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204 Cards in this Set

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When should a complete physical exam be done on a newborn?
Within the first 24 hours of life
What is the purpose of the physical exam in the newborn period?
-Detect for anomalies
-Identification of problems
(birth injuries, jaundice, or cardiopulmonary disorders)
What are the key general aspects of the neonatal physical exam?
-Head to toe
-Between the legs
-up the back
**Don't forget to turn the baby over**
What are some examples of pregnancy complications that would be important to include in the neonatal history?
-Gestational diabetes
-hypertensive disorder
(may affect fetal growth or lead to other complications)
Why must maternal medications be included in a neonatal history?
-Intraueterine effects
-excreted in breast milk
What are the important maternal illness prior to pregnancy?
SLE or idiopathic thrombocytopenic purpura
List the routine laboratory tests to conduct in pregnancy?
-Maternal blood type, antibody screen
-Rhesus (Rh) type
-Rubella status (immune or nonimmune)
-syphillis screen
-hepatitis B surface antigen
List the parts of quadruple screen.
-Alpha-fetoprotein
-Human chorionic gonadotropin (hCG)
-unconjugated estriol (uE3)
-inhibin A
What is alpha-fetoprotein (AFP)?
It is a protein produced by the baby
hCG is a hormone that is produced in the ____?
placenta
Unconjugated estriol is a form of the hormone ____ produced by the __ and the ___.
estrogen; fetus; placenta
Where is inhibin A produced?
in the placenta
List the 4 aspects of the general approach to the neonatal exam
-appearance and posture
-respiratory effort
-position
-color
The average weight of newborns is ___kg with a normal range between ___ and ___ kg.
3400; 2500; 4300
True or false: it is normal for a newborn to lose more than 3% of their body weight in the first 24 hours of life?
FALSE! under 3%
The average LENGTH of the newborn is ___cm with a normal range from __ to __ cm.
49.6; 45; 54
What are the differential diagnoses for a child born < 45cm in length?
-prematurity
-dwarfism
-turners
-osteogenesis imperfecta
What disorder should be considered at birth if the child is > 54 cm?
Marfan's
What is the normal head circumference for a newborn at term?
32-38cm
Head size and size of the ___ will vary according to age, sex and ___
fontanelles; ethnicity
What is the name of soft area of skull bone?
Craniotabes
Where are craniotabes often found?
parietal region
What does a craniotabe feel like?
Sensation of a ping-pong ball when depressed
When is craniotabe often seen?
-premature infants
-found in term infants whose head rested on the pelvic brim during the last few weeks of gestation
Caput succedaneum often crosses the __ __ and may be associated with ___ and ecchymosis.
suture line, petechiae
What head trauma is characterized by a poorly demarcated soft tissue swelling?
caput succedaneum
Craniotabes can be a pathologic finding in ___ and ___, although it usually occurs in normal infants.
syphilis; rickets
True or false: cephalohematoma is more common than caput?
FALSE
What is the name of the head trauma that is caused by an accumulation of blood or serum above the periosteum after a prolonged labor?
caput succedaneum
What may cause a cephalohematoma?
Prolonged labor or instrumentation
Cephalohematoma are often well ___ with fluctuant ___ and does not ___ ___ ___.
demarcated; swelling; cross suture lines
If a newborn has a skull fracture, elevated ridge or organizing tissue, what form of head birth trauma may they have experienced?
cephalohematoma
Cephalohematoma are often well ___ with fluctuant ___ and does not ___ ___ ___.
demarcated; swelling; cross suture lines
Linear fractures causing cephalohematoma need report Xray of the head to rule out ____ ___
leptomeningeal cysts
Pallor in infants is often associated with ___.
low hemoglobin
What might a child's skin look like with hypoxemia ?
cyanotic
___ skin color is associated with polycythemia.
plethora
If a newborn is juandice, then they most likely have elevated ___
bilirubin
A slate grey color to the skin in a newborn is often associated with ____
methemoglobinemia
TorF: acrocyanosis in the newborn in pathological?
False
What are the 7 harmless skin disorders of a newborn?
1. Related to fetal monitor, electrodes, amniocentesis
2. mongonlian spots
3. acrocyanosis
4. cutis marmorata
5.Harlequin color change
6. subcutaneous fat necrosis
7. erythema toxicum
What is the name of the epidermal inclusion cysts seen in 40-50% of infants
milia
What skin disorder in infants is do to obstruction of the eccrine sweat glands
Miliaria
What are cyrstallina?
superficial obstruction
WHat is the name of a deep skin obstruction in newborns?
rubra
What is milia?
white papules frequently found on the nose and cheeks and result from retention of keratin and sebaceous material in the pilosabaceous follicles
How long does milia tend to last in newborns>
several weeks
Miliaria are ___ vesicles on the forehead, __ and ___
pinpoint; scalp and skinfolds
Miliaria often clear after __ week
1
Miliaria are related to sweat ___ and described as __ heat. What are the recommendations for treatment?
retention; prickly; avoid excessive heat and use cetaphil
How is miliaria crystallina described?
small thin-walled vesicles resembling dewdrops without inflammation
Descrive miliaria pustulosa
consists of pustules with an erythematous base and is due to localized inflammation
20-37% of neonates with congenital exophytic scalp nodules with have...
underlying CNS disease
What is this an image of?
harlequin color change
What is this an image of?
Acne neonatorum: neonatal acne
Describe the characteristics of acne neonatorum.
-seen in 20% of infants
-resolves in the first few months of life
-very common
-resembles acne and appears between 2-4 weeks
-no therapy
What treatment option is rarely used for neonatal acne>
mild keratolytic (benzoyl peroxide)
Neonatal acne must be differentiated from ___ ___ __, which resolves within weeks.
Sebaceous Gland Hyperplasia
What is the name given to a generalized erruption of superficial pustules overlying hyperpigmented macules?
transient pustular melanosis
What ethnicity is at most risk for transient pustular melanosis?
african american newborns
pustules of transient pustular melanosis usually are removed with the ___ ___ so that only macules remain.
first bath
TorF: transient neonatal pustular melanosis is benign?
True
transient neonatal pustular melanosis is often seen in ___ to ___% of newborns
0.2 to 4
TNPM are small ___, generally present at birth, containing __ and no ___
vesicopustules; WBCs; organisms
the intact vesicle of TNPM ruptures to reveal a pigmented __ surrounded by a thin __ __
macule; skin ring
The most common newborn rash is ...
erythema toxicum neonatorum
describe the appearance of erythema toxicum neonatorum
Blotchy macular erythema which can develop into fine 1-3mm pale yellow papules, pustules on erythematous base
erythema toxicum neonatorum of effects the ___ follicles?
pilosebaceous
what are in the lesions of erythema toxicum neonatorum?
eosinophils
erythema toxicum neonatorum frequently spares the __ and the ___
palms and sole
erythema toxicum appears up to __ days later in newborns?
14
Lanugo is more pronounced in __, __, and __ infants
premature; black; hispanic
List the characteristics of vernix caseosa.
-excessive in premature
-absence in post-mature
-meconium stained in intrauterine distress
-yellow: hyperbilirubinemia
What are the 4 pigmentation variations found in newborns.
-mongonlian spots
-wide spread bruising
-port wine stain
-albinism
Macrostomia is often seen in newborns with ___
mucopolysaccharidoses
What disorder of the palate is often found in infants with fetal alcohol syndrome?
fish mouth
___ ___ are small, white, benign inclusion cysts on the palate and are clustered at the MIDPOINT of the junction between the soft and hard palate
eptsein pearls
What are the small bluish white swellings of variable size on the floor of the mouth representing a benign mucuous gland retention cysts
ranula
Natal teeth often occur in the __ __ __ region and frequently are ___.
lower central incisor; bilateral
What disorders of the tongue are often seen in newborns
-macroglossia
-hypothyroidism
-nucopolysaccharideoses
Why are natal teeth often a risk in newborns?
there is a risk of aspiration if they are loosely attached
Natal teeth often present in newborns with ___ ___
cleft palate
Microganthia often occurs with which syndromes
-pierre-Robin syndrome
-treacher-collins syndrome
What disorder is attributed to the most common brachial injury?
Erb-duchenne palsy
Which vertebrae are involved with erb-duchenne palsy?>
C5-6 and sometimes 7
What is the position of the arm of a child with erb-duchenne palsy?
Arm is abducted and internally rotated with elbow extension, wrist flexion
TorF: a child with erb duchenne palsy will not have an intact grasp reflex?
FALSE
What is the common position of the hand of a child with C7 involvement of erb-duchenne palsy?
waiter tip
TofF: Klumpke's palsy is more common than erb-duchenne palsy?
FALSE! much rarer: <1% of injuries
which vertebrae are involved in klumpke's palsy?
C8 and T1
ToF: there is an absence of the grasp reflex in klumpke's palsy?
TRUE
in klumpke's palsy the hand is ___ with no __ movement at the wrist and a paralysis of the __ __
paralyzed; voluntary; entire arm
Which population has a greater occurance of supernumerary digits at birth?
african americans
supernumerary digits tend to be ___ and lateral to the __ digit that is attached by a ___
hereditary; 5th; peduncle
ToF: supernumerary digits are the same as true extra digits and may have a nail
FALSE: they differ from true extra digits but CAN have a nail
A simian crease is often associated with which disorder
trisomy 21
What is this an example of?
supernumerary digit
What is this?
Simian crease
The umbilical cord should have how many vessels?
AVA
2 arteries and 1 vein
What % of newborns present with a single umbilical artery and what is it associated with?
0.2 to 1%; associated with renal abnormalities in 7% of these infants.

increased rate of chromosomal and other congenital anomalies
Which infants have a higher incidence of single umbilical arteries?
-SGA
-premature infants
-twins
the most commonly affected organs of single umbilical artery are the ___, __, __
heart; GI tract; CNS
What must the HCP ensure when a newborn has a single umbilical artery?
there is no connection to intraabdominal contents
Can the liver be palpated in newborns? if so how big is it?
Yes: 2cm below the costal margin
Where should the HCP start when assessing the spleen of an baby?
RLQ and working up towards the left midaxillary
What should the HCP be alert for if the spleen of a newborn is felt?
Congenital infection or extramedullary hematopoiesis
What is the likely diagnosis of a newborn with limited hip abduction?
DDH
What is the name of the common disorder that causes the intestinal contents of of a newborn to protrude out of the umbilicus?
umbilical hernia
Where should the hand be placed during ortolani and barlow?
on the knee and the greater trochancter
What are the 3 major steps in assessing for DDH?
1. hip abduction: should go 160-180 degrees symmetrically
2. Ortolani/Barlow
3. Galeazzi/Allis
Should an ultrasound of an infant with suspected DDH be done in the first 2 weeks of life? why or why not?
No; get a lot of false positives
Children that are toe walkers often have __ or short __ and are at greater risk for __.
CP; tendons; DDH
Which test (Ortolani/Barlow) places the dislocated hip back into the socket?
ortolani
What is the minimum length that a newborn boy's penis should be?
2cm. 1 inch!!
Ambiguous genitalia in males will have ___ at birth
micropenis
Which baby boys cannot be circumsized?
those that don't have an opening at the tip of the penis
What is the equation for term normal penis size?
3.6 +/- 0.7cm (2SD = 1.4) so 2.2cm is the minimum length
what are the possible causes for micropenis in newborns?
reduced androgen effect or reduced growth hormone during 2nd and third trimester
What aspects of the male genitalia should be inspected at birth?
glans, urethral opening, prepuce, shaft, and circumcised should be assessed for edema, incision and bleeding
A full tern infant boy should have __ pigmentation and a fully __ scrotum.
brown; rugated
When do the testes fall?
32 weeks
True or false: retractile testes can be pushed down?
True
How should the HCP assess the testes?
Start at the ischial tuberosity and push and push as they move down to the testes until they grab and hold them.
At what age should the testes remain in the scrotum?
age 1
the ___ of the testes is a clothes line and they travel down it to the scrotum?
gubernculum
What is vanishing testes syndrome
The baby has them and then they lose them. They will have an underdeveloped scrotal sack as they grow
What treatment has been found to help with retractile and ectopic testes?>
HCG helps them descend
What is cryptorchidism?
undescended testes and the scrotum of the neonate is often underdeveloped
Cyrtorchidism is often 10 times more common in ___ babies
premature
If a girl presents with an inguinal hernia, what must she be assessed for?
Turner's syndrome
What is an inguinal hernia
Intestine goes through and above the top of the scrotal sack and it feels squishy and air filled like "rice krispies"
Inguinal hernias occur 60% of the time on the __ side of the body?
right
inguinal hernia are more common in (boys/girls)
boys
Term or preterm infants have a higher rate of inguinal hernias?
preterm! 10x higher
What are the important aspect in assessing female genitalia at birth?
labia, clitoris, urethral opening, and external vaginal vault
Which organ of the female genitalia is enlarged in premies>?
the clitoris
What is the name of the white discharge found in babies from the maternal hormone?
leukoria
TorF: hymen tags that are seen on female infants are not normal and should be assessed>/
False: very common and they regress around age 5
BE ABLE TO LABEL VAGINAL OPENINGS For The FINAL!
What is hypertrichosis?
troughs of hair on the skin overlying the spine
What are the names of the fatty pads that lay over the spine>
lipomas
List the 5 overlying cutaneous markers for spinal problems?
1. Hypertrichosis
2. lipomas
3. lipomyelomeningeocele
4. lare hemangiomas
5. anal verge
If a child has large dimples more than 2.4 cm away from the anus and lack of reflexes, what might they have?
spina bifida occulta
ToF; occult lesions on the spine may be asymptomatic?
true
What are the factors to assess for during inspection of the feet
-syndactyly
-polydactyly
-rocker bottom feeter
which syndrome is associated with rocker bottom feet?>
trisomy 18
Which form of syndactyly is not pathologic?
when it occurs between the 2nd and 3rd toe. it is a minor phenotypic variation and often common
It is not common to have syndactyly between the __ and ___ toes and should be referred to surgery.
Big and 2nd
What is metatarusus adductus often associated with?
fix intrauterine position. Less common now that children are placed on their back
What is talipes equinovarus?
club feet
What are the specific aspects of posturing in club feet?>
-toes down
-heels up
-malrotation of the calcaneus
in club feet the child with have fixed __ of the foot or __ of the foot.
position; inversion
Describe the tonic neck reflex
-increase tone
-leg extension of side of head direction
-flexion in contra lateral arm and leg
What is the stepping and walking reflex?
range for minimal weight bearing to several brisk steps with plantar stimulation
The moro reflex appears at __ weeks and dissapears at __ to __ months
37; 3-6
Tonic neck reflex emerges at __ weeks and is gone at __ months
35; 6
when does the palmer grasp reflex start and stop?
28 weeks; 2-3 months
When does a cortical thumb ofthen go away?
2 months
The ___ reflex appears at 37 weeks and leave at 2-4 months
stepping
which reflex starts at 32 weeks and never leaves?
pupillary reflex
the ankle clonus reflex can have __ to __ beats; appears at __ week and leaves at __ months
5-10

33-35

1 month
When does the rooting reflex disappear?.
3-4 months
What is the name of the reflex that when the babies palm is grasped during nursing it will increase the suck?
Bapkin reflex
What disorder do you see a change from hypotonia to hypertonia?
CP
Which is more common hypo or hypertonia?
Hypotonia
What are the physical assessment features of neurological impairment?
-hypotonia
-weakness or decreased strength
-asymmetry of muscle tone and/ movement
-alteration in LOC
-seizures
-single or multiple cranial nerve involvement
-fasciculation
What are the assessment tools for reporting gestational age?
Dubowitz and Ballard
How is Ballard assessed>?
-6 neuromuscular maturity signs
-6 physical maturity signs
-best done at birth or within 1st 24 hours
ToF: the closer a baby is to term at birth the less likely they are to to have a positive scarf sign?
true
According to ballard, do premies bring their heels to their ears easily?
yes
What degree can a full term baby flex their hand down?
zero degrees
to be LGA the baby must be > __% for weight?
90
SGA = < ___% for weight
10
What disorder do you see a change from hypotonia to hypertonia?
CP
Which is more common hypo or hypertonia?
Hypotonia
What are the physical assessment features of neurological impairment?
-hypotonia
-weakness or decreased strength
-asymmetry of muscle tone and/ movement
-alteration in LOC
-seizures
-single or multiple cranial nerve involvement
-fasciculation
What are the assessment tools for reporting gestational age?
Dubowitz and Ballard
How is Ballard assessed>?
-6 neuromuscular maturity signs
-6 physical maturity signs
-best done at birth or within 1st 24 hours
ToF: the closer a baby is to term at birth the less likely they are to to have a positive scarf sign?
true
According to ballard, do premies bring their heels to their ears easily?
yes
What degree can a full term baby flex their hand down?
zero degrees
to be LGA the baby must be > __% for weight?
90
SGA = < ___% for weight
10
Babies that are born small, but look older most likely suffered from ___ ___ ___.
intrauterine growth restriction
IUGR happens in __ to __% of fetuses.
4-8
ToF: SGA = IUGR
False, IUGR can cause SGA but not the other way necessarily
If a babies rate of growth was less than their predetermined genetic potential they may have ___
IUGR
In an infant has a symmetric/total effect lack of growth, they suffered from an ___ insult of IUGR
early
What might a child look like that grew through a late onset of IUGR?
BIg head and a small body
what are some common causes of early insults of IUGR?
-infection
-chemical teratogen
-chromosomal abnormality
What are the common causes of late insult IUGR?
-uteroplacental insufficency
-congenital malformation
-brain sparing: normal head circumference
What is the pear analogy that helps differentiate the side of paralysis in children?
the stem of the pear is the side of the paralysis
A finding of sunsetting eyes in term babies may be indicative of ...
-hydrocephalous
-increased ICP
-kernicterus
What is this image showing? Is this pathologic?
Sail sign of the thymus gland. It is a normal finding until age 2 and is observed more often on the right side.
What is the image showing? What are the associated findings with this finding.
Overlapping fingers called camptodactily. Often associated with trisomy 13 (patau syndrome)
Trisomy 18 (Edward syndrome)
What is a normal cardio thoracic ratio in a newborn's heart?
<0.6
What is the number 1 fracture in newborns?
clavicle
ToF: clavicle fractures in newborns are often very difficult to heal and are a long process of recovery?
FALSE!
What are are the symptoms post clavicle fracture?
-asymmetric moro reflex and it can feel like crepitus under the skin as it heals
What are the common causes of clavicle fractures in children?
History of difficult delivery
-irregularity in contour
-shortening,
-tenderness
-crepitus on palpation
What are wormian bones?
sutural bones that are small, irregular bones that occur most often in the lamboidal sutures
What are wormian bones often found to be associated with>
-diseases manifesting with delayed or defective calvarial ossification, widened or delayed closure of cranial sutures, or delayed closure of the fontanelles

-Congenital hypothyroidism
-cleidocranial dysplasia
-osteogenesis imperfecta
-congenital hypophosphatasia
wormian bones often occur over ___ sutures
lambdoidal
What is the white arrow pointing to?
Wormian bones