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OB Peds > Test 2 > Flashcards

Test 2 Flashcards

1
Q

Ballard Scoring System

A

Term 37-42 weeks

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2
Q

Birthweight Classification

A

> 2500 g normal

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3
Q

Newborn Classifications

A

Appropriate for Gestational Age (AGA) 10th to 90th percentile
LGA-Large
SGA-Small

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4
Q

Two pulse locations

Rates

A

Apical- 3-5th costal interspace midclavicular
Femoral- Between ASIS and pubic tubercle
Infant- 120-170 (3yr 80-120=active adult rate)

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5
Q

Respiration where at what age
Effort (more important than rate)
Normals

A

Infants-abdomen; Children-Chest (CC)
Retraction (ribs SC notch), Contraction (SCM), Flaring nostrils, paradoxic breathing
Newborn 30-80 (10 years 16-20 same as adult)

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6
Q

Blood Pressure Techniques

Cuff size problems

A

Flush, After 2 years same as adult

Too wide- underestimate BP; Too narrow- artificially high BP (tight rope)

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7
Q

Average weight,
length,
head circumference
variance w/in family

A

5 lb 8 oz- 8 lb 13 oz 5+8=13
18-22 in
13-14 in
6 oz

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8
Q

APGAR

Normal Scores

A

Appearance, Pulse, Grimace, Activity, Respiration
1 min. normal 8-10, slight depression 5-7, severe 0-4
5 min normal 8-10, severe depression 0-7
Rare to get a 10 due to acrocyanosis

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9
Q

Rapidly increasing head circumference

Head circumference decreasing or falling behind

A

incr. intracranial pressure dDx: Hydrocephaly etc.

microcephaly dDx:craniosynostosis etc

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10
Q

2 Short congenital syndromes

A

Down

Turner (webbed neck, shield chest, widespread nipples, low hairline, lymphedema, etc.)

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11
Q

Normal Variants in newborns

A

Transient puffiness- should disappear in 2-3 days
Baldness- hair disappears in 2-3 months and grows back
Dark skinned- not the intensity of melanosis that occurs in 2-3 mo. except on scrotum and nail beds
Red Skin first few days of life

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12
Q

Cutis Marmorata

Acrocyanosis

A

transient mottling after infant is exposed to changing temperatures

blue hands and feet normal in cold BUT if feet worse than hands expect cardiac condition i.e. coartactation

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13
Q

Vernix Caseosa

A

White mixture of sebum and skin cells (cheeselike), covers infants body, protective

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14
Q

Lanugo

A

fine silky hair covering newborn esp. shoulders and back

lose in 10-14 days

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15
Q

Telangiectatic nevi

AKA

A

stork bites

red splotchy area at back of neck

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16
Q

Dermal melnocytes

AKA

A

Mongolia Spots
irregular blue/blue-gray areas seen in sacral and gluteal regions
$seen mostly in Latin, Native American, African, Asian descent

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17
Q

Erythema Toxicum

A

“baby acne”
pink papular rash with vesicles superimposed on trunk
appear 24-48 hrs. after birth resolve after several days (parents think it’s an allergic rxn)

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18
Q

Hyperbilirubinemia

A

Examine whole body (sclera, and mucosa) in daylight for “dermal icterus” yellow skin. starts in face and works down.
if in the face 5 mg/dL no problem
if in below nipples 12 mg/dL= worrisome
>20 mg/dL problems

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19
Q

Risk factors for Hyerbilirubinemia

Treatment

A

BREAST FEEDING-ß-glucoronidase, hemolytic disease, infxn, cephalhematoma, cutaneous/subcutaneous bleeds

Bili Lamp, Bili blanket

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20
Q

Physiologic Jaundice (normal)

A

50% of newborns can’t conjugate bilirubin
shows 1st day of life, normal 8-10 days, can be 3-4 weeks
Treatment- bili lamps & blankets, rarely rises above 20 mg/dL
Need regular bowel move’t to clear out bilirubin, may cause baby to be sleepy and not nurse

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21
Q

Pathological jaundice

A 
present w/in 24 hrs, intense, and/or persistent 
RBC abnormalities/sensitivity
Hemorrhage
Impaired Liver fxn
TORCH infection (syphilis)
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22
Q

Single simian line

A

Possible downs

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23
Q

Skin Turgor

Tenting

A

Pinching abdominal skin

means dehydration, malnutrition

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24
Q

Nail Clubbing

A 
CARDIOVASCULAR DISEASE
Respiratory disease
Thyroid disease
Cirrhosis
Colitis
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25
Q

Milia

A

Small white papules on face (whiteheads) from plugged sebaceous glands (similar to erythema toxicum)
Common in first 2-3 months

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26
Q

Milaria

A

NOT milia

Heat rash, caused by occlusion of sweat ducts, high heat and humidity

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27
Q

Impetigo

A

HONEY COLORED CRUSTS

caused by staph or strep infection

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28
Q

Strawberry Hemangioma

A

Birth: not present
1-2 mo: noticable
1-6 mo: most growth
12-18 mo: begins to shrink

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29
Q

Trichotillomania

A

Hair loss differing from male pattern baldness
Excessive emotional stress
OCD

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30
Q

Faun Tail Nevus

A

Spina Bifida Occulta

lumbosacral area

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31
Q

Cafe au lait spots

A

Suspect NEUROFIBROMATOSIS if >5 patches in child 1cm
Pulmonary Stenosis
Tuberous Sclerosis
Temporal Lobe dysrhythmia

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32
Q

Axillary/Inguinal Freckling

A

suspect NEUROFIBROMATOSIS

may or may not have cafe au lait spots

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33
Q

Facial Port Wine Stain

A

trigeminal nv. distribution
may be associated w/ STURGE WEBER syndrome leading to seizures
or Occular defects

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34
Q

Supernumerary Nipples

A

w/ other anomalies are renal abnormalities

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35
Q

Neonate Lymph Nodes

A

respond quickly to any stimulus esp. cervical & post. auricular
theory is that they make up for lack of antibodies by incr. phagocytosis and filtration

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36
Q

Obstructive Sleep Apnea

A 
excessively large tonsils leading to 
loud snoring, restless sleep
daytime sleepiness
morning headaches
can lead to DEVELOPMENTAL DELAY & FREQ. INFECTION
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37
Q

Lymph Exam

$

A

Not uncommon to find enlarged nodes

NORMAL- firm, movable, discrete, 2-3cm, fixed and immovable

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38
Q

Expected Lymph Node Enlargement

A

2 yr cervical submandibular

$NEVER normal for supraclavicular (Lung Ca, Stomach Ca, lymphoma)

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39
Q

Infectious Mononucleosis

EBV

A

may occur at any age
Enlarged ant. and post. Cervical chains
Pharyngitis, fatigue, malaise, fever
Splenomegaly, Hepatomegaly, RASH may be present.
Very Similar to strep, just have to do test.

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40
Q

Strep Pharyngitis

A

usually cold symptoms DON’T precede strep
Palatal petechiae, enlarge ant. cervical chain
Test needed to confirm

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41
Q

McIsaac strep score

A

temp. >100.4ºF +1
absence of cough +1
tender ant. C. adenopathy +1
tonsillar swelling/exudates +1

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42
Q

Cranial Molding

A

From vaginal birth cranial bones overlap

resumes a normal shape and size w/in one week

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43
Q

$ Caput Succedaneum

A

Subcutaneous Edem
Crosses suture lines
MC Occiput
soft poorly defined margins

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44
Q

$ Cephalhematoma

A

Subperiosteal bleed
Does NOT cross sutures
MC Parietal (asynclitic birth)
Firm well defined edges

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45
Q

Unusual contour of head causes

A

Preterm infants (resting position)
Irregular closing of sutures (craniosynostosis)
Positional Head Deformity (PHD)

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46
Q

Craniosynostosis

A

Premature union of sutures
microcephaly
rigid sutures, misshapen skull
NOT associated with mental retardedness

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47
Q

$ Positional Plagiochepaly

A 
Parallelogram \=\ (p-p)
Frontal Bulging
Ear Migrates ANT.
Bald spot on flat side
Will respond to Chiro management
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48
Q

$ Lambdoid Synostosis

A 
Trapezoid |=\
No frontal bulging
no bald spot
Ears Even
Tilted cranial base
Chiropractic management is no help
49
Q

Fontanel Closure

A

Post. ~2 mo.

Ant. 24 mo.

50
Q

Assessing Fontanelles

A

Bulging- infxn, ^ intracranial pressure
Depresseion- dehydration
ant. should be

51
Q

Transillumination

A

begin midline frontal and inch over entire head

should be

52
Q

Torticollis birth injury

A

Causes hematoma becomes fibrous mass 2-3 weeks later

53
Q

Microcephaly related to

A 
Craniostenosis
Cerebral Dysgenesis (mental retardation)
54
Q

Hydrocephalus

A

Bossing, Craniotabes (wasting)

Sclera visible above iris “setting sun sign”

55
Q

Down Syndrome

A 
Depressed nasal bridge
Epicanthal folds 
Mongolian slant of eyes
Low set ears 
Large tongue
56
Q

Fetal Alcohol Syndrome

A 
Smooth philtrum 
Widespread eyes: Inner epicanthal folds, Mild ptosis 
Hirsute forhead 
Short nose 
Thin upper lip
57
Q

Eye inspection

A

redness, hemorrhage, discharge, granular appearance, may indicate infection, allergy, or trauma

58
Q

External Eye Inspection

A

Hypertelorism (wide spaced) may indicate mental retardedness
Epicanthal folds- Downs or asia
Colobama- keyhole pupil, loss of fxn, asscted w/ other congenital abnormalities
Brushfield Spots- white specs in linear pattern around iris. Downs

59
Q

Strabismus

types and tests

A

esotropic, exotropic
Corneal Light
Cross Cover
Cover-Uncover

60
Q

Pseudostrabismus

A

symmetrical light reflex EVEN THOUGH less sclera midline
common in Asian and Native American Populations
disappears by 1yr

61
Q

Cross Cover Test

A

exotropic: moves L-M
esotropic: moves M-L

62
Q

Cover uncover test

A

Exotropic: moves Lateral
Esotropic: moves medial

63
Q

Paralytic Strabismus
Nonparalytic strabismus
amblyopia

A

Impairment of extraocular eye mm
can focus w/ either eye but not both simultaneously
reduced vision in a structurally normal eye

64
Q

Duane Syndrome

A

Characterized by congenital non-progressive horizontal ophthalmoplegia (inability to move the eyes) primarily affecting the abducens nucleus/nerve and the lateral rectus mm.

65
Q

snellen Chart grading

A

20/25 + 2 means 2 from 20/20 could be read

a difference in lines btwn eyes could indicate strabismus

66
Q

Anticipated Visual Acuity

A

3 yr- 20/50 3+2=5
4 yr 20/40 4-4
5 yr 20/30 5=2+3
6 yr 20/20

67
Q

Red Eye Reflex

A

Observe for opacities, dark spots, or whitespots within the circle of red glow
white spots could be, congenital cataracts, retinoblastoma

68
Q

Congenital Cataracts

A 
Require full metabolic, genetic, infectious, and systemic workup
TORCH infxn
Hypoglycemia
Trisomies
Prematurity
69
Q

Retinoblastoma

A

Congenital Malignant tumor

70
Q

Timing of fundoscopic exam

A

Usually deferred until 2-6 mo unless conditions suggest otherwise

71
Q

Retinopathy of Prematurity

A

Blood vessels are straightened and diverted temporarily, scarring (cicatriasis) may occur
^ Risk for: Retinal detachment, Glaucoma, Blindness (stevie wonder)

72
Q

Low/poorly shaped auricles associted with?

A

Renal disorders

73
Q

Pain on palpation
Mastoid
Tragus

A

Mastoiditis

Otitis externa

74
Q

How to best assess for ear infxn

A

Pneumatic otoscopy.
Red and immovable.
Can be red just from crying

75
Q

Choanal atresia

A

Congenital blockage of nasal passage. Will breathe when crying

76
Q

Baby bottle syndrome

A

Brown caries on incisors from bedtime bottle usage w/ juice.

77
Q

Black or grey teeth

A

Pulp decay

Iron therapy

78
Q

Mottled or pitted teeth

A

Enamel dysplasia

tetracycline treatment during tooth development

79
Q

Flattened edges

A

Bruxism, unconscious grinding of teeth

80
Q

Tonsil Grading (w/ picture)

A

1+ visible
2+ halfway to uvula
3+ nearly touching uvula
4+ touching each other

81
Q

Peritonsillar abscess

A

infxn btwn tonsils and pharynx

dysphagia, severe sore throat w/ pain, drooling

82
Q

Epiglotitis

A

Occurs 3-7 YO, acute onset of drooling. DON’T PUT ANYTHING IN THEIR MOUTH, medical emergency, can lead to rapid obstruction of airway
s/Sx fever, drooling, tripod position, croup cough

83
Q

Chest Inspection

A

A-P diameter=transverse
smaller chest than head-Intrauterine growth retardation, larger- poorly managed gestational diabetes
Round chest past 2nd year think chronic obstructive pulmonary issue i.e. COPD

84
Q

Nipple spacing

A

should be 1/4 of chest circ.

85
Q

Periodic Breathing

A

sequence of vigorous breathing followed by apnea for 10-15s.
concern w/ prolonged apnea, cyanosis
Term: wanes a few hours after birth
Preterm: as they approach term

86
Q

Increased Respiratory Effort

A

Retraction at supraclavicular notch, Flared Nostrils, Contraction of SCM’s, intercostal retraction, Tachypnea (only when combined w/ others)

87
Q

Laryngomalacia

A

Noisy breathing w/ wheezing and inspiratory stridor, due to floppy cartilage. Larynx will close with inspiration and expiration. Usually self limiting

88
Q

Bronchiolitis

A

RSV

89
Q

Croup

A

parainfluenza virus
1.5-3 YO, harsh cough after child has gone to sleep and they awaken, anxious. Seal Bark
Tr. breathe cold air out of a freezer

90
Q

Patent Ductus Arteriosis

A

^ pressure in pulmonary circ, ^ R Ventr. workload
asymptomatic-Loud, Symptomatic-Quiet, dyspnea w/ exertion
Machinery Murmur 1-3 intercostal space

91
Q

Patent Foramen Ovale

A

asymptomatic, may show cyanosis upon exertion

92
Q

Complete evaluation of the heart includes
purple skin
white skin
central cyanosis

A 
Skin, lungs, Liver
May detect hepatomegaly before lung crackles
purple-polycythemia
white- shock
congenital heart failure
93
Q

Cyanosis evident at birth or shortly after

A

$ Transposition of the Great Vessels $ always cyanotic
Tricuspid atresia
severe septal defect
severe pulmonic stenosis
Tetralogy of Fallot (blue, can be present after birth)

94
Q

Cyanosis that doesn’t appear until after neonatal period

A

Pure pulmonic stenosis
Eisenmenger comples (R-L shunt with pulmonary HTN)
Septal Defects
Tetralogy of Fallot (pink)

95
Q 
Capillary refill up to 2 years
Prolonged refill (>2 s) dDx
A
96
Q

Apical impulse

A

3-5th Lt intercostal space

heart lies more horizontal so it’s higher than adult, reaches adult position at 7YO

97
Q

Shifts in apical impulse: Pneumothorax
Diaphragmatic Hernia
Dextrocardia
Sinus Invertus

A

Away from pneumothorax
MC right sided hernia heart to the left
Right
Heart and stomach on R, liver on L

98
Q

Weak pulse
Bounding Pulse
difference btwn femoral and brachial

A

decr. cardiac output, peripheral vasoconstriction
L-R shunt (PDA)
coarctation of aorta

99
Q

Heart Rate
Fever
Sinus Arrythmea
Fixed Tachycardia

A

More variable w/ exercise
^ 10-20º w/ fever
more common, faster w/ inspiration, slower w/ expiration
means difficulty

100
Q

Heart Murmurs

Innocent murmurs

A 
normal w/in 2 days most are innocent
Grade I/II (soft)
last 2-3 days (short)
Systolic
No other s/Sx
$ 4S's
101
Q

Ausculatation Lxn

A 
1- Aortic
2- Pulmonic
3- Tricuspid
4- Mitral (A PeT Mouse)
5- LLSB (lower left sternal border)
102
Q

Investigate Murmur

A 
intense
persists into 2nd or 3rd day
fills systole
occupies ANY part of diastole
radiates widely
103
Q

Venous Hum

A

common condition

104
Q

Tetralogy of Fallot

Exam Findings

A
  1. VSD
  2. Overriding Aorta
  3. R Ventricular Hypertrophy
  4. Pulmonary Stenosis
    Precordial prominence, Parasternal heave, Systolic murmur 3rd ICS
    Req’ surgery
105
Q

Tet Spells

A

Central cyanosis

Paroxysmal dyspnea w/ loss of consciousness

106
Q

L Lower Sausage Mass
Midline Suprapubic mass
L/R upper Sausage mass
Olive shaped mass RUQ after infant vomits

A

Feces in sigmoid, Constipation
Feces in rectum, $ Hirschprung
Intussiception
Pyloric Stenosis

107
Q

Hirschprung

A

Absence of PS ganglion in sigmoid colon
failure to pass meconium in first 24-48 hrs.
Constipation, Distension, vomiting/diarrhea, failure to thrive

108
Q

Intussiception

A 
prolapse of intestinal segments
red currant jelly stool
ABCDEF
Abdominal or Anal sausage
Blood from rectum
Colic: babies draw up their legs
Distention, Dehydration, or shock
Emesis
Face pale
109
Q

Pyloric stenosis

A

Hypertrophy/obstruction of pyloric sphincter
projectile vomiting
feeding eagerly
dehydration
Small rounded mass in RUQ esp. after vomiting

110
Q

Gastroesophageal Reflux

A

Relaxation/incompetence of lower esophagus
Respiratory problems (aspiration)
Bleeding from esophagus

111
Q

Biliary Atresia

A

Congenital obstruction or absence of someor all of the bile duct system
Jaundice at 2-3 wk, Hepatomegaly, Abdominal distention, Poor weight gain, Pruritis, Stools lighter, Urine darkens

112
Q

Meconium Ileus

A

thickening/hardening of meconium > intestinal obstruction
fail to pass meconium in first 24 hrs (Hirschprung)
$ must consider cystic fibrosis

113
Q

Meckel’s Diverticulum

A

MC congenital anomaly of GI
dark red rectal bleeding
can be asymptomatic or mimic appendicitis

114
Q

Omphalocele

A

Intestine protruding through umbilical cord or umbilical area.
Visible through thick transparent membrane

115
Q

Necrotizing Enterocolitis

A

Immaturity of GI tract, inflammatory disease of Mucosa
occult blood in stools, respiratory distress
Often fatal due to perforation and septicemia

116
Q

HTN w/ bleeding means

A

Abruptio placentae

117
Q

Preeclampsia =

A

HTN +

proteinurea, thrombocytopenia, impaired liver fxn, renal insuff., pulmonary edema, Cerebral disturbances, visual Sx

118
Q

Adolescent issues

A 
HEADS
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Education
Activities, Ambition, Anger, Affect
Drugs
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OB Peds (1 decks)

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