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81 Cards in this Set

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What physical findings should be taking?
BP (UPPER AND LOWER EXT), weight, length, head/chest/abd circumference
What should you always examine first?
heart and lungs
What skin findings are normal from birth trauma?
petechiae (not diffuse), bruising, lacerations
When is jaundice abnormal?
during the 1st 24hrs of life
What are cafe au lait spots assoc with?
neurofibromatosis & ADHD
What are port wine stains?
made of dilated blood capillaries - permanent
Strawberry hemangioma
face, scalp, back, or chest

may develope at several weeks

grows rapidly, remains fixed, then dissappears by age 9
Cavernous hemangioma
red-blue spongy mass of tissue

may disappear - usu around school age
Which is more deeply situated - strawberry or cavernous hemangioma?
cavernous
What should midline lesions make you think of?
possible CNS connections
When should you biopsy a midline lesion?
only MAYBE after proper evaluation
What are mongolian spots
normal blue/brown spots on thighs, back, buttocks - mistaken for child abuse
What is erythema toxicum?
NORMAL papules on red base
What is neonatal pustular melanosis?
pustules that heal as brown pigmented macules
What are common terms for nevus flammeus/simplex?
stork bites, salmon patches, angel kisses (forehead)
What when do glabella lesions?
may take years - can often be seen into adulthood esp when flushed
When is vernix seen?
common after 35 wks - sheds into amnionic fluid after 40 wks
When is lanugo present?
in a preterm
What is common regarding sutures in newborn?
overlapping
When are sutures not palpable?
after 6 mo - final closure in adulthood
Which sutures close in early neonatal period?
metopic sutures
What is craniosynostosis?
premature closure of sutures = palpable ridge
When will a head return to normal shape after modling?
1 week
What is scalp edema that CROSSES midline?
caput sucedaneum
what is bleeding beneath periosteum of parietal bone that NEVER crosses suture lines?
cephalohematoma
What causes facial nerve paraysis?
damage to facial nerve from forceps delivery
when is mandibular placement commonly seen?
after breech/facial presentation deliveries
How do you classifly macrocephaly? what is the most common cause?
> 3 std above mean
hydrocephaly
How do you classify microcephaly?
> 3 std below mean
What is the name for a "ping pong ball" head? Is it normal?
Craniotabes - normal up to 3 yo
What do you call rounded, compressible, usually midline masses?
Encephalocoeles (Brain)
Meningocoeles (Spine)
What is occipital/frontal/parietal bossing?
big forehead frequently in preterm
When does the anterior fontanel close?
4-26 mos
When does the posterior fontanelle close?
remains palpable for 4-8 wks
Is early close of fontanelles a concern?
not as long as head grows normally
What do unusually small fontanels indicate?
slow brain growth or craniosynthostosis
What do sunken fontanels indicate?
dehydration >10%
What do bulging fontanels indicate?
hydrocephalus, meningitis/infxn, intravascular hemorrhage
What is craniosynostosis?
premature closing of a suture - alien baby
What happens to fontanel when a baby cries?
it bulges, but remains pulsatile
What does the anterior fontanelle look like in hydrocephalus?
rarely visibly pulsatile, almost always bulges
What is the significance of red reflex?
lens is clear
What is the significance of white reflex?
abnormal - think retinoblastoma
Are a babies PERRLA?
They are PPERRL - not accomodation
What will a baby do if you shine a bright light in its eye?
blink
2 common findings in eyes?
subconjunctival hemorrhage
disconjugate eye gaze
Describe the sun-setting sign
irises appear to sink beneath lower eyelids when infant quickly lowered
What are epstein pearls?
normal, small, white cysts at midline junction of hard and soft palate
What does a webbed neck indicate?
turner syndrome
What does a short neck indicate?
Klippel Feil Syndrome
Where do you find the PMI?
4th interspace close to sternum - abex beat not usu apparent
What does a continuous thrill indicate?
Patent Ductus Arteriosis
What does systolic thrill suggest?
congential heart disease
What do systolic murmurs on the 1st day of life indicate?
closing of ducus arteriosis
What do distant heart sounds suggest?
pneumothorax or pneumopericardium
What do right heart sounds suggest?
dextrocardia
What do weak/absent femoral pulses suggest?
coarctation of the aorta
How many veins/arteries does the umbilical cord normally have>
2 arteries, 1 vein
What is omphalitis?
erythema and infection at the cord base
What is omphalocoele?
herniation of intestines at umbilicis
What does a scaphiod abdomen suggest?
diaphragmatic hernia
What does distention suggest?
infection or congential obstuction
What is the difference between hypospadius and epispadius?
urethral meatus on the vental side or the dorsal side
Normal penile length
>2cm
Up to what gestational age may an infant still have undescended testicle?
up to 34 wks
How to differentiate between hernia and hydrocele?
transilluminate!
Is blood tinged vaginal discharge normal?
yes- after day 3
Define Developmental Dysplasia of the Hip (DDH)?
any abnormality of childs proximal femur or acetabulum - most commonly referring to neonatal hip instability to stable hip w/shallow acetabulum
When to perform hip exams?
at birth an through subsequent well child visits
When do ortolani and barlow tests become less sensitive?
after 2-3 mo
Signs of DDH at 3mo
asymmetric shortening of led, decreased aBduction, asymmetric thigh or gluteal folds
Signs of DDH in child
limp/waddling gait
hyperlordiosis of lumbar spine
What is a positive ortolani sign?
click or clunk when aBducting w/upward pressure

relocating dislocated hip
What is a positive barlow's sign?
femora head clicks as it dislocated when hips are aDducted w/backwards pressure
what should you notice about the anus?
patency and position
Name that reflex: turn to nipple
Sucking/rooting reflex
Name that reflex: extension of arms/grabbing toes
Moro/Startle Reflex
Name that reflex: toes curl when knees and hips bent
plantar grasp
Name that reflex: infant in prone position - lateral trun curvature toward stimulus
Galant reflex
Name that reflex: reub sacrum along spine - causes head and spine extension / knee flexion
perez reflex
When is placing and stepping response best seen?
best at 4-5 days