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MCN568 > Physical Assessment > Flashcards

Physical Assessment Flashcards

1
Q

routine examination of the newborn

A

within 24 hours of birth

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2
Q

Significant Congenital Anomalies

A

congenital heart disease, hypospadias, down syndrome

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3
Q

order of examination

A

The exact sequence in which the newborn is examined is flexible so long as the entire body is examined at some stage

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4
Q

general observation

A

weight, length, head circumference, GA, general observation, movement and tone

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5
Q

head and face

A

fontanelle, facial appearance, and dysmorphic features

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6
Q

eyes

A

cataract, red eye reflex

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7
Q

mouth

A

cleft lip and palate, central cyanosis

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8
Q

Upper limbs

A

digits, palmar creases

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9
Q

chest

A

RR, retraction, heart sounds and murmurs

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10
Q

pulses

A

femoral

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11
Q

genitalia and anus

A

hypospadias, undescended testes, ambiguous genitalia, anus-position and appearance

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12
Q

back

A

midline defects

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13
Q

abdomen

A

abdominal distention, enlarged liver, spleen, kidneys or mass

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14
Q

hips

A

developmental dysplasia of the hips

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15
Q

lower limbs

A

talipes-positional, equinovarus

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16
Q

CDC/WHO full term female weight

A

2.7-3.85kg

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17
Q

CDC/WHO full term male weight

A

2.8-4kg

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18
Q

head circumference female

A

32-35cm

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19
Q

head circumference male

A

33-36cm

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20
Q

central cyanosis

A

best observed on the tongue

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21
Q

asymmetric crying face

A

congenital absence of the depressor anguli oris muscle

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22
Q

neonatal urticaia

A

2-3 day of day, rash; white pinpoint papules at the center an erythematous base, EOSINOPHILS; migrates to other sites, resolved by day 5

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23
Q

neonatal pustular melanosis

A

birth; NEUTROPHILS; readily removed by wiping, can be mistakem for staphylococcal infection

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24
Q

Milia

A

bening white cyst; nose and cheeks; retention of keratin and sebaceous material

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25
Q

harlequin color change

A

reddening and blanching; last for few minutes, due to vasomotor instability

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26
Q

Mongolian blue spots

A

base of spine /buttocks

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27
Q

Cafe au lait spots

A

common, more than 6 underlying disorder

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28
Q

capillary hemangiomas/stork bites

A

pink macules, caused by distention of dermal capillaried; upper eyelids, mid forehead, nape of the neck; fade over teh first year

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29
Q

port-wine/nervus flammeus

A

unilateral or segmental, do not cross midline; do nto fade will grow with child and become darker; evaluate infant for glaucoma and brain lesions (intracranial vasular anormalities)

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30
Q

most common benigh tumor of infancy

A

strawberry nevus/infantile hemangiomas; RX: propranolol

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31
Q

tense fontanelle

A

increased intracranial pressure: HUS; meningitis: LP

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32
Q

caput succedaneum

A

bruising and edema of the presenting part of the head

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33
Q

cephalohematoma

A

bleeding between peristeum and skull bone, confine within margins of the skull sutures, parietal bone, does not cross midline

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34
Q

subgaleal hemorrhage

A

bleeding between galea aponeurosis and periosteum; vacuum extractions; “wave sign”; potencial for large blodo loss causing hypovolemic shock

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35
Q

craniosynostosis

A

premature fucion of one or more cranial sutures; might restrict brain growth

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36
Q

coloboms

A

defect in a normal eye tissue

CHARGE syndrome

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37
Q

normal ears

A

the top third of the ear is level with a line drawn from the inner to the outer canthus of the eye

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38
Q

preauricular tags

A

ear skin tag

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39
Q

webbed neck, lymphydema of the feet

A

Turner syndrome

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40
Q

normal periodic breathing

A

up to 10 sec

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41
Q

HR

A

120-160

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42
Q

heart murmur

A

reflect directly for ECHO

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43
Q

single umbilical artery

A

asymptomatic renal abnormalities

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44
Q

micropenis

A

less than 2cm, suggests congenital hypopitutarism

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45
Q

hypospadias

A

urethral meatus is in abnormal position

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46
Q

polydactyly

A

extra digits

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47
Q

syndactyly

A

fused gigits

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48
Q

clinodactyly

A

bend digits

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49
Q

Trisomy 21

A

single palmar transverse creases

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50
Q

Clavicle fractures

A

supportive care only, immobilization for comfort

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51
Q

talipes equinovarus

A

feet turned inward from intrauterine compression/clubfeet

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52
Q

Ortolani manouver

A

when the posteriorly dislocated femoral head can be returned to the acetabulum

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53
Q

Barlow manouver

A

when the femoral head is in the acetabulum at rest but is dislocatable posteriorly out of the acetabulum,

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54
Q

developmental reflexes

A

rooting, sucking, palmar grasp, moro responses

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55
Q

Ballard examination

A

GA, 6 neurological, and 6 physical

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56
Q

CCHD AAP recomendations

A

Any oxygen saturation (SpO2) is less than 90%.

Oxygen saturation is less than 95% in both extremities on three measures, each separated by 1 hour.

There is a greater than 3% absolute difference in oxygen saturation between the right hand and either foot on 3 measures, each separated by 1 hour.

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57
Q

Erythema and Abrasions

A

dystocia, forceps delivery; self resolving within several days

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58
Q

Petechiae

A

head, neck, upper portion of the chest, and lover portion of the back at birth after a difficult delivery, self resolving

59
Q

Ecchymoses/bruising

A

traumatic or breech deliveries; may cause increase in bili; resolve in 1 week

60
Q

subcutaneous fat necrosis

A

rare form of panniculitis seen mostly in term or post-term infants characterized by well-circumscribed, indurated lesions of the skin and underlying tissue; associated with perinatal asphyxia and may be associated with hypercalcemia

61
Q

Lacerations

A

inflicted with a scalpel during cesarean section

62
Q

caput succedaneum

A

frequently, vaquely demarcated area of edema over presenting portion of the scalp; serum or blood; may extend across the midline of the skull; diminished 48-72 hours post delivery; EXTERNAL to periosteum

63
Q

cephalhematoma

A

infrequent subperiosteal collection of blood overlying a cranial bone; mechanical trauma, rupture of diploic blood vessels that traverse from skull to periosteum; limitation to one bone; no overlying discoloration; later swelling, longer time of resolution: 3-4 weeks; BENEATH the periosteum

64
Q

subgaleal hemorrhage

A

collection of blood in soft tissue between the galea aponeurotica and periosteum of the skull; midforceps and vacuum extractions; fluctuating mass straddling cranial sutures, fontanelles, or both; signs of hypoperfusion and falling hematocrit; Prompt restoration of blood volume with fresh frozen plasma or blood is essential;

65
Q

skull fractures

A

uncommon; forceps delivery(depressed fractures) or difficult; most fractures are linear; labor

66
Q

linear fracture

A

soft tissue changes and cephalhematoma

67
Q

depresses fractures

A

visible, palpable indentations in the smooth countour of the skull, ping-pong ball

68
Q

Facial Nerve Palsy

A

spontaneous recovery; compression of the peripheral portion of the nerve by forceps or maternal sacral promontory; paralysis;

69
Q

clavicle fracture

A

greenstick type, but occasionally the fracture are complete

70
Q

liver rupture

A

most frequently injured abdominal organ during the birth process

71
Q

maxilla, lacrimal bones, and nose fractures

A

may present with respiratory distress and warrant emergent surgical attention

72
Q

Duchenne-Erb palsy

A

mechanical trauma to the spinal roots of the fifth cervical through the first thoracic nerves (D-E: 5th and 6th cervical roots)

73
Q

congenital anomaly

A

an internal or external structural defect that is identifiable at birth

74
Q

malformation

A

primary structural defect in tissue formation (neural tube defect, congenital heart defect); genetic or teratogenic factor

75
Q

deformation

A

abnormal mechanical forces acting on otherwise morphologically normal tissues; clubfoot, altered head shape

76
Q

disruption

A

destruction nor interruption of intrinsically normal tissue

77
Q

single gene / mendelian

A

limb anomalities

78
Q

chromosomal

A

Downs Syndrome

79
Q

subconjunctival hemorrhage

A

blood absorbed in 1-2 weeks

80
Q

phrenic nerve paralysis

A

injuries are unilateral and are associated with ipsilateral upper brachial plexus palsy; ultrasonographic examination; The infant should be positioned on the involved side, and oxygen should be administered for cyanosis or hypoxemia.

81
Q

torticollis

A

more of inuretro positioning; shortened sternocleidomastoid muscle; The head tilts toward the involved side, and the chin is somewhat elevated and rotated toward the opposite shoulder. The head cannot be moved passively into normal position.

82
Q

dysmorphisms

A

anomalous external physical features

83
Q

association

A

multiple congenital anomalities: VATER, CHARGE

84
Q

syndrome

A

recognized pattern of anomalities with specific, usually heritable cause: Holt-Oram syndrome, The Cornelia de Lange syndrome

85
Q

etiology of malformations broad categories

A

genetic(multifactorial, single gene/Mendelian, or chromosomal), environmental/teratogenic, and unknown

86
Q

genetic complex examples

A

congenital heart defects, neural tube defects, cleft lip and palate, clubfoot, congenital hip dysplasia; usually genetics and environmental

87
Q

single gene/Mendelian examples

A

limb anomalities, Smith-Lemli-Opitz syndrome;

88
Q

chromosomal examples

A

down syndrome/trisomy 21; trisomy 18, and trisomy 13; aneuplodidies of the sex chromosomes (Klinefelter syndrome or Turner syndrome)

89
Q

chromosomal aberrations testing

A

karyotype, FISH, chromosomal microarray (SNP); WES

90
Q

teratogen

A

anything external to the fetus that causes a structural or functional disability in prenatal or postnatal life

91
Q

common teratogens

A

alcohol, anticonvulsants, some altered metabolic states in the mother, (DM, phenylketonuria), infections (TORCH(toxoplasmosis, syphilis, rubella, cytomegalovirus, and herpes simplex

92
Q

congenital anomalities goal of the physical examination

A

to determine whether an anomaly is isolated or to detect a recognizable pattern of malformation so that a specific etiologic determination can be made

93
Q

genetics skin

A

trisomy 21, hypothyroidism, cornelia de Lange syndrome-marbling pattern called cutis marmorata; Cafe-au-lait spots_neurofibromatosis

94
Q

genetics hair

A

sparse hair: ectodermal dysplasia; hirsutism: cornelia de lange syndrome, FAS

95
Q

genetics head

A

macrocephaly, microcephaly

96
Q

dolichocephaly

A

increase in anteriorposterior diameter

97
Q

brachycephaly

A

decrease in anteriorposterior diameter

98
Q

plagiocephaly

A

assymetric head shape

99
Q

hypotelorism

A

eyes too close together

100
Q

hypertelorism

A

eyes too far apart

101
Q

holoprosencephaly

A

trisomy 13

102
Q

epicanthal folds

A

normal, but also in trisomy 21

103
Q

coloboma

A

defect in eyelid margins; CHARGE syndrome

104
Q

synophrys

A

fusion of the eyebrowns in the midline

105
Q

microstomia

A

small mouth

106
Q

macrostomia

A

large mouth

107
Q

omphalocele

A

abdominal contents protrude through the umbilical opening

108
Q

gastroschisis

A

isolated disruption in which the abdominal contents protrude through the periumbilical abdominal wall

109
Q

APGAR

A

heart rate, respiratory effort, muscle tone, reflex irritability, color

110
Q

BALLARD neurological

A

posture, square window, arm recoil, popliteal angle, scarf sign, heel to ear

111
Q

BALLARD physical

A

skin, lanugo, plantar surface, breast, ear/eye, genitalia

112
Q

sucking reflex

A

birth, develop 33-36 weeks GA

113
Q

rooting reflex

A

stroke the cheek and the corner of mouth

114
Q

palmar grasp

A

tighting grasp, apparent at 28 weeks, strong by 36 weeks

115
Q

tonic neck reflex

A

supine, head to the side, upper extremity extended on the side head is turned, fencing position

116
Q

moro reflex

A

response to the sensation of loss of support, spreading movement of arms and hands, appears at 24-26 weeks, evolves throught 38

117
Q

stepping refles

A

neonate held upright, alternating stepping movements

118
Q

truncal incurvation reflex

A

ventral suspension, pressure parallel to the spine and thoracic area

119
Q

babinski reflex

A

sole of the foot, plantar flexion, positive is normal: extension of toes, up to 18 months

120
Q

Alpha-Fetoprotien Level

A

15-18 weeks pregnancy; neural tube defects

121
Q

Aminocentesis

A

for MOB with known hereditary disorders, over 35 years old, Rh disease for optical density; trisomy 21; 18-20 weeks; later for fetal lung maturity

122
Q

Assessment of Fetal Activity

A

kick count by MOB; 28+ weeks; 4 fetal movements per hour

123
Q

Biophysical Profile

A

US and nonstress test; includes: AF index, fetal breathing, gross and fine movement, fetal tone

124
Q

Chorionic Villus Sampling

A

chromosomal or biochemical defects; transabdominal or transcervical; 10-12 weeks, results in 24 hours;

125
Q

Contraction Stress Test

A

FHR to uterine contractions; positive test (needs follow up) shows late decelerations in FHR

126
Q

Doppler Velocimetry

A

blood flow in the umbilical arteries during diastole; placental perfusion; used in twin to twin transfusion in utero

127
Q

Fetal Fibronectin Levels

A

“glue” , positive predictor of preterm labor and impending birth

128
Q

Human Placental Lactogen Levels

A

low levels indicate uteroplacental insufficiency in maternal HPT;

129
Q

Lecithin-Sphingomyelin Ration

A

L/S ration determines fetal lung maturity is done on AF; ; risk for many false high levels: blood, mec, vaginal seccretions

130
Q

Lung Profile

A

L/S ration and PG levels; increase PG indicate mature lungs;

131
Q

Maternal Serum Estriol Levels

A

increase as pregnancy advances; sharp or progressive decrease indicates fetal compromise;

132
Q

Noninvasive Prenatal Screening NIPS

A

cell-free DNA analysis; Trisomies; MOB blood testend of first trimester

133
Q

Nonstress Test

A

tests placental function that assesses FHR acceleration and variability; monitor MOB for 20-60 minutes increase of FHR by 15 bpm

134
Q

Shake Test

A

AF for lung maturity indicated by a complete ring of bubbles in dilution of AF and ethanol

135
Q

Ultrasound

A

GA, altered or abnormal growth, malformations; Placenta GRADE 0-III; Amniotic fluid volume (AFV); trisomy 21 (nuchal fold)

136
Q

Unconjugated Estriol and Human

Chorionic Gonadotropin Levels

A

trisomy 21 and 18;

137
Q

Cord Blood Gases

A

for low apgar scores,

138
Q

FHR monitoring

A

120-160 bpm normal; early decels: benign; variable decels: umbilical cord compressions; late decels: fetal hypoxemia

139
Q

pH of umbilical and/or fetal Scalp Blood

A

compared with APGAR scores; 7.27-7.28

140
Q

Brazelton Scale

A

“cost of attention” amount of energy the infant must expend to maintain interaction; evaluates baby reflexes, muscle tone, state changes, and responsiveness to physical and social stimuli

141
Q

dolichocephaly

A

premature infant; flattened one side of the head without craniosynotosis

142
Q

craniotabes

A

soft or thinning bone; “ping-pong ball”; vitamin D deficiency

143
Q

ankyloglossia

A

tonge tie

144
Q

cystic hygroma

A

neck mass

MCN568 (11 decks)

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