

Look at the neck! Extra neck skin is a typical congenital presentation.

58
Q

Vital signs vs age (neonate, 3, 12)

A
59
Q

What is going on in this throat x-ray?

A

Croup

Also known as laryngotracheobronchiti. A type of respiratory infection that is usually caused by a virus. The infection leads to swelling inside the trachea, which interferes with normal breathing and produces the classic symptoms of “barking” cough, stridor, and a hoarse voice.

60
Q

Fetal alcohol syndrome

A
61
Q

What is going on in this individual’s iris?

A

Lisch nodules

Dome-shaped gelatinous masses developing on the surface of the iris. Gold-tan to brown in color, they may grow up to 2 mm in diameter and attain variable sizes on the same iris. The presence of Lisch nodules is the most common clinical sign of neurofibromatosis type I (NF-1)