Peds Flashcards
1
Q
What are calming techniques for newborns
A
pacifier
feeding
sucking on finger
2
Q
What are you observing in newborns?
A
color
size
body proportions
nutritional status
posture
respiration
movements of head and extremities
3
Q
Under the age of 2 use the __________ chart for growth
A
WHO
4
Q
macroencepholy
A
bigger head circumference
5
Q
Microencephaly
A
a smaller head circumference
6
Q
What is considered failure to thrive ?
A
-growth <5th percentile for age
-drop > two quartiles in 6 months
-weight for length < 5th percentile
7
Q
What does APGAR stand for and what is a score at 1 and 5 minutes
A
Activity
Pulse
Grimace
Appearance
Respiration
may continue in 5 minute intervals until score is > 7
8
Q
APGAR score at 1 minute
A
8-10 normal
5-7 some nervous system depression
0-4 severe depression
9
Q
APGAR 5 minute score
A
8-10 normal
0-7 at risk for CNS and other organ system dysfunction
10
Q
SGA
A
small for gestational age <10%
11
Q
AGA
A
appropriate for gestational age
10-90%
12
Q
LGA
A
large for gestational age
>90%
13
Q
Gestational age: Preterm
A
<37 weeks
14
Q
Gestational age: late preterm
A
34-36 weeks
15
Q
Gestational age: term
A
37-41 weeks
16
Q
Gestational age: postterm
A
> 42 weeks
17
Q
Weight
A
extremely low birth weight: <1,000
very low birth weight < 1500 g
low birth weight < 2500 g
normal birth weight greater to or equal to 2500 g
18
Q
Most accurate route for temperature in infants
A
rectal, average rectal temp in infancy than adolescence is 99F
19
Q
Fever in infants
A
equal to or higher than 38 degrees C
20
Q
T/F infants body temp is less consistent than in adults
A
True
21
Q
HR for newborns
A
birth to 1 month: 140bpm
1month-6months: 130 bpm
6months-12 months: 115bpm
22
Q
What is a normal respiratory rate
A
newborn: 30-68 bpm
6-12 mo: 25-60 bpm
23
Q
Tachypnea respiration rate
A
RR > 60
24
Q
Periodic breathing
A
short pauses in breathing (usually 5-10 seconds) common in newborns and are considered normal
25
Apnea
pause in breathing 20 seconds or longer OR a pause in breathing
resulting in cyanosis/bradycardia
abnormal finding in term infants
26
Fever can raise respiratory rates in infants by up to _________respirations per
minute for each degree centigrade of fever
10
27
Systolic BP gradually _________throughout childhood
increases
28
BP readings from the thigh are approximately __________ mmHg higher than those from the upper arm. If they are the same or lower what should be suspected?
10, coarctation of the aorta should be suspected
29
O2 saturation
Measure hgb saturation
● Non-invasive method
● Two beams of light are shined through a pulse point
● Detects change of pulsing arterial blood color
30
Heart failure signs in infants
tachy tachypnea and liver failure
31
What are you observing when it pertains to lungs in newborns?
Tachypnea
○ Nasal flaring
○ Retractions
○ Grunting
○ Head bobbing
32
Rales (crackles)
crunching, crackling; associated with fluid
33
Wheezes
high pitched musical quality; associated with bronchospasm
34
Rhonchi
rattling; associated with mucus/secretions in airways
35
Stridor
audible high pitched wheezes indicating a narrowed airway
36
Pulses are graded as ________, __________, and ______
absent, 1+ (weak), 2+ (strong)
37
Persistently weak femoral pulses can be a sign of
_______________
aortic coarctation
38
Caput succedane
Swelling of the scalp over the occipital region. It results from capillary distention and extravastation of blood and fluid resulting in vacuum effect of rupture of the amniotic sac. crosses the suture line can resolve in one and 2 days
39
cephalohematoma
Localized swelling caused by subperiosteal hemorrhage from trama of birth. this swelling doesnt cross over the suture lines and can take 3 weeks to resolve
40
Large frontanelle =
Hypothyroidism, OI
41
Small frontanelle =
IUGR
42
Plagiocephaly
flat spot on one side of the head or entire back of the head
43
Oxycephaly
premature closure of all sutures
44
Brushfields spots
seen in kids with down syndrome and can sometimes be normal
45
Preauricular sinus
ear pit can be with renal conditions
46
Ear tag
usually benign
47
Choanal atresia
nasal passages are narrowed or blocked by soft tissue or bone
if its bilateral, the baby becomes cyanotic
if its unilateral can get air through other nasal passage but can have recurrent sinus infections
48
Epstein pearls
Tiny white or yellow, rounded mucous retention cysts
● Located along posterior midline of hard palate
-disappear within months
49
diastesis recti
separation of two rectus abdominal muscles, its benign
50
For the abdomen, if there are any Hypo/silence sounds it indicates
obstruction
51
For the abdomen, if there are any Hyper sounds it indicates
gastroenteritis
52
Abnormal olive shaped mass palpated in RUQ or midline
pyloric stenosis
often found between 4-6 mo of age common in first born males when feeding may see peristaltic wave
53
In males, you want to watch out for hydroceles and inguinal hernias. How can you tell the difference?
hydrocle will transmuilimiunate while inguinal will not
54
Ambiguous genitalia in a female indicates
mascularization of a female
55
Polydactly
6 fingers
56
Syndactyl
webbed fingers
57
Two tests for hip dysplasia
1. Orolani- abduct hip while applying an anterior force on the femur to reduce the hip joint a palpable movement of femoral head back into place is a + sign)
2. Barlow- adduct the hip while applying a posterior force on the knee to promote dislocation. + sign is indicates laxity and dislocateable hip, the baby needs to go to ultrasound (head of femur slipping onto the posterior lip of acetabulum is a + sign)
58
Sacral dimple
if hair associated/ want to investiage for spina bifida
59
Single plamar crease associated with
T21 and has to do with down syndrome
60
Arthrogryposis
Thin, weak, stiff or missing
muscles.
*Stiff joints due to extra
tissue→fibrosis
*Differences in the skin around their
joints, such as webbing
Causes:
fetal abnormalities, CT disorders, trauma, drugs, maternal disorders/illnesses in mother, mechnical limitation for uterus
61
Vernix caseosa
cheesy white substance seen on newbrosn made of proteins water and lipids and is a protective barier. may have edema with this on hands and feet that will resolve. the cheesy substance can last up to 10 days
62
Cutis marmorata
response to cold, just the way circulation catched up can last for few months in infants
63
Milia
new born acne, obstruction of sweat glands
64
Erythemia Toxicum
can be a normal finding appear usually 2-3 days, resolves on its own, unknown cause. its little pustules and erythematous
65
Preauricular sinus
due to a renal condition
66
Hypotonia/Hypertonia is indicative of
intracranial disease
67
Hypotonia
frog-leg position, arms flexed, hands near ears
68
DTR’s are present in newborns but difficult to elicit
○ Typical little diagnostic significance unless:
■ Response different from prior exam
■ Extreme Reponses
■ Asymetrical
69
If there is an asymetric DTR think of
PNS or CNS lesion
70
● Triceps/Brachioradialis and Abd Reflex--- difficult to illicit before
6 months
71
Anal Reflex/Wink- present at birth->
important to exclude if spinal cord injury suspected
72
Babinski (+) _______ in newborns
normal
73
Primitive Reflexes
Develop during gestation
● Demonstrable at birth then disappear at defined ages
● Abnormalities can suggest neurologic disease or developmental abnormality
74
Palmar grasp
they should grasp around you
birth -4 months (hands)
6-8 monthds (foot)
75
Rooting reflex if ythey fdont have this think of
central nerveous system disease
76
Rooting reflex
Stroke perioral skin at the corner of
the mouth
⦿ Mouth will open and infant will turn
toward the stimulated side and suck
present from birth to 3-4 mo
77
Moro Reflex
⦿ Hold infant supine, support head,
back and legs then abruptly lower
the entire body 1 foot
⦿ Arms will Abduct and extend, hands
will open, and legs will flex
⦿ Infant will cry!
⦿ Birth to 4 months
78
Asymmetric Tonic Neck Reflex
Supine infant, turn head to one side,
holding jaw over shoulder
⦿ Arms/legs on side to which head is
turned will extend while the
opposite leg will flex
⦿ Repeat on other side
⦿ Birth until 2-3 months
79
Trunk Incurvation (Galant) Reflex
Support infant prone and stroke one
side of the back 1cm from midline
from shoulder to buttock
⦿ Spine will curve toward stimulated
side
⦿ Birth to 3-4 months
spinal cord lesion or injury if not present
80
Landau Reflex
Suspend the infant prone with 1
hand
⦿ Head will lift up and spine will
straightem
⦿ Birth -> 6 months
if still there, prolonged, may be develomental delay
81
Parachute Reflex
Suspend prone and slowly lower
head to surface
⦿ Arms/legs will extend in a
protective fashion
-8months and beyond
82
Positive Support Reflex
Hold infant around trunk until feet
touch a flat surface
⦿ Hips, knees, ankles will extend the
infant will stand up, partially
bearing weight, sagging after 20-
30seconds
⦿ Birth or 2 months until 6 months
83
a newborn who is breeched may not have placing and stepping reflexes rihght away if its completely absent, worried about __________
paralysis
84
Placing and Stepping Reflexes
Hold upright, have one sole touch
the tabletop
⦿ Hip and knee of that foot will flex
and other foot will step forward
⦿ Alternate stepping will occur
⦿ Birth until variable age
85
AAP recommends infants < 1 year to be seen at:
Birth
* 3-5 days
* 1, 2, 4, 6, 9, 12 + 15 and 18 months then yearly
86
Obtaining an adequate psychosocial history: HEEADSS
⦿Home Environment
⦿ Education and Employment
⦿ Eating
⦿ Activities
⦿ Drugs and Alcohol
⦿ Sexuality
⦿ Suicide, depression, self-harm
⦿ Safety from injury/violence
87
Crying can cause an erythematous
TM
88
Femoral pulses are easier to palpate than __________, brachial easier than _______ on infants
brachial, radial
89
Tanner staging females:
difference between 4-5.....
90
Boys sexual maturity rating
......
91
18 m/o male with Acute otitis media, what drug are you going to use?
amoxicillin
< 2 years of age = 10 days
greater than 2 years of age = 5-7 days
92
Patient weights 20 lbs, what do we need to do to convert it
20/2.2 = 9.09 kg, would give 5.11 ml/dose
93
Patent ductus arteriosus (PDA)
Continuous “washing machine” murmur
94
The infants ear canal is directed ____________ from the outside, therefore pull the ear downward and outward not upward for the best view of the eardrum
downward
95
Mongolian blue spots
bluish/gray skin markings that commonly appear at birth or shortly after. They appear commonly on base of the spine, buttocks and back. They are benign and not associated with any condition.
96
Jaundice
occurs during days 2-5 of life, and progresses from head to toe as it peaks. Extreme jaundice may signify a hemolytic process of biliary or liver disease
