Peds Lecture Flashcards
What do you see with fetal alcohol syndrome?
indistinct philtrum micrognathia (smaller chin) low nasal bridge prominent epicanthal folds thin upper lip
about when can you get a reliable history form a child?
Around 8 years old
What do you need to screen breech babies for?
Hip dysplasia
What age is considered neonate?
first month of life
What is the early childhood age range?
1-4 years
What is the middle childhood age range?
5-10 years
What is the adolescent years?
11-20 years
About when should children string 2 words together?
18 months
When is BMI helpful?
Over 2 years of age
When do you start blood pressures in a child?
2 years of age
What are the most common causes of HTN in children?
Renal artery stenosis
coarctation of the aorta
What would be a sign of coarctation of the aorta?
High BP in the upper extremities than lower extremities
What is the most reliable of temperature?
Rectal, but usually do tympanic in clinic
What is the cut off for fever in children?
100.4 degrees
What normally causes bradycardia in children?
neurological condition, heart block, hypoxia, anaphylaxis
Are respiratory rates higher or lower in children?
Higher
What does a slow respiratory rate indicate in children?
Respiratory failure (impending doom sign)
What is the primary way babies eliminate bilirubin?
Feces
Do formula fed or breast fed babies tend to stay jaundice for longer?
breast fed (takes longer to be absorbed)
Where is central cyanosis?
Lips, chest
Sign of pulmonary complications, sepsis
What is acrocyanosis?
On extremities, armpits, neck
More of an issue of temperature regulation
What is direct bilirubin?
Normal bilirubin
Being conjugated, but reabsorbed
If you see indirect bilirubin elevation what does it mean?
There is a back up , hasn’t been conjugated by liver yet
lysis of RBCs
sign of biliary atresia or acute liver failure
Condition with lots of port wine stains, retardation, trigeminal nerve problems.
Sturge- Weber syndrome
What is an uncommon congenital telangiectasias usueally over limbs, can be associated with congenital malformations including glaucoma, syndactyly, renal hypoplasia
Cutis marmorata
Common rash in newborns. Over bridge of nose and cheeks. White pink point dots, look shiny. Resolve when pores are largers.
Milia; if inflamed (milia rubra)
What is fluffy hair on a fetus than can still be there in infancy. Usually on shoulders/ back
Lanugo
What are red swollen bumps on a babies’ face usually due to blocakges on pores. Go away within 2/3 months of life.
Erythemia toxicum
What is abnormal shape of head, usually enlarged. Often caused by craniosynostosis?
Plagiocephaly
What does a white reflex of the eyes indicate?
Detached retina
congenital illness
When do you start with visual acuity exam?
Age 3
Babies are obligate ____ breathers.
Nose
What is an obstruction of nasal passages- the baby is blue at rest but pinks up when crying.
Choanal atresia
What sinuses are present at birth?
Ethmoid
What is a white dot on the middle of the palate?
Epstein’s pearls
what are the best pulses for infants?
Brachial
femoral
Is S3 or S4 normal?
S3 is normal
S4 is also abnormal
What is a Stills murmur?
LL sternal border
musical sound
holosystolic
normal up to 2-5 yeras
humming noise from jugular vein. Best heard around clavicular area and at juggular
Venous Hum
What should the umbilical cord be made of?
2 arteries
1 vein
what is the term for knock knees?
genu valgum
hard mass in left upper quadrant. Feels like and olive pit. Will have acute vomiting of green substance
Pyloric stenosis
Which hernia is normal in infancy: inguinal or umbilical?
Umbilical
What is the first sign of puberty in males?
Increase in size of test (age 9-13.5)
What is the test where you bend a child’s knees and push straight down into table? (for hip dysplasia)
Barlow
What test is where you externally rotate the infants legs to test for hip dysplasia?
Ortolani test
what is the term for bow legged?
genu varum
What is an internal rotation and inversion at the ankle? unable to bring back towards normal.
Club feet
what is a test for weak hip abductors?
Trendelenburg-shift (sag to opposite side)
What tests for suspicion of Duchene’s muscular dystrophy?
Will do a reverse crab walk in order to get up
can’t go from lying down to standing using just leg muscles
What is the name for the startle reflex? When does it occur/ disappear?
Moro reflex
0-4 months/ 6 months
What is the asym tonic neck?
When you turn their head, they will turn their heads and feet towards that side.
Present at 0-2 months
hyperreflexia in the lower extremities can be significant for what?
muscular dystrophy
What are the main focuses for the 1st week visit in the newborn?
Mother’s/Parent’s appearance/interactions or evidence of depression: Newborn jaundice, weight, stool/urine pattern, murmurs, red reflex, hips
What should bath water temp be?
120F
Any fever within __________of life is a sign of serious infection.
2-3 months
What are pink “bloody” diapers?
urate crystals
_____ of milestones is always concerning.
Loss of
What is different for PMH in newborn versus adult?
PMH may include birth history and complications
When do you screen for hip dysplasia?
2-3 months
What is enuresis?
inability to control urination
What does HEEADSS stand for?
Home Environment Education Activities Drugs Sexuality Suicide/depression
How is the order of exam different for infants and toddlers versus adults?
start with least intimidating to most intimidating (usually start w/ reap/heart and then throat/genitals last)
What age can you examine a child without the parent present?
> 11 years
What does APGAR stand for?
Activity Pulse Grimace Appearance Respirations
If APGAR is between 5-7 at 1 minute it means
moderately depressed (some nervous system depression)
If APGAR if between 0-4 at 1 minute means
Severely depressed (immediate resuscitation)
APGAR that is excellent condition at 1 minute has what points?
8-10
If the 5 minute APGAR score is between 0-7, what is the risk
risk for subsequent CNS, other organ system dysfunction
What three components help determine GA?
weight, lenght, head circumferance
Where do you measure head circumference 0-2 years?
frontal occipital circumferance or OFC
A weight loss of more than _______% in 1st month of life is concerning for failure to thrive
10%
Why don’t you do a BMI for <2years?
most body mass is fat
What is failure to thrive related to?
Chronic disease Congenital disorder Inadequate calories and protein Improper feeding methods Intrauterine growth restriction Emotional deprivation
What is the most common cause of HTN for middle school age?
renal artery or renal disease
Coarctation of the aorta
primary HTN
What it the most common cause of HTN for infancy-preschool?
renal artery or renal disease
Coarctation of the aorta
What is the most comon cause of HTN in adolescents?
primary HTN
renal disease
drug induced
Where should you take temp?
tympanic or rectal
A fever > _______ in first 3 months of life is a sign of serious infection.
> 100.4F
How do children affect cardiac output?
through rate only (not stroke volume)
What is central cyanosis?
lips and truncal cyanosis; bad (heart disease/malformation, pulmonary complications, sepsis)
What is acrocyanosis?
extremities, folds of body, temperature related usually
How is bilirubin eliminated as baby? Why?
poop/urine; liver is still maturing
What can happen if bilirubin persists beyond the 1st weeks of life or have elevated/conjugated bilirubin?
can deposit in brain and cause seizure disorders or mental retardation
What resembles a bruise, is found in darker skinned populations and goes away within 4-5 years of life?
mongolian spot
What are multiple Cafe au Lait a sign of?
Neurofibrometosis
What is an uncommon telangiectasis usually over the limbs that can be associated with congenital malformations (glaucoma, syndactyly, renal hypoplasia)
Cutis marmorata
What are Milia and where are they found?
white pinpoint dots (hair follicle has pouched out and formed cysts); bridge of nose and cheeks
What is an inflamed milia called?
milia rubra
What is fluffy black hair on shoulder and back that goes away?
Lanugo
What is plagiocephaly?
abnormal shape of head; usually enlarged; often caused by craniosynostosis
What is craniosynostosis?
abnormal closure of sutures
Presence of lymph nodes is more commonly associated with this pathogen
virus
What is torticollis?
bleeding into SCM muscle during the stretching process of birth; a firm fibrous mass is felt within the muscles 2-3 weeks after birth and disappears over months
What nodes react most quickly to mild stimuli?
cervical and postauricular
What is the white reflex?
- congenital cataracts or congenital glaucoma, dethatched retina, rubella or varicella
- Always a bad thing to see this
What age do you begin to use charts for visual acuity?
> 3 years
What is most common visual disorder in children?
myopia (nearsightedness)
What is the reflex called when child blinks at sudden sharp sound?
acoustic blink refle
____ and _____ development are usually at the same time
eye and kidney
A formal hearing exam is recommended by AAP at ____ years
4
What is an obstruction of nasal passages associated with a baby blue at rest but pinks up when crying? Has difficulty nursing
Choanal atresia
Tiny white or yellow rounded mucous retention cysts that are found on the hard palate and go away in 6 months
Epstein’s pearls
Tonsillar hypertrophy is a sign of what
sleep apnea
What can wheezing be a sign of in infants and young children?
RSV, asthma
What 2 pulses do you take?
brachial
femoral
Are thrills normal?
can be normal from turbulence in the heart or great vessels
Why is S3 often normal in children?
can be normal due to rapid ventricular filling
What problems are associated with S4/gallop in children?
CHF, poor ventricular function
What are pathologic murmurs in children?
VSD, PDA, Pulmonary/aortic stenosis, AV regurgitation at birth, Aortic stenosis, aortic septal defect
What are benign murmurs of later preschool?
carotid bruit
What are benign murmurs of adolescence?
pulmonary flow murmur
What are benign murmurs of preschool =?
still’s, venous hum
What are benign murmurs of infancy?
closing ductus, peripheral pulmonary flow
What is different about the sound with percussion for children than adults?
more tympanic
How far below costal margin is liver edge normally?
1-2 cm
What is the first sign of puberty in girls and what is it in males?
Girls= growth spurt Males= growth of testes
When do you begin breast exams?
older adolescence
What does candida look like for diaper rash?
big red plaques, satellite lesions, painful, after illness or antibiotic use
What hernia is normal in infancy?
umbilical hernia
How long does maturity (puberty) take?
1.8 - 5 years
When do boys testes increase in size?
9-13.5 years
When does the growth spurt in girls happen?
9.5-14.5 years
Explain Ortolani test
Flex legs to form right angles at hips and knee
Abduct both hips simultaneously until both knees hit examining table
Explain Barlow test
Pull leg forward and adduct with posterior force (push hips towards table)
What does a positive Barlow mean?
dysplastic hip
What is the real name for bowlegged?
Genu varum
When is Genu varum abnormal and what is it a sign for?
Always abnormal 5+
Common in babies learning to walk; sign of Rickets
What is the real name for knockknee
Genu valgum
What should Genu valgum go away?
4-5 years
What foot problem is most common?
clubfoot
What is characteristic about clubfoot?
inversion and medial rotation not correctible by manual manipulation
What is Trendelenberg shift?
A pelvis that remains level when weight is borne on the unaffected side; positive sign is when the pelvis tilts toward the unaffected hip during weight bearing on affected side
What does Gower maneuver test for?
Duchenne’s musculodystrophy
What is the Gower maneuver?
Will rise to standing by rolling and pushing off the floor with arms while legs remain extended
What is Moro reflex (startle reflex)
Hold baby supine and abruptly lower body about 2 feet; arms abduct and extend, hands open, legs flex —> birth to 4-6 months
What is asymmetric tonic neck reflex?
Baby is supine turn head to one side, holding the jaw over shoulder; the arms/legs on side to which head is turned will extend while the opposite arm/leg flex —> 0-2 months
What is it when you support the baby prone with on hand and stroke one side of the back and the spine curves toward the stimulated side
Trunk Incurvation (Galant’s reflex) —> 0-2 months
What is when you hold the baby upright and have one foot touch the table. The hip and knee of that foot will flex and the other foot will step forward; alternate stepping will occur?
Placing and Stepping Reflex (0-? months)
What is when you suspend the baby prone with one hand and the head will lift up and the spine will straighten?
Landau 0-6 months
What is when you suspend the baby prone and slowly lower the head toward a surface. The arms and legs extend in protective fashion?
Parachute Reflex 0-6 months
