PLE 2019 Flashcards
How can infant’s perception and cognition be demonstrated during the first months of life? Demonstrated by:
A. Crying when hungry or sleepy
B. Eye gazing, head turning and sucking
C. Smiling when approached by mom or dad
D. Waking up during feeding period
A. Crying when hungry or sleepy
Social and Emotional:
● Begins to smile at people
● Can briefly calm herself (may bring hands to mouth and suck on hand)
● Tries to look at parent
Language/Communication
● Coos, makes gurgling sounds
● Turns head toward sounds
Cognitive (learning, thinking, problem-solving)
● Pays attention to faces
● Begins to follow things with eyes and recognize people at a distance
● Begins to act bored (cries, fussy) if activity doesn’t change
Movement/Physical Development
● Can hold head up and begins to push up when lying on tummy
● Makes smoother movements with arms and legs
During early childhood, children should sleep for how long without interruption?
A. 12-16 hours
B. 11-13 hours
C. 8-10 hours
D. 5-7 hours
C. 8-10 hours
> Toddler (1-3 yr)
Total sleep: average is 11-13 hr
Nighttime: average is 9.5-10.5 hr
Naps: average is 2-3 hr; decrease from 2 naps to 1 at average age of 18 mo
> Preschool (3-5 yr)
Nighttime: average is 9-10 hr
Naps decrease from 1 nap to no nap
Overall, 26% of 4 yr olds and just 15% of 5 yr olds nap
Baby Nicole already knows how to play peek-a-boo. She copies sounds and movements of others and points at things. She is able to stand with support, crawl and get into sitting position without support, and pulls to stand. She has met the milestones of what age?
A. 4 months
B. 9 months
C. 6 months
D. 12 months
B. 9 months
> 9 months
● May be afraid of strangers
● May be clingy with familiar adults
● Has favorite toys
● Understands “no”
● Makes a lot of different sounds like “mamamama” and “bababababa”
● Copies sounds and gestures of others
● Uses fingers to point at things
● Watches the path of something as it falls
● Looks for things she sees you hide
● Plays peek-a-boo
● Puts things in his mouth
● Moves things smoothly from one hand to the other
● Picks up things like cereal o’s between thumb and index finger
● Stands, holding on
● Can get into sitting position
● Sits without support
● Pulls to stand
● Crawls
The 9th month physical examination of an infant is difficult to do. Which endeavor is the LEAST likely way to get the child’s cooperation?
A. Talk to parent avoiding direct eye contact with child
B. Examine the child while on parent’s lap
C. Talk to the child with direct eye contact
D. Introduce the child to a small washable toy
A. Talk to parent avoiding direct eye contact with child
> General guidelines:
● Approach the infant gradually, using a toy or object for distraction.
● Perform much of the examination with the infant in the parent’s lap.
● Speak softly to the infant or mimic the infant’s sounds to attract attention.
● If the infant is cranky, make sure he or she is well fed before proceeding.
● Ask a parent about the infant’s strengths to elicit useful developmental and parenting information.
● Don’t expect to do a head-to-toe exam in a specific order. Take what the infant gives you and save the mouth and ear exam for last
What is/are the cause/causes of digital clubbing?
A. Chronic cardiac failure
B. Acute respiratory insufficiency
C. Defective heart valves
D. Chronic hypoxia and chronic lung disease
A. Chronic cardiac failure
> An increase in hypoxia may activate local vasodilators, consequently increasing blood flow to the distal portion of the digits; however, in most cases, hypoxia is absent in the presence of clubbing, and many diseases with noted hypoxia are not associated with clubbing.
Which statement is FALSE with regards to the origin of chronic coughs?
A. Lower respiratory stimuli include excessive secretions, aspirated foreign material, inhaled dust/gases.
B. Origin of coughs can also be a response to infectious agents or cigarette smoke.
C. Nighttime cough suggests upper airway disease such as sinusitis.
D. The receptors of chronic coughs are mostly located in the lower respiratory tract.
D. The receptors of chronic coughs are mostly located in the lower respiratory tract.
> Cough is a reflex response of the lower respiratory tract to stimulation of irritant or cough receptors in the airways’ mucosa. The most common cause in children is airway reactivity (asthma). Because cough receptors also reside in the pharynx, paranasal sinuses, stomach, and external auditory canal, the source of a persistent cough may need to be sought beyond the lungs.
Specific lower respiratory stimuli include excessive secretions, aspirated foreign material, inhaled dust particles or noxious gases, cold or dry air, and an inflammatory response to infectious agents or allergic processes.
Posterior pharyngeal drainage combined with a nighttime cough suggests chronic upper airway disease such as sinusitis. Additional useful information can include a history of atopic conditions (asthma, eczema, urticaria, allergic rhinitis), a seasonal or environmental variation
in frequency or intensity of cough, and a strong family history of atopic conditions, all suggesting an allergic cause; symptoms of malabsorption or family history indicating cystic fibrosis; symptoms related to feeding, suggesting aspiration or gastroesophageal reflux; a choking episode, suggesting foreign-body aspiration; headache or facial edema associated with sinusitis; and a smoking history in older children and adolescents or the presence of a smoker in the house.
Which one occurs during normal cardiac development?
A. The aortic sac gives rise to the right and left 1st aortic arches.
B. The 1st and 2nd arches form the common and internal carotid arteries.
C. The paired dorsal aorta will fuse to form the descending aorta.
D. The 5th arch persists in the mature circulation as a segment of the aortic arch.
C. The paired dorsal aorta will fuse to form the descending aorta.
> The aortic arch, head and neck vessels, proximal pulmonary arteries, and ductus arteriosus develop from the aortic sac, arterial arches, and dorsal aortae. When the straight heart tube develops, the distal outflow portion bifurcates into the right and left 1st aortic arches, which join
the paired dorsal aortae. The dorsal aortae will fuse to form the descending aorta.
The proximal aorta from the aortic valve to the left carotid artery arises from the aortic sac.
The 1st and 2nd arches largely regress by about 22 days, with the 1st aortic arch giving rise to the maxillary artery and the 2nd to the stapedial and hyoid arteries. The 3rd arches participate in the formation of the innominate artery and the common and internal carotid arteries. The right 4th arch gives rise to the innominate and right subclavian arteries, and the left 4th arch participates in formation of the segment of the aortic arch between the left carotid artery and the ductus arteriosus.
The 5th arch does not persist as a major structure in the mature circulation. The 6th arches join the more distal pulmonary arteries, with the right 6th arch giving rise to a portion of the proximal right pulmonary artery and the left 6th arch giving rise to the ductus arteriosus. The aortic arch between the ductus arteriosus and the left subclavian artery is derived from the left-sided dorsal aorta, whereas the aortic arch distal to the left subclavian artery is derived from the fused right and left dorsal aortae. Abnormalities in development of the paired aortic arches are responsible for right aortic arch, double aortic arch, and vascularrings.
Prostaglandin may be administered to patient with patent ductus arteriosus in which situation?
A. Patients who cannot undergo surgical management of ventricular septal defect.
B. Patient waiting for surgical management of transposition of great arteries.
C. Ductus arteriosus of a full term baby which has not closed a week after birth.
D. Ductus arteriosus persists in a child who is already 3 years old.
B. Patient waiting for surgical management of transposition of great arteries.
> Before birth, oxygenation of the fetus with transposition of great arteries is only slightly abnormal, but after birth, once the ductus arteriosus begins to close, the minimal mixing of systemic and pulmonary blood via the patent foramen ovale is usually insufficient and severe hypoxemia ensues, generally within the 1st few days of life.
When transposition is suspected, an infusion of prostaglandin E1 should be initiated immediately to maintain patency of the ductus arteriosus and improve oxygenation (dosage: 0.01-0.20 μg/kg/min).
Which of the following statements is true regarding cyanosis in the pediatric age group?
A. Acrocyanosis is a symptom of worsening cardiac functions in a newborn
B. Turning blue around the lips after crying vigorously is a definitive sign of heart disease
C. Cyanosis at rest is often overlooked due to variations in skin color of children
D. Mucous membranes are spared or not involved in true cyanosis in newborns
C. Cyanosis at rest is often overlooked due to variations in skin color of children
> Many infants and toddlers turn “blue around the lips” when crying vigorously or during breath- holding spells; this condition must be carefully differentiated from cyanotic heart disease by inquiring about inciting factors, the length of episodes, and whether the tongue and mucous membranes also appear cyanotic.
Newborns often have cyanosis of their extremities (acrocyanosis) when undressed and cold; this response to cold must be carefully differentiated from true cyanosis, where the mucous membranes are also blue.
What are heart murmurs?
A. They are signs of leaflet prolapse radiating anteriorly
B. They are results of audible vibrations caused by increased turbulence timed within the cardiac cycle
C. They are the differences between two cardiac chambers, ventricles and arteries
D. They are progressive attenuations of left ventricle to left atrial pressure gradient
B. They are results of audible vibrations caused by increased turbulence timed within the cardiac cycle
> Cardiac murmur is a characteristic sound generated by turbulence of blood flow through an orifice of the heart.
Which congenital malformation syndrome is least associated with the development of ventricular septal defect?
A. Trisomy 13
B. Fetal alcohol syndrome
C. Down’s syndrome
D. Congenital rubella
D. Congenital rubella
> Trisomy 13 (T13) and 18 (T18) are frequently (up to 80%) associated with multiple anomalies including congenital heart defects (CHD) such as atrial or ventricular septal defects (ASD, VSD), patent ductus arteriosus (PDA), atrioventricular septal defect (AVSD), tetralogy of Fallot (TOF) and others.
The specific defects that have been observed from prenatal alcohol exposure include defects to the atrioventricular valves (tricuspid and mitral) that allow blood to flow backward into the atria; ventricular septal defects, commonly known as a “hole in the heart” between the left and right ventricles; enlargement of the left ventricle, the primary pumping chamber in the heart; and an increased risk of developing heart disease later in adult life.
Ventricular septal defect is a common cardiac anomaly in Down syndrome.
Congenital rubella may also present with VSD. However, the most common congenital heart defect associated is PDA.
A patient presents with VSD in which blood is shunted from right to left secondary to the development of pulmonary vascular disease. This condition is known as:
A. Pulmonary arteriovenous fistula
B. Eisenmenger syndrome
C. Ectopia cordis
D. Ebstein anomaly
B. Eisenmenger syndrome
> Eisenmenger syndrome (ES) is a constellation of symptoms that arise from a congenital heart defect and result in large anatomic shunts. Due to anatomic variations present at birth, hemodynamic forces initially result in a left-right shunt, which develops into severe pulmonary arterial hypertension (PAH) and elevated vascular resistance. Ultimately, due to increased pulmonary vascular resistance, the left-to-right shunt will become a right-to-left shunt, resulting in significant hypoxemia and cyanosis.
The boot shaped sign seen in the radiographs of patients with Tetralogy of Fallot is from:
A. The convergence behind the heart of the pulmonary vein, instead of draining into the left atrium
B. The shortening of the left ventricular inflow tract and elongation of the left ventricular outflow tract
C. The contour of the aorta deformed by both pre and post stenotic dilation, and dilation of the subclavian artery
D. The upturning of the cardiac apex due to right ventricular hypertrophy and by the concavity of the main pulmonary artery
D. The upturning of the cardiac apex due to right ventricular hypertrophy and by the concavity of the main pulmonary artery
> The boot-shaped heart sign is a conventional radiographic finding in patients with TOF. The toe of the boot is formed by the upward pointing cardiac apex, which makes an acute angle with the diaphragm. The upturned cardiac apex is ascribed to right ventricular hypertrophy and occurs in 65% of patients with TOF.
This type of total anomalous pulmonary venous return involves pulmonary venous connection at the cardiac level. The pulmonary veins join either the coronary sinus or the right atrium. What type is this?
A. Type IV TAPVR
B. Type I TAPVR
C. Type II TAPVR
D. Type III TAPVR
C. Type II TAPVR
The most common major congenital heart lesion is:
A. TOF
B. VSD
C. PDA
D. ASD
B. VSD
> VSD is the most common cardiac malformation and accounts for 25% of congenital heart disease. Defects may occur in any portion of the ventricular septum, but most are of the membranous type.
