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140 Cards in this Set

  • Front
  • Back
Infancy includes what two parts?
- neonatal (1-29 days)
- postneonatal (30d -1 year)
Identify the components of the APGAR scale.
Appearance: 0= central cyanosis, 1= perhipheral cyanosis 2= pink

Pulse: 0= absent, 1= <100, 2= >100

Grimace: 0= none, 1= grimace, 2 = crying actively, sneeze, or cough

Activity: 0= flaccid, 1= some flexion of arms and legs, 2= active movement

Respirations: 0= absent, 1= slow irregular, 2= good, strong
The following APGAR scores at 1 min indicate what?
- 8
- 5
- 2
- 8: normal (8-10)
- 5: some depression (5-7)
- 2: severe depression (0-4)
The following APGAR scores at 5 mins indicate what?
- 8
- 5
- 2
- 8: Normal (8-10)
- 5,2: risk for subsequent CNS depression and organ dysfunction (0-7)
Describe neonatal clssification by age and weight.
Age:
- preterm: < 37wks
- term: 37-42 wks
- postterm: >42wks

Weight:
- ELBW: <1000g
- VLBW: <1500g
- LBW: <2500g
- Nml: >2500g
Identify the percentile for the following:
- SGA
- AGA
- LGA
- SGA: <10th
- AGA: 10-90th
- LGA: >90th
By 1 year, an infant's weight should have ___ and height ___
- weight tripled
- height doubled
At what age do normal infants:
- say 2 word phrases
- follow faces
- say 'dada' or 'mama'
- roll over
- sit
- smile
- pull to stand up
- walk
- grasp a rattle
- feed self
- imitates activities
- use a spoon
- 2 words: 10m
- follow faces: 0m
- dada/mama: 6m
- roll: 2-3m
- sit: 5-6m
- smile: 0m
- pull to stand: 7-8m
- walk: 12m
- grasp rattle: 2-3m
- feed self: 4-5m
- imitate activities: 10m
- spoon: 11-12m
Define failure to thrive in infants. WHat does it consist of?
- inadequate weight gain for age.
- growth <5th percentile
- growth drop >2 quartiles in 6m
- weight for height <5th percentile
Small head size when measured may suggest ___
premature closure of sutures or microcephaly
Abnormally large head size when measured is called ____ and an be caused by ___
1. macrocephaly
2. hydrocephalus, subdural bleed, tumor, genetic problem
A rapid heart rate too rapid to count can indicate ___
paroxysmal SVT
Bradycardia in infancy may be due to __
drug ingestion, hypoxia, intracranial or neuro conditions, or arrhythmia
Describe the average heart rate:
- 0-2m
-0-6m
- 6-12m
- birth- 2m: 90-190
- 0-6m: 80-180
- 6-12m: 75-155
Fever can cause increased respirations by up to ____
10 respirations/min per degree centigrade of fever
Cutoffs for tachypnea are:
- 0-2m: >60/min
- 2-12m: >50/min
What is acrocyanosis?
Cyanosis of hands and feet, esp if exposed to cold.
What is lanugo?
Fine, downy growth of hair at birth, over the entire body especially the shoulders and back. Thishair isshed within first few weeks.
A 6 month old presents with a light-brown, flat lesion approx 1.5cm wide. It is most likely due to what?
- cafe au-lait spot
What is vernix?
- vernix caeosa.
- sebum and desquamated epithelium that covers the neonatal body at birth.
Midline hair tufts over the lumbosacaral spine suggest __-
Spinal cord defect
Neonatal jaundice can be normal,b ut if it persists beyond 2-3 weeks may suggest ___
biliary obstruction or liver disease
Central cyanosis in a baby or any aged child should raise suspicion of ___
congenital heart disease
Where is the bets place to look for central cyanosis?
- tongue and oral mucosa
What is a "salmon patch"?
flat, irregular, light pink patches seen on the nape of the neck, upper eyelids, forehead, or upper lip. Benign resulting rom distended capillaries and disappear by age 1
What is a "port wine stain"?
unilateral dark, purplish lesion over the distribution of the ophthalmic branch of trigeminal nerve - may suggest Sturge-Weber syndrome
Significant edema in hands and feet of newborn girl may suggest ___
turner's syndrome
A baby is born with cyanosis in the palms of his hands and soles of his feet, this is called __-
acrocyanosis
Scattered vesicles on an erythematous base on the face and chest suggest ___
Miliaria - obstructed sweat glands.
A 2 day old infant presents iwth a rash of erythematous macules and central pinpoint vesicles scattered over teh entire body. They look like "flea bites" these suggest ___
Erythema toxicum - disappear by 1 week on their own
A newborn black baby presents with small vesiculopustules over a macular base. This suggests ___
pustular melanosis
A 2 week old infant presents with white, raised areas the size of a pin-head on his nose and cheeks. He likely has __
Milia - retention of sebum in openings of sebaceous glands
At birth, the anterior fontanelle measures ___
4-6cm
At what age does the anterior fontanelle close?
between 4-26 months
At what age does the posterior fontanelle close?
- 1-2cm at birth closes by 2m
How might the posterior fontanelle look in congenital hypothyroidsm?
enlarged
Bulging or tense fontanelle is seen in ____, whereas a sunken fontanelle may be a sign of __
infants with ICP = bulging
sunken = dehydration
What is molding?
- overlap of cranial bones at sutures at birth - disappears within 2 days of birth
What is the most common dysrhythmia in infants?
Paroxysmal SVT
Describe normal heart finidngs in an infant.
- split S2 (usually)
- S3
Presence of S4 in pediatrics suggests ___
decreased ventricular compliance suggesting CHF
Common causes of heart murmurs in infans include:
- closing ductus (transient, soft, ecjection murmur at ULSB
- Peripheral pulmonary flow (soft, ejectile, systolic, L of upper L sternal border and in lungs and axillae
Two common scrotal masses in newborns are __
hydroceles and inguinal hernias, esp on the right side
What is the Ortolani test?
- test the presence of posterior hip dislocation : place the baby supine with legs toard you. Flex to form R angles at hips and knees. Push posteriorly
What is the Barlow test?
test for anterior hip dislocation: knees bent, abduct and externally rotate hip, press anteriorly from behind the leg to assess for ant. dislocation
The Galeazzi or Alice test looks for
- femoral shortening: bring feet to buttocks and feet flat on table - look for variations in knee height
The most common severe congenital foot deformity is ___
talipes equinovarus = club foot
Babinski response to plantar stimultaion may be present in babies up to age ____
2.
Triceps, brachioradialis, and abdominal reflexes are difficult to elicit before what age?
6 mos
In assessing clonus, up to ___ pulsations are normal in newborns and young infants. Tthis is called
- 10 pulsations
- unsustained ankle clonus
What are primitive reflexes?
Responses that are typically demonstrable at birth and disappear at defined ages.
Name the most common primitive reflexes andthe age they are commonly found
- palmar grasp, 3-4m
- plantar grasp (feet), 0-6/8mos
- Moro reflex (startle reflex), 0-4mos
- Asymmetric tonic nex reflex (0-2m)
- positive support reflex, 0/2m-6m
- Rooting reflex (suckling) 0-4mos
- Trunk incurvation 0-2m
- Stepping reflexes, variable ages
- Landau reflex, 0-6m
- Parachute reflex 4-6 mos and doesn't go away (protective)
Define the following ages for dvelopmental milestones
- walking
- pedaling tricycle
- jumps in place
- throws
- plays games (peek a boo)
- speaks in 2-3 words
- Speaks in sentences
- Copies figures and defines words
- imagination present
- Dresses self
- walking 1 year
- pedaling - 4 yrs
- jump in place 3
- throw 2 yrs
- play peek a boo 1 year
- speaks in 2-3 workds 1yr
- speaks in sentences 3yr
- copies and defines 5 yr
- imagination 4 yr
- self dress: 5yr
At what age range do children become capable of logical thinking?
5-10 years
Well child checks are recommended at what ages?
- 12, 15, 18, 24 months and 30 months, with annual visits ages 3+
After age 2, children should grow at least ___cm /year
5
Interpret the following BMI ranges for children:
- <5th percentile
- >85th
- >95th
- <5th = underweight
- >85th = risk for overweight
- >95th = overweight
What is the most frequent cause of an elevated blood pressure in kids?
improperly performed exam, often due to wrong sized cuff
Define the average heart rates of the following age groups:
- 1-2 yrs
- 2-6 yrs
- 6-10 yrs
- 1-2: 70-150
- 2-6: 68-138
- 6-10: 65-125
Sinus bradycardia in children occurs at what rate?
- <100 in children under age 3
- <60 in children 3-9
A 4 year old child presents with a grade I-II "musical" murmur at early and midsystolic stages. It is best heard ____, and is called a ___
- best heard at mid/lower L sternal border
- Still's murmur
A 5 year old child presents with a contnuous humming sound that is louder in diastole. This is a ____
venous hum
A 6 year old child presents with early and midsystolic murmur louder on the L side and eliminated by carotied compression. This is called a ___
Carotid bruit
Define findings of precocious puberty in males
- enlarged penis and testes
- signs of pubertal changes at early age.
Common causes of a painful testicle in children include __
- epididymitis, orchitis, torsion of the testicle, torsion of the appendix testis
The appearance of pubic hair before age ___ shoudl be considred precocious puberty.
7
A common injury in toddlers resulting from "tugging" on the radial head is ___
nursemaid's elbow (subluxation of radial head)
Bowing of the legs is called ___
genu varum
Inward bowing of the legs or "knock-knees" is called ___
genu valgus
A common benign murmur heard in adolescents is the ___
pulmonary flow murmur - grade I-II/VI, soft, ejection murmur at upper L sternal border with normal S2
A pulmonary flow murmur with a fixed split S2, suggests what?
R heart volume load (ASD)
masses in breasts of adolescent girls are usually
benign fibroadenomas or cysts
Describe the Tanner stages of female breast development.
Stage 1: preadolescent (elevation of nipple only)
Stage 2: breast bud stage (elevation of breast and nipple as small mound, areolar enlargement
Stage 3: further enlarement and elevation of breast and areola, no separation of contours
Stage 4: progjection of areola and nipple to form secondary mound above level of breast
Stage 5: mature - projection of nipple only, areola has receded to general contour of breast
Describe the sex maturity rating in boys:
-Stage 1: no pubic hair, no change in penis size or testicular/ scrotal size
- stage 2: sparse pubiv hair, slight or no penile enlargement, testes larger, scrotum larger and slightly reddened
Stage 3: darker, coarser pubic hair growing sparsely, penis larger and longer, testicles and scrotum further enlarged
Stage 4: coarse and curly pubic hair as in adult, but not as great of area as adult, penis further enlarged and development of glans, testicles enlarged with scrotal skin darkened
Stage 5: Adult features of pubic hair, penis size and shape, and testicular and scrotal features
What is the most common cause of delayed puberty in males? When is delayed puberty suspected?
- most common cause: constitutional delay (familial issue)
- usually suspected in boys without signs of puberty by age 14
Nocturnal or daytime ejaculation may begin at what sexual maturity rating stage?
Stage 3
Describe the tanner stages of female pubic hair development
Stage 1: none
Stage 2: sparse growth of long, downy hair along labia
Stage 3: darker, coarser, curlier hair spreading sparsely over symphysis
Stage 4: Coarse and curly, greater area but doesn't include thighs
Stage 5: adult growth
A 16 year old female presents with delayed puberty. She is 5'7" and weighs 100lbs. you should suspect _
1. anorexia
2. chronic disease
An infant presents with yellowish white pustules on a red base. They are on teh cheeks. You should suspect ___
Erythema toxicum
An infant presents with red pustules and papules on the cheeks and nose, they have no other problems. You suspect __
Neonatal acne
A salmon-red, scaly eruption of the face, neck, axilla, and diaper area suggests ____
Seborrhea
A child has multiple >5 cafe au lait spots and axillary freckling. You should consider ___
Neurofibromatosis
A 6 month old presents with a bright red rask in the intriginous folds of the genitalia iwth satellite lesions along the edges...
Candidal diaper dermatitis
A 4 month old has had diarrhea recently. You notice a rash along the areas the diaper runs. What do you suspect?
Contact diaper dermatitis
___ is an infection that presents with bullous or crusty and yellowed lesions.
Impetigo
Adolescents can present with acne that involes open and closed ____ (blackheads and white heads) and inflamed pustules.
Blackheads = open comedones
Whiteheads = closed comedones
A 10 your old presents with scaling, crusting, and hair loss along the scalp with painful plaque and enlargement of occipital lymph nodes. You suspect ____
Tinea capitis
A 15 year old presents with an annular lesion on the R posterior shoulder with small papules along the border. You suspect ___
tinea corporis
A 2 month old presents with bulging in the anterior fontanelle, eyes deviated downward, and abnormally shaped head. You suspect ___
hydrocephalus
What is craniosynstosis?
premature closure of one or more sutures ofthe skull. Results in abonormal growth and shape of the head.
A small child presents with short palpebral fissures, wide and flattened philtrum, and think lips. You suspect ___
Fetal Alcohol syndrome
An infant presents with coarsse facial features, low-set hair line, sparse eyebrows, and enlarged tongue. You also note a hoarse cry, umbilical hernia, and mottled skin. You believe the child may also be developmentally delayed. You suspect ___
Congenital hypothyroid
An infant presents with bulging of frontal bones and nasal bridge dpression. He also has significant rhinitis, and a rash around his lips. You suspect
Congenital syphillis
A child presents with a small, rounded head, flattened nasal bridge, prominnent epicathal folds, and very small, low ears. He also has a large tongue. You suspect ___
down's syndrome
A 4 year old presents with staring eyes and a large bulge on his anterior neck. He's also very tall for his age. You suspect ____
Hyperthyroidism
What are brushfield's spots?
abnormal speckling spots on the iris suggest Down Syndrome
A 6 month old presents with white plaques on the internal buccal mucosa that do not clean off with rinsing... you suspect ___
oral candidiasis
Tender ulcerations on the oral mucosa surrounded by erythema suggest ___
Herpetic stomatitis
A child presents with a murmur with the following characteristics:
- heard in the upper L sternal border
- especially on ejection, with a peak in systole.
- Pulmonary valve stenosis
Describe teh murmur associated with an aortic valve stenosis
- Midsternal to upper R sternal border
- radiation to carotid arteries and supraternal notch
- may have thrill
- harsh ejection murmur
What is tetralogy of Fallot?
- VSD, malrotation of the aorta, and right-to-left shunting at VSD
- may present with pulmonic stenosis or pulmonic atresia
A child presents with increased cyanosis on activity, with a continuous grade IV murmur at the left sternal border that peaks on systole. You suspect
Tetrology of fallot
The most common congenital penile abnormality is ___
hypospadius
What is hypospadius?
- urethral meatus opens abnormally on ventral surfae of the penis.
Another word for "flat feet"
pes planus
Inversion of the foot suggests ____
Varus
Describe metatarsus adductus
forefoot is adducted but not inverted
Newborn health supervision visit should include:
- bonding
- how is feeding
- mom milk production
- signs of dehydration
- healing from delivery
Neonates will lose some weight after birth, but should return to birth weight by____
1-2 weeks
At what age should you begin considering examining a child without their parent present?
around age 11
How do you select the proper BP cuff size for children?
width of cuff should be 2/3 circumference of arm.
The most common causes of HTN for __ include:
a) infancy-preschool
b) middle school
c) adolescent
a) renal artery or renal disease, coarctation of aorta
b) above + primary HTN
c) primary HTN, renal disease, drug induced
What should you recall regarding temperatures in infants?
- do tympanic or rectal
- fever = >100.4 in 1st 3 months, after that returns to standard 98.6 ish...
Children affect CO through ____
Heart rate (can't change SV)
What should you keep in mind regarding children presenting with abnormal respiratory rates?
- only a few tricks in their bags, so respiratory rate can change for a lot of reasons - there IS a problem just don't necessarily tell where...
A pt presents with a lacy reddish or purplish coloration especially when exposed to cold temperatures. This suggests __
cutis marmorata
Describe the differences in presentaiton of eczema among children by age.
- young children = face and forearms (exposed surfaces)
- older kids and adults = creases of joints
Visual acuity charts can commonly be used with children age ____
3+
Children should receive a formal vision exam by age ___
4
____ has the highest sensitivity for hearing loss in children.
Parental observation
Formal hearing test should be done for children at age ___
4
What method do infants use for breathing?
Obligate nose breathers
What is choanal atresia?
Obstruction of nasal passages that results in cyanosis at rest but pink when crying, and often won't eat due to difficulty breathign
Pale, boggy mucosa in children or early adolescents suggests ___
allergies
Nasal polyps in children suggest ___
cystic fibrosis
A pt presents with "hypernasal speech"... you suspect ___
Submucosal cleft palate
A pt presents with a nasal voice and snoring, you consider ___
adenoidal hypertrophy
A child presents with a hoarse voice and cough, you suspect ____
viral infection
A child presents complaining it feels like they have "rocks in the mouth"... you suspect ___
Tonisillitis
Upper airway sounds in infants have what qualities?
- same sound at nose and stethoscope
- harsh and loud
- symmetric
- louder as stethoscope moves superiorly
- almost always inspiratory
Lower airway sounds in infants have what qualities?
- different sound from nose and stethoscope
- variable harshness
- asymmetric
- louder in lower chest near abdomen
- often has expiratory phase
Wheezing in infants and young children should raise suspicion of ___
asthma or RSV
The insp:exp ratio for respiration in children is usually __
1:1
An S4 sound (gallop) suggests what in children??
CHF, poor ventricular functioning
What findings are abnormal on cardiac auscultation?
- clicks,
- snaps
- S4
Distinguish between benign and pathological murmurs in children.
- Benign: <grade III, systolic, soft, low-pitch, vibratory, musical, humming

- Pathologic: VSD, PDA audible at 1-2 weeks, stenosis, AV regurg, ASD often >1yr
You palpate the abdomen of a neonate and find a small "olive-like" knot at the epigastrium... you suspect ___
pyloric stenosis
First sign of puberty in boys is ___ and occurs at what age?
- enlargement of testes, age 9-13.5
First sign of puberty in girls is ___ and occurs at what age?
- growth spurt
- age 9.5-14.5
Neonates can do what activities in each category:
- habituation
- attachment
- state regulation
- perception
- habituation: selectively and progressively shut out negative stimuli
- attachment - bonding with caregiver
- State regulation: modulate level of arousal in response to stimulation
- perception: regard faces, turn to voices, quiet in presence of singing, track colorful objects, respond to touch, recognize familiar scents